| 1. |
- Baranto, Adad, 1966, et al.
(författare)
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Interspinous Process Implants Causes Wear of the Spinous Processes in Patients Treated for Spinal Stenosis—An Experimental Biomechanical Study with Comparison to Clinical Cases
- 2016
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Ingår i: Open Journal of Orthopedics. - : Scientific Research Publishing, Inc.. - 2164-3008 .- 2164-3016. ; :6, s. 201-210
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Tidskriftsartikel (refereegranskat)abstract
- There are few biomechanical studies on Interspinous Process Implants (IPD); however none investigate the amount of wear on spinous processes. Therefore the objective of the present study was to investigate the effect of repetitive loading of the IPD Aperius on the spinous processes in a biomechanical porcine model. For comparison, three patients treated surgically with the same device have been followed for one to two years clinically and with image analyses (X-rays, MRI, CT-scans). Four lumbar spines from 6 months old porcine were divided into seven segments, which received IPD. The segments were exposed to 20,000 cyclical loads. Afterwards the deformation (wear) of the segments was registered. The wear of the spinous processes was measured in mm on a following CT-scan. Additionally, the wear of the ex-vivo was compared to that of the spinous processes investigated by CT-scans or X-ray in three patients treated surgically with the same interspinous implant. The mean maximal deformation of porcine specimens was 1.79 mm (SD 0.25) with the largest deformation occurring in the first quarter of the loading (<5000 cycles). The mean wear of the spinous processes after loading was 6.57 mm. A similar level of wear (mean 12.7 mm) of the spinous processes was detected in the patients. The Aperius IPD creates significant wear on the spinous processes in an experimental biomechanical study. Similar wear of the spinous pro-
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| 2. |
- Halldin, Klas, 1967, et al.
(författare)
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Clinical application of a new three-dimensional radiological classification of lumbar disc herniations
- 2005
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Ingår i: Ups J Med Sci. - 0300-9734. ; 110:2, s. 159-65
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Tidskriftsartikel (refereegranskat)abstract
- The results after lumbar discectomy are usually satisfactory. However, there is a group of patients with less favorable result. The predictive factors affecting the result are not fully understood. In this paper a new radiological classification for lumbar disc herniations has been used in order to study the predictive value of the type and location of the herniation for the postoperative result. 142 patients operated with standard lumbar discectomy were included in the study. The preoperative CT-scans were used to classify the disc herniations in the transverse, sagittal and longitudinal directions and the size of the herniations were calculated. At a mean of 7.7 years postoperatively a patient administrated questionnaire was used to compare the clinical results to the radiological findings. A significantly smaller size of the lumbar disc herniation was found with increasing age, which could reflect the increased degeneration of the disc. Patients with a wide transverse distribution of the herniation seem to have a less favorable postoperative outcome in terms of higher rate of repeat surgery (p = 0.056). No other correlations were found.
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| 3. |
- Halldin, Klas, 1967, et al.
(författare)
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Is increased segmental motion early after lumbar discectomy related to poor clinical outcome 5 years later?
- 2005
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Ingår i: Int Orthop. - : Springer Science and Business Media LLC. - 0341-2695. ; 29:4, s. 260-4
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to compare segmental motion in the early postoperative phase after lumbar discectomy to the outcome 5 years postoperatively. The study population had radiologically verified symptomatic L4-L5 or L5-S1 lumbar disc herniation and was referred with an indication for lumbar discectomy. Radiostereometry was performed in the supine and standing positions. The L4-L5 and L5-S1 segments were analysed separately. L4-L5 segments adjacent to the operated L5-S1 segment constituted a reference segment for the operated L4-L5 and vice versa. Twenty-one patients were available for the follow-up at 5 years. Outcome was classified as functionally good or poor. Repeated or planned repeat surgery at the same level during follow-up was considered as poor outcome. The L4-L5 segments in the poor group showed different direction of sagittal rotation (anterior versus posterior) of L4 on L5 compared with the good group (p<0.01). On the L5-S1 segment, patients with poor outcome displayed an increased anterior translation of about 1 mm (p<0.01) compared with the reference segments. Our study suggests that increased inducible vertebral displacement in the early postoperative phase after discectomy is associated with a poor clinical outcome.
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| 4. |
- Halldin, Klas, 1967
(författare)
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Lumbar disc herniation. Clinical outcome and segmental stability using a new radiological classification and radiostereometry
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Satisfactory results following conventional lumbar discectomy have been reported in 70-90% of cases. Remaining or recurrent low back pain or sciatica is, however, seen in many patients for reasons not yet fully understood. A relationship has previously been shown between the morphologic characteristics, i.e. shape and direction, of the disc herniation on preoperative films and the clinical results after surgery. Disturbed motion pattern or instability of the operated motion segment has also been presented as possible cause to poor postoperative results. Aims: To analyze 1) the relation between morphological characteristics of LDH on preoperative films analyzed with a new classification and the postoperative results and 2) the effect of the surgical procedure on inducible displacement of motion segments subjected to surgery for LDH, and 3) the relation between this inducible displacement and the portoperative results. Patients and methods: A new morphological classification of lumbar disc herniations was developed based on computed tomography (CT) and magnetic resonance tomography (MRI) images and subsequently applied on a retrospective study population comprising 142 patients. Following a reliability analysis of the classification, the preoperative images of 150 patients in a prospective study were graded according to the proposed classification and compared to 2 years outcome after surgery. Radiostereometric analysis (RSA) was used in 21 patients to prospectively analyze postoperative inducible segmental motion (inducible displacement) of the operated segment between supine and standing position over a 5 year period and results of RSA before discharge were compared to the clinical results 5 years after surgery. Results and conclusions: A high intra- and interrater reliability was found for the proposed classification. Larger sagittal and longitudinal distribution of the disc herniations were found on grading of CT images compared to MRI images. Morphologic characteristics of the herniation such as position in the spinal canal, direction and size were of no importance for the postoperative clinical results. The RSA analysis revealed a stiffening of the lumbo-sacral segments but no increase of inducible displacement 5 years after surgery. The pattern of inducible displacement in the sagittal plane at the two operated levels, which might be explained by grades of degeneration, was associated with a poor clinical outcome.
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| 5. |
- Halldin, Klas, 1967, et al.
(författare)
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The effect of standard lumbar discectomy on segmental motion: 5-year follow-up using radiostereometry
- 2005
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Ingår i: Int Orthop. - : Springer Science and Business Media LLC. - 0341-2695. ; 29:2, s. 83-7
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Tidskriftsartikel (refereegranskat)abstract
- We measured the effects of lumbar discectomy on segmental motion over a period of 5 years. Twenty-four patients with lumbar disc herniation were treated by standard lumbar discectomy at the L4-L5 or L5-S1 level. Peroperatively, tantalum markers were inserted into L4, L5, and the sacrum. Radiostereometric analysis was performed at discharge from hospital and 5 years postoperatively. The treated level was compared with the corresponding untreated level. Thus, patients who had discectomy at the L4-L5 level served as controls for patients with L5-S1 lesions and vice versa. The relative rotation and translation in relation to the three cardinal axes were calculated. Inducible displacements over the two discs were calculated between the supine and standing positions. At the L4-L5 level, there were no differences in inducible displacements between the operated and control levels at discharge or 5 years postoperatively. At the L5-S1 level we found decreasing inducible movement in the sagittal plane over time for discectomy patients. The reason for decreasing mobility over time after discectomy at the L5-S1 but not at the L4-L5 level is unknown. Mechanical factors caused by the more vertical orientation of the L5-S1 disc in combination with degenerative changes could be one explanation.
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| 6. |
- Halldin, Klas, 1967, et al.
(författare)
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Three-dimensional radiological classification of lumbar disc herniation in relation to surgical outcome
- 2009
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Ingår i: International Orthopaedics. - : Springer Science and Business Media LLC. - 0341-2695 .- 1432-5195. ; 33:3, s. 725-30
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Tidskriftsartikel (refereegranskat)abstract
- Centrally located lumbar disc herniations have been reported to be of predictive value for poor post-operative clinical outcome. One hundred and fifty patients undergoing lumbar disc herniation surgery were prospectively included. Herniation-related parameters, including the grading of contours, were assessed from pre-operative computed tomography (CT) and magnetic resonance imaging (MRI) images using a new three-dimensional grading system. The radiological findings were compared with outcome parameters two years post-operatively (patient-assessed pain, function/health scores and evaluation by an independent observer). An intra- and inter-observer validation of the classification was performed in a subgroup of patients. High intra-observer and good inter-observer reliability for both CT and MRI was seen. In the study population, no relation between the distribution or size of the herniations and outcome at 2-year follow-up were found. The distribution and size of the lumbar disc herniations with the three-dimensional classification were not found to be of importance for the clinical outcome.
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| 7. |
- Jonasson, Pall, et al.
(författare)
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Prevalence of joint-related pain in the extremities and spine in five groups of top athletes.
- 2011
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Ingår i: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347.
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Joint-related pain conditions from the spine and extremities are common among top athletes. The frequency of back pain has, however, been studied in more detail, and the frequency of low-back pain in top athletes in different high-load sports has been reported to be as high as 85%. Sport-related pain from different joints in the extremities is, however, infrequently reported on in the literature. METHODS: Seventy-five male athletes, i.e. divers, weight-lifters, wrestlers, orienteers and ice-hockey players and 12 non-athletes (control group) were included in the study. A specific self-assessed pain-oriented questionnaire related to the cervical, thoracic and lumbar spine, as well as the various joints, i.e. shoulders, elbows, wrists, hips, knees and ankles, was filled out by the athletes and the non-athletes. RESULTS: The overall frequency of pain reported by the athletes during the last week/last year was as follows; cervical spine 35/55%; thoracic spine 22/33%; lumbar spine 50/68%; shoulder 10/21%; elbow 7/7%; wrist 7/8%; hip 15/23%; knee 22/44%; and ankle 11/25%. The corresponding values for non-athletes were cervical spine 9/36%; thoracic spine 17/33%; lumbar spine 36/50%; shoulder 0/9%; elbow 9/0%; wrist 0/0%; hip 9/16%; knee 10/9%; and ankle 0/0%. A higher percentage of athletes reported pain in almost all joint regions, but there were no statistically significant differences (n.s.), with the exception of the knees (P=0.05). Over the last year, athletes reporting the highest pain frequency in the lumbar spine were ice-hockey players and, in the cervical spine, wrestlers and ice-hockey players. The highest levels of knee pain were found among wrestlers and ice-hockey players, whereas the highest levels for wrist pain were found among divers, hip pain among weight-lifters, orienteers and divers and ankle pain among orienteers. For the thoracic spine, shoulder and elbow regions, only minor differences were found. CONCLUSION: There was no statistically significant difference in prevalence of pain in the neck, spine and joints between top athletes in different sports or between athletes and non-athletes. However, pain in one spinal region was correlated to reported pain in other regions of the spine. Moreover, pain in the spine was also correlated to pain in the shoulders, hips and knees. LEVEL OF EVIDENCE: Prognostic case-control study, Level III.
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| 8. |
- Rönnberg, Katarina, 1969, et al.
(författare)
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Patients' satisfaction with provided care/information and expectations on clinical outcome after lumbar disc herniation surgery
- 2007
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Ingår i: Spine. - : Ovid Technologies (Wolters Kluwer Health). - 0362-2436 .- 1528-1159. ; 32:2, s. 256-261
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN. A prospective study of patients undergoing lumbar disc herniation surgery. OBJECTIVES. To assess patients' satisfaction with care/preoperative information, if expectations on surgical results and ability to return to work are related to baseline characteristics, and/or can predict self-reported outcome. Self-reported outcome was compared with objective outcome. SUMMARY OF BACKGROUND DATA. Patients' expectations on treatment results have been discussed as a predictive factor for postoperative outcome and satisfaction demonstrated to be directly related to patient expectations. METHODS. The study includes 148 patients, 46% women, mean age 40 (range 18-66). Before and 2 years after surgery, questionnaires about given information/care, expected/present work ability, and expectations on/obtained improvement of physical functions/symptoms (leg and back pain, sensibility, and muscle function) were filled in. The visual analog scale leg pain, Zung Depression Scale, and Oswestry Disability Index were used as baseline characteristics. At 2-year follow-up, self-reported and objective outcome was assessed. RESULTS. Satisfaction with given information/care were reported by 46% and 82%, respectively. Zung Depression Scale related to expectations on leg pain recovery (P = 0.022), work ability (P = 0.046), and satisfaction with given information (P = 0.031). Patients who expected to return (76%) and not return (24%) to work, returned in 78% and 26%, respectively (P = 0.021). A high agreement between self-reported outcome and objective outcome were found (P < 0.001). CONCLUSIONS. Patients undergoing lumbar disc herniation surgery are mostly satisfied with provided care before and after surgery, however, less satisfied with information provided. Further, patients with preoperative positive expectations on work return and realistic expectations on pain and physical recovery have a greater chance to be satisfied with the surgical results. © 2007 Lippincott Williams & Wilkins, Inc.
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| 9. |
- Rönnberg, Katarina, 1969, et al.
(författare)
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Peridural scar and its relation to clinical outcome : A randomised study on surgically treated lumbar disc herniation patients
- 2008
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Ingår i: European spine journal. - : Springer. - 0940-6719 .- 1432-0932. ; 17:12, s. 1714-1720
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Tidskriftsartikel (refereegranskat)abstract
- A prospective randomised 2-year follow-up study on patients undergoing lumbar disc herniation surgery. The objective was to investigate the relationship between peridural scarring and clinical outcome, the scar development 6 and 24 months postoperatively by using MRI, and if ADCON-L (a bioresorbable carbohydrate polymer gel) has an effect on scar size and/or improve patients' outcome after lumbar disc herniation surgery. The association between peridural scarring and recurrent pain after lumbar disc herniation surgery is debated. Numerous materials have been used in attempts to prevent or reduce postoperative peridural scarring; however, there are conflicting data regarding the clinical effects. The study included 119 patients whose mean age was 39 years (18-66); 51 (47%) were women. Sixty patients (56%) were perioperatively randomised to receive ADCON-L, and 48 (44%) served as controls. All patients underwent MRI at 6 and 24 months postoperatively, and an independent radiologist graded the size, location and development of the scar, by using a previously described scoring system. Pre- and 2-year postoperatively patients graded their leg pain on a visual analogue scale (VAS). At the 2-year follow-up patients rated their satisfaction with treatment (subjective outcome) and were evaluated by an independent neurologist (objective outcome), using MacNab score. There was no relationship between size or localisation of the scar and any of the clinical outcomes (VAS, subjective and objective outcome). The scar size decreased between 6 and 24 months in 49%, was unchanged in 42% and increased in 9% of the patients. Patients treated with ADCON-L did not demonstrate any adverse effects, nor did they demonstrate less scarring or better clinical outcome than control patients. No significant association between the presence of extensive peridural scar or localisation of scar formation and clinical outcome could be detected in the present study. Further, no positive or negative effects of ADCON-L used in disc herniation surgery could be seen.
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| 10. |
- Silverplats, Katarina, 1969, et al.
(författare)
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Clinical factors of importance for outcome after lumbar disc herniation surgery : long-term follow-up
- 2010
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Ingår i: European spine journal. - : Springer. - 0940-6719 .- 1432-0932. ; 19:9, s. 1459-1467
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Tidskriftsartikel (refereegranskat)abstract
- Factors as age, sex, smoking, duration of leg pain, working status, type/level of disc herniation and psychosocial factors have been demonstrated to be of importance for short-term results after lumbar discectomy. There are few studies with long-term follow-up. In this prospective study of lumbar disc herniation patients undergoing surgery, the result was evaluated at 2 and 5-10 (mean 7.3) years after surgery. Predictive factors for satisfaction with treatment and objective outcome were investigated. Out of the included 171 patients undergoing lumbar discectomy, 154 (90%) patients completed the 2-year follow-up and 140 (81%) completed the long-term follow-up. Baseline data and questionnaires about leg- and back pain intensity (VAS), duration of leg pain, disability (Oswestry Disability Index), depression (Zung Depression Scale), sick leave and employment status were obtained preoperatively, at 2-year- and long-term follow-up. Primary outcome included patient satisfaction with treatment (at both time points) and assessment of an independent observer at the 2-year follow-up. Secondary outcomes at 2-year follow-up were improvement of leg and back pain, working capacity and the need for analgesics or sleeping pills. In about 70% of the patients excellent or good overall result was reported at both follow-ups, with subjective outcome measurements. The objective evaluation after 2 years was in agreement with this result. Time on sick leave was found to be a clinically important predictor of the primary outcomes, with a potential of changing the probability of a satisfactory outcome (both objective and subjective) from around 50% (sick leave >3 months) to 80% (sick leave <2 months). Time on sick leave was also an important predictor for several of the secondary outcomes; e.g. working capacity and the need for analgesics.
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| 11. |
- Silverplats, Katarina, 1969, et al.
(författare)
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Health-related quality of life in patients with surgically treated lumbar disc herniation : 2- and 7-year follow-up of 117 patients
- 2011
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 82:2, s. 198-203
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Health-related quality of life (HRQoL) instruments have been of increasing interest for evaluation of medical treatments over the past 10-15 years. In this prospective, long-term follow-up study we investigated the influence of preoperative factors and the change in HRQoL over time after lumbar disc herniation surgery. Methods: 117 patients surgically treated for lumbar disc herniation (L4-L5 or L5-S1) were evaluated with a self-completion HRQoL instrument (EQ-5D) preoperatively, after 2 years (96 patients) and after 7 years (89 patients). Baseline data (age, sex, duration of leg pain, surgical level) and degree of leg and back pain (VAS) were obtained preoperatively. The mean age was 39 (18-66) years, 54% were men, and the surgical level was L5-S1 in 58% of the patients. The change in EQ-5D score at the 2-year follow-up was analyzed by testing for correlation and by using a multiple regression model including all baseline factors (age, sex, duration of pain, degree of leg and back pain, and baseline EQ-5D score) as potential predictors. Results: 85% of the patients reported improvement in EQ-5D two years after surgery and this result remained at the long-term follow-up. The mean difference (change) between the preoperative EQ-5D score and the 2-year and 7-year scores was 0.59 (p < 0.001) and 0.62 (p < 0.001), respectively. However, the HRQoL for this patient group did not reach the mean level of previously reported values for a normal population of the same age range at any of the follow-ups. The changes in EQ-5D score between the 2- and 7-year follow-ups were not statistically significant (mean change 0.03, p = 0.2). There was a correlation between baseline leg pain and the change in EQ-5D at the 2-year (r = 0.33, p = 0.002) and 7-year follow-up (r = 0.23, p = 0.04). However, when using regression analysis the only statistically significant predictor for change in EQ-5D was baseline EQ-5D score. Interpretation: Our findings suggest that HRQoL (as measured by EQ-5D) improved 2 years after lumbar disc herniation surgery, but there was no further improvement after 5 more years. Low quality of life and severe leg pain at baseline are important predictors of improvement in quality of life after lumbar disc herniation surgery. © Nordic Orthopaedic Federation.
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| 12. |
- Thoreson, Olof, 1981, et al.
(författare)
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A Flat Sagittal Spinal Alignment Is Common among Young Patients with Lumbar Disc Herniation
- 2016
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Ingår i: Open Journal Of Orthopedics. - : Scientific Research Publishing, Inc.. - 2164-3008 .- 2164-3016. ; 6:9, s. 294-304
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recent studies suggest a correlation between spinal sagittal alignment and different types of lumbar pathologies due to different load patterns on the lumbar spine. The main objective of this study was to investigate the preoperative spinal sagittal alignment in young patients (<25 years) undergoing lumbar disc herniation surgery. Methods: Information regarding preoperative clinical examinations was collected from the patient medical charts. Preoperative MRI examinations were used to classify lumbar types according to four sagittal spinal alignment groups (1: a long thoracic kyphosis, 2: a flat back, 3: a normal spine and 4: an increased thoracic kyphosis). Other MRI findings were also noted. Classification of lumbar types was performed independently by three spine surgeons. To compare two sample proportions the 2-sample z-test was performed. Results: The distribution of lumbar curve types was: Type 1, 17% (9 patients); Type 2, 62% (33 patients); Type 3, 17% (9 patients) and Type 4, 4% (2 patients). The distribution of operated levels was: L3 - L4, 2% (1 patient); L4 - L5, 47% (25 patients); L5 - S1, 42% (22 patients) and L4 - L5 + L5 - S1, 9% (5 patients). Conclusions: A majority of the young patients (62%) that underwent surgery due to herniated disc in the lumbar spine were classified as Type 2 indicating a flat back. Future studies are needed to increase the knowledge about spinopelvic sagittal alignment and the correlation to spinal pathologies.
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