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- El-Hajj, Victor Gabriel, et al.
(författare)
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Evolution of patient-reported outcome measures, 1, 2, and 5 years after surgery for subaxial cervical spine fractures, a nation-wide registry study
- 2023
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Ingår i: The spine journal. - : Elsevier BV. - 1529-9430 .- 1878-1632. ; 23:8, s. 1182-1188
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND CONTEXT: A longer duration of patient follow up arguably provides more reli-able data on the long-term effects of a treatment. However, the collection of long-term follow up data is resource demanding and often complicated by missing data and patients being lost to follow up. In surgical fixation for cervical spine fractures, data are lacking on the evolution of patient reported out -come measures (PROMs) beyond 1-year of follow up. We hypothesized that the PROMs would remain stable beyond the 1-year postoperative follow up mark, regardless of the surgical approach.PURPOSE: To assess the trends in the evolution of patient-reported outcome measures (PROMs) at 1, 2-, and 5-years following surgery in patients with traumatic cervical spine injuries.STUDY DESIGN: Nation-wide observational study on prospectively collected data.PATIENT SAMPLE: Individuals treated for subaxial cervical spine fractures with anterior, poste-rior, or combined anteroposterior approaches, between 2006 and 2016 were identified in the Swed-ish Spine Registry (Swespine).OUTCOME MEASURES: PROMs consisting of EQ-5D-3Lindex and the Neck Disability Index (NDI) were considered.METHODS: PROMs data were available for 292 patients at 1 and 2 years postoperatively. Five-years PROMs data were available for 142 of these patients. A simultaneous within-group (longitu-dinal) and between group (approach-dependent) analysis was performed using mixed ANOVA. The predictive ability of 1-year PROMs was subsequently assessed using linear regression.RESULTS: Mixed ANOVA revealed that PROMs remained stable from 1-to 2-years as well as from 2-to 5-years postoperatively and were not significantly affected by the surgical approach (p<0.05). A strong correlation was found between 1-year and both 2-and 5-years PROMs (R>0.7; p<0.001). Linear regression confirmed the accuracy of 1-year PROMs in predicting both 2-and 5-years PROMs (p<0.001).CONCLUSION: PROMs remained stable beyond 1-year of follow up in patients treated with ante-rior, posterior, or combined anteroposterior surgeries for subaxial cervical spine fractures. The 1 -year PROMs were strong predictors of PROMs measured at 2, and 5 years. The 1-year PROMs were sufficient to assess the outcomes of subaxial cervical fixation irrespective of the surgical approach.& COPY; 2023 The Author(s). Published by Elsevier Inc.This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
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| 2. |
- El-Hajj, Victor Gabriel, et al.
(författare)
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The Effect of Concomitant Spinal Cord Injury on Postoperative Health-related Quality of Life After Traumatic Subaxial Cervical Spine Injuries : A Nationwide Registry Study
- 2024
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier. - 0003-9993 .- 1532-821X. ; 105:6, s. 1069-1075
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the effect of spinal cord injury (SCI) on the health-related quality of life (HRQoL) in patients surgically treated for traumatic subaxial cervical spine injuries and investigate the agreement between objective neurologic outcomes and patient reported outcome measures (PROMs) in that context.Study Design: Observational study on prospectively collected multi-institutional registry data. Setting: Sweden. Participants: Patients with traumatic subaxial spine injuries identified in the Swedish Spine Registry (Swespine) between 2006 and 2016.Interventions: Anterior, posterior, or anteroposterior cervical fixation surgery. Main Outcomes: Patient-reported outcome measures (PROMs) consisting of EQ-5D-3L(index) and Neck Disability Index (NDI).Results: Among the 418 identified patients, 93 (22%) had a concomitant SCI. In this group, 30 (32%) had a complete SCI (Frankel A), and the remainder had incomplete SCIs (17%) Frankel B; 25 (27%) Frankel C; 22 (24%) Frankel D. PROMs significantly correlated with the Frankel grade (P<.001). However, post hoc analysis revealed that the differences between adjacent Frankel grades failed to reach both statistical and clinical significance. On univariable linear regression, the Frankel grade was a significant predictor of a specific index derived from the EQ-5D-3L questionnaire (EQ-5D-3L(index)) at 1, 2, and 5 years postoperatively as well as the NDI at 1 and 2 years postoperatively (P<.001). Changes of PROMs over time from 1, to 2, and 5 years postoperatively did not reach statistical significance, regardless of the presence and degree of SCI (P>.05).Conclusion: Overall, the Frankel grade significantly correlated with the EQ-5D-3L(index) and NDI and was a significant predictor of PROMs at 1, 2, and 5 years. PROMs were stable beyond 1 year postoperatively regardless of the severity of the SCI. (c) 2024 by the American Congress of Rehabilitation Medicine. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
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| 3. |
- Singh, Aman, et al.
(författare)
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Outcome and Health-Related Quality of Life After Combined Anteroposterior Surgery Versus Anterior Surgery Alone in Subaxial Cervical Spine Fractures Analysis of a National Multicenter Data Set
- 2023
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 0362-2436 .- 1528-1159. ; 48:12, s. 853-858
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Tidskriftsartikel (refereegranskat)abstract
- Study design.Observational study on prospectively collected data. Objectives.To compare patient-reported outcomes and complications after anteroposterior surgery or anterior surgery in subaxial cervical spine fractures. Summary of Background Data.There is no consensus regarding the optimal surgical approach for subaxial cervical spine fractures. Although anterior surgery is often sufficient to restore stability, anteroposterior surgery is sometimes preferred in severe instability. The effects of a more extensive procedure on patient-reported outcomes have not been investigated. We hypothesized that patient-reported outcomes and complication rates were similar between these surgical approaches. Materials and Methods.Individuals treated with either a combined anteroposterior or anterior surgery alone between 2006 and 2016 and with at least 1-year follow-up were identified in the Swedish Spine Registry. Cases were matched 1:2 for age (+/- 5 y). Outcomes were Neck Disability Index (NDI), EQ-5D-3L index, satisfaction, reoperations, and surgeon-reported and patient-reported complications within 90 days. Mann-Whitney U-tests and chi(2) tests were used in statistical comparisons. Results.The median [interquartile range] number of instrumented vertebrae was 3 [2-5.5] in the anteroposterior group and 2 [2-3] in the anterior group (P<0.001). The mean +/- SD follow-up time was 3.5 +/- 2.3 years in the anteroposterior and 3.8 +/- 2.0 years in the anterior group (P=0.39), respectively. At follow-up, Neck Disability Index was 20 [6-37] in the anteroposterior group and 18 [3.5-40] in the anterior group (P=0.69), and the median EQ-5D-3L index was 0.73 [0.12-0.80] in the anteroposterior group and 0.75 [0.62-0.89] in the anterior group (P=0.27). Satisfaction with the treatment was reported by 90% in the anteroposterior group and by 87% in the anterior group (P=0.98). None of the individuals in the anteroposterior and 6 of the individuals in the anterior group were reoperated (P=0.18). Conclusion.Patients operated on with anteroposterior or anterior surgery for subaxial cervical spine fractures are equally satisfied and report similar health-related quality of life measures.
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| 4. |
- Stenimahitis, Vasilios, et al.
(författare)
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Long-term Outcomes After Periprocedural and Spontaneous Spinal Cord Infarctions : A Population-Based Cohort Study
- 2023
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Ingår i: Neurology. - : Ovid Technologies (Wolters Kluwer Health). - 0028-3878 .- 1526-632X. ; 101:2, s. E114-E124
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives: Spinal cord infarction (SCInf) is a rare condition where consensus regarding diagnostic criteria is lacking, and misdiagnosis or delayed diagnosis can be detrimental. The aim of this study was to describe baseline findings and predictors of long-term functional outcome in a population-based cohort of patients with SCInf.Methods: All adult patients (aged 18 years or older) treated at the spinal cord injury unit of the study center, between 2006 and 2019, and discharged with a G95 diagnosis (other and unspecified disease of the spinal cord) were screened for inclusion. The diagnostic criteria proposed by Zalewski et al. were retrospectively applied to evaluate the certainty of the SCInf diagnosis.Results: A total of 270 patients were screened and 57 were included in the study, of whom 30 had a spontaneous SCInf and 27 had a periprocedural SCInf. The median American Spinal Cord Injury Association Impairment Scale (AIS) on admission was C, which at a median follow-up of 2.1 years had improved to D (p = 0.002). Compared with periprocedural cases, those with spontaneous SCInf showed significantly better admission AIS (median AIS D vs B, p < 0.001), fewer multilevel SCInf (27% vs 59%, p = 0.029), shorter hospital stay (median 22 vs 44 days, p < 0.001), and better AIS (median AIS D vs C, p < 0.001) and ambulatory status on long-term follow-up (66% vs 1%, p < 0.001). Regression analyses revealed that spontaneous SCInfs (odds ratio [OR] 5.91 [1.92-18.1], p = 0.002) and more favorable admission AIS (OR 33.6 [7.72-146], p < 0.001) were significant predictors of more favorable AIS at follow-up, with admission AIS demonstrating independent predictive ability (OR 35.9 [8.05-160], p < 0.001).Discussion: SCInf is a rare neurologic emergency lacking specific management guidelines. While the presumptive diagnosis is based on the typical presentation and clinical findings, T2-weighted and diffusion-weighted MRI were the most useful diagnostic tools in establishing a definitive diagnosis. Our data show that spontaneous SCInf mostly affected a single spinal cord segment, whereas periprocedural cases were more extensive, had poorer AIS on admission, poorer ambulatory function, and longer hospital stays. Regardless of the etiology, significant neurologic improvements were seen at long-term follow-up, highlighting the importance of active rehabilitation.
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