| 1. |
|
|
| 2. |
- Danielsson, Aina, 1953, et al.
(författare)
-
A prospective study of brace treatment versus observation alone in adolescent idiopathic scoliosis: a follow-up mean of 16 years after maturity
- 2007
-
Ingår i: Spine. - 1528-1159 .- 0362-2436. ; 32:20, s. 2198-207
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: The Swedish patients included in the previous SRS brace study were invited to take part in a long-term follow-up. OBJECTIVE: To investigate the rate of scoliosis surgery and progression of curves from baseline as well as after maturity. SUMMARY OF BACKGROUND DATA: Brace treatment was shown to be superior to electrical muscle stimulation, as well as observation alone, in the original SRS brace study. Few other studies have shown that brace treatment is effective in the treatment of scoliosis. METHODS: Of 106 patients, 41 in Malmo (all Boston brace treatment) and 65 in Goteborg (observation alone as the intention to treat), 87% attended the follow-up, including radiography and chart review. All radiographs were (re)measured for curve size (Cobb method) by an unbiased examiner. Searching in the mandatory national database for performed surgery identified patients who had undergone surgery after maturity. RESULTS: The mean follow-up time was 16 years and the mean age at follow-up was 32 years The 2 treatment groups had equal curve size at inclusion. The curve size of patients who were treated with a brace from the start was reduced by 6 degrees during treatment, but the curve size returned to the same level during the follow-up period. No patients who were primarily braced went on to undergo surgery. In patients with observation alone as the intention to treat, 20% were braced during adolescence due to progression and another 10% underwent surgery. Seventy percent were only observed and increased by 6 degrees from inclusion until now. No patients underwent surgery after maturity. Progression was related to premenarchal status. CONCLUSION: The curves of patients with adolescent idiopathic scoliosis with a moderate or smaller size at maturity did not deteriorate beyond their original curve size at the 16-year follow-up. No patients treated primarily with a brace went on to undergo surgery, whereas 6 patients (10%) in the observation group required surgery during adolescence compared with none after maturity. Curve progression was related to immaturity.
|
|
| 3. |
- Danielsson, Aina, 1953, et al.
(författare)
-
Back pain and function 22 years after brace treatment for adolescent idiopathic scoliosis: A case-control study - Part I
- 2003
-
Ingår i: Spine. - 0362-2436. ; 28, s. 2078-2085
-
Tidskriftsartikel (refereegranskat)abstract
- Study Design. A consecutive series of patients with adolescent idiopathic scoliosis and brace-treated (BT) between 1968 and 1977 before age 21 years (BT: n = 127; 122 females and 5 males) were followed-up at least 20 years after completion of the treatment. Objectives. To determine the long-term outcome in terms of back pain and function in patients BT for adolescent idiopathic scoliosis. Summary of Background Data. Few reports on long-term outcome of back pain and function have previously been presented for consecutive groups of these patients. Materials and Methods. One hundred ten (87%) BT patients were reexamined as part of an unbiased personal follow-up. This included a clinical examination, evaluation of curve size (Cobb method), and degenerative findings in full standing frontal and lateral radiographs. Validated questionnaires in terms of general and disease-specific quality-of-life aspects as well as present back and pain symptoms were used. One hundred nine had complete follow-up. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. Results. The deterioration of the curves was a mean of 7.9 degrees for all curves, excluding the only patient who underwent operation after 4 years (increase = 27 degrees). The patients had significantly more degenerative disc changes than the controls. Lumbar and thoracic back pain, although mild (2.7 on visual analogue scale), was significantly more frequent among the patients than the controls (75 vs. 47%, P = 0.0050 and 35.8 vs. 22.0%, P = 0.033, respectively). Only 24% of the patients admitted daily pain and analgesics were sparsely used. The patients had a slightly, but significantly, worse back function as measured by the Oswestry Disability Index (9.2 vs. 4.8, P = 0.0012) and general function score (7.7 vs. 4.2, P = 0.0006), but general health-related quality of life was not affected. No differences could be seen in sociodemographic variables between the groups, except for having ever been on sick leave because of the back (38% vs. 19%, P = 0.0036). Furthermore, no differences could be found between patients with different curve types (single thoracic, n = 50; lumbar, n = 19; double curves, n = 40). No correlation could be found between pain and its localization and curve size, an increase of at least 10 degrees since end of treatment, curve type, degenerative changes on any of the two lowest lumbar disc levels, body mass index, or smoking. Conclusions. More than 20 years after brace treatment for AIS, minimal pain and no dysfunction occurred compared with normal controls. Compared with surgically treated patients with a mean end result similar to this group, no significant differences were found except that BT patients experience more affective components of their pain.
|
|
| 4. |
- Danielsson, Aina, 1953, et al.
(författare)
-
Body Appearance and Quality of Life in Adult Patients with Adolescent Idiopathic Scoliosis Treated with a Brace or Under Observation Alone During Adolescence.
- 2011
-
Ingår i: Spine. - 1528-1159. ; 37:9, s. 755-762
-
Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: Study Design. The SRS brace study (JBJS-A, 1995) was comprised of patients with adolescent idiopathic scoliosis with moderate curve sizes (25-35°). Forty observed and 37 braced patients (77% of the original group) attended a follow-up a mean of 16 years after onset of maturity.Objectives. To analyze whether the subjectively evaluated present body appearance affects outcome as measured by quality of life in adult patients, previously treated by observation alone (non-braced) or with a brace during adolescence.Summary of Background Data. Few reports exist where validated outcome measures for body appearance have been used.Methods. Two quality of life questionnaires (SRS-22 and SF-36) were answered. The patient's opinion on body appearance was evaluated pictorially (i.e. sketches) using the Spinal Appearance Questionnaire, in which seven aspects of asymmetry are graded. These scores were compared with curve sizes, scoliometer measurements for grading trunk asymmetry and quality of life measures.Results. At follow-up, both groups were similar in terms of age (mean 32 years) and curve size (mean 35°). Distortion was inversely related to SRS-22 total score and satisfaction/dissatisfaction with management subscore, but not related to the SRS-22 function subscore. No difference was found between the groups in terms of trunk rotation, where the means were 10.7° and 10.8° for the non-braced and braced patients, respectively. The non-braced patients estimated that their body appearance was significantly less distorted than the braced patients (mean 12.9 and 15.0, respectively; p = 0.0028).Conclusions. Patients who experienced less body asymmetry were more satisfied with treatment and had a better quality of life. In spite of similar curve sizes and trunk rotation in both groups, the non-braced patients felt that their body appearance was less distorted than the braced patients.
|
|
| 5. |
- Danielsson, Aina, 1953, et al.
(författare)
-
Health-related quality of life in untreated versus brace-treated patients with adolescent idiopathic scoliosis: a long-term follow-up
- 2010
-
Ingår i: Spine. - 0362-2436. ; 35:2, s. 199-205
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: The previous Scoliosis Research Society brace study (JBJS-A, 1995) included patients with adolescent idiopathic scoliosis (AIS) with moderate curve sizes (25 degrees -35 degrees). The Swedish patients in this study were examined in a long-term follow-up. OBJECTIVE: The aim was to analyze and compare quality of life in adulthood between AIS patients who were only observed or treated with a brace during adolescence. SUMMARY OF BACKGROUND DATA: Quality of life as measured by the SRS-22 has not previously been presented for adult untreated AIS patients. METHODS: Forty patients who were only observed (due to a curve increase of less than 6 degrees until maturity), and 37 brace-treated patients attended the complete follow-up, including clinical and radiologic examination, and answered 2 quality of life questionnaires (SRS-22 and Short Form-36 [SF-36]). RESULTS: No differences were found between the groups in terms of age at follow-up (mean: 32 years), follow-up time after maturity (mean: 16.0 years), and curve size at inclusion (mean: 30 degrees) or at follow-up (mean: 35 degrees). The SRS-22/total score was a mean of 4.2 for braced patients and 4.1 for only observed patients. Neither total scores/subscales of the SRS-22 or SF-36 differed significantly between the groups. For the SF-36, no differences in relation to the Swedish age-matched norm scales were found for either group. CONCLUSION: Patients with moderate AIS report good quality of life in their 30s, as measured by both the SRS-22 and SF-36, regardless of whether they received no active treatment or were brace treated during adolescence. Neither of the groups displayed any difference compared with the age-matched norm groups for the SF-36.
|
|
| 6. |
- Danielsson, Aina, 1953, et al.
(författare)
-
Spinal range of motion, muscle endurance, and back pain and function at least 20 years after fusion or brace treatment for adolescent idiopathic scoliosis: a case-control study
- 2006
-
Ingår i: Spine. - 1528-1159. ; 31:3, s. 275-83
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: A consecutive series of patients with adolescent idiopathic scoliosis (AIS), treated between 1968 and 1977 before 21 years of age with either distraction and fusion using Harrington rods (ST, n = 156; 145 females and 11 males) or with brace (BT, n = 127; 122 females and 5 males), were followed at least 20 years after completion of the treatment. OBJECTIVES: To determine the long-term outcome in terms of spinal mobility and muscle strength and its possible correlations to present back pain and function in patients surgically or brace treated for AIS. SUMMARY OF BACKGROUND DATA: Few reports on long-term outcome on these variables have previously been presented for this group of patients. METHODS: A total of 135 (87%) of ST and 102 (80%) of BT patients underwent a complete examination by two unbiased observers incl. evaluation of lumbar muscle endurance and spinal mobility, curve size (Cobb method), validated questionnaires in terms of general and disease-specific quality of life aspects, as well as present back function and pain. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. RESULTS: For both ST and BT groups, lumbar spinal motion as well as muscle endurance were significantly decreased compared with controls. For ST patients, better lumbar extensor and flexor muscle endurance or lumbar spinal mobility correlated with a better physical function. The length of fusion into the lumbar spine correlated inversely with lumbar range of motion, but the finger-floor distance was not affected. BT patients with reduced lumbar spinal mobility experienced lumbar back pain more often than controls. CONCLUSIONS: For both brace treated and surgically treated AIS patients, spinal mobility and muscle endurance were reduced more than 20 years after completed treatment. The physical function was not severely restricted.
|
|
| 7. |
- Deyo, R. A., et al.
(författare)
-
Spinal fluid surgery
- 2005
-
Ingår i: Spine J. - 1529-9430. ; 5:6
-
Tidskriftsartikel (refereegranskat)
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Giesecke, T., et al.
(författare)
-
Evidence of augmented central pain processing in idiopathic chronic low back pain
- 2004
-
Ingår i: Arthritis Rheum. - : Wiley. - 0004-3591. ; 50:2, s. 613-23
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: For many individuals with chronic low back pain (CLBP), there is no identifiable cause. In other idiopathic chronic pain conditions, sensory testing and functional magnetic resonance imaging (fMRI) have identified the occurrence of generalized increased pain sensitivity, hyperalgesia, and altered brain processing, suggesting central augmentation of pain processing in such conditions. We compared the results of both of these methods as applied to patients with idiopathic CLBP (n = 11), patients with widespread pain (fibromyalgia; n = 16), and healthy control subjects (n = 11). METHODS: Patients with CLBP had low back pain persisting for at least 12 months that was unexplained by MRI/radiographic changes. Experimental pain testing was performed at a neutral site (thumbnail) to assess the pressure-pain threshold in all subjects. For fMRI studies, stimuli of equal pressure (2 kg) and of equal subjective pain intensity (slightly intense pain) were applied to this same site. RESULTS: Despite low numbers of tender points in the CLBP group, experimental pain testing revealed hyperalgesia in this group as well as in the fibromyalgia group; the pressure required to produce slightly intense pain was significantly higher in the controls (5.6 kg) than in the patients with CLBP (3.9 kg) (P = 0.03) or the patients with fibromyalgia (3.5 kg) (P = 0.006). When equal amounts of pressure were applied to the 3 groups, fMRI detected 5 common regions of neuronal activation in pain-related cortical areas in the CLBP and fibromyalgia groups (in the contralateral primary and secondary [S2] somatosensory cortices, inferior parietal lobule, cerebellum, and ipsilateral S2). This same stimulus resulted in only a single activation in controls (in the contralateral S2 somatosensory cortex). When subjects in the 3 groups received stimuli that evoked subjectively equal pain, fMRI revealed common neuronal activations in all 3 groups. CONCLUSION: At equal levels of pressure, patients with CLBP or fibromyalgia experienced significantly more pain and showed more extensive, common patterns of neuronal activation in pain-related cortical areas. When stimuli that elicited equally painful responses were applied (requiring significantly lower pressure in both patient groups as compared with the control group), neuronal activations were similar among the 3 groups. These findings are consistent with the occurrence of augmented central pain processing in patients with idiopathic CLBP.
|
|
| 11. |
- Giesecke, T., et al.
(författare)
-
Zentrale Schmerzverarbeitung bei chronischem Rückenschmerz : Hinweise auf verminderte Schmerzinhibition : Central pain processing in chronic low back pain : Evidence for reduced pain inhibition
- 2006
-
Ingår i: Schmerz. - : Springer Science and Business Media LLC. - 0932-433X. ; 20:5, s. 411-417
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: A study of patients with low back pain (LBP) had revealed altered central pain processing. At an equal pain level LBP patients had considerably more neuronal activation in the somatosensory cortices than controls. In a new analysis of this dataset, we further investigated the differences in central pain processing between LBP patients and controls, looking for possible pathogenic mechanisms.METHODS: Central pain processing was studied by functional magnetic resonance imaging (fMRI), using equally painful pressure stimuli in a block paradigm. In this study, we reanalyzed the fMRI data to statistically compare pain-elicited neuronal activation of both groups.RESULTS: Equally painful pressure stimulation resulted in a significantly lower increase of regional cerebral blood flow (rCBF) in the periaqueductal gray (PAG) of the LBP patients. The analysis further revealed a significantly higher increase of rCBF in LBP than in HC in the primary and secondary somatosensory cortex and the lateral orbitofrontal cortex (LOFK), elicited by these same stimuli.CONCLUSIONS: These findings support a dysfunction of the inhibitory systems controlled by the PAG as a possible pathogenic mechanism in chronic low back pain.
|
|
| 12. |
- Nachemson, Alf, 1931
(författare)
-
[A Swedish paradox explained]
- 2004
-
Ingår i: Lakartidningen. - 0023-7205. ; 101:20
-
Tidskriftsartikel (refereegranskat)
|
|
| 13. |
|
|
| 14. |
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
|
|
| 18. |
|
|
| 19. |
- Nachemson, Alf, 1931, et al.
(författare)
-
Postoperative flat back
- 2005
-
Ingår i: The Filed Spine. - Philadelphia : Lippincott Wiliams & Wilkins. ; , s. 53-56
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
|
|
| 20. |
|
|
| 21. |
- van Tulder, M W, et al.
(författare)
-
WITHDRAWN: Lumbar supports for prevention and treatment of low-back pain.
- 2006
-
Ingår i: Cochrane database of systematic reviews (Online). - 1469-493X. ; :2
-
Tidskriftsartikel (refereegranskat)abstract
- Lumbar supports are used in the treatment of low back pain patients to make the impairment and disability vanish or decrease. Lumbar supports are also used to prevent the onset of low back pain (primary prevention) or to prevent recurrences of a low back pain episode (secondary prevention).
|
|
