| 1. |
- Försth, Peter, et al.
(författare)
-
A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis
- 2016
-
Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 374:15, s. 1413-1423
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND The efficacy of fusion surgery in addition to decompression surgery in patients who have lumbar spinal stenosis, with or without degenerative spondylolisthesis, has not been substantiated in controlled trials.METHODS We randomly assigned 247 patients between 50 and 80 years of age who had lumbar spinal stenosis at one or two adjacent vertebral levels to undergo either decompression surgery plus fusion surgery (fusion group) or decompression surgery alone (decompression-alone group). Randomization was stratified according to the presence of preoperative degenerative spondylolisthesis (in 135 patients) or its absence. Outcomes were assessed with the use of patient-reported outcome measures, a 6-minute walk test, and a health economic evaluation. The primary outcome was the score on the Oswestry Disability Index (ODI; which ranges from 0 to 100, with higher scores indicating more severe disability) 2 years after surgery. The primary analysis, which was a per-protocol analysis, did not include the 14 patients who did not receive the assigned treatment and the 5 who were lost to follow-up.RESULTS There was no significant difference between the groups in the mean score on the ODI at 2 years (27 in the fusion group and 24 in the decompression-alone group, P = 0.24) or in the results of the 6-minute walk test (397 m in the fusion group and 405 m in the decompression- alone group, P = 0.72). Results were similar between patients with and those without spondylolisthesis. Among the patients who had 5 years of follow-up and were eligible for inclusion in the 5-year analysis, there were no significant differences between the groups in clinical outcomes at 5 years. The mean length of hospitalization was 7.4 days in the fusion group and 4.1 days in the decompression-alone group (P< 0.001). Operating time was longer, the amount of bleeding was greater, and surgical costs were higher in the fusion group than in the decompression-alone group. During a mean follow-up of 6.5 years, additional lumbar spine surgery was performed in 22% of the patients in the fusion group and in 21% of those in the decompression-alone group.CONCLUSIONS Among patients with lumbar spinal stenosis, with or without degenerative spondylolisthesis, decompression surgery plus fusion surgery did not result in better clinical outcomes at 2 years and 5 years than did decompression surgery alone.
|
|
| 2. |
- Andersson, Petra, et al.
(författare)
-
Innovativa elsystem i byggnader : konsekvenser för brandsäkerhet
- 2019
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Det sker en snabb teknikutveckling i den elektriska miljön i byggnader, framförallt i våra bostäder. Ett exempel är lokal produktion av el, där solcellsinstallationer blir alltmer populära. Sådan elproduktion medför även förändringar i övriga delar av byggnaders elektriska infrastruktur, såsom DC-nät och i vissa fall energilagring i batterisystem. Utvecklingen sker till stor del som ett svar på behovet av mer hållbara lösningar, ur ett växthuseffektperspektiv, för vår elförsörjning, och förstärks bland annat av statligt stöd och ökad tillgänglighet på marknaden.Ny elektrisk teknologi kan leda till ökad brandrisk och denna förstudie har haft som mål att undersöka denna problematik. Metoden har varit workshops med intressenter och experter inom området, intervjuer, samt litteraturstudier.Av de studerade områdena förefaller solcellsanläggningar skapa störst utmaningar i framtiden om inget görs. Detta beror dels på bristfälligt regelverk men även på att dessa system är distribuerade i byggnaderna med flera delar som kan orsaka brand och att delar är exponerade för utomhusklimat vilket får stora konsekvenser vad gäller uppkomst av fel.Brandsäkerheten i samhället har sett ur ett långt tidsperspektiv väsentligt förbättrats. Detta har huvudsakligen drivits fram med hjälp av ett förbättrat regelverk, som ofta inkluderat förbättrade provnings- och kvalificeringsmetoder. En generell observation i detta projekt är att regelverket inte hinner utvecklas i samma takt som tekniken. Detta är en ofta återkommande utmaning inom brandsäkerhet, men gäller speciellt för de teknikområden som behandlas i denna rapport där utvecklingen går mycket snabbt, och de ingående komponenterna nästan uteslutande har stor inneboende brandpotential. Rapporten konstaterar att för att skapa ett relevant regelverk behövs tillämpad forskning, så kallad prenormativ forskning, inom prioriterade områden för att besvara de frågor som ställs vid formulerandet av nya regler och standarder. Exempel på områden som bör prioriteras är 1) komplettering av det än så länge magra statistiska underlaget för bränder i solcellsinstallationer med olycksutredningar, och studier av redan befintliga olycksutredningar, 2) studier av branddynamiken i solcellsinstallationer, såväl byggnadsapplicerade som integrerade, och såväl tak- som fasadmonterade sådana, 3) studier av ljusbågars uppkomst och hur dessa kan undvikas, alternativt hur det kan undvikas att de ger upphov till bränder, 4) skapa underlag för säker installation av batterilager, samt 5) kvalitetssäkring av så kallade second-life batterier, dvs. begagnade batterier, som används i batterilager.
|
|
| 3. |
|
|
| 4. |
- Blixt, Simon, et al.
(författare)
-
Reliability of thoracolumbar burst fracture classification in the Swedish Fracture Register
- 2024
-
Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central (BMC). - 1471-2474. ; 25:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Swedish Fracture Register (SFR) is a national quality register for all types of fractures in Sweden. Spine fractures have been included since 2015 and are classified using a modified AOSpine classification. The aim of this study was to determine the accuracy of the classification of thoracolumbar burst fractures in the SFR.METHODS: Assessments of medical images were conducted in 277 consecutive patients with a thoracolumbar burst fracture (T10-L3) identified in the SFR. Two independent reviewers classified the fractures according to the AOSpine classification, with a third reviewer resolving disagreement. The combined results of the reviewers were considered the gold standard. The intra- and inter-rater reliability of the reviewers was determined with Cohen's kappa and percent agreement. The SFR classification was compared with the gold standard using positive predictive values (PPV), Cohen's kappa and percent agreement.RESULTS: The reliability between reviewers was high (Cohen's kappa 0.70-0.97). The PPV for correctly classifying burst fractures in the SFR was high irrespective of physician experience (76-89%), treatment (82% non-operative, 95% operative) and hospital type (83% county, 95% university). The inter-rater reliability of B-type injuries and the overall SFR classification compared with the gold standard was low (Cohen's kappa 0.16 and 0.17 respectively).CONCLUSIONS: The SFR demonstrates a high PPV for accurately classifying burst fractures, regardless of physician experience, treatment and hospital type. However, the reliability of B-type injuries and overall classification in the SFR was found to be low. Future studies on burst fractures using SFR data where classification is important should include a review of medical images to verify the diagnosis.
|
|
| 5. |
- Blixt, Simon, et al.
(författare)
-
Reliability of thoracolumbar burst fracture classification in the Swedish Fracture Register
- 2024
-
Ingår i: BMC MUSCULOSKELETAL DISORDERS. - : BioMed Central (BMC). - 1471-2474. ; 25:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background The Swedish Fracture Register (SFR) is a national quality register for all types of fractures in Sweden. Spine fractures have been included since 2015 and are classified using a modified AOSpine classification. The aim of this study was to determine the accuracy of the classification of thoracolumbar burst fractures in the SFR.Methods Assessments of medical images were conducted in 277 consecutive patients with a thoracolumbar burst fracture (T10-L3) identified in the SFR. Two independent reviewers classified the fractures according to the AOSpine classification, with a third reviewer resolving disagreement. The combined results of the reviewers were considered the gold standard. The intra- and inter-rater reliability of the reviewers was determined with Cohen's kappa and percent agreement. The SFR classification was compared with the gold standard using positive predictive values (PPV), Cohen's kappa and percent agreement.Results The reliability between reviewers was high (Cohen's kappa 0.70-0.97). The PPV for correctly classifying burst fractures in the SFR was high irrespective of physician experience (76-89%), treatment (82% non-operative, 95% operative) and hospital type (83% county, 95% university). The inter-rater reliability of B-type injuries and the overall SFR classification compared with the gold standard was low (Cohen's kappa 0.16 and 0.17 respectively).Conclusions The SFR demonstrates a high PPV for accurately classifying burst fractures, regardless of physician experience, treatment and hospital type. However, the reliability of B-type injuries and overall classification in the SFR was found to be low. Future studies on burst fractures using SFR data where classification is important should include a review of medical images to verify the diagnosis.
|
|
| 6. |
- Blixt, S., et al.
(författare)
-
Validity of the short musculoskeletal function assessment questionnaire in patients with a spine fracture
- 2023
-
Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 32, s. 1471-1479
-
Tidskriftsartikel (refereegranskat)abstract
- PurposeThe aim of this study was to validate the use of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in patients with a spine fracture.MethodsCross-sectional cohort of individuals that had sustained a spine fracture (C1-L5) one year earlier. Patients were asked to fill out SMFA, Oswestry Disability Index (ODI), EQ-5D-3L and EQ-VAS. Spearman's rank correlation coefficient (rho) was used to assess convergent validity for each patient-reported outcome measure (PROM). Bland-Altman plots were used to assess PROM agreement.Results82 patients completed all questionnaires. The correlations between SMFA Dysfunction and Bother indices and ODI were 0.89 and 0.86, with EQ-5D-3L index 0.89 and 0.80, and with EQ-VAS 0.80 and 0.73, respectively. The correlation for separate categories of the SMFA dysfunction index (daily activities, emotional status, arm and hand function, mobility) ranged between 0.71-0.87 for ODI, 0.72-0.84 for EQ-5D-3L index, and 0.67-0.77 for EQ-VAS. A selection of the ten items of SMFA that had the highest correlations with ODI resulted in a correlation of 0.91. The agreements between SMFA indices and ODI in Bland-Altman plots were good with small differential biases and minimal proportional biases, but worse for SMFA and EQ-5D-3L index and EQ-VAS.ConclusionThe SMFA indices are highly correlated with ODI in patients with a spine fracture. The Dysfunction index and Bother index, or selected SMFA items, may be used to assess outcome in patients with spine fractures as an alternative to ODI.
|
|
| 7. |
- Das, Oisik, et al.
(författare)
-
Functionalised biochar in biocomposites: The effect of fire retardants, bioplastics and processing methods
- 2023
-
Ingår i: Composites Part C: Open Access. - : Elsevier. - 2666-6820. ; 11
-
Tidskriftsartikel (refereegranskat)abstract
- Fire retardants, although can impart fire-safety in polymeric composites, are detrimental to the mechanical properties. Biochar can be used, in conjunction with fire retardants, to create a balance between fire-safety and mechanical performance. It is possible to thermally dope fire retardants into the pores of biochar to make it functionalised. Thus, the current work is intended in identifying a composite having the combination of the most desirable fire retardant, bioplastic, and a suitable processing method. A comparison was made between two fire retardants (lanosol and ammonium polyphosphate), bioplastics (wheat gluten and polyamide 11), and composite processing methods (compression and injection moulding). It was found that wheat gluten containing ammonium polyphosphate-doped biochar made by compression moulding had the best fire-safety properties with the lowest peak heat release rate (186 kW/m2), the highest fire performance index (0.6 m2s/kW), and the lowest fire growth index (1.6 kW/ms) with acceptable mechanical properties compared to the corresponding neat bioplastic. Thus, for gluten-based polymers, the use of ammonium polyphosphate thermally doped into biochar processed by compression moulding is recommended to both simultaneously improve fire-safety and conserve the mechanical strength of the resulting biocomposites.
|
|
| 8. |
- Elmekaty, Mohamed, et al.
(författare)
-
Safety of a novel modular cage for transforaminal lumbar interbody fusion : clinical cohort study in 20 patients with degenerative disc disease
- 2018
-
Ingår i: SICOT-J. - : EDP SCIENCES S A. - 2426-8887. ; 4
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Transforaminal lumbar interbody fusion (TLIF) is used to reconstruct disc height and reduce degenerative deformity in spinal fusion. Patients with osteoporosis are at high risk of TLIF cage subsidence; possibly due to the relatively small footprint compared to anterior interbody devices. Recently, modular TLIF cage with an integral rail and slot system was developed to reduce cage subsidence and allow early rehabilitation. Objective: To study the safety of a modular TLIF device in patients with degenerative disc disorders (DDD) with regard to surgical complications, non-union, and subsidence. Methods: Patients with DDD treated with a modular TLIF cage (Polyetheretherketone(PEEK), VTI interfuse S) were analysed retrospectively with one-year follow-up. Lumbar sagittal parameters were collected preoperatively, postoperatively and at one year follow-up. Cage subsidence, fusion rate, screw loosening and proportion of endplate coverage were assessed in computed tomography scan. Results: 20 patients (age 66 +/- 10 years, 65% female, BMI 28 +/- 5 kg/m(2)) with a total of 37 fusion levels were included. 15 patients had degenerative spondylosis and 5 patients had degenerative scoliosis. The cages covered >60% of the vertebral body diameters. Lumbar lordosis angle and segmental disc angle increased from 45.2 +/- 14.5 and 7.3 +/- 3.6 to 52.7 +/- 9.1 and 10.5 +/- 3.5 (p=0.029 and 0.0002) postoperatively for each parameter respectively without loss of correction at one year follow up. One case of deep postoperative infection occurred (5%). No cage subsidence occurred. No non-union or screw loosening occurred. Conclusions: The modular TLIF cage was safe with regard to subsidence and union-rate. It restored and maintained lumbar lordosis angle, segmental disc angle and disc height, which can be attributed to the large footprint of this modular cage.
|
|
| 9. |
|
|
| 10. |
|
|
