| 1. |
- Buwaider, Ali, et al.
(författare)
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Predictors of early mortality following surgical or nonsurgical treatment of subaxial cervical spine fractures : a retrospective nationwide registry study
- 2024
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Ingår i: The spine journal. - : Elsevier. - 1529-9430 .- 1878-1632.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Traumatic subaxial cervical spine fractures are a significant public health concern due to their association with spinal cord injuries (SCI). Despite being mostly caused by low-energy trauma, these fractures significantly contribute to morbidity and mortality. Currently, research regarding early mortality based on the choice of treatment following these fractures is limited. Identifying predictors of early mortality may aid in postoperative patient monitoring and improve outcomes. PURPOSE: This study aimed to identify predictors of 30-days, 90-days, and 1-year mortality in adults treated for subaxial fractures.STUDY DESIGN: A retrospective review of the nationwide Swedish Fracture Register (SFR). PATIENT SAMPLE: All adult patients in the SFR who underwent treatment for a subaxial cervical fracture (n = 1,963).OUTCOME MEASURES: Analyzed variables included age, sex, injury mechanism, neurological function, fracture characteristics, and treatment type. The primary endpoints were 30-days, 90-days, and 1-year mortality.METHODS: About 1,963 patients in the SFR, treated for subaxial cervical fractures between 2013 and 2021, were analyzed. Surgical procedures included anterior, posterior, or anteroposterior approaches. Nonsurgical treatment included collar treatment or medical examinations without intervention. Stepwise regression and Cox regression analysis were used to determine predictors. Model performance was tested using the area under the receiver operating characteristic curve (AUC).RESULTS: 620 patients underwent surgery and 1,343 received nonsurgical treatment. Surgical cases had primarily translation fractures, with 323 (52%) displaying no neurological deficits. Mortality rates at 30 days, 90 days, and 1 year were 22/620 (3.5%), 35/620 (5.6%), and 53/620 (8.5%), respectively. Age and SCI were predictors of mortality. Nonsurgically treated patients mostly had compression fracture, with 1,214 (90%) experiencing no neurological deficits. Mortality rates at 30 days, 90 days, and 1 year were 41/1,343 (3.1%), 71/1,343 (5.3%), and 118/1,343 (8.7%). Age, male sex, SCI and fractures occurring at the C3 or C6 levels were predictors of mortality. An intact neurological function was a positive predictor of survival among nonsurgically treated patients (AUC >0.78).CONCLUSIONS: Age and SCI emerged as significant predictors of early mortality in both surgically and nonsurgically treated patients. An intact neurological function served as a protective factor against early mortality in nonsurgically treated patients. Fractures at C3 or C6 vertebrae may impact mortality.
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| 2. |
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| 3. |
- de Dios, Eddie, 1987, et al.
(författare)
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Comparison of the patient-derived modified Japanese Orthopaedic Association scale and the European myelopathy score
- 2024
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Ingår i: European Spine Journal. - : SPRINGER. - 0940-6719 .- 1432-0932. ; 33:3, s. 1205-1212
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To compare the patient-derived modified Japanese Orthopaedic Association (P-mJOA) scale with the European myelopathy score (EMS) for the assessment of patients with degenerative cervical myelopathy (DCM). Methods: In this register-based cohort study with prospectively collected data, included patients were surgically treated for DCM and had reported both P-mJOA and EMS scores at baseline, 1-year follow-up, and/or 2-year follow-up to the Swedish Spine Register. P-mJOA and EMS scores were defined as severe (P-mJOA 0–11 and EMS 5–8), moderate (P-mJOA 12–14 and EMS 9–12), or mild (P-mJOA 15–18 and EMS 13–18). P-mJOA and EMS mean scores were compared, and agreement was evaluated with Spearman’s rank correlation coefficient (ρ), the intraclass correlation coefficient (ICC), and kappa (κ) statistics. Results: Included patients (n = 714, mean age 63.2years, 42.2% female) completed 937 pairs of the P-mJOA and the EMS. The mean P-mJOA and EMS scores were 13.9 ± 3.0 and 14.5 ± 2.7, respectively (mean difference –0.61 [95% CI –0.72 to –0.51; p < 0.001]). Spearman’s ρ was 0.84 (p < 0.001), and intra-rater agreement measured with ICC was 0.83 (p < 0.001). Agreement of severity level measured with unweighted and weighted κ was fair (κ = 0.22 [p < 0.001]; κ = 0.34 [p < 0.001], respectively). Severity levels were significantly higher using the P-mJOA (p < 0.001). Conclusion: The P-mJOA and the EMS had similar mean scores, and intra-rater agreement was high, whereas severity levels only demonstrated fair agreement. The EMS has a lower sensitivity for detecting severe myelopathy but shows an increasing agreement with the P-mJOA for milder disease severity. A larger interval to define severe myelopathy with the EMS is recommended.
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| 4. |
- de Dios, Eddie, 1987, et al.
(författare)
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Improvement rates, adverse events and predictors of clinical outcome following surgery for degenerative cervical myelopathy
- 2022
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Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 31:12, s. 3433-3442
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To investigate improvement rates, adverse events and predictors of clinical outcome after laminectomy alone (LAM) or laminectomy with instrumented fusion (LAM + F) for degenerative cervical myelopathy (DCM). Methods: This is a post hoc analysis of a previously published DCM cohort. Improvement rates for European myelopathy score (EMS) and Neck Disability Index (NDI) at 2- and 5-year follow-ups and adverse events are presented descriptively for available cases. Predictor endpoints were EMS and NDI scores at follow-ups, surgeon- and patient-reported complications, and reoperation-free interval. For predictors, univariate and multivariable models were fitted to imputed data. Results: Mean age of patients (LAM n = 412; LAM + F n = 305) was 68years, and 37.4% were women. LAM + F patients had more severe spondylolisthesis and less severe kyphosis at baseline, more surgeon-reported complications, more patient-reported complications, and more reoperations (p ≤ 0.05). After imputation, the overall EMS improvement rate was 43.8% at 2years and 36.3% at 5years. At follow-ups, worse EMS scores were independent predictors of worse EMS outcomes and older age and worse NDI scores were independent predictors of worse NDI outcomes. LAM + F was associated with more surgeon-reported complications (ratio 1.81; 95% CI 1.17–2.80; p = 0.008). More operated levels were associated with more patient-reported complications (ratio 1.12; 95% CI 1.02–1.22; p = 0.012) and a shorter reoperation-free interval (hazard ratio 1.30; 95% CI 1.08–1.58; p = 0.046). Conclusions: These findings suggest that surgical intervention at an earlier myelopathy stage might be beneficial and that less invasive procedures are preferable in this patient population.
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| 5. |
- de Dios, Eddie, et al.
(författare)
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Laminectomy alone versus laminectomy with fusion for degenerative cervical myelopathy : a long-term study of a national cohort
- 2022
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Ingår i: European spine journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 31:2, s. 334-345
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To compare patient-reported 5-year clinical outcomes between laminectomy alone versus laminectomy with instrumented fusion in patients with degenerative cervical myelopathy in a population-based cohort.METHODS: All patients in the national Swedish Spine Register (Swespine) from January 2006 until March 2019, with degenerative cervical myelopathy, were assessed. Multiple imputation and propensity score matching based on clinicodemographic and radiographic parameters were used to compare patients treated with laminectomy alone with patients treated with laminectomy plus posterior-lateral instrumented fusion. The primary outcome measure was the European Myelopathy Score, a validated patient-reported outcome measure. The scale ranges from 5 to 18, with lower scores reflecting more severe myelopathy.RESULTS: Among 967 eligible patients, 717 (74%) patients were included. Laminectomy alone was performed on 412 patients (mean age 68 years; 149 women [36%]), whereas instrumented fusion was added for 305 patients (mean age 68 years; 119 women [39%]). After imputation, the propensity for smoking, worse myelopathy scores, spondylolisthesis, and kyphosis was slightly higher in the fusion group. After imputation and propensity score matching, there were on average 212 pairs patients with a 5-year follow-up in each group. There were no important differences in patient-reported clinical outcomes between the methods after 5 years. Due to longer hospitalization times and implant-related costs, the mean cost increase per instrumented patient was approximately $4700 US.CONCLUSIONS: Instrumented fusions generated higher costs and were not associated with superior long-term clinical outcomes. These findings are based on a national cohort and can thus be regarded as generalizable.
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| 6. |
- de Dios, Eddie, 1987, et al.
(författare)
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MRI-based measurements of spondylolisthesis and kyphosis in degenerative cervical myelopathy.
- 2023
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Ingår i: BMC medical imaging. - : BioMed Central (BMC). - 1471-2342. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- To provide normative data and to determine accuracy and reliability of preoperative measurements of spondylolisthesis and kyphosis on supine static magnetic resonance imaging (MRI) of patients with degenerative cervical myelopathy.T2-weighted midsagittal images of the cervical spine were in 100 cases reviewed twice by one junior observer, with an interval of 3 months, and once by a senior observer. The spondylolisthesis slip (SSlip, mm) and the modified K-line interval (mK-line INT, mm) were assessed for accuracy with the standard error of measurement (SEm) and the minimum detectable change (MDC). Intraobserver and interobserver reliability levels were determined using the intraclass correlation coefficient (ICC).The SEm was 0.5mm (95% CI 0.4-0.6) for spondylolisthesis and 0.6mm (95% CI 0.5-0.7) for kyphosis. The MDC, i.e., the smallest difference between two examinations that can be detected with statistical certainty, was 1.5mm (95% CI 1.2-1.8) for spondylolisthesis and 1.6mm (95% CI 1.3-1.8) for kyphosis. The highest reliability levels were seen between the second observation of the junior examiner and the senior observer (ICC=0.80 [95% CI 0.70-0.87] and ICC=0.96 [95% CI 0.94-0.98] for SSlip and mK-line INT, respectively).This study provides normative values of alignment measurements of spondylolisthesis and kyphosis in DCM patients. It further shows the importance of taking measurement errors into account when defining cut-off values for cervical deformity parameters and their potential clinical application in surgical decision-making.
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| 7. |
- Elmekaty, Mohamed, et al.
(författare)
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Safety of a novel modular cage for transforaminal lumbar interbody fusion : clinical cohort study in 20 patients with degenerative disc disease
- 2018
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Ingår i: SICOT-J. - : EDP SCIENCES S A. - 2426-8887. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Transforaminal lumbar interbody fusion (TLIF) is used to reconstruct disc height and reduce degenerative deformity in spinal fusion. Patients with osteoporosis are at high risk of TLIF cage subsidence; possibly due to the relatively small footprint compared to anterior interbody devices. Recently, modular TLIF cage with an integral rail and slot system was developed to reduce cage subsidence and allow early rehabilitation. Objective: To study the safety of a modular TLIF device in patients with degenerative disc disorders (DDD) with regard to surgical complications, non-union, and subsidence. Methods: Patients with DDD treated with a modular TLIF cage (Polyetheretherketone(PEEK), VTI interfuse S) were analysed retrospectively with one-year follow-up. Lumbar sagittal parameters were collected preoperatively, postoperatively and at one year follow-up. Cage subsidence, fusion rate, screw loosening and proportion of endplate coverage were assessed in computed tomography scan. Results: 20 patients (age 66 +/- 10 years, 65% female, BMI 28 +/- 5 kg/m(2)) with a total of 37 fusion levels were included. 15 patients had degenerative spondylosis and 5 patients had degenerative scoliosis. The cages covered >60% of the vertebral body diameters. Lumbar lordosis angle and segmental disc angle increased from 45.2 +/- 14.5 and 7.3 +/- 3.6 to 52.7 +/- 9.1 and 10.5 +/- 3.5 (p=0.029 and 0.0002) postoperatively for each parameter respectively without loss of correction at one year follow up. One case of deep postoperative infection occurred (5%). No cage subsidence occurred. No non-union or screw loosening occurred. Conclusions: The modular TLIF cage was safe with regard to subsidence and union-rate. It restored and maintained lumbar lordosis angle, segmental disc angle and disc height, which can be attributed to the large footprint of this modular cage.
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| 8. |
- Heary, Robert F., et al.
(författare)
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Cervical spondylotic myelopathy : A two decade experience
- 2019
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Ingår i: Journal of Spinal Cord Medicine (JSCM). - : Taylor & Francis. - 1079-0268 .- 2045-7723. ; 42:4, s. 407-415
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Forskningsöversikt (refereegranskat)abstract
- Context: Cervical myelopathy occurs as a result of compression of the cervical spinal cord. Symptomatology includes, but is not limited to, pain, weakness, paresthesias, or gait/balance difficulties. Objective: To present a two-decade experience with the management of cervical myelopathy. Methods: Literature was reviewed to provide current guidelines for management as well as accompanying clinical presentations. Results: Surgical decompression, if necessary, may be achieved from either an anterior, a posterior, or a combined anterior-posterior (AP) approach. The indications for each approach, as well as the surgical techniques, are described. Conclusion: Several etiologies may lead to cord compression and cervical myelopathy. The best vector of approach with regard to anterior versus posterior surgical intervention is still under investigation. Regardless, management via surgical decompression has been demonstrated repeatedly to improve the CSM patients' quality of life.
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| 9. |
- Holy, Marek, 1981-, et al.
(författare)
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Operative treatment of cervical radiculopathy : anterior cervical decompression and fusion compared with posterior foraminotomy
- 2021
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Ingår i: Trials. - : BioMed Central. - 1745-6215. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cervical radiculopathy is the most common disease in the cervical spine, affecting patients around 50-55 year of age. An operative treatment is common clinical praxis when non-operative treatment fails. The controversy is in the choice of operative treatment, conducting either anterior cervical decompression and fusion or posterior foraminotomy. The study objective is to evaluate short- and long-term outcome of anterior cervical decompression and fusion (ACDF) and posterior foraminotomy (PF)METHODS: A multicenter prospective randomized controlled trial with 1:1 randomization, ACDF vs. PF including 110 patients. The primary aim is to evaluate if PF is non-inferior to ACDF using a non-inferiority design with ACDF as "active control." The neck disability index (NDI) is the primary outcome measure, and duration of follow-up is 2 years.DISCUSSION: Due to absence of high level of evidence, the authors believe that a RCT will improve the evidence for using the different surgical treatments for cervical radiculopathy and strengthen current surgical treatment recommendation.TRIAL REGISTRATION: ClinicalTrials.gov NCT04177849. Registered on November 26, 2019.
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| 10. |
- Holy, Marek, et al.
(författare)
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Operative treatment of cervical radiculopathy : anterior cervical decompression and fusion compared with posterior foraminotomy: study protocol for a randomized controlled trial
- 2021
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Ingår i: Trials. - : BioMed Central (BMC). - 1745-6215. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background; Cervical radiculopathy is the most common disease in the cervical spine, affecting patients around 50-55 year of age. An operative treatment is common clinical praxis when non-operative treatment fails. The controversy is in the choice of operative treatment, conducting either anterior cervical decompression and fusion or posterior foraminotomy. The study objective is to evaluate short- and long-term outcome of anterior cervical decompression and fusion (ACDF) and posterior foraminotomy (PF) Methods: A multicenter prospective randomized controlled trial with 1:1 randomization, ACDF vs. PF including 110 patients. The primary aim is to evaluate if PF is non-inferior to ACDF using a non-inferiority design with ACDF as "active control." The neck disability index (NDI) is the primary outcome measure, and duration of follow-up is 2 years. Discussion: Due to absence of high level of evidence, the authors believe that a RCT will improve the evidence for using the different surgical treatments for cervical radiculopathy and strengthen current surgical treatment recommendation.
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| 11. |
- Kitamura, Kazuya, et al.
(författare)
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Evaluating a paradigm shift from anterior decompression and fusion to muscle-preserving selective laminectomy : a single-center study of degenerative cervical myelopathy
- 2022
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Ingår i: Journal of Neurosurgery. - : American Association of Neurological Surgeons. - 1547-5654 .- 1547-5646. ; 37:5, s. 740-748
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Muscle-preserving selective laminectomy (SL) is an alternative to conventional decompression surgery in patients with degenerative cervical myelopathy (DCM). It is less invasive, preserves the extensor musculature, and maintains the range of motion of the cervical spine. Therefore, the preferred treatment for DCM at the authors' institution has changed from anterior decompression and fusion (ADF), including anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF), toward SL. The aim of this study was to evaluate surgical outcomes before and after this paradigm shift with patient-reported outcome measures (PROMs), complications, reoperations, and cost-effectiveness.METHODS: This study was a retrospective register-based cohort study. All patients with DCM who underwent ADF or SL at the authors' institution from 2008 to 2019 were reviewed. Using ANCOVA, changes in PROMs from baseline to the 2-year follow-up were compared between the two groups, adjusting for clinicodemographic parameters, baseline PROMs, number of decompressed levels, and MRI measurements (C2-7 Cobb angle, C2-7 sagittal vertical axis [SVA], and modified K-line interval [mK-line INT]). The PROMs, including the European Myelopathy Score (EMS), the Neck Disability Index (NDI), and the EQ-5D, were collected from the national Swedish Spine Register. Complications, reoperations, and in-hospital treatment costs were also compared between the two groups.RESULTS: Ninety patients (mean age 60.7 years, 51 men [57%]) were included in the ADF group and 63 patients (mean age 68.8 years, 41 men [65%]) in the SL group. The ADF and SL groups had similar PROMs at baseline. The preoperative MR images showed similar C2-7 Cobb angles (10.7° [ADF] vs 14.1° [SL], p = 0.12) and mK-line INTs (4.08 vs 4.88 mm, p = 0.07), but different C2-7 SVA values (16.2 vs 19.3 mm, p = 0.04). The comparison of ANCOVA-adjusted mean changes in PROMs from baseline to the 2-year follow-up presented no significant differences between the groups (EMS, p = 0.901; NDI, p = 0.639; EQ-5D, p = 0.378; and EQ-5D health, p = 0.418). The overall complication rate was twice as high in the ADF group (22.2% vs 9.5%, p = 0.049), while the reoperation rate was comparable (16.7% vs 7.9%, p = 0.146). The average in-hospital treatment cost per patient was $6617 (USD) for SL, $7046 for ACDF, and $12,000 for ACCF.CONCLUSIONS: SL provides similar PROMs after 2 years, a significantly lower complication rate, and better cost-effectiveness compared with ADF.
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| 12. |
- Kontakis, Michael G., et al.
(författare)
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Artificial disc replacement and adjacent-segment pathology : 10-year outcomes of a randomized trial
- 2022
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Ingår i: Journal of Neurosurgery. - : AMER ASSOC NEUROLOGICAL SURGEONS. - 1547-5654 .- 1547-5646. ; 36:6, s. 945-953
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Artificial disc replacement (ADR) is designed to preserve motion and thus protect against adjacent-segment pathology (ASP) and act as an alternative treatment to fusion surgery. The question remains, how well do ADR devices perform after 10 years of follow-up compared with fusion surgery in terms of patient satisfaction, sustainability, and protection against ASP?METHODS: This was the 10-year follow-up study of 153 participants who underwent ADR or fusion surgery after anterior decompression due to cervical degenerative radiculopathy (ISRCTN registration no. 44347115). Scores on the Neck Disability Index (NDI), EQ-5D, and visual analog scale for neck and arm pain were obtained from the Swedish Spine Registry and analyzed using ANCOVA. Information about secondary surgical procedures was collected from medical records and presented as Kaplan-Meier curves. MRI and flexion-extension radiography were performed, and ASP was graded according to the Miyazaki classification system.RESULTS: Ten participants were lost to follow-up, which left 143 participants (80 underwent ADR and 65 underwent anterior cervical discectomy and fusion). There were no differences between groups in terms of patient-reported outcome measures (10-year difference in NDI scores 1.7 points, 95% CI -5.1 to 8.5, p = 0.61). Nineteen (24%) participants in the ADR group compared with 9 (14%) in the fusion group underwent secondary surgical procedures. The higher reoperation rate of the ADR group was mainly due to 11 female participants with device loosening. The rates of reoperation due to ASP were similar between groups, which was confirmed with MRI assessment of ASP that also showed no differences between the groups (p = 0.21).CONCLUSIONS: This was the first 10-year follow-up study to compare ADR with fusion surgery and to provide MRI information for the assessment of ASP. The authors found no benefit of ADR over fusion surgery after anterior decompression for cervical degenerative radiculopathy.
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| 13. |
- MacDowall, Anna, et al.
(författare)
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Anxiety and depression affect pain drawings in cervical degenerative disc disease
- 2017
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Ingår i: Upsala Journal of Medical Sciences. - : TAYLOR & FRANCIS LTD. - 0300-9734 .- 2000-1967. ; 122:2, s. 99-107
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Pain drawings have been frequently used in the preoperative evaluation of spine patients. Until now most investigations have focused on low back pain patients, even though pain drawings are used in neck pain patients as well. The aims of this study were to investigate the pain drawing and its association to preoperative demographics, psychological impairment, and pain intensity. Methods: We carried out a post hoc analysis of a randomized controlled trial, comparing cervical disc replacement to fusion for radiculopathy related to degenerative disc disease. Preoperatively the patients completed a pain drawing, the Hospital Anxiety and Depression Scale (HADS), and a visual analogue scale (VAS). The pain drawing was evaluated according to four established methods, now modified for cervical conditions. Comparisons were made between the pain drawing and age, sex, smoking, and employment status as well as HADS and VAS. Results: Included were 151 patients, mean age of 47 years, female/male: 78/73. Pain drawing results were not affected by age, sex, smoking, and employment status. Patients with non-neurogenic pain drawings according to the modified method by Ransford had higher points on HADS-anxiety, HADS-depression, and HADS-total. Patients with markings in the head region had higher score on HADS-depression. Markings in the neck and lower arm region were associated with high values of VAS-neck and VAS-arm. Conclusions: Pain drawings were affected by both pain intensity and anxiety/depression in cervical spine patients. Therefore, the pain drawing can be a useful tool when interpreting the patients' pain in correlation to psychological impairment and pain location.
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| 14. |
- MacDowall, Anna, et al.
(författare)
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Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy : a randomized controlled trial with 5-year outcomes
- 2019
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Ingår i: Journal of Neurosurgery. - 1547-5654 .- 1547-5646. ; 30:3, s. 323-331
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVEThe method of artificial disc replacement (ADR) has been developed as an alternative treatment to fusion surgery after decompression for cervical degenerative disc disease (DDD) with radiculopathy. Preserving the motion of ADR devices aims to prevent immobilization side effects such as adjacent-segment pathology (ASP). However, long-term follow-up evaluations using MRI are needed to investigate if this intent is achieved.METHODSThe authors performed a randomized controlled trial with 153 patients (mean age 47 years) undergoing surgery for cervical radiculopathy. Eighty-three patients received an ADR and 70 patients underwent fusion surgery. Outcomes after 5 years were assessed using patient-reported outcome measures using the Neck Disability Index (NDI) score as the primary outcome; motion preservation and heterotopic ossification by radiography; ASP by MRI; and secondary surgical procedures.RESULTSScores on the NDI were approximately halved in both groups: the mean score after 5 years was 36 (95% confidence interval [CI] 31–41) in the ADR group and 32 (95% CI 27–38) in the fusion group (p = 0.48). There were no other significant differences between the groups in six other patient-related outcome measures. Fifty-four percent of the patients in the ADR group preserved motion at the operated cervical level and 25% of the ADRs were spontaneously fused. Seventeen ADR patients (21%) and 7 fusion patients (10%) underwent secondary surgery (p = 0.11), with 5 patients in each group due to clinical ASP.CONCLUSIONSIn patients with cervical DDD and radiculopathy decompression as well as ADR, surgery did not result in better clinical or radiological outcomes after 5 years compared with decompression and fusion surgery.
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| 15. |
- MacDowall, Anna, et al.
(författare)
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Artificial Disc Replacement versus Fusion in Patients with Cervical Degenerative Disc Disease with radiculopathy : 5-year Outcomes from the National Swedish Spine Register
- 2019
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Ingår i: Journal of Neurosurgery. - 1547-5654 .- 1547-5646. ; 30:2, s. 159-167
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The long-term efficacy of artificial disc replacement (ADR) surgery compared with fusion after decompression for the treatment of cervical degenerative disc disease and radiculopathy has not previously been investigated in a population-based setting.METHODS: All patients with cervical degenerative disc disease and radiculopathy who were in the national Swedish Spine Registry (Swespine) beginning in January 1, 2006, were eligible for the study. Follow-up information was obtained up to November 15, 2017. The authors compared, using propensity score matching, patients treated with anterior decompression and insertion of an ADR with patients who underwent anterior decompression combined with fusion surgery. The primary outcome was the Neck Disability Index (NDI), a patient-reported function score ranging from 0% to 100%, with higher scores indicating greater disability and a minimum clinically important difference of > 15%.RESULTS: A total of 3998 patients (2018: 1980 women/men) met the inclusion criteria, of whom 204 had undergone arthroplasty and 3794 had undergone fusion. After propensity score matching, 185 patients with a mean age of 49.7 years remained in each group. Scores on the NDI were approximately halved in both groups after 5 years, but without a significant mean difference in NDI (3.0%; 95% CI -8.4 to 2.4; p = 0.28) between the groups. There were no differences between the groups in EuroQol-5 Dimensions or in pain scores for the neck and arm.CONCLUSIONS: In patients with cervical degenerative disc disease and radiculopathy, decompression plus ADR surgery did not result in a clinically important difference in outcomes after 5 years, compared with decompression and fusion surgery.
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| 16. |
- MacDowall, Anna, 1976-
(författare)
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Cervical Radiculopathy : Studies on Pain Analysis and Treatment
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Knowledge about how to interpret pain-analyzing tools such as the pain drawing test and the visual analog scale (VAS) in cervical spine patients are sparse; hence, they have never been validated for this subgroup of patients. The method of artificial disc replacement (ADR) has been developed as an alternative treatment to fusion surgery after decompression for cervical degenerative disc disease (DDD) with radiculopathy. Preserved motion of ADR devices aims to prevent immobilization side effects such as stiffness, dysphagia and adjacent segment pathology. Long-term follow-ups of these devices compared with the gold standard treatment are needed to create future guidelines.Objectives: This thesis aims at (1) validating the pain drawing as an investigational tool for the cervical spine, (2) validating the VAS for the cervical spine regarding the measurement noise and the minimum clinically important difference (MCID), (3) comparing ADR with fusion surgery at 5-years of follow-up regarding outcome and complications in a randomized controlled trial (RCT) as well as in the Swedish spine (Swespine) registry, and (4) investigating possible predictors to outcome after surgical treatment of cervical radiculopathy.Methods: An RCT with 153 patients undergoing surgery for cervical radiculopathy was performed. Baseline data, the Neck disability index (NDI), two sets of VAS-neck and VAS-arm scores, the EQ-5D, Hospital anxiety and depression scale (HADS), Dysphagia short questionnaire and a pain drawing test were gathered preoperatively and after 5 years. Radiographs in flexion/extension and MRIs were done preoperatively and at follow-up. All patients registered in Swespine since January 1st, 2006 with cervical DDD and radiculopathy treated with ADR or fusion surgery, were included. Baseline data, the NDI, EQ-5D, and VAS-neck and VAS-arm scores were analyzed at 1, 2, 5 and 10-years of follow-up as well as the information regarding secondary surgeries.Results: Pain drawings interpreted with the simple body region method showed good inter-rater reliability in cervical spine patients. Markings in the upper arm region on the pain drawing predicted surgical treatment outcome and markings in the head region predicted depression. The measurement noise was ~10 mm and the MCID was ~20 mm on a 100 mm pain VAS. In both the RCT and Swespine register the outcome after ADR surgery were comparable with fusion at 5 years of follow-up, except for an elevated risk regarding secondary surgery on the index level in the ADR group. Fifty percent of the patients in the RCT, allocated to ADR surgery had preserved motion of less than 5°, at the 5-year follow-up, and 25%, mostly men were spontaneously fused. Preserved motion did not prevent adjacent segment pathology. High values of preoperative HADS scores were negative predictors of outcome.Conclusions: In patients with cervical DDD and radiculopathy both the pain drawing test and the VAS are validated tools to interpret the patients’ pain. Preoperative mental distress affects long-term outcome much more than the allocated treatment, ADR or fusion surgery in patients with cervical radiculopathy.Clinical Trial Registration: ISRCTN, registration number: 44347115.
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| 17. |
- MacDowall, Anna, et al.
(författare)
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Comparison of posterior muscle-preserving selective laminectomy and laminectomy with fusion for treating cervical spondylotic myelopathy: study protocol for a randomized controlled trial
- 2023
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Cervical spondylotic myelopathy (CSM) is the predominant cause of spinal cord dysfunction in the elderly. The patients are often frail and susceptible to complications. Posterior surgical techniques involving non-fusion are complicated by postlaminectomy kyphosis and instrumented fusion techniques by distal junction kyphosis, pseudarthrosis, or implant failure. The optimal surgical approach is still a matter of controversy.Since anterior and posterior fusion techniques have been compared without presenting any superiority, the objective of this study is to compare stand-alone laminectomy with laminectomy and fusion to determine which treatment has the lowest frequency of reoperations. Methods This is a multicenter randomized, controlled, parallel-group non-inferiority trial. A total of 300 adult patients are allocated in a ratio of 1:1. The primary endpoint is reoperation for any reason at 5 years of follow-up. Sample size and power calculation were performed by estimating the reoperation rate after laminectomy to 3.5% and after laminectomy with fusion to 7.4% based on the data from the Swedish spine registry (Swespine) on patients with CSM. Secondary outcomes are the patient-derived Japanese Orthopaedic Association (P-mJOA) score, Neck Disability Index (NDI), European Quality of Life Five Dimensions (EQ-5D), Numeric Rating Scale (NRS) for neck and arm pain, Hospital Anxiety and Depression Scale (HADS), development of kyphosis measured as the cervical sagittal vertical axis (cSVA), and death. Clinical and radiological follow-up is performed at 3, 12, 24, and 60 months after surgery. The main inclusion criterium is 1-4 levels of CSM in the subaxial spine, C3-C7. The REDcap software will be used for safe data management. Data will be analyzed according to the modified intention to treat (mITT) population, defined as randomized patients who are still alive without having emigrated or left the study after 2 and 5 years. Discussion This will be the first randomized controlled trial comparing two of the most common surgical treatments for CSM: the posterior muscle-preser ving selective laminectomy and posterior laminectomy with instrumented fusion. The results of the myelopathy randomized controlled (MyRanC) study will provide surgical treatment recommendations for CSM. This may result in improvements in surgical treatment and clinical practice regarding CSM.
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| 18. |
- MacDowall, Anna, et al.
(författare)
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Effects of preoperative mental distress versus surgical modality, arthroplasty, or fusion on long-term outcome in patients with cervical radiculopathy
- 2018
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Ingår i: Journal of Neurosurgery. - : AMER ASSOC NEUROLOGICAL SURGEONS. - 1547-5654 .- 1547-5646. ; 29:4, s. 371-379
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE Several efforts have been made to investigate the long-term efficacy of artificial disc replacement surgery compared with that of fusion after decompression for the treatment of cervical degenerative disc disease and radiculopathy. However, research on the impact of mental distress on surgical treatment outcome has been sparse. The aim of the authors was to investigate the potential predictive value of preoperative risk factors in determining long-term outcome. METHODS A total of 153 patients (mean age 47 years) with single-or double-level cervical degenerative disc disease and radiculopathy were randomly assigned to undergo either anterior cervical discectomy and fusion (n = 70) or artificial disc replacement (n = 83). The primary outcome was the Neck Disability Index (NDI) score, a patient-reported function score that ranges from 0% to 100%; higher scores indicate greater disability. Preoperative variables such as sex, age, smoking status, employment status, having a strenuous job, neck pain duration, arm pain duration, amount of regular exercise, Hospital Anxiety and Depression Scale (HADS) score, NDI score, whether surgery was performed on 1 or 2 levels, and allocated treatment were analyzed in multiple linear regression models with the 5-year NDI score as the outcome. RESULTS A total of 47 (31%) patients had either a HADS anxiety or HADS depression score of 10 points or higher. High values on the preoperative HADS were a negative predictor of outcome (p = 0.009). Treatment allocation had no effect on 5-year NDI scores (p = 0.32). CONCLUSIONS Preoperative mental distress measured with the HADS affects long-term outcome in surgically treated patients with cervical radiculopathy.
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| 19. |
- MacDowall, Anna, et al.
(författare)
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Pain drawings predict outcome of surgical treatment for degenerative disc disease in the cervical spine
- 2017
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 122:3, s. 194-200
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Pain drawings have been frequently used in the preoperative evaluation of spine patients. For lumbar conditions comprehensive research has established both the reliability and predictive value, but for the cervical spine most of this knowledge is lacking. The aims of this study were to validate pain drawings for the cervical spine, and to investigate the predictive value for treatment outcome of four different evaluation methods.METHODS: We carried out a post hoc analysis of a randomized controlled trial, comparing cervical disc replacement to fusion for radiculopathy related to degenerative disc disease. A pain drawing together with Neck Disability Index (NDI) was completed preoperatively, after 2 and 5 years. The inter- and intraobserver reliability of four evaluation methods was tested using κ statistics, and its predictive value investigated by correlation to change in NDI.RESULTS: Included were 151 patients, mean age of 47 years, female/male: 78/73. The interobserver reliability was fair for the modified Ransford and Udén methods, good for the Gatchel method, and very good for the modified Ohnmeiss method. Markings in the shoulder and upper arm region on the pain drawing were positive predictors of outcome after 2 years of follow-up, and markings in the upper arm region remained a positive predictor of outcome even after 5 years of follow-up.CONCLUSIONS: Pain drawings were a reliable tool to interpret patients' pain prior to cervical spine surgery and were also to some extent predictive for treatment outcome.
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| 20. |
- MacDowall, Anna, et al.
(författare)
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Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy : up to 5 years of outcome from the national Swedish Spine Register
- 2020
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Ingår i: Journal of Neurosurgery. - : American Association of Neurological Surgeons. - 1547-5654 .- 1547-5646. ; 32:3, s. 344-352
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The long-term efficacy of posterior foraminotomy compared with anterior cervical decompression and fusion (ACDF) for the treatment of degenerative disc disease with radiculopathy has not been previously investigated in a population-based cohort.METHODS: All patients in the national Swedish Spine Register (Swespine) from January 1, 2006, until November 15, 2017, with cervical degenerative disc disease and radiculopathy were assessed. Using propensity score matching, patients treated with posterior foraminotomy were compared with those undergoing ACDF. The primary outcome measure was the Neck Disability Index (NDI), a patient-reported outcome score ranging from 0% to 100%, with higher scores indicating greater disability. A minimal clinically important difference was defined as > 15%. Secondary outcomes were assessed with additional patient-reported outcome measures (PROMs).RESULTS: A total of 4368 patients (2136/2232 women/men) met the inclusion criteria. Posterior foraminotomy was performed in 647 patients, and 3721 patients underwent ACDF. After meticulous propensity score matching, 570 patients with a mean age of 54 years remained in each group. Both groups had substantial decreases in their NDI scores; however, after 5 years, the difference was not significant (2.3%, 95% CI -4.1% to 8.4%; p = 0.48) between the groups. There were no significant differences between the groups in EQ-5D or visual analog scale (VAS) for neck and arm scores. The secondary surgeries on the index level due to restenosis were more frequent in the foraminotomy group (6/100 patients vs 1/100), but on the adjacent segments there was no difference between groups (2/100).CONCLUSIONS: In patients with cervical degenerative disc disease and radiculopathy, both groups demonstrated clinical improvements at the 5-year follow-up that were comparable and did not achieve a clinically important difference from one another, even though the reoperation rate favored the ACDF group. This study design obtains population-based results, which are generalizable.
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| 21. |
- MacDowall, Anna, et al.
(författare)
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Surgical treatment outcome on a national cohort of 176 patients with cervical manifestation of rheumatoid arthritis.
- 2021
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Ingår i: Journal of Craniovertebral Junction and Spine. - : Medknow Publications. - 0974-8237 .- 0976-9285. ; 12:3, s. 248-256
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Rheumatoid arthritis (RA) affecting the cervical spine results in instability and deformity that can be divided into the subtypes C1-C2 horizontal (atlantoaxial instability), C0-C2 vertical (basilar invagination), subaxial, and combined instabilities. The aim of this study was to compare the surgical treatments and outcomes of RA-related deformity and instability in a population-based setting.Patients and Methods: All patients with RA in the national Swespine register from January 1, 2006, to March 20, 2019, were assessed. Baseline characteristics, surgical treatments, European Myelopathy Scale (EMS), Neck Disability Index, the Visual Analog Scale for neck and arm pain as well as pre- and postoperative imaging were analyzed. The follow-up time points were at 1-, 2-, and 5 years after surgery.Results: A total of 176 patients were included. There were 62 (35%) patients with C1-C2 horizontal instability, 48 (27%) with C0-C2 vertical instability, 19 (11%) patients with subaxial instability, 43 (24%) patients with combined instability, and 4 patients without instability served as controls. The EMS improved in the C1-C2 horizontal instability group after fusion surgery (Δ =2.6 p) but remained within baseline confidence intervals in the other groups. All patients regardless of instability improved in pain. The subaxial instability had the highest risk of death within 5 years after surgery (11/19, 58%). The most dangerous complications due to implant failure were seen in patients instrumented with laminar hooks.Conclusion: The neurological outcome after fusion surgery is poor and the death rate is high in patients with cervical RA-related instability and deformity.
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| 22. |
- MacDowall, Anna, et al.
(författare)
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Validation of the Visual Analogue Scale in the Cervical Spine
- 2018
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Ingår i: Journal of Eurosurgery. - Charlottesville, Virginia. - 1547-5654 .- 1547-5646. ; 28:3, s. 227-235
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The Visual analogue scale (VAS) is frequently used to measure treatment outcome in patients with cervical spine disorders. The minimum clinically important difference (MCID) is the smallest change in a score that has clinical importance to the patient. Although it has been established for other medical fields, knowledge of the VAS MCID for the cervical spine is sparse, and it has rarely been considered in relation to measurement noise. The goals in this study were as follows: 1) to validate the VAS-neck and VAS-arm instruments for the cervical spine (e.g. repeatability); 2) to investigate the possible influence of predictive factors and the Hospital Anxiety and Depression Scale (HADS) score on repeatability; and 3) to compute the MCID with five different methods.Methods: A post hoc analysis of a prospective randomized controlled trial with 151 patients undergoing surgery for cervical radiculopathy due to degenerative disc disease (DDD) was performed. Information on age, sex, smoking habits, exercise and employment status, HADS score, and VAS-neck and VAS-arm scores was gathered before surgery and after 1 year. The VAS was applied twice on every occasion with 15 minutes in-between. Repeatability and the association with predictors and HADS score were analyzed using the one-sample t-test, linear regression models and Spearman correlation. The MCID was calculated with the following methods: average change, change difference, receiver operating characteristic curve, effect size, and minimum detectable change (MDC).Results: The repeatability in VAS-neck was 8.1 mm and in VAS-arm 10.4 mm. Less consistent values on the VAS correlated to female sex and higher values on HADS. For VAS-neck the MCID ranged from 4.6 to 21.4 and for VAS-arm it ranged from 1.1 to 29.1. The highest MCID came from the MDC method, which was the only method that gave values above the measurement noise in both VAS-neck and VAS-arm.Conclusions: Measurement noise in VAS-neck and VAS-arm for the cervical spine was influenced by female sex and HADS score. The only method to compute MCID that consistently gave results above the measurement noise in VAS-neck and VAS-arm was the MDC.
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| 23. |
- Marques, Catarina, 1969-, et al.
(författare)
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Accuracy and Reliability of X-ray Measurements in the Cervical Spine
- 2020
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Ingår i: Asian Spine Journal. - : KOREAN SOC SPINE SURGERY. - 1976-1902 .- 1976-7846. ; 14:2, s. 169-176
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: This study is a post hoc analysis of a multicenter prospective randomized controlled trial which compared artificial disc replacement and anterior cervical discectomy and fusion. Purpose: Useful radiographic parameters for assessing cervical alignment include the Cobb angles, T1 slope (TS), occipitocervical inclination (OCI). K-line tilt (KLT), and cervical sagittal vertical axis (cSVA). This study aimed to determine measurement accuracy and reliability for these parameters. Overview of Literature: Various authors have assessed repeatability by comparing different methods of measurement, but knowledge of measurement error and minimal detectable change is scarce. Methods: We evaluated 75B lateral cervical radiographs. One medical student and one spine surgeon (i.e., measured x2 within 4 weeks) independently measured the parameters obtaining 5,850 values. Standard error of measurement (SEm) and minimum detectable change (MDC) were calculated for each parameter. The accuracy and reliability of the Cobb angle measurements were calculated for the different types of angles: cervical lordosis, prosthesis angle, segmental angle with two hone surfaces (SABB), and segmental angle with one bone and one metal surface. Reliability was determined with intraclass correlation coefficient (ICC). Results: SEm was 1.8 degrees and MDC was 5.0 degrees for the Cobb angle, with an intraobserver/interobserver ICC of 0.958/0.8B6. All the different subtypes of Cobb angles had an ICC higher than 0.950, except SABB (intraobserver/interobserver ICC of 0.922/0.716). The most accurate and reliable measurement was for KLT. Conclusions: This study provides normative data on SEm and MDC for Cobb angles, T1S, KLT, OCI, and cSVA in cervicalcervicai lateral radiographs. Reliability was excellent for all parameters except SABB (e.g., good).
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| 24. |
- Marques, Catarina, 1969-
(författare)
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Studies on Cervical Artificial Disc Replacement
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Artificial disc replacement (ADR) was developed as an alternative to anterior fusion after decompression for cervical degenerative radiculopathy. By preserving motion, it was expected to prevent acceleration of adjacent segment pathology (ASP) associated with fusion, and lead to better clinical outcomes. The aims of this thesis were to evaluate whether ADR surgery leads to better outcomes than fusion surgery, to investigate if it prevents the acceleration of ASP, and to analyze its potential complications. In a multicenter randomized controlled trial (RCT) 153 patients were randomized to ADR (DiscoverTM implant) or fusion surgery (autograft, plate and screws). The outcomes at 5 and 10 years postoperatively were analyzed with Neck Disability Index (NDI) as primary measure. Heterotopic ossification (HO), ASP, and secondary surgery where analyzed. The measurements of radiographic parameters used in the assessment of cervical alignment where validated.To further analyze secondary surgery after ADR, a descriptive register cohort study was done with 42 patients whose data were retrieved from Swespine and completed with medical charts, images, and a telephone interview. There was no difference in NDI scores between groups in the RCT, 5 or 10 years postoperatively. Radiological and clinically significant ASP were similar in both groups. There was more secondary surgery in the ADR group compared with the fusion group, mainly due to device loosening in women. Severe HO was seen in 71% of the ADR implants 5 years postoperatively, and 27% were fused, male sex being a clear risk factor.Normative data for measurement error were provided on the cervical alignment measurements, and the most reliable were the K-line tilt and the cervical sagittal vertical axis (cSVA). In the 42 patients in the register cohort study the most common diagnosis leading to reoperation was loosening of the ADR implant and/or ASP, predominantly treated with fusion surgery. Reoperation resulted in good outcomes in the vast majority of patients. At the long-term, there is no clinical benefit of ADR over fusion surgery after decompression for cervical degenerative radiculopathy. ADR, compared with fusion surgery, does not prevent acceleration of ASP, and results in more reoperations. Revision surgery for failed cervical ADRs is effective and justified.
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| 25. |
- Marques, Catarina, 1969-, et al.
(författare)
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The fate of failed cervical arthroplasties: outcome of revision surgery
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: To analyze the diagnoses leading to secondary surgery, the surgical methods used in reoperations, and the final clinical outcomes, in patients reoperated after a primary reconstruction with a cervical artificial disc replacement (ADR). Methods: Descriptive cohort study of 42 ADR patients who underwent secondary surgery at the index or adjacent level. Data collected from the National Swedish Register for Spine Surgery 2006 through 2018, completed with information from patients’ charts, images, and a telephone interview with the patients. Analysis of time to reoperation, diagnosis leading to reoperation, surgical method, and outcome at 2 years, measured as change in neck pain, arm pain and function, as well as overall patient satisfaction. Results: The most common diagnosis leading to reoperation was loosening (n=16), clinical adjacent segment pathology (ASP) (n=8), or a combination thereof (n=6). Thirty-four of the surgeries were performed at the index level. Mean time to reoperation was 44 months.Reoperation consisted of extraction of the ADR and fusion surgery in 32 cases. Function improved after the reoperation in 32 patients. Twenty-four of 30 patients who had neck pain, and 28 of 32 who had arm pain improved after the reoperation. No patients reported post-operative aggravation of symptoms.Conclusion: Failure of ADR is mainly due to loosening of the implant and/or ASP, and is predominantly treated with fusion surgery. Reoperation results in good outcomes (complete or nearly complete recovery) in the vast majority of patients. We conclude that revision surgery for failed cervical arthroplasty is effective and justified.
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| 26. |
- Marques, Catarina, 1969-, et al.
(författare)
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Unintended fusion in cervical artificial disk replacement : a prospective study on heterotopic ossification, progression, and clinical outcome, with 5-year follow-up
- 2021
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Ingår i: European spine journal. - : Springer. - 0940-6719 .- 1432-0932. ; 30:6, s. 1662-1669
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Heterotopic ossification (HO) may cause unintended fusion in artificial disk replacement (ADR), failing to preserve motion. The reported incidence of HO varies hugely. This study aimed to determine prevalence of HO, progression, predisposing factors to occurrence and to progression, and potential effect on clinical outcomes. Methods Eighty-three patients treated with ADRs for cervical radiculopathy at one or two segments were extracted from a previously published RCT. Of the 83 patients, 59 had remaining ADR (79 implants) and sufficiently high-quality X-rays at 5 years of follow-up to allow analysis. HO was graded on plain films according to Mehren/Suchomel. Prevalence, progression, predisposing factors and effect on clinical outcome (Neck Disability Index-NDI) were analyzed. Results At 2 years, HO was seen in 46/55 ADR implants (84%), severe enough to affect mobility in 27/55 (49%). At 5 years, HO was seen in 92% of 79 implants, severe in 71%. Male sex was a predisposing factor to HO. No predisposing factors to progression were identified. NDI was not affected by the severity of HO. Conclusion Almost all ADR implants in our study have HO at 5 years of follow-up. Male sex is a risk factor. Severe HO did not affect clinical outcome.
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| 27. |
- Norling, Ulf, et al.
(författare)
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Prehospital spinal rörelsebegränsning vid trauma
- 2019
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Traumanätverk Sverige samlar yrkesverksamma läkare och sjuksköterskorinom svensk traumavård. Vid sitt möte i Göteborg 1 december 2016 beslutadenätverket att tillsammans med projektet Säker Traumavård ta fram nationellarekommendationer för prehospital spinal rörelsebegränsning av patienter vidtrauma. Yrkesföreningarnas styrelser utsåg undertecknade representanter attmedverka i arbetet. Löf (Landstingens Ömsesidiga Försäkringsbolag) har viaprojektet Säker Traumavård bekostat arbetsgruppens arbetstid och resekostnader.Arbetsgruppen har efter litteratursökning och 5 protokollförda arbetsmötenarbetat fram föreliggande nationella rekommendationer. Samtliga föreningari Säker Traumavård har efter remissrunda juni – september 2018 ställt sigbakom rekommendationerna och det färdiga resultatet har presenterats förTraumanätverk Sverige den 30 nov 2018.Rekommendationerna ska ses som en sammanställning och värdering av idag bästa kända kunskap inom det beskrivna området. Dokumentet har ingenföreskrivande funktion och författarna kan inte i något avseende hållas juridisktansvariga för innehållet.Avsikten är att rekommendationerna ska resultera i ett enhetligt omhändertagandeav traumapatienter, där tekniker för prehospital spinal rörelsebegränsning användsså att de gör nytta för de patienter som behöver det, men inte används för patienteroch i situationer där de inte gör nytta. Syftet med bildmaterialet är att ge exempelpå hur prehospital spinal rörelsebegränsning kan utföras.
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| 28. |
- Norling, Ulf, et al.
(författare)
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Spinal rörelsebegränsningvid trauma : Prehospitalt och hospitalt
- 2022
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Traumanätverk Sverige samlar yrkesverksamma läkare och sjuksköterskorinom svensk traumavård. Vid sitt möte i Göteborg 1 december 2016 beslutadenätverket att tillsammans med projektet Säker Traumavård ta fram nationellarekommendationer för prehospital spinal rörelsebegränsning av patientervid trauma. Yrkesföreningarnas styrelser utsåg undertecknade representanteratt medverka i arbetet. Löf (Löf regionernas ömsesidiga försäkringsbolag)har via projektet Säker Traumavård bekostat arbetsgruppens arbetstid ochresekostnader.Arbetsgruppen har efter litteratursökning och protokollförda arbetsmötenarbetat fram föreliggande nationella rekommendationer.Rekommendationerna ska ses som en sammanställning och värdering av år2022 bästa kända kunskap inom det beskrivna området. Dokumentet har ingenföreskrivande funktion och författarna kan inte i något avseende hållas juridisktansvariga för innehållet.Avsikten är att rekommendationerna ska resultera i ett enhetligt omhändertagande av traumapatienter, där tekniker för spinal rörelsebegränsning användsså att de gör nytta för de patienter som behöver det, men inte används förpatienter och i situationer där de inte gör nytta. Syftet med bildmaterialet är attge exempel på hur prehospital spinal rörelsebegränsning kan utföras.
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| 29. |
- Papavero, Luca, et al.
(författare)
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Degenerative Cervical Myelopathy : A 7-Letter Coding System That Supports Decision-Making for the Surgical Approach
- 2020
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Ingår i: Neurospine. - : The Korean Spinal Neurosurgery Society. - 2586-6583 .- 2586-6591. ; 17:1, s. 164-171
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To validate with a prospective study a decision-supporting coding system for the surgical approach for multilevel degenerative cervical myelopathy.METHODS: Ten cases were presented on an internet platform, including clinical and imaging data. A single-approach (G1), a choice between 2 (G2), or 3 approaches (G3) were options. Senior and junior spine surgeons analyzed 7 parameters: location and extension of the compression of the spinal cord, C-spine alignment and instability, general morbidity and bone diseases, and K-line and multilevel corpectomy. For each parameter, an anterior, posterior, or combined approach was suggested. The most frequent letter or the last letter (if C) of the resulting 7-letter code (7LC) suggested the surgical approach. Each surgeon performed 2 reads per case within 8 weeks.RESULTS: G1: Interrater reliability between junior surgeons improved from the first read (κ = 0.40) to the second (κ = 0.76, p < 0.001) but did not change between senior surgeons (κ = 0.85). The intrarater reliability was similar for junior (κ = 0.78) and senior (κ = 0.71) surgeons. G2: Junior/senior surgeons agreed completely (58%/62%), partially (24%/23%), or did not agree (18%/15%) with the 7LC choice. G3: junior/senior surgeons agreed completely (50%/50%) or partially (50%/50%) with the 7LC choice.CONCLUSION: The 7LC showed good overall reliability. Junior surgeons went through a learning curve and converged to senior surgeons in the second read. The 7LC helps less experienced surgeons to analyze, in a structured manner, the relevant clinical and imaging parameters influencing the choice of the surgical approach, rather than simply pointing out the only correct one.
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| 30. |
- Sangeorzan, Irina, et al.
(författare)
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Toward Shared Decision-Making in Degenerative Cervical Myelopathy : Protocol for a Mixed Methods Study
- 2023
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Ingår i: JMIR Research Protocols. - : JMIR Publications. - 1929-0748. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health care decisions are a critical determinant in the evolution of chronic illness. In shared decision-making (SDM), patients and clinicians work collaboratively to reach evidence-based health decisions that align with individual circumstances, values, and preferences. This personalized approach to clinical care likely has substantial benefits in the oversight of degenerative cervical myelopathy (DCM), a type of nontraumatic spinal cord injury. Its chronicity, heterogeneous clinical presentation, complex management, and variable disease course engenders an imperative for a patient-centric approach that accounts for each patient's unique needs and priorities. Inadequate patient knowledge about the condition and an incomplete understanding of the critical decision points that arise during the course of care currently hinder the fruitful participation of health care providers and patients in SDM. This study protocol presents the rationale for deploying SDM for DCM and delineates the groundwork required to achieve this.Objective: The study's primary outcome is the development of a comprehensive checklist to be implemented upon diagnosis that provides patients with essential information necessary to support their informed decision-making. This is known as a core information set (CIS). The secondary outcome is the creation of a detailed process map that provides a diagrammatic representation of the global care workflows and cognitive processes involved in DCM care. Characterizing the critical decision points along a patient's journey will allow for an effective exploration of SDM tools for routine clinical practice to enhance patient-centered care and improve clinical outcomes.Methods: Both CISs and process maps are coproduced iteratively through a collaborative process involving the input and consensus of key stakeholders. This will be facilitated by Myelopathy.org, a global DCM charity, through its Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy community. To develop the CIS, a 3-round, web-based Delphi process will be used, starting with a baseline list of information items derived from a recent scoping review of educational materials in DCM, patient interviews, and a qualitative survey of professionals. A priori criteria for achieving consensus are specified. The process map will be developed iteratively using semistructured interviews with patients and professionals and validated by key stakeholders.Results: Recruitment for the Delphi consensus study began in April 2023. The pilot-testing of process map interview participants started simultaneously, with the formulation of an initial baseline map underway.Conclusions: This protocol marks the first attempt to provide a starting point for investigating SDM in DCM. The primary work centers on developing an educational tool for use in diagnosis to enable enhanced onward decision-making. The wider objective is to aid stakeholders in developing SDM tools by identifying critical decision junctures in DCM care. Through these approaches, we aim to provide an exhaustive launchpad for formulating SDM tools in the wider DCM community.
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| 31. |
- Telloni, Daniele, et al.
(författare)
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Evolution of Solar Wind Turbulence from 0.1 to 1 au during the First Parker Solar Probe-Solar Orbiter Radial Alignment
- 2021
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Ingår i: Astrophysical Journal Letters. - : American Astronomical Society. - 2041-8205 .- 2041-8213. ; 912:2
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Tidskriftsartikel (refereegranskat)abstract
- The first radial alignment between Parker Solar Probe and Solar Orbiter spacecraft is used to investigate the evolution of solar wind turbulence in the inner heliosphere. Assuming ballistic propagation, two 1.5 hr intervals are tentatively identified as providing measurements of the same plasma parcels traveling from 0.1 to 1 au. Using magnetic field measurements from both spacecraft, the properties of turbulence in the two intervals are assessed. Magnetic spectral density, flatness, and high-order moment scaling laws are calculated. The Hilbert-Huang transform is additionally used to mitigate short sample and poor stationarity effects. Results show that the plasma evolves from a highly Alfvenic, less-developed turbulence state near the Sun, to fully developed and intermittent turbulence at 1 au. These observations provide strong evidence for the radial evolution of solar wind turbulence.
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| 32. |
- Telloni, Daniele, et al.
(författare)
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Observation and Modeling of the Solar Wind Turbulence Evolution in the Sub-Mercury Inner Heliosphere
- 2022
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Ingår i: Astrophysical Journal Letters. - : Institute of Physics Publishing (IOPP). - 2041-8205 .- 2041-8213. ; 938:2
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Tidskriftsartikel (refereegranskat)abstract
- This letter exploits the radial alignment between the Parker Solar Probe and BepiColombo in late 2022 February, when both spacecraft were within Mercury's orbit. This allows the study of the turbulent evolution, namely, the change in spectral and intermittency properties, of the same plasma parcel during its expansion from 0.11 to 0.33 au, a still unexplored region. The observational analysis of the solar wind turbulent features at the two different evolution stages is complemented by a theoretical description based on the turbulence transport model equations for nearly incompressible magnetohydrodynamics. The results provide strong evidence that the solar wind turbulence already undergoes significant evolution at distances less than 0.3 au from the Sun, which can be satisfactorily explained as due to evolving slab fluctuations. This work represents a step forward in understanding the processes that control the transition from weak to strong turbulence in the solar wind and in properly modeling the heliosphere.
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| 33. |
- Tominaga, Hiroyuki, et al.
(författare)
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Surgical treatment of the severely damaged atlantoaxial joint with C1-C2 facet spacers Three case reports
- 2019
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Ingår i: Medicine. - : LIPPINCOTT WILLIAMS & WILKINS. - 0025-7974 .- 1536-5964. ; 98:22
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Atlantoaxial subluxation (AAS), caused by congenital factors, inflammation such as rheumatoid arthritis, infection, neoplasia, or trauma, is rare and severely erodes and subluxates atlantoaxial (AA) joints. For these patients, surgical reduction, and stabilization are difficult. Surgery, including anterior transoral decompression and posterior fixation, anterior endonasal decompression and fixation, and posterior decompression with AA or occipitocervical fixation, is often the only treatment available. However, there have only been 2 reports of C1-C2 facet spacer use in treating AAS. Here, we report the case histories of 3 patients with severely damaged and subluxated AA joints and symptomatic basilar invagination (BI), malalignment, or C2 root compression. Patient concerns: The cases included 2 women with rheumatoid arthritis and 1 man with spondyloarthropathy secondary to ulcerative colitis. Diagnosis: Radiographic imaging revealed severely damaged and subluxated AA joints. Their symptoms included worsening pain in the neck or occiput with or without myelopathy and neuralgia. Interventions: After realignment with C1-C2 spacers and posterior C1-C2 screw fixation, the patient symptoms were resolved. Outcomes: Of note, 2 of the 3 patients were healed without complications. One patient who underwent secondary revision surgery because of rod breakage and obvious nonunion at C0-C2 was determined to be healed at 1-year follow-up after the revision surgery. Lessons: We confirmed that C1-C2 facet spacers both reduced BI and occipitocervical coronal malalignment as well as releasing C2 root compression. Therefore, surgical restoration and fixation should be a required treatment in this very rare group of patients.
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