| 1. |
- Aasa, Ulrika, et al.
(författare)
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Physical Activity Might Be of Greater Importance for Good Spinal Control Than If You Have Had Pain or Not : A Longitudinal Study
- 2015
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 40:24, s. 1926-1933
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Longitudinal design. A cohort followed in 3 waves of data collection.OBJECTIVE: The aim of the study was to describe the relationships between the performance of 2 tests of spinal control at the age of 52 years and low back pain, physical activity level, and fitness earlier in life, as well as to describe the cross-sectional relationships between these measures.SUMMARY OF BACKGROUND DATA: Altered spinal control has been linked to pain; however, other stimuli may also lead to inability to control the movements of the spine.METHODS: Participants answered questions about physical activity and low back pain, and performed physical fitness tests at the age of 16, 34, and 52 years. The fitness test battery included tests of endurance in the back and abdominal muscles, a submaximal bicycle ergometer test to estimate maximal oxygen uptake, and measurements of hip flexion, thoracic spine flexibility, and anthropometrics. Two tests were aggregated to a physical fitness index. At the age of 52, also 2 tests of spinal control, the standing Waiter's bow (WB) and the supine double leg lower (LL) were performed.RESULTS: Logistic regression analyses showed that higher back muscle endurance at the age of 34 years could positively predict WB performance at 52 years and higher physical fitness at the age of 34 could positively predict LL performance at 52 years. Regarding cross-sectional relationships, an inability to perform the WB correctly was associated with lower physical fitness, flexibility and physical activity, and larger waist circumference. An inability to correctly perform the LL was associated with lower physical fitness. One-year prevalence of pain was not significantly associated with WB or LL test performance.CONCLUSION: An active life resulting in higher physical fitness is related to better spinal control in middle-aged men and women. This further strengthens the importance of physical activity throughout the life span.LEVEL OF EVIDENCE: 3.
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| 5. |
- Ahlqwist, Anna, et al.
(författare)
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Physical therapy treatment of back complaints on children and adolescents.
- 2008
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Ingår i: Spine. - 1528-1159. ; 33:20
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: A randomized controlled trial was performed. OBJECTIVES: To evaluate how 2 different treatment options affect perception of health, pain, and physical functioning over time among children and adolescents with low back pain (LBP). SUMMARY OF BACKGROUND DATA: LBP among children and adolescents has increased. The literature shows that children with LBP also suffer from this condition as adults. Thus, it is important to prevent and treat LBP in children and adolescents. METHODS: Forty-five children and adolescents were consecutively randomized into one of 2 treatment groups and were studied for 12 weeks. Group 1 was given individualized physical therapy and exercise and a standardized self-training program and back education. Group 2 was given self-training program and back education but no individualized therapy. The children and adolescents were tested before and after the treatment period. Child Health Questionnaire Child Form 87, Roland & Morris Disability Questionnaire, Painometer, Back Saver Sit and Reach, and test of trunk muscle endurance were used to evaluate the interventions. RESULTS: Both groups improved statistically significant in most parameters over time. On comparison between the groups the physical function measured by Roland & Morris Disability Questionnaire and the duration of pain measured by Painometer improved statistically significant in Group 1. CONCLUSION: An individual assessment by a knowledgeable physiotherapist and an active treatment model improve how children and adolescents experience their back problems with respect to health and physical function, pain, strength, and mobility, regardless of whether treatment consists of a home exercise program with follow-up or home exercise combined with exercise and treatment supervised by a physiotherapist.
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| 6. |
- Ahonen, Matti, et al.
(författare)
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Back Pain and Quality of Life 10 Years After Segmental Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis
- 2023
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 0362-2436 .- 1528-1159. ; 48:10, s. 665-671
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Tidskriftsartikel (refereegranskat)abstract
- Study Design.Comparative cohort study. Objective.The aim of the present study was to evaluate pain and health-related quality of life (HRQoL) in surgically managed patients with a minimum follow-up of 10 years compared with patients with untreated adolescent idiopathic scoliosis (AIS) and a healthy control group. Summary of Background Data.Posterior spinal fusion with pedicle screws is the standard treatment for AIS, although it remains unclear whether this procedure results in improved long-term HRQoL compared with untreated patients with AIS. Patients and Methods.Sixty-four consecutive patients at a minimum follow-up of 10 years, who underwent posterior pedicle screw instrumentation for AIS were prospectively enrolled. Fifty-three (83%) of these patients completed Scoliosis Research Society (SRS) 24 questionnaires, clinical examination, and standing spinal radiographs. Pain and HRQoL were compared with age and sex-matched patients with untreated AIS and healthy individuals. Results.The mean major curve was 57 degrees preoperatively and 15 degrees at the 10-year follow-up. SRS-24 self-image domain score showed a significant improvement from preoperative to 2 years and remained significantly better at the 10-year follow-up (P < 0.001). Patients fused to L3 or below had lower pain, satisfaction, and total score than patients fused to L2 or above (P < 0.05), but self-image, function, and activity scores did not differ between groups at 10-year follow-up. Pain, self-image, general activity, and total SRS domains were significantly better at 10-year follow-up in the surgically treated patients as compared with untreated patients (all P < 0.05). Healthy controls had significantly higher total scores than those surgically treated at 10-year follow-ups (P < 0.001). Conclusion.Patients undergoing segmental pedicle screw instrumentation for AIS maintain high-level HRQoL during a 10-year follow-up. Their HRQoL was significantly better than in the untreated patients with AIS, except for the function domain. However, HRQoL remained at a lower level than in healthy controls.
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| 7. |
- Alipour, Akbar, et al.
(författare)
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Four-year incidence of sick leave because of neck and shoulder pain and its association with work and lifestyle
- 2009
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 34:4, s. 413-418
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Four-year prospective cohort study. OBJECTIVE: To find the incidence of sick leave because of neck and shoulder pain (NSP) in industrial workers, and its association with work and lifestyle risk factors. SUMMARY OF BACKGROUND DATA: Longitudinal studies to investigate NSP incidence and risk factors are rare, and even fewer have been conducted in middle- and low-income countries. METHODS: After inviting all full-time employees of an Iranian car manufacturing company with 18,031 employees to participate in a baseline study, they were followed for 4 years. New episodes of sick leave because of NSP have been calculated based on sickness absence registration between the years 2003 and 2007. The incidence was compared for participants and nonparticipants. The association between sick leave, physical, and psychosocial risk factors at work, and previous self-reported NSP, was calculated for the remaining population of baseline participants (12,184 employees) during a 4-year follow-up. RESULTS: During a 4-year follow-up of study subjects for the remaining participants of the baseline study, the incidence of sick leave was 0.8% (98 sick leave cases in 12,184 employees). For nonparticipants this incidence was 4.2% (130 cases in 3127 employees). In the final regression model for sick leave cases, the remaining factors for potential physical risk factors were repetitive work and sitting positions at work; for psychosocial factors unattractive work was the only significant remaining factor. CONCLUSION: The incidence of NSP based on sick leave is definitely very low compared with previous studies in high-income countries. This incidence varies between participants and nonparticipants. Risk factors for sick leave differ from risk factors for self-reported pain. A young population, job security, the insurance system, different health behaviors, and healthy worker bias, are all factors that may affect the results, and sick-leave as an outcome must be interpreted with more caution in middle- and low-income countries.
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| 8. |
- Andersson, Eva A, et al.
(författare)
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Diverging intramuscular activity patterns in back and abdominal muscles during trunk rotation.
- 2002
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1159 .- 0362-2436. ; 27:6, s. E152-60
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: An intramuscular electromyographic study was performed on trunk rotations during sitting and standing. OBJECTIVE: The aim was to provide new information on activation levels for deep trunk muscles in various unresisted and resisted trunk rotations. SUMMARY AND BACKGROUND DATA: Frequent daily trunk twisting and decreased maximal strength during trunk rotation have been associated with low back pain or sciatic pain. However, the involvement of deep trunk muscles during different trunk rotations is relatively unknown. METHODS: Ten healthy subjects participated. Fine-wire electrodes were inserted, under ultrasound guidance, into psoas, quadratus lumborum, the superficial medial lumbar erector spinae (ES-s, multifidus) and its deep lateral portion (ES-d, iliocostalis), iliacus, rectus abdominis, obliquus externus, and obliquus internus. RESULTS: The highest involvement for all muscles was observed on the ipsilateral side, in maximal trunk twists with shoulder resistance, except obliquus externus, which showed a dominant contralateral side, and rectus abdominis, which was little activated in all rotations. In contrast, maximal trunk twist without shoulder resistance, i.e., freely performed, resulted generally in lower levels for all muscles involved and in a shift of side dominance for the lumbar muscles quadratus lumborum, psoas, and ES-s. CONCLUSIONS: During trunk rotations the activity patterns for various trunk muscles could drastically change, and even be the opposite, between the two body sides, within the same type of task, depending on several factors such as initial position, effort level, sitting or standing, and external shoulder resistance.
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| 9. |
- Andersson, Eleonor I., et al.
(författare)
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Performance Tests in People With Chronic Low Back Pain Responsiveness and Minimal Clinically Important Change
- 2010
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Ingår i: Spine. - : J B Lippincott Co. - 0362-2436 .- 1528-1159. ; 35:26, s. E1559-E1563
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Cohort study. Objective. To assess the responsiveness and minimal clinically important change (MCIC) of 6 commonly-used performance tests (5-minute walking, 50-ft walking, sit-to-stand, 1 minute stair climbing, loaded forward reach, Progressive Isoinertial Lifting Evaluation). Summary of Background Data. Performance tests are used to evaluate physical function in people with low back pain. Little is known about their clinimetric properties. Methods. Performance tests were administered in people with chronic nonspecific low back pain (n = 198) before and after 10 weeks of treatment. At 10 weeks, the global perceived effect scale was used to determine if participants judged themselves as worsened, unchanged, or improved. The mean change scores for each performance test were calculated. A performance test was considered responsive if the area under the receiver operating characteristic curve (AUC) was equal to or greater than 0.70. We used 2 methods to evaluate MCIC: the optimal cut-off point based on the receiver operating characteristic curve, which takes into account both sensitivity and specificity, and the minimal detectable change for improvement, which considers test specificity only. Results. In general, the mean change scores were the smallest in participants who judged themselves worsened and largest in those reporting to be improved. Sit-to-stand (AUC = 0.75) and stair climbing (AUC = 0.72) were the only performance tests that showed adequate responsiveness. For sit-to-stand, the MCIC ranged from 4.1 to 9.8 seconds (19%-45% of the mean baseline score). For stair climbing, the MCIC ranged from 14.5 to 23.9 steps (19%-31% of the mean baseline score). Conclusion. Only 2 of the 6 performance tests were responsive. Both had acceptable MCIC values. Developing individualized performance tests might partly overcome the general lack of responsiveness of performance tests. Future research should focus on the clinimetric testing of performance tests in subgroups.
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| 12. |
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| 13. |
- Baranto, Adad, 1966, et al.
(författare)
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Acute chest pain in a top soccer player due to thoracic disc herniation
- 2009
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Ingår i: Spine (Phila Pa 1976). - 1528-1159. ; 34:10
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Case report. OBJECTIVE: An unusual and previously not reported case of upper thoracic disc herniation combined with acute chest pain, is presented. SUMMARY OF BACKGROUND DATA: Disc herniation in the thoracic spine is rare. There are only a few cases of thoracic disc herniation in top athletes presented in the literature. The clinical presentation of a thoracic disc herniation can vary widely depending on its location and morphologic characteristics. Clinically, the acute symptoms may be severe. METHODS: A 24-year-old soccer player with acute left-sided chest pain that started in the middle of a soccer game has been followed clinically and with MRI examinations for 3 years. RESULTS: MRI of the thoracic spine showed a left-sided paramedial disc herniation at T2-T3 level and the right-sided paramedial disc herniation at T3-T4 level. The player was prescribed initial rest and subsequent physical rehabilitation. He had no further symptoms during rehabilitation to full training, and could resume play and remained symptom free for the rest of the season.The following season, the player experienced a similar sudden thoracic pain episode during training. This time the chest pain was right-sided. A new MRI of the thoracic spine showed unchanged findings. The initial rehabilitation was similar to the one used in the first episode. After 15 months with no symptoms during normal life the player was allowed to increase the intensity of training gradually and after 2 years the patient played soccer at elite level again. However, 3 years later the symptoms relapsed and the player ended his career after another rehabilitation period. CONCLUSION: In conclusion, it is important to consider thoracic disc herniation as acute chest pain in athletes and that the long-term prognosis of this entity is not always good.
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| 14. |
- Baranto, Adad, 1966, et al.
(författare)
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Acute injury of an intervertebral disc in an elite tennis player: a case report.
- 2010
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Ingår i: Spine. - 1528-1159 .- 0362-2436. ; 35:6
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Tidskriftsartikel (refereegranskat)abstract
- A case report.To present a previously not described rare case of intradiscal hematoma due to acute trauma in an elite tennis player.Several studies have demonstrated a high frequency of radiological changes in the spine of athletes, especially in sports with high loads on the back. Signs of disc degeneration without disc herniation have frequently been found in magnetic resonance imaging (MRI) studies of the spine of athletes. It has also been shown that radiological abnormalities of the spine in young athletes are correlated to back pain.An elite male tennis player experienced pain in the right buttock after a backhand stroke. He was successfully treated for hip problems and started to play competitive tennis, 2 weeks later. After few games, a backhand stroke again resulted in intense pain projected in the os coccyx region. At examination, there were no neurologic disturbances. At palpation over the spinal processes (Springing test) of L1-L2, the patient experienced intense pain projected to the os coccyx region.MRI examination showed an injured L1-L2 disc with fluid inside the disc with a signal similar to blood. Four additional MRI examinations were performed 2 weeks and 2 years after the injury until disc degeneration is formed. Radiograph examination before and 2 years after the injury is available.In conclusion, trauma in athletes can cause intradiscal hematoma, which probably is a new etiology for disc degeneration. Also that sudden onset of pain in the hip or the gluteal region may be caused by referred pain due to a disc lesion. Intradiscal hematoma can be visualized using MRI.
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| 15. |
- Baranto, Adad, 1966, et al.
(författare)
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Fracture patterns of the adolescent porcine spine: an experimental loading study in bending-compression
- 2005
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Ingår i: Spine. - 1528-1159. ; 30:1, s. 75-82
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: To expose functional spinal units from adolescent porcine to mechanical flexion-compression and extension-compression to failure. The biomechanical, radiologic, magnetic resonance imaging, and histologic characteristics are described. OBJECTIVES: The aim of the present study was to investigate the fracture pattern of functional spinal units from adolescent porcine lumbar spines in in vitro compression loading and bending. SUMMARY OF BACKGROUND DATA: In several studies, it has been shown that the adolescent spine, especially the vertebral growth zones, is vulnerable to trauma. A high frequency of abnormalities affecting the spine has been found among athletes participating in sports with high demands on the back. The etiology of these abnormalities is still a controversial issue. METHODS: Sixteen functional spinal units obtained from eight adolescent male pigs were used. Eight functional spinal units were exposed to flexion-compression and eight functional spinal units to extension-compression loading to failure. They were examined with plain radiography and magnetic resonance imaging before and after the loading. The functional spinal units were finally examined macroscopically and histologically. RESULTS: Fractures/separations were seen in the growth zone anteriorly and more frequently, posteriorly in functional spinal units exposed to flexion-compression. In the extension-compression group, such injuries occurred only anteriorly. Only large fractures could be seen on plain radiographs and on magnetic resonance imaging. Macroscopically, a fracture/separation could be seen in 15 cases and histologically in all 16 cases. The median angle at failure for the flexion group was 17 degrees (range, 12-19) and for the extension group 17 degrees (range, 13-19 degrees). The median ultimate compression load in the flexion-compression group was 1894 N (range, 1607-3138 N) and in the extension-compression group 1801 N (range, 1158-2368 N). CONCLUSIONS: The weakest part of the growing porcine lumbar spine, when compressed into flexion- or extension-compression, was the growth zone. The injury was more extensive in extension loading than during flexion loading. Growth zone injuries of the adolescent spine may go undetected on plain radiographs and magnetic resonance imaging.
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| 16. |
- Barreto Henriksson, Helena, et al.
(författare)
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Support of Concept that Migrating Progenitor Cells from Stem Cell Niches Contribute to Normal Regeneration of the Adult Mammal Intervertebral Disc: A Descriptive study in the New Zeeland white Rabbit.
- 2012
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 37:9, s. 722-732
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: Study Design. Descriptive experimental study performed in rabbits of two age groups.Objective. To study and investigate presence of prechondrocytic cells and cell migration routes in the IVD region, to gain knowledge about the normal IVD regeneration pattern.Summary of Background Data. Disc degeneration is believed to play a major role in patients with chronic lumbar pain. Regeneration processes and cell migration within the intervertebral disc (IVD) have been sparsely described. Therefore it is of interest to increase knowledge of these processes in order to understand pathological conditions of the IVD.Methods. 5-bromo-2-deoxyuridine (BrdU) in vivo labelling was performed in two groups of rabbits, 3 and 9 months old at the beginning of the experiment, in total 27 rabbits. BrdU is incorporated into DNA during mitosis and then it is gradually diluted with each cell division until it finally disappears. Incorporation of BrdU was then visualized by immunohistochemistry (IHC) at different time points providing cell division pattern and presence of slow-cycling cells in the IVD region. IVD tissue was investigated by IHC for: Growth- and differentiation-factor-5 (GDF5), SOX9 (chondrogenic lineage markers), SNAIL homolog1 (SNAI1), SNAIL homolog2 (SLUG)(migration markers) and β1-INTEGRIN (cellular adhesion marker). In addition, GDF5, SOX9 and BMPRIB expression were investigated on genetic level.Results. BrdU+ cells were observed in early time points in the IVD niche, adjacent to the epiphyseal plate, at later time points mainly in outer region of the annulus fibrosus (AF) for both age groups of rabbits, indicating a gradual migration of cells. The presence of SLUG, SNAI1, GDF5, SOX9 and β1-INTEGRIN were found in same regions.Conclusion. The results suggest a cellular migration route from the IVD stem cell niche toward the AF and the inner parts of the IVD. These findings may be of importance for understanding IVD regenerative mechanisms and for future development of biological treatment strategies.
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| 17. |
- Barreto Henriksson, Helena, et al.
(författare)
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Transplantation of human mesenchymal stems cells into intervertebral discs in a xenogeneic porcine model.
- 2009
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Ingår i: Spine. - 1528-1159. ; 34:2, s. 141-8
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Experimental and descriptive study of a xenotransplantation model in minipigs. OBJECTIVE: To study survival and function of human mesenchymal stem cells (hMSCs) after transplantation into injured porcine spinal discs, as a model for cell therapy. SUMMARY OF BACKGROUND DATA: Biologic treatment options of the intervertebral disc are suggested for patients with chronic low back pain caused by disc degeneration. METHODS: Three lumbar discs in each of 9 minipigs were injured by aspiration of the nucleus pulposus (NP), 2 weeks later hMSCs were injected in F12 media suspension (cell/med) or with a hydrogel carrier (Puramatrix) (cell/gel). The animals were sacrificed after 1, 3, or 6 months. Disc appearance was visualized by magnetic resonance imaging. Immunohistochemistry methods were used to detect hMSCs by antihuman nuclear antibody staining, and further performed for Collagen II, Aggrecan, and Collagen I. SOX 9, Aggrecan, Versican, Collagen IA, and Collagen IIA and Collagen IIB human mRNA expression was analyzed by real-time PCR. RESULTS: At magnetic resonance imaging all injured discs demonstrated degenerative signs. Cell/gel discs showed fewer changes compared with cell/med discs and only injured discs at later time points. hMSCs were detected in 9 of 10 of the cell/gel discs and in 8 of 9 of the cell/med discs. Immunostaining for Aggrecan and Collagen type II expression were observed in NP after 3 and 6 months in gel/cell discs and colocalized with the antihuman nuclear antibody. mRNA expression of Collagen IIA, Collagen IIB, Versican, Collagen 1A, Aggrecan, and SOX9 were detected in both cell/med and cell/gel discs at the time points 3 and 6 months by real-time PCR. CONCLUSION: hMSCs survive in the porcine disc for at least 6 months and express typical chondrocyte markers suggesting differentiation toward disc-like cells. As in autologous animal models the combination with a three-dimensional-hydrogel carrier seems to facilitate differentiation and survival of MSCs in the disc. Xenotransplantation seems to be valuable in evaluating the possibility for human cell therapy treatment for intervertebral discs.
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| 18. |
- Bauer, H
(författare)
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Surgical strategy for spinal metastases
- 2002
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 1528-1159 .- 0362-2436. ; 27:10, s. 1124-1125
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 19. |
- Bergknut, Niklas, et al.
(författare)
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The Dog as an Animal Model for Intervertebral Disc Degeneration?
- 2012
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 37, s. 351-358
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Prospective observational and analytic study.Objective. To investigate whether spontaneous intervertebral disc degeneration (IVDD) occurring in both chondrodystrophic (CD) and nonchondrodystrophic dogs (NCD) can be used as a valid translational model for human IVDD research.Summary of Background Data. Different animal models are used in IVDD research, but in most of these models IVDD is induced manually or chemically rather than occurring spontaneously.Methods. A total of 184 intervertebral discs (IVDs) from 19 dogs of different breeds were used. The extent of IVDD was evaluated by macroscopic grading, histopathology, glycosaminoglycan content, and matrix metalloproteinase 2 activity. Canine data were compared with human IVD data acquired in this study or from the literature.Results. Gross pathology of IVDD in both dog types (CD and NCD) and humans showed many similarities, but the cartilaginous endplates were significantly thicker and the subchondral cortices significantly thinner in humans than in dogs. Notochordal cells were still present in the IVDs of adult NCD but were not seen in the CD breeds or in humans. Signs of degeneration were seen in young dogs of CD breeds (<1 year of age), whereas this was only seen in older dogs of NCD breeds (5-7 years of age). The relative glycosaminoglycan content and metalloproteinase 2 activity in canine IVDD were similar to those in humans: metalloproteinase 2 activity increased and glycosaminoglycan content decreased with increasing severity of IVDD.Conclusion. IVDD is similar in humans and dogs. Both CD and NCD breeds may therefore serve as models of spontaneous IVDD for human research. However, as with all animal models, it is important to recognize interspecies differences and, indeed, the intraspecies differences between CD and NCD breeds (early vs. late onset of IVDD, respectively) to develop an optimal canine model of human IVDD.
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| 20. |
- Berglund, Lars, et al.
(författare)
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Effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness : a randomized controlled trial
- 2017
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Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 42:15, s. E876-E882
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN:Randomized controlled trial.OBJECTIVE:The aim of this study was to compare the effects of low-load motor control (LMC) exercises and a high-load lifting (HLL) exercise, on lumbar multifidus (LM) thickness on either side of the spine and whether the effects were affected by pain intensity or change in pain intensity.SUMMARY OF BACKGROUND DATA:There is evidence that patients with low back pain (LBP) may have a decreased size of the LM muscles with an asymmetry between sides in the lower back. It has also been shown that LMC training can affect this asymmetry. It is, however, not known whether a high-load exercise has the same effect.METHODS:Sixty-five participants diagnosed with nociceptive mechanical LBP were included and randomized into LMC exercises or a HLL exercise, the deadlift. The LM thickness was measured using rehabilitative ultrasound imaging (RUSI), at baseline and after a 2-month training period.RESULTS:There were no differences between interventions regarding effect on LM muscle thickness. However, the analysis showed a significant effect for asymmetry. The thickness of the LM muscle on the small side increased significantly compared with the large side in both intervention groups, without influence of pain at baseline, or change in pain intensity.CONCLUSION:At baseline, there was a difference in thickness of the LM muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the LM muscles on the small side, irrespective of exercise load. The increase in LM thickness does not appear to be mediated by either current pain intensity or the magnitude of change in pain intensity.
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| 21. |
- Berglund, Lars, et al.
(författare)
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Effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness : a randomized controlled trial
- 2017
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Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 42:15, s. E876-E882
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: Randomized controlled trialObjective: The aim of this study was to compare the effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness among patients with nociceptive mechanical low back pain.Summary of Background Data: There is evidence that patients with low back pain may have a decreased size of the lumbar multifidus muscles with an asymmetry between left/right sides in the lower back. It has also been shown that low-load motor control training can affect this asymmetry; essentially, it is effective in equalizing side differences in lumbar multifidus muscle size. It is, however, not known whether a high-load exercise has the same effect.Methods: Sixty-five participants diagnosed with nociceptive mechanical low back pain were included and randomized into low-load motor control exercises or a high-load lifting exercise, the deadlift. The lumbar multifidus thickness at the fifth lumbar vertebra was measured, using rehabilitative ultrasound imaging, at baseline and after a 2-month training period.Results: There were no differences between interventions regarding effect on lumbar multifidus muscle thickness. However, the linear mixed model analysis showed a significant effect for asymmetry. The thickness of the lumbar multifidus muscle on the small side increased significantly compared to the large side in both intervention groups.Conclusions: There was a difference in thickness of the lumbar multifidus muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the lumbar multifidus muscles on the small side, irrespective of exercise load.
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| 22. |
- Bergmann, Annekatrin, et al.
(författare)
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Do occupational risks for low back pain differ from risks for specific lumbar disc diseases? : Results of the German Lumbar Spine Study (EPILIFT)
- 2017
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 42:20, s. E1204-E1211
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Tidskriftsartikel (refereegranskat)abstract
- Study design: A multicenter, population based, case-control study.Objective: The aim of the present analysis is to clarify potential differences in the "occupational risk profiles" of structural lumbar disc diseases on the one hand, and low back pain (LBP) on the other hand.Summary of background data: Physical workplace factors seem to play an important etiological role.Methods: We recruited 901 patients with structural lumbar disc diseases (disc herniation or severe disc space narrowing) and 233 control subjects with "low-back-pain." Both groups were compared with 422 "low-back pain free" control subjects. Case history, pain data, neurological deficits, and movement restrictions were documented. LBP was recorded by the Nordic questionnaire on musculoskeletal symptoms. All magnetic resonance imaging, computed tomography, and X-rays were inspected by an independent study radiologist. The calculation of cumulative physical workload was based on a computer-assisted interview and a biomechanical analysis by 3-D-dynamic simulation tool. Occupational exposures were documented for the whole working life.Results: We found a positive dose-response relationship between cumulative lumbar load and LBP among men, but not among women. Physical occupational risks for structural lumbar disc diseases [odds ratio (OR) 3.7; 95% confidence interval (95% CI) 2.3-6.0] are higher than for LBP (OR 1.9; 95% CI 1.0-3.5).Conclusion: Our finding points to potentially different etiological pathways in the heterogeneous disease group of LBP. Results suggest that not all of the structural disc damage arising from physical workload leads to LBP.
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| 23. |
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| 24. |
- Brink, Rob C., et al.
(författare)
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Anterior Spinal Overgrowth Is the Result of the Scoliotic Mechanism and Is Located in the Disc
- 2017
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Ingår i: Spine. - : LIPPINCOTT WILLIAMS & WILKINS. - 0362-2436 .- 1528-1159. ; 42:11, s. 818-822
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Cross-sectional study. Objective. To investigate the presence and magnitude of anterior spinal overgrowth in neuromuscular scoliosis and compare this with the same measurements in idiopathic scoliosis and healthy spines. Summary of Background Data. Anterior spinal overgrowth has been described as a potential driver for the onset and progression of adolescent idiopathic scoliosis (AIS). Whether this anterior overgrowth is specific for AIS or also present in nonidiopathic scoliosis has not been reported. Methods. Supine computed tomography (CT) scans of thirty AIS patients (thoracic Cobb 21-81 degrees), thirty neuromuscular (NM) scoliotic patients (thoracic Cobb 19-101 degrees) and 30 nonscoliotic controls were used. The difference in length in per cents between the anterior and posterior side {[(Delta A-P)/P] * 100%, abbreviated to A-P%} of each vertebral body and intervertebral disc, and between the anterior side of the spine and the spinal canal (A-C%) were determined. Results. The A-P% of the thoracic curves did not differ between the AIS (+1.2 perpendicular to 2.2%) and NM patients (+0.9 +/- 4.1%, P = 0.663), both did differ, however, from the same measurements in controls (-3.0 +/- 1.6%; Pamp;lt; 0.001) and correlated linearly with the Cobb angle (AIS r = 0.678, NM r = 0.687). Additional anterior length was caused by anterior elongation of the discs (AIS: A-P% disc +17.5 +/- 12.7% vs. A-P% body - 2.5 +/- 2.6%; Pamp;lt; 0.001, NM: A-P% disc + 19.1 +/- 18.0% vs. A-P% body -3.5 +/- 5.1%; Pamp;lt; 0.001). The A-C% T1-S1 in AIS and NM patients were similar (+ 7.9 +/- 1.8% and + 8.7 +/- 4.0%, P = 0.273), but differed from the controls (+4.2 +/- 3.3%; Pamp;lt; 0.001). Conclusion. So called anterior overgrowth has been postulated as a possible cause for idiopathic scoliosis, but apparently it occurs in scoliosis with a known origin as well. This suggests that it is part of a more generalized scoliotic mechanism, rather than its cause. The fact that the intervertebral discs contribute more to this increased anterior length than the vertebral bodies suggests an adaptation to altered loading, rather than a primary growth disturbance.
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| 25. |
- Brisby, Helena, 1965, et al.
(författare)
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In vivo measurement of facet joint nitric oxide in patients with chronic low back pain.
- 2007
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Ingår i: Spine. - 1528-1159. ; 32:14, s. 1488-92
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Tidskriftsartikel (refereegranskat)abstract
- Prospective case-control study testing a new diagnostic method.The aim of the present study was to investigate the concentration of nitric oxide (NO) in the perifacetal region in patients with chronic low back pain and healthy controls.Facet joint arthrosis may be a pain source in chronic back pain. Increased concentrations of NO, an oxygen-free radical, have been demonstrated in temporomandibular and knee joints with osteoarthritis.Patients with at least 6 months' duration of chronic low back pain and signs of facet joint osteoarthrosis (n = 24) and healthy volunteers (n = 7) were included. A detailed questionnaire, including visual analogue scale, was completed before and 6 weeks after the measurements. NO was measured with a custom-designed electrochemical real-time NO sensor inserted under fluoroscopic guidance. All patients received corticosteroids and local anesthetics after NO measurements.NO measurements were obtained from all participants. No adverse effects were noted. The patients with chronic low back pain demonstrated higher concentrations of NO in the perifacetal region compared with healthy controls (1.66 +/- 0.28 vs. 0.46 +/- 0.14 nmol/L, P = 0.007). No association between NO concentration and pain duration or pain level was detected. Patients with a positive response to local anesthetics and corticosteroid injection (defined as a >or=20 mm reduction of visual analogue scale at the 6-week follow-up visit) had higher NO concentrations than patients without positive response.The study demonstrates that it is feasible and safe to measure NO with a real time-sensor in or around the facet joints. The findings of higher concentrations of NO in the perifacetal region in chronic low back patients compared with healthy controls indicate that the degenerative process of the joints in these patients may cause increased NO production. The observation of higher NO concentrations in the perifacetal region in patients responding to corticosteroid/local anesthetic infiltration indirectly suggest a more pronounced inflammatory process in these patients.
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| 26. |
- Brisby, Helena, 1965, et al.
(författare)
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Thalamic activation in a disc herniation model.
- 2007
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Ingår i: Spine. - 1528-1159. ; 32:25, s. 2846-52
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: A novel approach combining a rodent disc herniation model with electrophysiologic recordings of thalamic evoked responses. OBJECTIVE: To assess short-term effects of nucleus pulposus (NP) application on dorsal root ganglions (DRG) on high threshold afferent fiber evoked activation in the thalamus. SUMMARY OF BACKGROUND DATA: Epidural application of NP in combination with mechanical compression induces pain related behavior in rats associated with enhanced activity of pain-processing neurons in the dorsal horn of the spinal cord. However, possible effects on neuronal activity in the pain processing ventral posterior lateral (VPL) thalamic nucleus following NP application on DRG have not been investigated. METHODS: Responses in the contralateral VPL evoked by electrical stimulation of the sciatic nerve and of the fourth lumbar (L4) DRG were recorded in adult Sprague-Dawley rats. Records were obtained before and during application (5, 10, and 20 minutes) of NP or of adipose tissue (AT) to the L4 DRG. AT was used as control for mechanical effects of NP application. RESULTS: Application of NP resulted in an increase of evoked thalamic responses to 138% +/- 10% of control after 20 minutes (P < 0.01), whereas AT application for 20 minutes resulted in a reduction of evoked responses to 77% +/- 4% (P < 0.05). Recordings in control animals (i.e., with no application) demonstrated stable evoked neuronal thalamic activity for up to 40 minutes. CONCLUSION: The study demonstrates that NP application onto DRG increases afferent fiber evoked responses in the thalamus and in view of the opposite effects of AT application suggests that these effects may be specific for NP. The results show that NP affects sensory transmitting pathways within a few minutes, possibly due to rapid and reversible alterations in the neuronal excitability. The study thus introduces a rodent model for studying sensory afferent evoked thalamic activity related to DRG injury which may be used to evaluate analgesics and anti-inflammatory drugs used for pain relief in disc herniation and neuropathic pain patients.
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| 27. |
- Brisby, Helena, 1965, et al.
(författare)
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The effect of running exercise on intervertebral disc extracellular matrix production in a rat model
- 2010
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Ingår i: Spine. - 1528-1159. ; 35:15, s. 1429-1436
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Using a running rat model, the effects of physical exercise on cellular function and intervertebral disc (IVD) extracellular matrix were studied. OBJECTIVE: To investigate whether 3-weeks treadmill running exercise can stimulate matrix production and cellular proliferation of the IVD. SUMMARY OF BACKGROUND DATA: Appropriate physical exercise plays an important role in the treatment of patients with low back pain-associated IVD disorder. However, it is unknown how regular exercise affects the disc at the cellular level. METHODS: Twelve Sprague-Dawley rats underwent a daily treadmill exercise regime for a total of 3 weeks. Twelve nonexercised rats served as controls. The spinal lumbar IVD were collected and paraffin embedded for histologic analysis. Cell counts were determined on hematoxylin-eosin- and Masson-Trichrome-stained paraffin sections. Protein expression of collagen-I, collagen-II, aggrecan, Sox-9, and Sox-6 was evaluated with immunohistochemical staining. mRNA expression of Sox-9 and collagen-2 were studied by in situ hybridization. Proteoglycans were visualized with Alcian blue. Apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay. RESULTS: The cell numbers in the anulus fibrosus (AF) increased by 25% (P < 0.05) after 3 weeks of exercise. Collagen-2 and Sox-9 mRNA were strongly expressed in the nucleus pulposus (NP) samples of the running group, but weakly expressed in the controls. An increase in collagen-II, aggrecan, and Sox-9 protein expression in NP and AF regions of the disc was detected in the exercised rats compared with controls. Quantification of Alcian blue staining demonstrated increased proteoglycan in both NP (8-fold) and AF (7-fold) in the exercised group compared with controls (P < 0.05). In addition, no significant differences were observed between the experimental groups in cellular apoptosis, collagen-I, or Sox-6 expression. CONCLUSION: In this study, increased extracellular matrix production and cell proliferation with no induction of disc cell apoptosis was observed in the lumbar IVD after a 3-week running regimen in rats, suggesting that regular exercise may have an augmentative effect on cells and matrix production.
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| 28. |
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| 29. |
- Brolin, Karin, et al.
(författare)
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Development of a finite element model of the upper cervical spine and a parameter study of ligament characteristics
- 2004
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 29:4, s. 376-385
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Numeric techniques were used to study the upper cervical spine. Objectives. To develop and validate an anatomic detailed finite element model of the ligamentous upper cervical spine and to analyze the effect of material properties of the ligaments on spinal kinematics. Summary of Background Data. Cervical spinal injuries may be prevented with an increased knowledge of spinal behavior and injury mechanisms. The finite element method is tempting to use because stresses and strains in the different tissues can be studied during the course of loading. The authors know of no published results so far of validated finite element models that implement the complex geometry of the upper cervical spine. Methods. The finite element model was developed with anatomic detail from computed tomographic images of the occiput to the C3. The ligaments were modeled with nonlinear spring elements. The model was validated for axial rotation, flexion, extension, lateral bending, and tension for 1.5 Nm, 10 Nm, and 1500 N. A material property sensitivity study was conducted for the ligaments. Results. The model correlated with experimental data for all load cases. Moments of 1.5 Nm produced joint rotations of 3degrees to 23degrees depending on loading direction. The parameter study confirmed that the mechanical properties of the upper cervical ligaments play an important role in spinal kinematics. The capsular ligaments had the largest impact on spinal kinematics (40% change). Conclusions. The anatomic detailed finite element model of the upper cervical spine realistically simulates the complex kinematics of the craniocervical region. An injury that changes the material characteristics of any spinal ligament will influence the structural behavior of the upper cervical spine.
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| 30. |
- Brynhildsen, Jan, 1962-, et al.
(författare)
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Is Hormone Replacement Therapy a Risk Factor for Low Back Pain Among Postmenopausal Women?
- 1998
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Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 23:7, s. 809-813
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: Cross-sectional study with two age cohorts.Objective: To assess whether women receiving hormone replacement therapy after menopause have a higher prevalence of back problems than women who do not receive such treatment.Background: Back pain is a common medical problem: throughout life and especially during pregnancy. Hormonal factors have been proposed as a possible contributor.Patients and Methods: A validated postal questionnaire was sent in early 1995 to all 1324 women of 55 years and 56 years of age residing in Linkoping, Sweden. This questionnaire included questions about current rent hormone replacement treatment, previous and current back problems, medical care for back problems, parity, exercise and smoking habits, and occupation.Results: The questionnaire was returned by 84.7% of the women. There was a significant, albeit weak, positive association between current use of hormone replacement treatment and low back pain. Previous back problems during pregnancy was a strong risk factor for current back pain, whereas neither current smoking nor regular physical exercise was a risk factor according to multiple logistic regression analysis. The interaction of smoking and an occupation involving heavy lifting significantly affected back pain.Conclusions: Women receiving hormone replacement treatment had a slightly, but significantly, higher prevalence of current back pain than nonusers (48% vs. 42%, respectively, P < 0.05), which could not be explained by differences in occupation, smoking habits, or current physical activity. Although the association be-tween hormone replacement therapy and back problems is weak and probably of minor clinical importance, it is speculated that hormonal effects on joints and ligaments may be involved.
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| 31. |
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| 32. |
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| 33. |
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| 34. |
- Carling, Malin S, et al.
(författare)
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Preoperative Fibrinogen Plasma Concentration Is Associated With Perioperative Bleeding and Transfusion Requirements in Scoliosis Surgery.
- 2011
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Ingår i: Spine. - 1528-1159. ; 36:7, s. 549-55
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN.: Prospective observational study. OBJECTIVE.: To investigate the potential association between fibrinogen, bleeding, and transfusion requirements after scoliosis surgery. SUMMARY OF BACKGROUND DATA.: Bleeding complications during and after orthopedic surgery are associated with increased morbidity and mortality. Early identification of patients with increased risk of excessive bleeding offers the possibility to initiate countermeasures. Fibrinogen is a key protein in the coagulation cascade, and thus a potential biomarker for bleeding risk. METHODS.: A total of 82 otherwise healthy patients (mean age: 15 ± 3 years, 85% girls) undergoing surgery for adolescent idiopathic scoliosis were included in the study. Patient variables (age, gender, operation time, and thrombosis prophylaxis), preoperative laboratory variables (hemoglobin, platelet count, activated partial thromboplastin time [aPTT], prothrombin time [PT], and fibrinogen), peroperative and postoperative bleeding volume, and transfusions were registered. Correlations between laboratory variables and bleeding volume were calculated with Pearson test. Patient variables and laboratory variables were compared with Student t test between patients with bleeding volume in the upper quartile ("bleeders") and the remaining patients, and between patients with extensive transfusion (defined as >2 U of packed red cells) and no or limited transfusions (≤2 U). RESULTS.: Mean fibrinogen concentration was 3.0 ± 0.7 g/L (range, 1.3-4.9). Mean total perioperative bleeding volume was 1552 ± 1019 mL (range, 100-5800 mL). Total bleeding volume correlated significantly with preoperative fibrinogen concentration (r = -0.31, P = 0.005) but neither with platelet count, aPTT, nor PT (P = 0.61, 0.46, and 0.57, respectively). Bleeders had significantly lower preoperative fibrinogen plasma concentration (2.6 ± 0.6 vs. 3.1 ± 0.6 g/L, P = 0.002). Of total, 16% (13/82) of the patients were transfused with >2 U of packed red cells.Patients with extensive transfusions had significantly lower preoperative fibrinogen plasma concentration (2.5 ± 0.7 vs. 3.1 ± 0.6 g/L, P = 0.002), while preoperative platelet count, aPTT, and PT did not differ. CONCLUSION.: The results indicate that preoperative fibrinogen concentration is a limiting factor for postoperative hemostasis during and after scoliosis surgery. Preoperative measurement of fibrinogen concentration provides more information about bleeding volume and transfusion requirements than standard screening tests.
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| 35. |
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| 36. |
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| 37. |
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| 38. |
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| 39. |
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| 40. |
- Carrwik, Christian, et al.
(författare)
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Predictive Scores Underestimate Survival of Patients With Metastatic Spine Disease : A Retrospective Study of 315 Patients in Sweden
- 2020
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 45:6, s. 414-419
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Retrospective cohort study.OBJECTIVE: To validate the precision of four predictive scoring systems for spinal metastatic disease and evaluate whether they underestimate or overestimate survival.SUMMARY OF BACKGROUND DATA: Metastatic spine disease is a common complication to malignancies. Several scoring systems are available to predict survival and to help the clinician to select surgical or nonsurgical treatment.METHODS: Three hundred fifteen adult patients (213 men, 102 women, mean age 67 yr) undergoing spinal surgery at Uppsala University Hospital, Sweden, due to metastatic spine disease 2006 to 2012 were included. Data were collected prospectively for the Swedish Spine Register and retrospectively from the medical records. Tokuhashi scores, Revised Tokuhashi Scores, Tomita scores, and Modified Bauer Scores were calculated and compared with actual survival data from the Swedish Population Register.RESULTS: The mean estimated survival time after surgery for all patients included was 12.4 months (confidence interval 10.6-14.2) and median 5.9 months (confidence interval 4.5-7.3). All four scores had significant correlation to survival (P < 0.0001) but tended to underestimate rather than overestimate survival. Modified Bauer Score was the best of the four scores to predict short survival, both regarding median and mean survival. Tokuhashi score was found to be the best of the scores to predict long survival, even though the predictions were inaccurate in 42% of the cases.CONCLUSION: Predictive scores underestimate survival for the patients which might affect important clinical decisions.LEVEL OF EVIDENCE: 3.
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| 41. |
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| 42. |
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| 43. |
- Cornefjord, M., et al.
(författare)
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Cerebrospinal fluid biomarkers in experimental spinal nerve root injury
- 2004
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Ingår i: Spine. - 1528-1159. ; 29:17, s. 1862-8
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Cerebrospinal fluid biomarkers were evaluated in a setup using established pig models to mimic clinical disc herniation. OBJECTIVES: To investigate biomarkers for nerve tissue injury, inflammation, and pain in cerebrospinal fluid after mechanical compression and/or nucleus pulposus application to spinal nerve roots. SUMMARY OF BACKGROUND DATA: The association between mechanical compression, biochemical effects of nucleus pulposus, and nerve root injury in degenerative disc disorders is incompletely investigated. METHODS: The unilateral S1 nerve root was exposed in 20 pigs. The animals were divided into four groups (n = 5 each): 1) slow-onset mechanical compression with an ameroid constrictor; 2) autologous nucleus pulposus application; 3) mechanical compression plus nucleus pulposus; and 4) sham operation. After 1 week, 6 mL of cerebrospinal fluid was collected, and four structural nerve proteins, neurofilaments, S-100, glial fibrillary acidic protein, neuron-specific enolase, the proinflammatory cytokine interleukin-8, the neurotransmitter nociceptin, and substance P endopeptidase activity were analyzed using immunoassays. RESULTS: The concentration of neurofilament was increased in the mechanical compression group (17.0 microg/L +/- 5.0) and in the mechanical compression plus nucleus pulposus group (19.8 +/- 12.1 microg/L) compared with the sham group (0.9 +/- 0.9 microg/L) and the nucleus pulposus group (0.4 +/- 0.1 microg/L) (P < 0.01 for both). The concentration of nociceptin was increased significantly in the mechanical compression group (24.0 +/- 8.6 fm/mL) and in the mechanical compression plus nucleus pulposus group (31.2 +/- 6.6 fm/mL) compared with the sham group (7.0 +/- 1.3 fm/mL) (P < 0.05 and P < 0.01, respectively). A correlation was found between concentrations of neurofilament and nociceptin (r = 0.50, P < 0.05). There were no intergroup differences regarding glial fibrillary acidic protein, neuron-specific enolase, S-100, interleukin-8, or substance P endopeptidase activity. CONCLUSIONS: The present study demonstrates increased concentrations of neurofilament and nociceptin in cerebrospinal fluid after nerve root compression. A simultaneous application of nucleus pulposus did not increase the response.
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| 44. |
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| 45. |
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| 46. |
- Crnalic, Sead, et al.
(författare)
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Predicting survival for surgery of metastatic spinal cord compression in prostate cancer : a new score
- 2012
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Ingår i: Spine. - 0362-2436 .- 1528-1159. ; 37:26, s. 2168-2176
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Study design. We retrospectively analyzed prognostic factors for survival in prostate cancer patients operated for metastatic spinal cord compression.Objective. The aim was to obtain a clinical score for prediction of survival after surgery.Summary of background data. Survival prognosis is important when deciding about treatment of patients with metastatic spinal cord compression. The criteria for identifying prostate cancer patients who may benefit from surgical treatment are unclear.Patients and methods The study comprised 68 consecutive patients with prostate cancer operated for metastatic spinal cord compression at Umeå University Hospital, Sweden. The indication for surgery was neurological deficit; 53 patients had hormone-refractory prostate cancer, and 15 patients had previously untreated, hormone-naïve prostate cancer. In 42 patients posterior decompression was performed and 26 patients were operated with posterior decompression and stabilization.Results A new score for prediction of survival was developed based on the results of survival analyses. The score includes: hormone status of prostate cancer, Karnofsky performance status, evidence of visceral metastasis, and preoperative serum PSA. The total scores ranged from 0 to 6. Three prognostic groups were formulated: group A (n = 32) with scores 0-1; group B (n = 23) with scores 2-4, and group C (n = 12) with scores 5-6. The median overall survival was 3 (0.3 - 20) months in group A, 16 (1.8 - 59) months in group B, and in group C more than half (7 of 12) of patients were still alive.Conclusion We present a new prognostic score for predicting survival of prostate cancer patients after surgery for metastatic spinal cord compression. The score is easy to apply in clinical practice and may be used as additional support when making decision about treatment.
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| 47. |
- Cuellar, Jason M., et al.
(författare)
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The Effects of Amicar and TXA on Lumbar Spine Fusion in an Animal Model
- 2014
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 39:19, s. E1132-E1137
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Animal model. Objective. To determine whether aminocaproic acid (Amicar) and tranexamic acid (TXA) inhibit spine fusion volume. Summary of Background Data. Amicar and TXA are antifibrinolytics used to reduce perioperative bleeding. Prior in vitro data showed that antifibrinolytics reduce osteoblast bone mineralization. This study tested whether antifibrinolytics Amicar and TXA inhibit spine fusion. Methods. Posterolateral L4-L6 fusion was performed in 50 mice, randomized into groups of 10, which received the following treatment before and after surgery: (1) saline; (2) TXA 100 mg/kg; (3) TXA 1000 mg/kg; (4) Amicar 100 mg/kg; and (5) Amicar 1000 mg/kg. High-resolution plane radiography was performed after 5 weeks and micro-CT (computed tomography) was performed at the end of the 12-week study. Radiographs were graded using the Lenke scale. Micro-CT was used to quantify fusion mass bone volume. One-way analysis of variance by ranks with Kruskal-Wallis testing was used to compare the radiographical scores. One-way analysis of variance with least significant difference post hoc testing was used to compare the micro-CT bone volume. Results. The average +/- standard deviation bone volume/total volume (%) measured in the saline, TXA 100 mg/kg, TXA 1000 mg/kg, Amicar 100 mg/kg, and Amicar 1000 mg/kg groups were 10.8 +/- 2.3%, 9.7 +/- 2.2%, 13.4 +/- 3.2%, 15.5 +/- 5.2%, and 17.9 +/- 3.5%, respectively. There was a significant difference in the Amicar 100 mg/kg (P < 0.05) and Amicar 1000 mg/kg (P < 0.001) groups compared with the saline group. There was greater bone volume in the Amicar groups compared with the TXA group (P < 0.001). There was more bone volume in the TXA 1000 mg/kg group compared with TXA 100 mg/kg (P < 0.05) but the bone volume in neither of the TXA groups was different to saline (P = 0.49). There were no between-group differences observed using plane radiographical scoring. Conclusion. Amicar significantly "enhanced" the fusion bone mass in a dose-dependent manner, whereas TXA did not have a significant effect on fusion compared with saline control. These data are in contrast to prior in vitro data that antifibrinolytics inhibit osteoblast bone mineralization.
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| 48. |
- Daggfeldt, Karl, et al.
(författare)
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The visible human anatomy of the lumbar erector spinae.
- 2000
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 0362-2436 .- 1528-1159. ; 25:21, s. 2719-25
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Image data of the male and female cadavers from the Visible Human Project were visualized and quantified. OBJECTIVE: To clarify the anatomy of the lumbar part of the human lumbar erector spinae muscles. SUMMARY OF BACKGROUND DATA: Recent studies have shown discrepancies in the description of the anatomy of the lumbar part of the lumbar erector spinae. The main differences concern whether lumbar fascicles of iliocostalis lumborum exist and whether the lumbar fascicles have direct attachments to the ilium or attach via the erector spinae aponeurosis. With the Visible Human Project from the U.S. National Library of Medicine, a new powerful basis for anatomic investigation has become available. METHODS: Software was produced to visualize sections oriented in any direction and with maximum resolution of the Visible Human male and female. Three-dimensional coordinates of anatomic structures in the image space could be marked in the cross-sectional images. The geometry and the physiologic cross-sectional areas of the erector spinae fascicles of lumbar origin were thus derived. RESULTS AND CONCLUSIONS: The study supports a classification of the lateral fascicles of the lumbar part of the lumbar erector spinae as part of iliocostalis lumborum. In both the male and the female, a large part of the erector spinae fibers of lumbar origin attached to the erector spinae aponeurosis. These results are of importance for biomechanical analysis of force transmission in the lumbar spine.
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| 49. |
- Danielsson, Aina, 1953, et al.
(författare)
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A prospective study of brace treatment versus observation alone in adolescent idiopathic scoliosis: a follow-up mean of 16 years after maturity
- 2007
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Ingår i: Spine. - 1528-1159 .- 0362-2436. ; 32:20, s. 2198-207
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: The Swedish patients included in the previous SRS brace study were invited to take part in a long-term follow-up. OBJECTIVE: To investigate the rate of scoliosis surgery and progression of curves from baseline as well as after maturity. SUMMARY OF BACKGROUND DATA: Brace treatment was shown to be superior to electrical muscle stimulation, as well as observation alone, in the original SRS brace study. Few other studies have shown that brace treatment is effective in the treatment of scoliosis. METHODS: Of 106 patients, 41 in Malmo (all Boston brace treatment) and 65 in Goteborg (observation alone as the intention to treat), 87% attended the follow-up, including radiography and chart review. All radiographs were (re)measured for curve size (Cobb method) by an unbiased examiner. Searching in the mandatory national database for performed surgery identified patients who had undergone surgery after maturity. RESULTS: The mean follow-up time was 16 years and the mean age at follow-up was 32 years The 2 treatment groups had equal curve size at inclusion. The curve size of patients who were treated with a brace from the start was reduced by 6 degrees during treatment, but the curve size returned to the same level during the follow-up period. No patients who were primarily braced went on to undergo surgery. In patients with observation alone as the intention to treat, 20% were braced during adolescence due to progression and another 10% underwent surgery. Seventy percent were only observed and increased by 6 degrees from inclusion until now. No patients underwent surgery after maturity. Progression was related to premenarchal status. CONCLUSION: The curves of patients with adolescent idiopathic scoliosis with a moderate or smaller size at maturity did not deteriorate beyond their original curve size at the 16-year follow-up. No patients treated primarily with a brace went on to undergo surgery, whereas 6 patients (10%) in the observation group required surgery during adolescence compared with none after maturity. Curve progression was related to immaturity.
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| 50. |
- Danielsson, Aina, 1953, et al.
(författare)
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Back pain and function 23 years after fusion for adolescent idiopathic scoliosis: a case-control study-part II.
- 2003
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Ingår i: Spine. - 1528-1159. ; 28:18
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Tidskriftsartikel (refereegranskat)abstract
- A consecutive series of patients with adolescent idiopathic scoliosis, treated between 1968 and 1977 before age 21 years with distraction and fusion using Harrington rods (surgically treated: n = 156; 145 females and 11 males) were followed-up at least 20 years after completion of the treatment.To determine the long-term outcome in terms of back pain and function in patients surgically treated for adolescent idiopathic scoliosis.Few reports on long-term outcome of back pain and function have previously been presented for this group of patients. Results presented are not conclusive regarding effects on back pain and its correlation to a fusion extending into the lower lumbar spine.One hundred forty-two (91%) of the patients were reexamined as part of an unbiased personal follow-up. This included a clinical examination and evaluation of curve size (Cobb method) and degenerative findings in full standing frontal and lateral radiographs. Validated questionnaires in terms of general and disease-specific quality of life aspects as well as present back and pain symptoms were used. One hundred thirty-nine had complete follow-up. An age- and sex-matched control group of 100 individuals was randomly selected and subjected to the same examinations.The deterioration of the curves was 3.5 degrees for all curves and eight (5.1%) of the patients treated with fusion had undergone some additional curve-related surgical procedure. The patients had significantly more degenerative disc changes than the controls. Lumbar pain, although mild (2.4 on visual analogue scale), was significantly more frequent among the patients than the controls (65 vs. 47%, P = 0.0079). Only 25% of the patients admitted daily pain, and analgesics were sparsely used. No major differences of back function and general health-related quality of life were noted between the patients or the controls. Except for having been on sick-leave ever because of the back (45% vs. 19%, P = 0.0040) no differences could be seen in sociodemographic variables between the groups. Furthermore, no differences could be found between patients fused to L3 or higher (n = 102) versus L4 or lower (n = 37). No correlation could be found between pain and its localization and various variables on the scoliotic curve, body mass index, or smoking. Persisting discomfort and/or sensory loss were noted significantly more often among the patients who had the autologous bone harvesting performed through a separate incision over the iliac crest (24.3%) than among those in whom this was performed through an elongated midline incision (4.6%, P = 0.0015).Minimal pain and no dysfunction occurred (mean) 23 years after fusion for adolescent idiopathic scoliosis compared with normal straight controls. Significantly more pain in the scar region occurred when bone graft from an incision over the posterior iliac crest was used for harvesting bone to the fusion compared with an incision performed as an elongation of the midline incision used for the scoliosis surgery.
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