| 11. |
- Peolsson, Anneli, 1967-, et al.
(författare)
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Long-term randomised comparison between a carbon fibre cage and the Cloward procedure in the cervical spine
- 2007
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Ingår i: European spine journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 16:2, s. 173-178
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Tidskriftsartikel (refereegranskat)abstract
- A prospective randomised study. To compare the long-term outcome of anterior cervical decompression and fusion (ACDF) with a cervical intervertebral fusion cage (CIFC) and the Cloward procedure (CP). We have previously shown that the 2 year outcome of ACDF with the CIFC is the same as for the CP. The fusion rate in CIFC group was, however, only 55%, compared to 85% in CP group. The long-term outcome of CIFC ispoorly documented. Ninety-five patients with at least 6 months duration of neck pain and radicular arm pain were randomly allocated for ACDF with the CIFC or the CP. Radiographs were obtained at 2 years. Questionnaires about pain, disability (Neck Disability Index, NDI), distress, quality of life and global outcome were obtained from 83 patients (87%) (43 CIFC, 40 CP) at a mean follow-up time of 6 years (range 56–94 months). There were no significant differences in any outcome variable between the two treatments. For both CP and CIFC the pain intensity improved (P<0.0001) whereas the NDI was unchanged at long-term follow-up compared to preoperatively. In the CIFC group patients with a healed fusion had significantly less mean pain (24 mm) and NDI (26%) than patients with pseudarthrosis (42 and 41, respectively). Furthermore, the mean pain and NDI reported by CIFC patients with a healed fusion was significantly less than in healed CP patients (37 and 38, respectively). The long-term outcome is the same for the CIFC and the CP, with similar improvements of pain but with considerable remaining functional disability. However, in the subgroup of patients with healed CIFC the outcome was clearly better than for the non-healed CIFC group, and also clearly better than for the healed CP group. Thus, if the healing problem associated with the CIFC can be solved the results indicate that a better outcome can be expected with the cage than with the CP.
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| 12. |
- Peolsson, Anneli, et al.
(författare)
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Physical Function Outcome in Cervical Radiculopathy Patients After Physiotherapy Alone Compared With Anterior Surgery Followed by Physiotherapy A Prospective Randomized Study With a 2-Year Follow-up
- 2013
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 38:4, s. 300-307
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Prospective randomized study. Objective. To investigate differences in physical functional outcome in patients with radiculopathy due to cervical disc disease, after structured physiotherapy alone (consisting of neck-specific exercises with a cognitive-behavioral approach) versus after anterior cervical decompression and fusion (ACDF) followed by the same structured physiotherapy program. Summary of Background Data. No earlier studies have evaluated the effectiveness of a structured physiotherapy program or postoperative physical rehabilitation after ACDF for patients with magnetic resonance imaging–verified nerve compression due to cervical disc disease. Methods. Our prospective randomized study included 63 patients with radiculopathy and magnetic resonance imaging–verified nerve root compression, who were randomized to receive either ACDF in combination with physiotherapy or physiotherapy alone. For 49 of these patients, an independent examiner measured functional outcomes, including active range of neck motion, neck muscle endurance, and hand-related functioning before treatment and at 3-, 6-, 12-, and 24-month follow-ups. Results. There were no significant differences between the 2 treatment alternatives in any of the measurements performed (P = 0.17–0.91). Both groups showed improvements over time in neck muscle endurance (P <= 0.01), manual dexterity (P <= 0.03), and right-handgrip strength (P = 0.01). Conclusion. Compared with a structured physiotherapy program alone, ACDF followed by physiotherapy did not result in additional improvements in neck active range of motion, neck muscle endurance, or hand-related function in patients with radiculopathy. We suggest that a structured physiotherapy program should precede a decision for ACDF intervention in patients with radiculopathy, to reduce the need for surgery.
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| 13. |
- Peolsson, Anneli, 1967-, et al.
(författare)
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Prediction of fusion and importance of radiological variables for the outcome of anterior cervical decompression and fusion
- 2004
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Ingår i: European spine journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 13:3, s. 229-234
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Tidskriftsartikel (refereegranskat)abstract
- In a prospective randomised study with a 2-year follow-up, 103 patients were randomised to anterior cervical decompression and fusion (ACDF) with a cervical carbon-fibre intervertebral fusion cage (CIFC) or the Cloward procedure (CP). The purpose of the present study was to report predictors for fusion and also to investigate the importance of radiological variables for the clinical outcome. Gender, age, smoking habits, disc height, segmental kyphosis and type of surgical procedure were used as independent (before surgery) variables in a multiple regression model. Male gender, one-level surgery and CP treatment were significant predictors of fusion and explained 14% of the variability of fusion status at follow-up. Number of levels operated on, however, did not influence the clinical outcome. Fifty-two per cent of the women and 17% of the men in the CIFC group, and 25% of the women and 8% of the men in the CP group, had pseudarthrosis. Although patients with a healed fusion had significantly less pain intensity than patients with pseudarthrosis, radiological variables explained only 4% of the variability of pain at follow-up. Apart from a significant correlation between preoperative kyphosis and neck disability index at follow-up, no significant correlation between either postoperative kyphosis or preoperative or postoperative disc height and clinical outcome was found. Neither degree of segmental kyphosis nor disc height was different between patients with healed fusion and pseudarthrosis. One can conclude that male gender and type of surgery were significant predictors for a healed fusion and that pseudarthrosis affected outcome. In contrast to the commonly held view based mainly on theoretical considerations, no effect on clinical outcome could be demonstrated for segmental kyphosis and disc height at follow-up. Overall, the study shows that the importance of radiological factors as predictors for fusion as well as clinical outcome is limited.
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| 14. |
- Peolsson, Anneli, 1967-, et al.
(författare)
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Predictive factors for arm pain, neck pain, neck specific disability and health after anterior cervical decompression and fusion
- 2006
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Ingår i: Acta Neurochirurgica. - : Springer Science and Business Media LLC. - 0001-6268 .- 0942-0940. ; 148:2, s. 167-173
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Tidskriftsartikel (refereegranskat)abstract
- Background. Predictive factors for a low arm and neck pain, and good health after anterior cervical decompression and fusion (ACDF) with a cervical carbon fibre intervertebral fusion cage (CIFC) are still lacking.Method. A prospective consecutive study to investigate which preoperative factors that could predict a good outcome with regard to arm pain, neck pain, Neck Disability Index (NDI) and general health three years after ACDF with CIFC was conducted. Thirty-four patients were included before surgery. Measurements took place the day before, six months, one year and three years after ACDF.Findings. In multivariate analysis, to be a non-smoker before surgery was the most important factor for a low postoperative arm pain, a low pain frequency was the most important factor for low postoperative neck pain, normal rating on Distress and Risk Assessment Method (DRAM) was the most important factor for high function on NDI and a low initial pain intensity was the most important factor for good postoperative health. For all outcome variables a normal rating on DRAM was an important factor for a good outcome.Conclusions. Non-smoking, a low pain level and normal rating on DRAM were the best preoperative predictors of a good outcome in ACDF. Inclusion criteria for surgery should be based on a bio psychosocial model and DRAM seems to be useful for including the traditional inclusion criteria.
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| 15. |
- Peolsson, Anneli, et al.
(författare)
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Predictive factors for the outcome of anterior cervical decompression and fusion
- 2003
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Ingår i: European spine journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 12:3, s. 274-280
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Tidskriftsartikel (refereegranskat)abstract
- In a prospective study, 103 patients were randomised to anterior cervical decompression and fusion (ACDF) with a cervical carbon-fibre intervertebral fusion cage or the Cloward procedure. Preoperative background variables, active range of neck motion, handgrip strength, radiological evaluation and subjective variables were used in a multiple regression model to find the strongest predictors of postoperative outcome as measured by current pain intensity and the Neck Disability Index (NDI). Male sex, greater kyphosis at the level operated on, non-smoking, a greater neck mobility in right rotation, low disability on NDI, and older age were predictors of pain reduction and explained 30% of current pain intensity at follow-up. Higher educational level, non-smoking, greater kyphosis at the level operated on, a greater flexion mobility, greater right handgrip strength and lower current pain intensity were predictors of improvement, and explained 28% of the postoperative outcome on NDI. The most important predictor for postoperative pain intensity was the magnitude of the preoperative kyphosis. Preoperative pain intensity was the most important predictor for improved NDI. At follow-up about 70% of the patients still had deficit based on current pain intensity and NDI, and 44% had remaining dysfunction based on Odom's criteria. In conclusion, the multivariate analysis shows that male sex, non-smoking, greater segmental kyphosis and a low pain and disability level are preoperative predictors of a good outcome in ACDF. In addition, the study suggests the importance of other predictive variables than those studied for the outcome of ACDF.
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| 16. |
- Skeppholm, Martin, et al.
(författare)
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The Discover artificial disc replacement versus fusion in cervical radiculopathy-a randomized controlled outcome trial with 2-year follow-up
- 2015
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Ingår i: The spine journal. - : Elsevier BV. - 1529-9430 .- 1878-1632. ; 15:6, s. 1284-1294
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND CONTEXT: Several previous studies comparing artificial disc replacement (ADR) and fusion have been conducted with cautiously positive results in favor of ADR. This study is not, in contrast to most previous studies, an investigational device exemption study required by the Food and Drug Administration for approval to market the product in the United States. This study was partially funded with unrestricted institutional research grants by the company marketing the artificial disc used in this study. PURPOSE: To compare outcomes between the concepts of an artificial disc to treatment with anterior cervical decompression and fusion (ACDF) and to register complications associated to the two treatments during a follow-up time of 2 years. STUDY DESIGN/SETTING: This is a randomized controlled multicenter trial, including three spine centers in Sweden. PATIENT SAMPLE: The study included patients seeking care for cervical radiculopathy who fulfilled inclusion criteria. In total, 153 patients were included. OUTCOME MEASURES: Self-assessment with Neck Disability Index (NDI) as a primary outcome variable and EQ-5D and visual analog scale as secondary outcome variables. METHODS: Patients were randomly allocated to either treatment with the Depuy Discover artificial disc or fusion with iliac crest bone graft and plating. Randomization was blinded to both patient and caregivers until time for implantation. Adverse events, complications, and revision surgery were registered as well as loss of follow-up. RESULTS: Data were available in 137 (91%) of the included and initially treated patients. Both groups improved significantly after surgery. NDI changed from 63.1 to 39.8 in an intention-to-treat analysis. No statistically significant difference between the ADR and the ACDF groups could be demonstrated with NDI values of 39.1 and 40.1, respectively. Nor in secondary outcome measures (EQ-5D and visual analog scale) could any statistically significant differences be demonstrated between the groups. Nine patients in the ADR group and three in the fusion group underwent secondary surgery because of various reasons. Two patients in each group underwent secondary surgery because of adjacent segment pathology. Complication rates were not statistically significant between groups. CONCLUSIONS: Artificial disc replacement did not result in better outcome compared to fusion measured with NDI 2 years after surgery.
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| 17. |
- Vavruch, Ludek
(författare)
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DNA content, proliferation markers and histopathology as prognostic factors in Astrocytic tumours
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The DNA index and S-phase fractions obtained from freshly frozen and paraffin-embedded specimens of 49 primary intracranial tumors showed significant correlation. Very similar results were obtained when a subgroup of astrocytomas was analyzed. Thus, the feasibility of DNA-flow cytometry for retrospective studies of archival tumor specimens was confirmed. In a study of 134 astrocytomas a strong correlation between grade of malignancy, S-phase fraction and DNA ploidy type was seen. In multivariate Cox regression analysis of 60 cases with grade II or Ill astrocytomas, age, grade of malignancy, DNA ploidy and S-phase were independent prognostic factors. An age of under 50, grade II, low S-phase and tetraploid DNA pattern correlated with long survival. Twenty-two recurrent astrocytomas were investigated after primary and repeated surgery. The grade of malignancy had significantly increased at the time of re-operation. The S-phase also tended to increase while the DNA-index was essentially unchanged. In recurrent astrocytomas the original_grade of malignancy was the most important prognostic parameter, which significantly correlated with time to recurrence and with survival after reoperation. The recurrence-free interval was significantly shorter in patients over 50 years of age and patients with an aneuploid DNA pattern at the time of the first surgery. However, when DNA ploidy, histopathological grade and age were evaluated simultaneously in a multivariale analysis, DNA ploidy was not an independent prognostic indicator. A strong correlation was found between the cell replication measured as Ki-67 labeling index and grades of malignancy at primary and repealed surgery. When less than 10 percent of cells were stained by Ki-67 after primary surgery, patient survival was prolonged approximately three times compared to survival of patients with a high Ki-67 labeling index.
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