| 1. |
- Charalampidis, Anastasios
(författare)
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Idiopathic scoliosis : aspects on surgical and non-surgical treatment
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The term scoliosis has been used to describe conditions that lead to deformation of the spine. It derives from the ancient Greek ‘σκολίωσις’ and the root word ‘σκολιός’ which means ‘bent or crooked’. In its most common form, scoliosis is of unknown - idiopathic - cause and origin. It affects roughly 3% of children and adolescents during growth and in mild cases no treatment is required. In moderate cases, bracing has been proposed, with the aim to halt progression of idiopathic scoliosis. It is most common with full-time bracing using rigid, custom made thoracolumbosacral orthoses. It is worn for 16-20 hours per day until skeletal maturity and has been shown to prevent scoliosis progression to a surgical threshold in about 70% of the cases. However, compliance to the treatment has been one of the major drawbacks seen with the full-time brace. Therefore, night-time braces, worn only during the night, have started to gain popularity over the years. Nevertheless, evidence on the effectiveness of night-time bracing has only been based on retrospective studies. More recently, specific scoliosis exercise regimes consisting of self-mediated correction maneuvers in 3 dimensions have also emerged. So far, there has been only one high quality study showing effectiveness of this modality, in patients with mild idiopathic scoliosis. A trial was performed consisting of 135 patients randomized to self-mediated physical activity in combination with either night-time brace, or scoliosis-specific exercise, or self-mediated physical activity alone. Night-time brace was shown to be more effective than self-mediated physical activity in preventing scoliosis progression. On the other hand, scoliosis-specific exercise did not show any clinical benefit when compared to the self-mediated physical activity. Additionally, comparison between the nigh-time brace group and a group of patients who declined participation in the trial and received a full-time brace showed similar effectiveness on the prevention of curve progression. In case the deformity progresses to more severe curves, surgery may be suggested. Over the last decades, a posterior exposure to the spine with a high number of implants and predominantly pedicle screw based fixation techniques has been favored over traditional techniques with low number of implants for the correction of scoliosis. These techniques have been suggested to increase correction and fusion rates and eliminate the risks associated with exposure of the chest wall and/or abdomen in anterior approaches to the spine. Disadvantages of the posterior approach to the spine include extended muscle dissection, need for a higher number of vertebrae to be fused and risk for neurological injuries to the spinal cord. To date, whether posterior based fusion may result in better clinical and radiographic outcomes compared to anterior fusion is still unclear. Moreover, whether higher number of implants per vertebra (implant density) results in better clinical and radiographic outcomes is still debatable. In a nationwide registry-based cohort, we identified patients who underwent anterior (n=27) and posterior (n=32) fusion surgery for a thoracolumbar/lumbar type of scoliosis. We found that despite a longer operative time in the anterior group and higher blood loss and longer fusion constructs in the posterior group, both procedures resulted in significant correction of the scoliosis with similar patient-reported outcome and satisfaction; suggesting that the type of approach is not related to health-reported quality of life. By using the same nationwide database, we also identified 328 surgically treated idiopathic scoliosis patients who were then divided into tertiles based on the number of implants used per operated vertebra. We found no differences in the correction rate of the curve and health-reported quality of life in the different tertiles, suggesting that a high number of implants is not necessarily beneficial in the surgical treatment of idiopathic scoliosis. Studies have shown that, what is perceived as successful radiographic outcome, may not necessarily correlate with patient´s own perception of successful outcome after surgery for idiopathic scoliosis. Patients may still experience persistent back pain and worse quality of life, despite an excellent radiographic outcome. By using the same nationwide database, we identified 280 patients treated with posterior fusion surgery for idiopathic scoliosis and divided them into a high (n=67) and a low (=213) postoperative pain group, based on their self-reported postoperative back pain scores. We found that patients in the high pain group also reported higher back pain and worse quality of life before surgery, compared to the low postoperative pain group. High preoperative back pain and low preoperative mental health were identified as predictors of persistent pain after surgery.
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| 2. |
- Charalampidis, Anastasios, et al.
(författare)
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Nighttime Bracing or Exercise in Moderate-Grade Adolescent Idiopathic Scoliosis
- 2024
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Ingår i: JAMA Network Open. - : AMER MEDICAL ASSOC. - 2574-3805. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Moderate-grade adolescent idiopathic scoliosis (AIS) may be treated with full-timebracing. For patients who reject full-time bracing, the effects of alternative, conservativeinterventions are unknown.OBJECTIVE To determine whether self-mediated physical activity combined with either nighttimebracing (NB) or scoliosis-specific exercise (SSE) is superior to a control of physical activity alone (PA)in preventing Cobb angle progression in moderate-grade AIS.DESIGN, SETTING, AND PARTICIPANTS The Conservative Treatment for Adolescent IdiopathicScoliosis (CONTRAIS) randomized clinical trial was conducted from January 10, 2013, throughOctober 23, 2018, in 6 public hospitals across Sweden. Male and female children and adolescentsaged 9 to 17 years with an AIS primary curve Cobb angle of 25° to 40°, apex T7 or caudal, and skeletalimmaturity based on estimated remaining growth of at least 1 year were included in the study. Datesof analysis were from October 25, 2021, to January 28, 2023.INTERVENTIONS Interventions included self-mediated physical activity in combination with eitherNB or SSE or PA (control). Patients with treatment failure were given the option to transition to afull-time brace until skeletal maturity.MAIN OUTCOMES AND MEASURES The primary outcome was curve progression of 6° or less(treatment success) or curve progression of more than 6° (treatment failure) seen on 2 consecutiveposteroanterior standing radiographs compared with the inclusion radiograph before skeletalmaturity. A secondary outcome of curve progression was the number of patients undergoing surgeryup until 2 years after the primary outcome.RESULTS The CONTRAIS study included 135 patients (45 in each of the 3 groups) with a mean (SD)age of 12.7 (1.4) years; 111 (82%) were female. Treatment success was seen in 34 of 45 patients (76%)in the NB group and in 24 of 45 patients (53%) in the PA group (odds ratio [OR], 2.7; 95% CI, 1.1-6.6).The number needed to treat to prevent curve progression with NB was 4.5 (95% CI, 2.4-33.5).Treatment success occurred in 26 of 45 patients (58%) in the SSE group (OR for SE vs PA, 1.2; 95% CI,0.5-2.8). Up to 2 years after the primary outcome time point, 9 patients in each of the 3 groupsunderwent surgery.CONCLUSIONS AND RELEVANCE In this randomized clinical trial, treatment with NB preventedcurve progression of more than 6° to a significantly higher extent than did PA, while SSE did not; inaddition, allowing transition to full-time bracing after treatment failure resulted in similar surgicalfrequencies independent of initial treatment. These results suggest that NB may be an effectivealternative intervention in patients rejecting full-time bracing.
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| 3. |
- Diarbakerli, Elias, et al.
(författare)
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PReventing Idiopathic SCOliosis PROgression (PRISCOPRO) : A protocol for a quadruple-blinded, randomized controlled trial comparing 3D designed Boston brace to standard Boston brace
- 2021
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Ingår i: PLOS ONE. - San Francisco, CA, United States : Public Library of Science. - 1932-6203. ; 16:8
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionIdiopathic scoliosis is the most common spinal deformity in children. Treatment strategies aim to halt progression of the curve. Patients are treated mainly with thoracolumbosacral orthosis (TLSO) if indicated. This form of brace treatment has been shown to be cumbersome and tough on growing individuals. However, computer aided design and manufactured (CAD/CAM) braces might increase comfortability and ultimately outcome if compliance is improved. In a multicenter, randomized controlled trial, we aim to compare CAD/CAM designed Boston 3D-brace to standard Boston brace.MethodsSubjects: 170 previously untreated and skeletally immature children diagnosed with idiopathic scoliosis, aged 9–17 years of age (curve magnitude Cobb 25–40 degrees) will be included. Interventions: Both groups will receive a physical activity prescription according to the World Health Organization recommendations. Randomization will be performed 1:1 to a 3D CAD/CAM designed Boston 3D-brace or a standard Boston brace, both with prescribed daily wear time of 20 hours. Outcome: The subjects will participate in the study until curve progression or until skeletal maturity. The primary outcome variable is failure of treatment, defined as progression of the Cobb angle more than 6 degrees compared to the baseline x-ray. The progression is confirmed if seen on two consecutive standing spinal x-rays. Radiographs will be taken at each six-month follow-up. Secondary outcome measures include patient and clinical reported outcomes, including number of individuals requiring surgical intervention.DiscussionThis study will show if efficacy in brace treatment can be improved with new brace designs.
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| 4. |
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| 5. |
- Dufvenberg, Marlene, 1961-, et al.
(författare)
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Six-Month Results on Treatment Adherence, Physical Activity, Spinal Appearance, Spinal Deformity, and Quality of Life in an Ongoing Randomised Trial on Conservative Treatment for Adolescent Idiopathic Scoliosis (CONTRAIS)
- 2021
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Ingår i: Journal of Clinical Medicine. - Basel, Switzerland : MDPI. - 2077-0383. ; 10:21
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Tidskriftsartikel (refereegranskat)abstract
- Adolescents with idiopathic scoliosis (AIS) often receive conservative treatments aiming to prevent progression of the spinal deformity during puberty. This study aimed to explore patient adherence and secondary outcomes during the first 6 months in an ongoing randomised controlled trial of three treatment interventions. Interventions consisted of physical activity combined with either hypercorrective Boston scoliosis night brace (NB), scoliosis-specific exercise (SSE), or physical activity alone (PA). Measures at baseline and 6 months included angle of trunk rotation (ATR), Cobb angle, International Physical Activity Questionnaire short form (IPAQ-SF), pictorial Spinal Appearance Questionnaire (pSAQ), Scoliosis Research Society (SRS-22r), EuroQol 5-Dimensions Youth (EQ-5D-Y) and Visual Analogue Scale (EQ-VAS). Patient adherence, motivation, and capability in performing the intervention were reported at 6 months. The study included 135 patients (111 females) with AIS and >1-year estimated remaining growth, mean age 12.7 (1.4) years, and mean Cobb angle 31 (±5.3). At 6 months, the proportion of patients in the groups reporting high to very high adherence ranged between 72 and 95%, while motivation ranged between 65 and 92%, with the highest proportion seen in the NB group (p = 0.014, p= 0.002). IPAQ-SF displayed significant between group main effects regarding moderate activity (F = 5.7; p = 0.004; ηp2 = 0.10), with a medium-sized increase favouring the SSE group compared to NB. Walking showed significant between group main effects, as did metabolic equivalent (MET-min/week), with medium (F = 6.8, p = 0.002; ηp2 = 0.11, and large (F = 8.3, p = < 0.001, ηp2 = 0.14) increases, respectively, for the SSE and PA groups compared to NB. From baseline to 6 months, ATR showed significant between group medium-sized main effects (F = 1.2, p = 0.019, ηp2 = 0.007) favouring the NB group compared to PA, but not reaching a clinically relevant level. In conclusion, patients reported high adherence and motivation to treatment, especially in the NB group. Patients in the SSE and PA groups increased their physical activity levels without other clinically relevant differences between groups in other clinical measures or patient-reported outcomes. The results suggest that the prescribed treatments are viable first-step options during the first 6 months.
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| 6. |
- Gerdhem, Lovisa, et al.
(författare)
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Patient-reported Data as Predictors of Surgical Outcome in Patients With Degenerative Cervical Myelopathy : Analysis of a National Multicenter Dataset
- 2023
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 48:2, s. 113-119
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: Retrospective study design on prospectively collected registry data.Objective: To investigate whether improvement after surgery for degenerative cervical myelopathy is associated with preoperative disease severity and to identify predictors of outcome.Summary of Background Data: Degenerative cervical myelopathy is the most common cause of spinal cord compromise in adults and surgery is often the treatment of choice. Identifying predictors may help to improve patient selection.Materials and Methods: This nationwide study from the Swedish spine registry included 901 patients treated surgically for degenerative cervical myelopathy. To investigate improvement in different disease severity groups, the individuals were divided into quartiles based on their preoperative European Myelopathy Scale (EMS) and EuroQol-5 Dimension (EQ-5D) index. Statistical analyses were made with analysis of variance, χ2, McNemar, and t tests. Multivariable linear or logistic regression was used to identify predictors for one-year improvement in EMS and EQ-5D index, and satisfaction at one year. In the regressions, the patient-reported outcome measures were dichotomized at their median, except improvement in EMS.Results: All patient-reported outcome measures improved from baseline to the one-year follow-up (P<0.001). Statistically significant outcome improvements were seen in all disease severity groups. Preoperative low EMS (β=−1.37, P<0.001), long walking distance (<500 vs. >500 m; β=0.44, P=0.030), and low NDI (β=−0.43, P=0.048) were independent predictors of improvement in EMS. R2 was 0.11 for the multivariable model. Preoperative low EQ-5D index (odds ratio=0.11; 95% confidence interval: 0.07–0.16) and low NDI (0.56; 0.36–0.88) were independent predictors of improvement in EQ-5D index. Preoperative high EMS (1.86; 1.20–2.90) and shorter arm pain duration [<12 vs. >12 months (0.54; 0.33–0.88)] were independent predictors of satisfaction.Conclusions: Postoperative improvement was seen over the whole range of disease severity. Disease severity, symptom duration, and walking distance were predictors of outcome in patients treated surgically for degenerative cervical myelopathy.
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| 7. |
- Helenius, Linda, et al.
(författare)
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Postoperative outcomes of pedicle screw instrumentation for adolescent idiopathic scoliosis with and without a subfascial wound drain: a multicentre randomized controlled trial
- 2022
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Ingår i: The Bone & Joint Journal. - : British Editorial Society of Bone & Joint Surgery. - 2049-4394 .- 2049-4408. ; 104-B:9, s. 1067-1072
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Tidskriftsartikel (refereegranskat)abstract
- AimsThe aim of this study was to evaluate whether, after correction of an adolescent idiopathic scoliosis (AIS), leaving out the subfascial drain gives results that are no worse than using a drain in terms of total blood loss, drop in haemoglobin level, and opioid consumption.MethodsAdolescents (aged between 10 and 21 years) with an idiopathic scoliosis (major curve ≥ 45°) were eligible for inclusion in this randomized controlled noninferiority trial (n = 125). A total of 90 adolescents who had undergone segmental pedicle screw instrumentation were randomized into no-drain or drain groups at the time of wound closure using the sealed envelope technique (1:1). The primary outcome was a drop in the haemoglobin level during first three postoperative days. Secondary outcomes were 48-hour postoperative oxycodone consumption and surgical complications.ResultsAll 90 patients were included in the primary outcome analysis (no drain = 43; drain = 47). The mean total postoperative blood loss (intraoperative and drain output) was significantly higher in the group with a subfascial drain than in the no-drain group (1,008 ml (SD 520) vs 631 ml (SD 518); p < 0.001). The drop in haemoglobin level did not differ between the study groups over the postoperative timepoints (p = 0.290). The 48-hour opioid consumption was significantly higher in the no-drain group (2.0 mg/kg (SD 0.9) vs 1.4 (SD 0.6); p = 0.005). Two patients in the no-drain and one patient in the drain group developed a surgical site infection.ConclusionLeaving the subfascial drain out after pedicle screw instrumentation for AIS is not associated with higher postoperative haemoglobin levels. Patients treated without a subfascial drain needed 30% more opioids during the first 48 hours than those who had a drain.
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| 8. |
- Révész, David Fröjd, et al.
(författare)
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Effectiveness of laminectomy with fusion and laminectomy alone in degenerative cervical myelopathy
- 2022
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Ingår i: European spine journal. - : Springer-Verlag New York. - 0940-6719 .- 1432-0932. ; 31:5, s. 1300-1308
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The effectiveness of laminectomy with fusion and laminectomy alone in degenerative cervical myelopathy was compared.Methods Individuals treated with laminectomy with fusion or laminectomy alone at or below the second cervical vertebra were identified in the Swedish spine registry. 66 individuals treated with laminectomy and instrumented fusion were age matched to 132 individuals treated with laminectomy alone. The European Myelopathy Scale (EMS), the Neck Disability Index (NDI), the Numeric Rating Scale (NRS) for neck pain and the EQ-5D index were available at baseline, and at 1 and 2 year follow-ups. Statistical analyses were performed with Mann-Whitney U tests and paired T tests. Effect sizes were described with Cohen's D.Results Data at baseline did not differ significantly between the groups with the exception of a longer laminectomy in the fusion group (4.2 vs 3.4 vertebras; p < 0.001). Both groups improved EMS, NDI, NRS and EQ-5D from baseline to 1 year (p <= 0.011), with no additional improvement between 1 and 2 years (all p >= 0.09). Effect sizes for change from baseline were small to medium in both groups. At 2 years the laminectomy with fusion group and the laminectomy alone group had a median (25th;75th percentile) EMS of 13 (11;13) and 13 (11;15) (p = 0.77), NDI of 39 (24;54) and 27 (10;41) (p = 0.045), NRS of 4 (1;2) and 2 (0;5) (p = 0.048), and EQ-5D index of 0.67 (0.25;0.73) and 0.66 (0.17;0.76) (p = 0.96).Conclusion The results of this study suggest similar effectiveness of laminectomy with instrumented fusion and laminectomy alone in degenerative cervical myelopathy.
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