| 1. |
- Carrwik, Christian, 1977-
(författare)
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Surgical treatment of spinal metastasis
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to study surgical treatment of spinal metastasis from several points of view, with a focus on predictive tools and survival after surgery. Study I includes 315 patients treated surgically at Uppsala University Hospital 2006-2012 due to spinal metastatic disease. Based on the data known at the time of surgery, predictive scores were calculated using four different scoring systems (Tokuhashi, revised Tokuhashi, Tomita and modified Bauer scores). The predictions were then compared with true survival data. All of the scores had a statistically significant correlation to survival but all of them tended to underestimate rather than overestimate survival. Study II focused on patients with an unknown primary tumour (UPT). We reviewed 393 cases treated at Uppsala University Hospital, where 122 (31%) had an unknown primary tumour at the time of surgery. A survival analysis showed that the patients with an UPT had a longer estimated survival compared to the group with a known primary tumour (KPT). The estimated median survival time in the UPT group was 15.6 months, compared to 7.4 months in the KPT group. The mean estimated survival time was 48.1 months in the UPT group and 21.6 months in the KPT group. The difference was statistically significant (p=0.001).Study III is a retrospective multi-registry study linking the Swedish spine surgery database Swespine with the Swedish Cause of Death (CoD) Register. The analysis included 1820 patients who underwent surgery due to spinal metastatic disease at 19 hospitals in Sweden 2006-2016. The study showed that both the mean and the median estimated survival time after surgery are well above the recommended three months threshold for surgery, suggesting that surgical treatment could be indicated in even more cases. In study IV, prognostic tools were revisited with a validation study of PathFx 3.0, an online open-source tool to estimate survival for patients with skeletal metastases. A cohort of 668 patients treated at Uppsala University Hospital and Karolinska University Hospital were included in the study and the results indicate that PathFx 3.0 could predict survival after treatment with good reliability, especially for patients with long expected survival. As PathFx can be updated to reflect advancements in oncological treatment, this type of tool is probably more useful than the rigid point-based scoring systems evaluated in study I.
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| 2. |
- Carrwik, Christian, 1977-, et al.
(författare)
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Survival after surgery for spinal metastatic disease: a nationwide multiregistry cohort study.
- 2021
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:11
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate survival after surgery and indications for surgery due to spinal metastatic disease.A retrospective longitudinal multiregistry nationwide cohort study.19 public hospitals in Sweden with spine surgery service, where 6 university hospitals account for over 90% of the cases.1820 patients 18 years or older undergoing surgery due to spinal metastatic disease 2006-2018 and registered in Swespine, the Swedish national spine surgery registry.Decompressive and/or stabilising spine surgery due to spinal metastatic disease.Survival (median and mean) after surgery.Indications for surgery, types of surgery and causes of death.The median estimated survival after surgery was 6.2 months (95% CI: 5.6 to 6.8) and the mean estimated survival time was 12.2 months (95% CI: 11.4 to 13.1). Neurologic deficit was the most common indication for surgery and posterior stabilisation was performed in 70.5% of the cases. A neoplasm was stated as the main cause of death for 97% of the patients.Both median and mean survival times were well above the generally accepted thresholds for surgical treatment for spinal metastases, suggesting that patient selection for surgical treatment on a national level is adequate. Further research on quality of life after surgery and prognostication is needed.
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| 3. |
- Robinson, Anna-Lena, 1971-, et al.
(författare)
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C2 Fracture Subtypes, Incidence, and Treatment Allocation Change with Age : A Retrospective Cohort Study of 233 Consecutive Cases
- 2017
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Ingår i: BioMed Research International. - : HINDAWI LTD. - 2314-6133 .- 2314-6141.
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Tidskriftsartikel (refereegranskat)abstract
- The currently available data on the distribution of C2 fracture subtypes is sparse. This study was designed to identify the proportions of the second cervical vertebra (C2) fracture subtypes and to present age and gender specific incidences of subgroups. A dataset of all patients treated between 2002 and 2014 for C2 fractures was extracted from the regional hospital information system. C2 fractures were classified into odontoid fractures types 1, 2, and 3, Hangman's fractures types 1, 2, and 3, and atypical C2 fractures. 233 patients (female 51%, age 72 +/- 19 years) were treated for a C2 fracture. Odontoid fractures were found in 183 patients, of which 2 were type 1, 127 type 2, and 54 type 3, while 26 of C2 fractures were Hangman's fractures and 24 were atypical C2 fractures. In the geriatric subgroup 89% of all C2 fractures were odontoid, of which 71% were type 2 and 29% type 3. There was an increasing incidence of odontoid fractures types 2 and 3 from 2002 to 2014. 40% of C2 fractures were treated surgically. This study presents reliable subset proportions of C2 fractures in a prospectively collected regional cohort. Knowledge of these proportions facilitates future epidemiological studies of C2 fractures.
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| 4. |
- Robinson, Anna-Lena, 1971-, et al.
(författare)
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Epidemiology of C2 Fractures in the 21st Century : A National Registry Cohort Study of 6,370 Patients from 1997 to 2014
- 2017
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Ingår i: Advances in Orthopedics. - : Hindawi Publishing Corporation. - 2090-3464 .- 2090-3472.
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Tidskriftsartikel (refereegranskat)abstract
- Objective. C2 fractures are a common injury in the elderly population. Treatment is often complicated due to osteoporosis and patient comorbidity. This study aims to investigate the incidence and treatment trend of C2 fractures in Sweden. Methods. Patients with the principal and secondary diagnosis of fracture of the second vertebrae (ICD-10: S12.1) between 1997 and 2014 were identified in the Swedish National Patient Registry (NPR). Results. Between 1997 and 2014, 6,370 patients with a C2 fracture (51% male; age: ) were identified in the NPR. The incidence of C2 fractures increased from 3 to 6 per 100,000 (; ), mainly due to an increase of incidence in the geriatric subgroup (≥70 years). The percentage of surgically treated patients decreased from 1997 to 2014 (; ). Younger age, male gender, spinal cord injury, and earlier year of admission were associated with surgical treatment assignment.Discussion. This study documents a rising incidence of C2 fractures in the elderly during the last two decades in Sweden. Greater awareness of fractures, improved diagnostics, coding, and a higher activity level of the patients are plausible causes. The declining trend of surgical treatment warrants further study.
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| 6. |
- Robinson, Anna-Lena, 1971-, et al.
(författare)
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Surgical treatment improves survival of elderly with axis fracture : a national population-based multi-registry cohort study
- 2018
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Ingår i: The spine journal. - : Elsevier BV. - 1529-9430 .- 1878-1632. ; 18, s. 1853-1860
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Tidskriftsartikel (refereegranskat)abstract
- Background ContextFractures of the axis (C2) are the most common cervical spinal injuries in the elderly population. Several authors have reported improved survival among elderly patients with C2 fractures when treated surgically.PurposeWe aimed to analyze whether surgery improves survival of elderly with C2 fractures.Study Design/SettingAn observational population-based longitudinal multi-registry study was carried out.Patient SampleSwedish Patient Registry 1997 to 2014 and Swedish Cause of Death Registry 1997 to 2014 served as source of patient sample.Outcome measuresSurvival after C2 fracture according to non-surgical and surgical treatment was the outcome measure.MethodsWe included all patients treated for the primary diagnosis of C2 fracture (10th revision of the International Statistical Classification of Diseases and Related Health Problems or ICD-10: S12.1) at an age ≥70 years and receiving treatment at a health-care facility. Non-surgical treatment comprises cervical collar or halo-vest treatment. Surgical treatment was identified in the Swedish patient registry extract using the Swedish classification of procedural codes. Survival was determined using the Kaplan-Meier method. Comorbidity was determined using the Charlson Comorbidity Index.ResultsOf the included 3,375 elderly patients with C2 fractures (43% men, aged 83±7 years), 22% were treated surgically. Surgical treatment was assigned based on age, gender, and year of treatment. The 1-year survival of 2,618 non-surgically treated patients was 72% (n=1,856), and 81% (n=614) for the 757 surgically treated (p<.001, relative risk reduction=11%). Adjusted for age, gender, comorbidity, and year of injury, surgically treated patients had greater survival than non-surgically treated patients (hazard ratio=0.88, 95% confidence interval: 0.79–0.97). Among those above 88 years of age (95% confidence interval: 85–92), surgical treatment lost its effect on survival.ConclusionsDespite the frailty of elderly patients, the morbidity of cervical external immobilization with a rigid collar seemingly weighs greater than surgical morbidity, even in octogenarians. For those above 88 years of age, non-surgical treatment should be primarily attempted.
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| 7. |
- Robinson, Anna-Lena, 1971-, et al.
(författare)
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Surgical vs. non-surgical management of displaced type-2 odontoid fractures in patients aged 75 years and older : study protocol for a randomised controlled trial
- 2018
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Ingår i: Trials. - : BMC. - 1745-6215. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background: Displaced odontoid fractures in the elderly are treated non-surgically with a cervical collar or surgically with C1-C2 fusion. Due to the paucity of evidence, the treatment decision is often left to the discretion of the expert surgeon.Methods: The Uppsala Study on Odontoid Fracture Treatment (USOFT) is a multicentre, open-label, randomised controlled superiority trial evaluating the clinical superiority of the surgical treatment of type-2 odontoid fractures, with a 1-year Neck Disability Index (NDI) as the primary endpoint. Fifty consecutive patients aged >= 75 years, with displaced type-2 odontoid fracture, are randomised to non-surgical or surgical treatment. Excluded are patients with an American Society of Anaesthesiologists (ASA) score >= 4, dementia nursing care or anatomical cervical anomalies. The minimal clinically important difference of the NDI is 3.5 points. A minimum of 16 patients are needed in each group to test the superiority with 80% power. By considering a 1-year mortality forecast of 29%, up to 25 participants are recruited in each group. The non-surgical group is fitted with a rigid cervical collar for 12 weeks. The surgical group is treated with a posterior C1-C2 fusion. All participants are monitored with regard to the NDI, EuroQol score (EQ-5D), socio-demographics and computed tomography (CT) at the time of injury, at 6 weeks, 3 months and 12 months. At 12 months, a dynamic radiographical investigation of upper cervical stability is performed. The secondary endpoints are: EQ-5D score, activities of daily living (ADL), bony union, upper cervical stability and mortality.Discussion: USOFT is the first randomised controlled trial comparing non-surgical and surgical management of type-2 odontoid fractures in the elderly. Using the NDI and EQ-5D as endpoints, future value-based decisions may consider quality-adjusted life years gained. Major limitations are (1) the allocation bias of the open-label study design, (2) that only higher training levels of all core specialties of spine surgery are included in the surgical treatment arm and (3) that only one type of surgical stabilisation is investigated (posterior C1-C2 fusion), while other methods are not included in this study.
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| 8. |
- Robinson, Yohan, 1977-, et al.
(författare)
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Complications and Survival after long Posterior Instrumentation of Cervical and Cervicothoracic Fractures related to Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis
- 2015
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 40:4, s. E227-E233
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Prospective cohort study.OBJECTIVE: This study investigates the results of long posterior instrumentation with regard to complications and survival.SUMMARY OF BACKGROUND DATA: Fractures of the cervical spine and the cervicothoracic junction related to ankylosing spinal disease (ASD) endanger both sagittal profile and spinal cord. Both anterior and posterior stabilization methods are well established, and clear treatment guidelines are missing.METHODS: Forty-one consecutive patients with fractures of the cervicothoracic junction related to ASD were treated by posterior instrumentation. All patients were followed prospectively for 2 years using a standardized protocol.RESULTS: Five patients experienced postoperative infections, 3 patients experienced postoperative pneumonia, 2 patients required postoperative tracheostomy, and 1 patient had postoperative cerebrospinal fluid leakage due to accidental durotomy. No patient required reoperation due to implant failure or nonunion. Mean survival was 52 months (95% confidence interval: 42-62 mo). Survival was affected by patient age, sex, smoking, and spinal cord injury.CONCLUSION: Patients with ASD experiencing a fracture of the cervicothoracic region are at high risk of developing complications. The posterior instrumentation of cervical spinal fractures related to ASD is recommended due to biomechanical superiority. Level of Evidence: 4.
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| 10. |
- Robinson, Yohan, 1977-, et al.
(författare)
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Systematic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly
- 2014
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Ingår i: BioMed Research International. - : Hindawi Publishing Corporation. - 2314-6133 .- 2314-6141. ; 2014, s. 231948-
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Forskningsöversikt (refereegranskat)abstract
- Odontoid fractures type II according to Anderson and d’Alonzo are not uncommon in the elderly patients. Still, due to the paucity of evidence the published treatment guidelines are far from equivocal. This systematic review focuses on the published results of type II odontoid fracture treatment in the elderly with regard to survival, nonunion, and complications. After a systematic literature research 38 publications were included. A cumulative analysis of 1284 published cases found greater survival if elderly patients with odontoid fractures type II received surgical treatment (RR = 0.64). With regard to nonunion in 669 published cases primary posterior fusion had the best fusion results. The systematic literature review came to the following conclusions. (1) Surgical stabilisation of odontoid fractures type II improves survival in patients between 65 and 85 years of age compared to nonsurgical treatment. (2) Posterior atlantoaxial fusion for odontoid fractures type II in the elderly has the greatest bony union rate. (3) Odontoid nonunion is not associated with worse clinical or functional results in the elderly. (4) The complication rate of nonsurgical treatment is similar to the complication rate of surgical treatment of odontoid fractures type II in the elderly.
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