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- Abbott, Allan, et al.
(författare)
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Leg pain and psychological variables predict outcome 2-3 years after lumber fusion surgery
- 2011
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Ingår i: European spine journal. - : Springer. - 0940-6719 .- 1432-0932. ; 20:10, s. 1626-1634
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Tidskriftsartikel (refereegranskat)abstract
- Prediction studies testing a thorough range of psychological variables in addition to demographic, work-related and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2-3 years after lumbar fusion. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical straight leg raise significantly predicted back pain. Post-operative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and post-operative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.
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| 2. |
- Abul-Kasim, Kasim, et al.
(författare)
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Dural ectasia in adolescent idiopathic scoliosis: quantitative assessment on magnetic resonance imaging.
- 2010
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Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; Apr 7, s. 754-759
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Tidskriftsartikel (refereegranskat)abstract
- To our knowledge, the assessment of dural sac diameters in patients with adolescent idiopathic scoliosis (AIS) is not reported in the literature. The aim of this study was to find out if, dural ectasia occurs more frequently among patients with AIS, to define cut-off values for dural sac ratio and test the validity of such values. A total of 126 spine MRIs (79 patients with AIS and 47 control subjects) were included in this retrospective analysis (age range 7-25 years, 62% were females). Dural sac diameter (DSD) and vertebral body diameter (VBD) were estimated and dural sac ratio (DSR = DSD/VBD) was calculated at T5 and L3. DSR at T5 and L3 were 0.69 +/- 0.12, and 0.52 +/- 0.10, respectively, in patients with AIS compared with 0.62 +/- 0.11, and 0.44 +/- 0.07, respectively, in controls (P = 0.001 at T5 and <0.001 at L3). Our estimated cut-off values for DSR were 0.84 and 0.58 at T5 and L3, respectively. This resulted in 100% sensitivity compared with 74% when using the cut-off values proposed by Oosterhof et al. No statistically significant association was found between the occurrence of dural sac enlargement in patients with AIS and the severity of scoliotic deformity, the apical vertebral rotation, epidural fat thickness, occurrence of pain, neurological deficit, atypical scoliosis or rapid curve progression. Females were affected more frequently than males. As dural sac enlargement means thinning of the pedicles, we believe that the findings of this study have important clinical implications on the preoperative workup of AIS.
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| 3. |
- Abul-Kasim, Kasim, et al.
(författare)
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Patients with adolescent idiopathic scoliosis of Lenke type-1 curve exhibit specific pedicle width pattern.
- 2012
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Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 21, s. 57-63
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Study aim was to find out if patients with Lenke type 1 curve exhibit smaller pedicles and specific pedicle width pattern compared with individuals with no scoliosis. MATERIALS AND METHODS: 4,828 pedicle width measurements (T1-L5) in 61 consecutive patients with adolescent idiopathic scoliosis of Lenke type 1 curve, 61 control subjects, and 20 patients with Lenke type 5 curve, were retrospectively performed by an experienced neuroradiologist. RESULTS: Among patients with Lenke type 1 curve, the differences between the width of right and left upper thoracic pedicles were statistically significant; smallest at right T4 (2.6 mm). At scoliotic apex, the pedicles on the concave (left) side were significantly smaller than those on the convex (right) side; smallest at left T7 (3.2 mm). Among patients with Lenke type 1 curve, 97% had pedicle width <4 mm. CONCLUSIONS: Our study showed that patients with Lenke type 1 curve exhibit smaller pedicles and asymmetric pedicle width compared with control subjects.
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| 4. |
- Abul-Kasim, Kasim, et al.
(författare)
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Radiological and clinical outcome of screw placement in adolescent idiopathic scoliosis: evaluation with low-dose computed tomography.
- 2010
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Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 19:1, s. 96-104
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Tidskriftsartikel (refereegranskat)abstract
- Posterior corrective surgery using "all pedicle screw construct" carries risk of neurovascular complications. The study aims were to assess the screw placement in patients with adolescent idiopathic scoliosis using CT with low-radiation dose, and to evaluate the clinical outcome in patients with misplaced pedicle screws. CTs of 49 consecutive patients (873 screws, 79% thoracic) were retrospectively evaluated by two independent radiologists. A new grading system was developed to distinguish between lateral, medial and anterior cortical perforations, endplate perforation and foraminal perforation. The grading system is based on whether the cortical violation is partial or total rather than on mm-basis. The overall rate of screw misplacement was 17% (n = 149): 8% were laterally placed and 6.1% were medially placed. The rates of anterior cortical, endplate and foraminal perforation were 1.5, 0.9, and 0.5%, respectively. Lateral cortical perforation was more frequent in the thoracic spine (P = 0.005), whereas other types of misplacement including medial cortical perforation were more frequent on the left and the concave side of scoliotic curves (P = 0.002 and 0.003). No neurovascular complications were reported. The association between the occurrence of screw misplacement and the Cobb angle was statistically significant (P = 0.037). Misplacements exceeding half screw diameter should be classified as unacceptable. Low-dose CT implies exposing these young individuals to a significantly lower radiation dose than do other protocols used in daily clinical practice. We recommend using low-dose CT and the grading system proposed here in the postoperative assessment of screw placement.
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| 9. |
- Bodon, Gergely, et al.
(författare)
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Anatomical changes in occipitalization : is there an increased risk during the standard posterior approach?
- 2013
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Ingår i: European spine journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 22:3 suppl., s. 512-516
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE:The purpose of this study was to examine the anatomic changes in a case of occipitalization of the atlas.METHODS:Occipitalization of the atlas was found accidentally in a 64-year-old male cadaver. Anatomic dissection was carried out to examine the posterior aspect of the upper cervical region and craniocervical junction. The occipitalized atlas was then harvested and macerated to study the bony anomaly.RESULTS:In this case of occipitalization, fusion was observed at both lateral masses and at the left posterior hemiarch of the atlas. We found the following soft tissue changes: the rectus capitis posterior minor muscle was lacking on the left side and was atrophic on the right, the obliquus capitis superior muscle was present on both sides showing moderate atrophy and fatty changes. The posterior atlanto-axial membrane was thinner and asymmetric, had a free edge on the right side. Lateral to this edge the dura was lying free. We believe that these changes of the posterior atlanto-axial membrane together with the increased distance between the fused posterior arch of the atlas and the lamina of the axis could cause the observed "dura bulge" at this level. The vertebral artery was entering the skull through a canal on the left side.CONCLUSIONS:In our case, occipitalization considerably changed the anatomy of the upper cervical spine and craniocervical junction. Special care must be taken when using the posterior approach to avoid neurovascular injury in cases with occipitalization.
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