| 1. |
- Debono, Bertrand, et al.
(författare)
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Consensus statement for perioperative care in lumbar spinal fusion : Enhanced Recovery After Surgery (ERAS®) Society recommendations
- 2021
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Ingår i: The spine journal. - : Elsevier. - 1529-9430 .- 1878-1632. ; 21:5, s. 729-752
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care have led to improvements in outcomes in numerous surgical areas, through multimodal optimization of patient pathway, reduction of complications, improved patient experience and reduction in the length of stay. ERAS represent a relatively new paradigm in spine surgery.PURPOSE: This multidisciplinary consensus review summarizes the literature and proposes recommendations for the perioperative care of patients undergoing lumbar fusion surgery with an ERAS program.STUDY DESIGN: This is a review article.METHODS: Under the impetus of the ERAS (R) society, a multidisciplinary guideline development group was constituted by bringing together international experts involved in the practice of ERAS and spine surgery. This group identified 22 ERAS items for lumbar fusion. A systematic search in the English language was performed in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Systematic reviews, randomized controlled trials, and cohort studies were included, and the evidence was graded according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Consensus recommendation was reached by the group after a critical appraisal of the literature.RESULTS: Two hundred fifty-six articles were included to develop the consensus statements for 22 ERAS items; one ERAS item (prehabilitation) was excluded from the final summary due to very poor quality and conflicting evidence in lumbar spinal fusion. From these remaining 21 ERAS items, 28 recommendations were included. All recommendations on ERAS protocol items are based on the best available evidence. These included nine preoperative, eleven intraoperative, and six postoperative recommendations. They span topics from preoperative patient education and nutritional evaluation, intraoperative anesthetic and surgical techniques, and postoperative multi-modal analgesic strategies. The level of evidence for the use of each recommendation is presented.CONCLUSION: Based on the best evidence available for each ERAS item within the multidisciplinary perioperative care pathways, the ERAS (R) Society presents this comprehensive consensus review for perioperative care in lumbar fusion.
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| 2. |
- Elmose, Signe Forbech, et al.
(författare)
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Magnetic Resonance Imaging Proxies for Segmental Instability in Degenerative Lumbar Spondylolisthesis Patients
- 2022
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Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 47:21, s. 1473-1482
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Tidskriftsartikel (refereegranskat)abstract
- Study design: Retrospective cohort study.Objective: The aim was to investigate whether findings on magnetic resonance imaging (MRI) can be proxies (MRIPs) for segmental instability in patients with degenerative lumbar spinal stenosis (LSS) and/or degenerative spondylolisthesis (LDS) L4/L5.Background: LDS has a heterogeneous nature. Some patients have a dynamic component of segmental instability associated with LDS. Studies have shown that MRI can show signs of instability.Methods: Patients with LSS or LDS at L4/L5 undergoing decompressive surgery +/- fusion from 2010 to 2017, with preoperative standing lateral spine radiographs and supine lumbar MRI and enrolled in Danish national spine surgical database, DaneSpine. Instability defined as slip of >3 mm on radiographs. Patients divided into two groups based upon presence of instability. Outcome measures: radiograph: sagittal slip (mm). MRIPs for instability: sagittal slip >3 mm, facet joint angle (degrees), facet joint effusion (mm), disk height index (%), and presence of vacuum phenomena. Optimal thresholds for MRIPs was determined by receiver operating characteristic (ROC) curves and area under the curve (AUC). Logistic regression to investigate association between instability and MRIPs.Results: Two hundred thirty-two patients: 47 stable group and 185 unstable group. The two groups were comparable with regard to baseline patient-reported outcome measures. Thresholds for MRIPs: bilateral facet joint angle >= 46 degrees; bilateral facet effusion >= 1.5 mm and disk height index >= 13%. Logistic regression showed statistically significant association with MRIPs except vacuum phenomena, ROC curve AUC of 0.951. By absence of slip on MRI logistic regression showed statistically significant association between instability on radiograph and the remaining MRIPs, ROC curve AUC 0.757.Conclusion: Presence of MRIPs for instability showed statistically significant association with instability and excellent ability to predict instability on standing radiograph in LSS and LDS patients. Even in the absence of slip on MRI the MRIPs had a good ability to discriminate presence of instability.
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| 3. |
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| 4. |
- Hareni, Niyaz, et al.
(författare)
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Back pain is also improved by lumbar disc herniation surgery
- 2021
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Ingår i: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 92:1, s. 4-8
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Indication for lumbar disc herniation (LDH) surgery is usually to relieve sciatica. We evaluated whether back pain also decreases after LDH surgery.Patients and methods: In the Swedish register for spinal surgery (SweSpine) we identified 14,097 patients aged 20-64 years, with pre- and postoperative data, who in 2000-2016 had LDH surgery. We calculated 1-year improvement on numeric rating scale (rating 0-10) in back pain (Nback) and leg pain (Nleg) and by negative binomial regression relative risk (RR) for gaining improvement exceeding minimum clinically important difference (MCID).Results: Nleg was preoperatively (mean [SD]) 6.7 (2.5) and Nback was 4.7 (2.9) (p < 0.001). Surgery reduced Nleg by mean 4.5 (95% CI 4.5-4.6) and Nback by 2.2 (CI 2.1-2.2). Mean reduction in Nleg) was 67% and in Nback 47% (p < 0.001). Among patients with preoperative pain ≥ MCID (that is, patients with significant baseline pain and with a theoretical possibility to improve above MCID), the proportion who reached improvement ≥ MCID was 79% in Nleg and 60% in Nback. RR for gaining improvement ≥ MCID in smokers compared with non-smokers was for Nleg 0.9 (CI 0.8-0.9) and -Nback 0.9 (CI 0.8-0.9), and in patients with preoperative duration of back pain 0-3 months compared with > 24 months for Nleg 1.3 (CI 1.2-1.5) and for Nback 1.4 (CI 1.2-1.5).Interpretation: LDH surgery improves leg pain more than back pain; nevertheless, 60% of the patients with significant back pain improved ≥ MCID. Smoking and long duration of pain is associated with inferior recovery in both Nleg and Nback.
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| 5. |
- Holy, Marek, 1981-, et al.
(författare)
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Occult spondylodiscitis after cervical intradiscal injection with radiopaque gelified ethanol, DiscoGel : A case report
- 2022
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Ingår i: Interdisciplinary Neurosurgery. - : Elsevier. - 2214-7519. ; 28
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Tidskriftsartikel (refereegranskat)abstract
- Background: A 25-year-old patient was treated for post-traumatic neck pain with intradiscal injections at the C3-4 and C4-5 levels using radiopaque gelified ethanol. After the injections, the axial neck pain increased. Laboratory infection parameters were normal despite the progressive disc destruction observed on CT scans at both index levels. The patient underwent debridement and anterior cervical discectomy and fusion. Staphylococcus epi-dermidis and Cutibacterium acnes grew in all the intraoperative cultures. The patient was subsequently treated with Rifampicin and Moxifloxacin and after 3 months no signs of infection were observed. CT scan showed solid fusion of the at the index segments 7 months postoperatively.Conclusion: Infections after intradiscal injections are rare and we believe this is the first case describing iatrogenic spondylodiscitis after DiscoGel injection. When increased axial neck pain is experienced after injection with DiscoGel, post-operative spondylodiscitis should be suspected. Even if laboratory parameters are normal, examinations with MRI and CT should be performed and if these studies show signs of infection, surgical revision should be conducted.
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| 6. |
- Holy, Marek, 1981-, et al.
(författare)
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Operative treatment of cervical radiculopathy : anterior cervical decompression and fusion compared with posterior foraminotomy
- 2021
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Ingår i: Trials. - : BioMed Central. - 1745-6215. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cervical radiculopathy is the most common disease in the cervical spine, affecting patients around 50-55 year of age. An operative treatment is common clinical praxis when non-operative treatment fails. The controversy is in the choice of operative treatment, conducting either anterior cervical decompression and fusion or posterior foraminotomy. The study objective is to evaluate short- and long-term outcome of anterior cervical decompression and fusion (ACDF) and posterior foraminotomy (PF)METHODS: A multicenter prospective randomized controlled trial with 1:1 randomization, ACDF vs. PF including 110 patients. The primary aim is to evaluate if PF is non-inferior to ACDF using a non-inferiority design with ACDF as "active control." The neck disability index (NDI) is the primary outcome measure, and duration of follow-up is 2 years.DISCUSSION: Due to absence of high level of evidence, the authors believe that a RCT will improve the evidence for using the different surgical treatments for cervical radiculopathy and strengthen current surgical treatment recommendation.TRIAL REGISTRATION: ClinicalTrials.gov NCT04177849. Registered on November 26, 2019.
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| 7. |
- Joelson, Anders, 1970-, et al.
(författare)
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Additional operation rates after surgery for degenerative spine diseases : minimum 10 years follow-up of 4705 patients in the national Swedish spine register
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:12
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To identify rates of additional operation after the index operation for degenerative lumbar spine diseases.Design Retrospective register study.Setting National outcome data from Swespine, the National Swedish spine register.Participants: A total of 4705 patients who underwent one-level surgery for degenerative disk disease (DDD) or lumbar spinal stenosis (LSS) with or without degenerative spondylolisthesis (DS) between 1 January 2007 and 31 December 2010 were followed from 1 January 2007 to 31 December 2020 to record all cases of additional lumbar spine operations.Interventions One-level spinal decompression and/or posterolateral fusion for degenerative spine diseases.Primary outcome measures: Number of additional operations.Results: Additional operations were more common at adjacent levels for patients with LSS with DS treated with decompression and fusion whereas additional operations were more evenly distributed between the index level and the adjacent levels for DDD treated with fusion and LSS with and without DS treated with decompression only. For patients younger than 60 years, treated with decompression and fusion for LSS with DS, the additional operations were evenly distributed between the index level and the adjacent levels.Conclusions: There are different patterns of additional operations following the index procedure after surgery for degenerative spine diseases. Rigidity across previously mobile segments is not the only important factor in the development of adjacent segment disease (ASD) after spinal fusion, also the underlying disease and age may play parts in ASD development. The findings of this study can be used in the shared decision-making process when surgery is a treatment option for patients with degenerative lumbar spine diseases as the first operation may be the start of a series of additional spinal operations for other degenerative spinal conditions, either at the index level or at other spinal levels.
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| 8. |
- Joelson, Anders, 1970-, et al.
(författare)
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Associations between future health expectations and patient satisfaction after lumbar spine surgery : a longitudinal observational study of 9929 lumbar spine surgery procedures
- 2023
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study aimed to investigate the associations between general health expectations and patient satisfaction with treatment for the two common spine surgery procedures diskectomy for lumbar disk herniation (LDH) and decompression for lumbar spinal stenosis (LSS). DESIGN: Register study with prospectively collected preoperative and 1-year postoperative data.SETTING: National outcome data from Swespine, the national Swedish spine register.PARTICIPANTS: A total of 9929 patients, aged between 20 and 85 years, who were self-reported non-smokers, and were operated between 2007 and 2016 for one-level LSS without degenerative spondylolisthesis, or one-level LDH, were identified in the national Swedish spine register (Swespine). We used SF-36 items 11c and 11d to assess future health expectations and present health perceptions. Satisfaction with treatment was assessed using the Swespine satisfaction item.INTERVENTIONS: One-level diskectomy for LDH or one-level decompression for LSS.PRIMARY OUTCOME MEASURES: Satisfaction with treatment. RESULTS: For LSS, the year 1 satisfaction ratio among patients with negative future health expectations preoperatively was 60% (95% CI 58% to 63%), while it was 75% (95% CI 73% to 76%) for patients with positive future health expectations preoperatively. The corresponding numbers for LDH were 73% (95% CI 71% to 75%) and 84% (95% CI 83% to 85%), respectively.CONCLUSIONS: Patients operated for the common lumbar spine diseases LSS or LDH, with negative future general health expectations, were significantly less satisfied with treatment than patients with positive expectations with regard to future general health. These findings are important for patients, and for the surgeons who counsel them, when surgery is a treatment option for LSS or LDH.
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| 9. |
- Joelson, Anders, 1970-, et al.
(författare)
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Properties of SF-6D when longitudinal data from 16,398 spine surgery procedures is applied to 9 national SF-6D value sets
- 2021
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Ingår i: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 92:5, s. 532-537
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: There are several national value sets for SF-6D. For studies conducted in countries without a country-specific value set the authors may use a value set from a neighboring or culturally similar county. We evaluated the consequences of using different national value sets in SF-6D index-based outcome analyses.Patients and methods: Patients surgically treated for lumbar spinal stenosis or lumbar disk herniation between 2007 and 2017 were recruited from the national Swedish spine register. 16,398 procedures were eligible for analysis. The SF-6D health states were coded to SF-6D preference indices using value sets for 9 countries. The SF-6D index distributions were then estimated with kernel density estimation. The change in SF-6D index before and after treatment was evaluated with the standardized response mean (SRM).Results: There was a marked variability in mean and shape for the resulting SF-6D index distributions. There were considerable differences in SF-6D index distribution shape before and after treatment using the same value set. The effect sizes of 2-year change (SRM) were in most cases similar when the 9 value sets were applied on pre- and post-treatment data.Interpretation: We found a marked variability in SF-6D index distributions when a single large data set was applied to 9 national SF-6D value sets. Consequently, we recommend that SF-6D index data from studies conducted in countries without country-specific SF-6D value sets is interpreted with caution.
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| 10. |
- Joelson, Anders, 1970-, et al.
(författare)
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Properties of the EQ-5D-3L index distribution when longitudinal data from 27,328 spine surgery procedures are applied to nine national EQ-5D-3L value sets
- 2021
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Ingår i: Quality of Life Research. - : Springer. - 0962-9343 .- 1573-2649. ; 30, s. 1467-1475
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of the current study was to apply a single large longitudinal EQ-5D-3L data set to several national EQ-5D-3L value sets and explore differences in EQ-5D-3L index density functions and effect sizes before and after treatment.METHODS: Patients, surgically treated for lumbar spinal stenosis or lumbar disk herniation between 2007 and 2017, were recruited from the national Swedish spine register. A total of 27,328 procedures were eligible for analysis. The EQ-5D health states were coded to EQ-5D-3L summary indices using value sets for 9 countries: Argentina, Australia, Canada, China, Germany, Italy, Sweden, the UK, and the US. The EQ-5D-3L summary index distributions were then estimated with kernel density estimation. The change in EQ-5D-3L index before and after treatment was evaluated with the standardized response mean (SRM).RESULTS: There was a high variability in the resulting EQ-5D-3L index density functions. There were also considerable differences in EQ-5D-3L index density functions before and after treatment using the same value set. Effect sizes of 2-year change (SRM), however, were similar when the 9 value sets were applied on pre- and post-treatment data.CONCLUSIONS: We found a marked variability in EQ-5D-3L index density functions when a single large data set was applied to 9 national EQ-5D-3L value sets. Consequently, studies that aggregate international data, e.g. meta-analyses, may produce misleading results if the underlying differences in EQ-5D-3L index density functions are inadequately handled. On the basis of the results of our study, we recommend against pooling of different national EQ-5D-3L index data.
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