| 1. |
- Hermansen, Anna, et al.
(författare)
-
A more than 20-year follow-up of pain and disability after anterior cervical decompression and fusion surgery for degenerative disc disease and comparisons between two surgical techniques
- 2023
-
Ingår i: BMC Musculoskeletal Disorders. - : BMC. - 1471-2474. ; 24:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundFollow-ups more than 20 years after neck surgery are extremely rare. No previous randomized studies have investigated differences in pain and disability more than 20 years after ACDF surgery using different techniques. The purpose of this study was to describe pain and functioning more than 20 years after anterior cervical decompression and fusion surgery, and to compare outcomes between the Cloward Procedure and the carbon fiber fusion cage (CIFC).MethodsThis study is a 20 to 24-year follow-up of a randomized controlled trial. Questionnaires were sent to 64 individuals, at least 20 years after ACDF due to cervical radiculopathy. Fifty individuals (mean age 69, 60% women, 55% CIFC) completed questionnaires. Mean time since surgery was 22.4 years (range 20,5-24). Primary outcomes were neck pain and neck disability index (NDI). Secondary outcomes were frequency and intensity of neck and arm pain, headache, dizziness, self-efficacy, health related quality of life or global outcome. Clinically relevant improvements were defined as 30 mm decrease in pain and a decrease in disability of 20 percentage units. Between-group differences over time were analyzed with mixed design ANOVA and relationships between main outcomes and psychosocial factors were analyzed by Spearman s rho.ResultsNeck pain and NDI score significantly improved over time (p < .001), with no group differences in primary or secondary outcomes. Eighty-eight per cent of participants experienced improvements or full recovery, 71% (pain) and 41% (NDI) had clinically relevant improvements. Pain and NDI were correlated with lower self-efficacy and quality of life.ConclusionThe results from this study do not support the idea that fusion technique affects long-term outcome of ACDF. Pain and disability improved substantially over time, irrespective of surgical technique. However, the majority of participants reported residual disability not to a negligible extent. Pain and disability were correlated to lower self-efficacy and quality of life.
|
|
| 2. |
- Hermansen, Anna, 1974-, et al.
(författare)
-
Balance problems and dizziness after neck surgery–associations with pain and health-related quality of life
- 2020
-
Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040.
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Symptoms of dizziness or imbalance are often present in individuals with a variety of neck-disorders. The aims of this study were to determine the prevalence of patient-reported balance problems and dizziness 10–13years after surgery for cervical degenerative disc disease; evaluate associations with neck pain and health-related quality of life; and investigate how these individuals described dizziness. Material and methods: Sixty-eight individuals, 10years or more after anterior cervical decompression and fusion surgery, who previously participated in a randomized controlled trial were included. Participants completed questionnaires including ratings of dizziness and balance problems, the Dizziness Handicap Inventory, and an open-ended question regarding their experience of dizziness. Secondary outcomes were neck pain and quality of life. Results: Seventy-two percent experienced occasional or daily symptoms of unsteadiness and/or dizziness. Intensity ratings for dizziness during movement and for balance problems were similar and rather low, but had an impact on quality of life. Ratings of dizziness at rest were even lower. Dizziness ratings were associated with neck pain. Strenuous activities were related to dizziness and dizziness was primarily described as intermittent and non-rotatory. Conclusions: Dizziness or balance problems in the long-term after surgery for cervical degenerative disc disease are common and have an impact on daily life. Ratings of problem frequency and intensity were usually low. Dizziness and balance problems may affect quality of life. Patients’ descriptions of these problems are in line with common symptoms of cervicogenic dizziness. © 2019, © 2019 The Author(s). Published by Taylor & Francis.
|
|
| 3. |
- Joelson, Anders, 1970-, et al.
(författare)
-
Adjacent segment disk degeneration three decades after fusion without attempted reduction for high-grade isthmic spondylolisthesis
- 2020
-
Ingår i: Spine Deformity. - : Springer Science and Business Media LLC. - 2212-134X .- 2212-1358. ; 8, s. 743-750
-
Tidskriftsartikel (refereegranskat)abstract
- Study design: Observational study. Objectives: To evaluate adjacent segment disk degeneration (ASD) after fusion without attempted reduction at a young age for high-grade isthmic spondylolisthesis. Summary of background data: The clinical relevance of ASD remains unclear. Previous studies have shown that spinal fusion is associated with increased ASD but without influence on clinical outcome. Since high-grade spondylolisthesis is a severe kyphotic deformity, one could hypothesize that fusion without attempted reduction in young patients leads to accelerated adjacent segment disk degeneration in adult life. Methods: Anterior and posterior disk heights were evaluated on supine radiographs of the spine 8years and 29years after fusion without attempted reduction for high-grade spondylolisthesis and also on standing radiographs 8years and 33years after surgery. Pelvic parameters were evaluated on standing radiographs obtained 33years after surgery. Health-related quality of life was evaluated with the Scoliosis Research Society (SRS)-22r questionnaire. Results: One segment above fusion the anterior disk height significantly decreased on standing radiographs. Two segments above the fusion, the anterior disk height significantly decreased on supine as well as on standing radiographs. The largest reduction was found two segments above the fusion where the disk height was reduced from 33 to 28% of anterior vertebral height between the measurements at mean 8years and mean 33years after surgery. There were no statistically significant decreases in posterior disk heights in any measurement. The disk height showed a moderate negative correlation to PT. There was no correlation between disk height reduction and SRS-22r outcome. Conclusions: In our long-term follow-up of fusion without attempted reduction for high-grade spondylolisthesis in young patients, we found only a minor but statistically significant reduction in adjacent segment disk height which had no apparent impact on clinical outcome. Level of evidence: Level IV. © 2020, Scoliosis Research Society.
|
|
| 4. |
- Joelson, Anders, 1970-, et al.
(författare)
-
Clinical appearance and reliability in visual assessment after in situ fusion for high-grade isthmic spondylolisthesis
- 2021
-
Ingår i: Spine Deformity. - : Springer Science and Business Media LLC. - 2212-134X .- 2212-1358. ; 9, s. 155-160
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The current literature on clinical appearance after surgery for high-grade spondylolisthesis is inconclusive. The few long-term comparative studies on surgical reduction versus in situ fusion report contradictory findings concerning appearance-related issues. The purpose of the current study was to evaluate and quantify clinical appearance three decades after in situ fusion for high-grade isthmic spondylolisthesis. Methods: The Scoliosis Research Society (SRS)-22r questionnaire, digital photographs and standing lateral radiographs were used to evaluate clinical appearance for 22 patients three decades after in situ fusion for high-grade spondylolisthesis. The appearance was assessed by two spine surgeons, by the patient themselves, and by quantification of cosmesis relevant radiographic variables including pelvic parameters and sagittal balance. Results: The surgeon inter- and intraobserver reliability of the photographic evaluation of the trunk deformity was at most moderate (Cohen’s kappa 0.5). Correlation analysis revealed at most medium correlation between radiographic outcome and self-rated (SRS-22r) self-image (Spearman’s rank correlation coefficient 0.3). The agreement between patient and surgeon-rated trunk appearance was poor (Cohen’s kappa 0.2). Conclusions: Photographic evaluation of the trunk deformity in high-grade spondylolisthesis is unreliable. There were only weak correlations between patient self-assessed trunk appearance and radiographic parameters. The results reflect the pronounced subjectivity of cosmesis, and that the trunk deformity in high-grade spondylolisthesis is not easily observed. Level of evidence: IV. © 2020, Scoliosis Research Society.
|
|
