| 1. |
- Andersen, Mikkel Österheden, et al.
(författare)
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Surgical Treatment of Degenerative Disk Disease in Three Scandinavian Countries : An International Register Study Based on Three Merged National Spine Registers
- 2019
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Ingår i: Global Spine Journal. - : SAGE PUBLICATIONS LTD. - 2192-5682 .- 2192-5690. ; 9:8, s. 850-858
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: Observational study of prospectively collected data.Objectives: Patients with chronic low back pain resistant to nonoperative treatment often face a poor prognosis for recovery. The aim of the current study was to compare the variation and outcome of surgical treatment of degenerative disc disease in the Scandinavian countries based on The International Consortium for Health Outcomes Measurement core spine data sets.Methods: Anonymized individual level data from 3 national registers were pooled into 1 database. At the time of surgery, the patient reports data on demographics, lifestyle topics, comorbidity, and data on health-related quality of life such as Oswestry Disability Index, Euro-Qol-5D, and back and leg pain scores. The surgeon records diagnosis, type of surgery performed, and complications. One-year follow-ups are obtained with questionnaires. Baseline and 1-year follow-up data were analyzed to expose any differences between the countries.Results: A total of 1893 patients were included. At 1-year follow-up, 1315 (72%) patients responded. There were statistically significant baseline differences in age, smoking, comorbidity, frequency of previous surgery and intensity of back and leg pain. Isolated fusion was the primary procedure in all the countries ranging from 84% in Denmark to 76% in Sweden. There was clinically relevant improvement in all outcome measures except leg pain.Conclusions: In homogenous populations with similar health care systems the treatment traditions can vary considerably. Despite variations in preoperative variables, patient reported outcomes improve significantly and clinically relevant with surgical treatment.
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| 2. |
- Charalampidis, A, et al.
(författare)
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The Use of Intraoperative Neurophysiological Monitoring in Spine Surgery
- 2020
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Ingår i: Global spine journal. - : SAGE Publications. - 2192-5682 .- 2192-5690. ; 10:1 Suppl, s. 104S-114S
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Tidskriftsartikel (refereegranskat)abstract
- Narrative review. Objective: To summarize relevant studies regarding the utilization of intraoperative neurophysiological monitoring (IONM) techniques in spine surgery implemented in recent years. Methods: A literature search of the Medline database was performed. Relevant studies from all evidence levels have been included. Titles, abstracts, and reference lists of key articles were included. Results: Multimodal intraoperative neurophysiological monitoring (MIONM) has the advantage of compensating for the limitations of each individual technique and seems to be effective and accurate for detecting perioperative neurological injury during spine surgery. Conclusion: Although there are no prospective studies validating the efficacy of IONM, there is a growing body of evidence supporting its use during spinal surgery. However, the lack of validated protocols to manage intraoperative alerts highlights a critical knowledge gap. Future investigation should focus on developing treatment methodology, validating practice protocols, and synthesizing clinical guidelines.
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| 3. |
- Elmose, Signe F., et al.
(författare)
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Radiological Definitions of Sagittal Plane Segmental Instability in the Degenerative Lumbar Spine - A Systematic Review
- 2023
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Ingår i: Global Spine Journal. - : Sage Publications. - 2192-5682 .- 2192-5690. ; 13:2, s. 523-533
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Forskningsöversikt (refereegranskat)abstract
- Study Design: Systematic Review.Objective: To collect and group definitions of segmental instability, reported in surgical studies of patients with lumbar spinal stenosis (LSS) and/or lumbar degenerative spondylolisthesis (LDS). To report the frequencies of these definitions. To report on imaging measurement thresholds for instability in patients and compare these to those reported in biomechanical studies and studies of spine healthy individuals.To report on studies that include a reliability study.Methods: This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies eligible for inclusion were clinical and biomechanical studies on adult patients with LDS and/or LSS who underwent surgical treatment and had data on diagnostic imaging. A systematic literature search was conducted in relevant literature databases. Full text screening inclusion criteria was definition of segmental instability or any synonym. Two reviewers independently screened articles in a two-step process. Data synthesis presented by tabulate form and narrative synthesis.Results: We included 118 studies for data extraction, 69% were surgical studies with decompression or fusion as interventions, 31% non-interventional studies. Grouping the definitions of segmental instability according similarities showed that 24% defined instability by dynamic sagittal translation, 26% dynamic translation and dynamic angulation, 8% used a narrative definition. Comparison showed that non-interventional studies with a healthy population more often had a narrative definition.Conclusion: Despite a reputation of non-consensus, segmental instability in the degenerative lumbar spine can radiologically be defined as > 3 mm dynamic sagittal translation.
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| 4. |
- Jalalpour, Kourosh, et al.
(författare)
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A Randomized Controlled Trial Comparing Transforaminal Lumbar Interbody Fusion and Uninstrumented Posterolateral Fusion in the Degenerative Lumbar Spine.
- 2015
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Ingår i: Global spine journal. - : SAGE Publications. - 2192-5682 .- 2192-5690. ; 5:4, s. 322-8
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Tidskriftsartikel (refereegranskat)abstract
- Study DesignRandomized controlled trial. ObjectiveDespite a large number of publications of outcomes after spinal fusion surgery, there is still no consensus on the efficacy of the several different fusion methods. The aim of this study was to determine whether transforaminal lumbar interbody fusion (TLIF) results in an improved clinical outcome compared with uninstrumented posterolateral fusion (PLF) in the surgical treatment for chronic low back pain. MethodsThis study included 135 patients with degenerative disk disease (n=96) or postdiskectomy syndrome (n=39). Inclusion criteria were at least 1year of back pain with or without leg pain in patients aged 20 to 65 with one- or two-level disease. Exclusion criteria were sequestration of disk hernia, psychosocial instability, isthmic spondylolisthesis, drug abuse, and previous spine surgery other than diskectomy. Pain was assessed by visual analog scale (pain index). Functional disability was quantified by the disability rating index and Oswestry Disability Index. The global outcome was assessed by the patient and classified as much better, better, unchanged, or worse. The patients were randomized to conventional uninstrumented PLF (n=67) or TLIF (n=68). PLF was performed in a standardized fashion using autograft. TLIF was performed with pedicle titanium screw fixation and a porous tantalum interbody spacer with interbody and posterolateral autograft. The clinical outcome measurements were obtained preoperatively and at 12 and 24 months postoperatively. The 2-year follow-up rate was 98%. ResultsThe two treatment groups improved significantly from preoperatively to 2 years' follow-up. At final follow-up, the results in the TLIF group were significantly superior to those in the PLF group in pain index (2.0 versus 3.9, p=0.007) and in disability rating index (22 versus 36, p=0.003). The Oswestry Disability Index was better in the TLIF group (20 versus 28, p=0.110, not significant). The global assessment was clearly superior in the TLIF group: 63% of patients scored "much better" in the TLIF group as compared with 48% in the PLF group (p=0.017). ConclusionsThe results of the current study support the use of TLIF rather than uninstrumented PLF in the surgical treatment of the degenerative lumbar spine. The less optimal outcome after uninstrumented PLF may be explained by the much higher reoperation rate.
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| 5. |
- Löfgren, Håkan, 1957-, et al.
(författare)
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Sagittal Alignment After Laminectomy Without Fusion as Treatment for Cervical Spondylotic Myelopathy : Follow-up of Minimum 4 Years Postoperatively
- 2020
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Ingår i: Global Spine Journal. - : Sage Publications. - 2192-5682 .- 2192-5690. ; 10:4, s. 425-432
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Tidskriftsartikel (refereegranskat)abstract
- Objectives:The aims of this study were to evaluate the incidence of sagittal malalignment including kyphosis following cervical laminectomy without fusion as treatment for cervical spondylotic myelopathy and to assess any correlation between malalignment and clinical outcome.Study Design:Retrospective cohort study.Methods:In all, 60 patients were followed up with conventional radiography at an average of 8 years postoperatively. The cervical lordosis (C2-C7 Cobb angle), C2-C7 sagittal vertical axis (cSVA) and C7 slope were measured on both preoperative and postoperative images. Patients completed a questionnaire covering Neck Disability Index (NDI), visual analogue scale for neck pain, and general health (EQ-5D).Results:Mean C2-C7 Cobb angle was 8.6° (SD 9.0) preoperatively, 3.4° (10.7) postoperatively and 9.6° (14.5) at follow-up. Ultimately, 3 patients showed >20° cervical kyphosis. Mean cSVA was 16.3 mm (SD 10.2) preoperatively, 20.6 mm (11.8) postoperatively, and 31.6 mm (11.8) at follow-up. Mean C7 slope was 20.4° (SD 8.9) preoperatively, 18.4° (9.4) postoperatively, and 32.6° (10.2) at follow-up. The preoperative to follow-up increase in cSVA and C7 slope was statistically significant (both P < .0001), but not for cervical lordosis. The preoperative to follow-up change in cSVA correlated moderately with preoperative cSVA (r = 0.43, P = .002), as did the corresponding findings regarding C7 slope (r = 0.52, P = .0001). A comparison of radiographic measurements with clinical outcome showed no strong correlations.Conclusions:No preoperative to follow-up change in cervical lordosis was found in this group; 5.0% developed >20° kyphosis. No clear correlation between sagittal alignment and clinical outcome was shown.
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| 6. |
- Robinson, Yohan, 1977-, et al.
(författare)
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Finite element analysis of long posterior transpedicular instrumentation for cervicothoracic fractures related to ankylosing spondylitis
- 2018
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Ingår i: Global Spine Journal. - : SAGE Publications. - 2192-5682 .- 2192-5690. ; 8:6, s. 570-578
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Tidskriftsartikel (refereegranskat)abstract
- Background: Spinal fractures related to AS are often treated by long posterior stabilisation. The biomechanical rationale behind is the neutralisation of long lever arms in the ankylosed spine to avoid non-union or neurological deterioration. Despite the widespread application of long posterior instrumentation it has never been investigated in a biomechanical model. The objective of this study is to develop a finite element model for spinal fractures related to AS and to establish a biomechanical foundation for long posterior stabilisation of cervicothoracic fractures related to ankylosing spondylitis (AS).Methods: An existing finite element-model (consisting of two separately developed models) including the cervical and thoracic spine were adapted to the conditions of AS (all discs fused, C0-C1 and C1-C2 mobile) and a fracture at the level C6-C7 was simulated. Besides a normal spine (no AS, no fracture) and the uninstrumented fractured spine four different posterior transpedicular instrumentations were tested: 1. Fracture uninstrumented, 2. Short instrumentation C6-C7, 3. Medium instrumentation C5-T1, 4. Long instrumentation C3-T3, 5. Skipped level long instrumentation C3-C6-C7-T3.Three loads (1.5g, 3.0g, 4.5g) were applied according to a specific load curve. Kinematic data such as the gap distance in the fracture site were obtained. Furthermore the stresses in the ossified parts of the discs were evaluated.Findings: All posterior stabilisation methods could normalise the axial stability at the fracture site as measured with gap distance. With larger accelerations than 1.5g , it was seen that the longer instrumentations resulted in lesser maximal gap distance than the Short instrumentation. The maximum stress at the cranial instrumentation end (C3-C4) was slightly greater if every level was instrumented, than in the skipped level model. The skipped level instrumentation achieved similar rotatory stability as the long multilevel instrumentation.Interpretation: The FE model developed simulated a spinal fracture at C6-C7 level. Skipping instrumentation levels without giving up instrumentation length also reduces the stresses in the ossified tissue within the range of the instrumentation and does not decrease the stability in a finite element model of a cervicothoracic fracture related to AS. Considering the risks associated with every additional screw placed, the skipped level instrumentation has advantages with regard to patient safety. The effects of the degree of osteoporosis, screw placement and pre-existing kyphosis on the construct stability were not investigated in this study and should be a matter of further research.
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| 7. |
- Robinson, Yohan, 1977-, et al.
(författare)
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Management of Anterior Column Defects in Pyogenic Spondylodiscitis. : A Systematic Review
- 2015
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Ingår i: Global Spine Journal. - Thousand Oaks, CA, U.S.A. : Sage Publications. - 2192-5682 .- 2192-5690. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionStudy design: systematic review.Study Rationale: The surgical treatment of the anterior column defect in spondylodiscitis has been controversial for a long time and continues to remain so. Many techniques are described to manage the anterior column defect either through a posterior only method, anterior only method, or a combination of both. Many of the systematic reviews trying to investigate the best evidence for management involve tubercular and pyogenic, also all spinal column levels including cervical spine in their inclusion criteria regarding the differences in pathology, biomechanics, and natural history.ObjectivesThe objective of the article is to present the difference in effectiveness and long-term reliability of all techniques which focus only on pyogenic infections in thoracolumbar segments.Material and MethodsA systematic review of literature was performed using PubMed, ISI Web of Science, and Ovid Medline databases using the same search phrase: (anterior OR vertebral body OR defect) AND (spondylodiscitis OR discitis), further search was applied through reviewing references of the included search results. Articles were reviewed by the authors based on predetermined inclusion and exclusion criteria.ResultsPubMed search yielded 303 results, Ovid Medline yielded 451 results, and ISI Web of Science yielded 279 results. After title review and exclusion of duplication and non-English or German language articles, 32 articles were included and after final full text review 12 articles were included and presented. Three groups were formulated: anterior, posterior, and combined. Comparison included VAS, ODI, healing percentage, kyphosis correction and its maintenance, CRP, neurology, and complications.ConclusionThere is a significant superiority of the combined anterior and posterior techniques in maintenance of kyphosis correction on the long-term follow-up, otherwise, due to the diversity of the criteria of evaluation of results in different articles, more clinical research should be directed to investigate the results of surgical management of anterior column defects in pyogenic thoracolumbar levels in particular.
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| 8. |
- Sigmundsson, Freyr Gauti, 1972-, et al.
(författare)
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Surgery for Lumbar Spinal Stenosis in Patients With Mild Leg Pain Levels Is Associated With Unsatisfactory Outcome
- 2021
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Ingår i: Global Spine Journal. - : Sage Publications. - 2192-5682 .- 2192-5690. ; 11:8, s. 1202-1207
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: Prospective register cohort study.Objectives: The indication for surgery in patients with lumbar spinal stenosis (LSS) is considered to be leg pain and neurogenic claudication (NC). Nevertheless, a significant part of patients operated for LSS have mild leg pain levels defined as leg pain <= minimally important clinical difference (MICD). Information is lacking on how to inform these patients about the probable outcome of surgery. The objective was to report the outcome of surgery for LSS in patients with a mild preoperative level of leg pain.Methods: A total of 2559 patients operated upon for LSS with preoperative leg pain <= 3 NRS (Numerical Rating Scale) were evaluated for outcome at the 1-year follow-up. NRS for back pain, the Oswestry Disability Index (ODI), and the EuroQol (EQ-5D) were used.Results: In the period 2007 to 2017, we identified 3239 patients (14%) who had mild leg pain (<= 3 on the NRS). In this cohort, leg pain increased 0.40 (0.56-0.37) and back pain decreased 1.0 (0.95-1.2) at the 1-year follow up. ODI decreased 11.1 (10.2-11.4) and the EQ-5D increased 0.15 (0.17-0.14). A total of 31% reached successful outcome in terms of back pain, 43% in terms of ODI and 48% in terms of EQ-5D. 63% of the patients were satisfied with the outcome.Conclusion: A minority of patients with mild leg pain levels operated upon for LSS attain MICD for back pain, ODI, and EQ-5D. The results from this study can aid the surgeon in the shared decision-making process before surgery.
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