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- Sigmundsson, Freyr Gauti, 1972-, et al.
(author)
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Correlation between disability and MRI findings in lumbar spinal stenosis : a prospective study of 109 patients operated on by decompression
- 2011
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In: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 82:2, s. 204-210
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Journal article (peer-reviewed)abstract
- BACKGROUND AND PURPOSE: MRI is the modality of choice when diagnosing spinal stenosis but it also shows that stenosis is prevalent in asymptomatic subjects over 60. The relationship between preoperative health-related quality of life, functional status, leg and back pain, and the objectively measured dural sac area in single and multilevel stenosis is unknown. We assessed this relationship in a prospective study.PATIENTS AND METHODS: The cohort included 109 consecutive patients with central spinal stenosis operated on with decompressive laminectomy or laminotomy. Preoperatively, all patients completed the questionnaires for EQ-5D, SF-36, Oswestry disability index (ODI), estimated walking distance and leg and back pain (VAS). The cross-sectional area of the dural sac was measured at relevant disc levels in mm², and spondylolisthesis was measured in mm. For comparison, the area of the most narrow level, the number of levels with dural sac area < 70 mm², and spondylolisthesis were studied.RESULTS: Before surgery, patients with central spinal stenosis had low HRLQoL and functional status, and high pain levels. Patients with multilevel stenosis had better general health (p = 0.04) and less leg and back pain despite having smaller dural sac area than patients with single-level stenosis. There was a poor correlation between walking distance, ODI, the SF-36, EQ-5D, and leg and back pain levels on the one hand and dural sac area on the other. Women more often had multilevel spinal stenosis (p = 0.05) and spondylolisthesis (p < 0.001). Spondylolisthetic patients more often had small dural sac area (p = 0.04) and multilevel stenosis (p = 0.06).INTERPRETATION: Our findings indicate that HRQoL, function, and pain measured preoperatively correlate with morphological changes on MRI to a limited extent.
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| 2. |
- Sigmundsson, Freyr Gauti, 1972-, et al.
(author)
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Impact of pain on function and health related quality of life in lumbar spinal stenosis. A register study of 14,821 patients
- 2013
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In: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 38:15, s. E937-45
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Journal article (peer-reviewed)abstract
- STUDY DESIGN: Descriptive register study.OBJECTIVE: To describe preoperative levels of leg and back pain in patients operated for lumbar spinal stenosis, and to obtain information on how 3 different pain constellations (back pain < leg pain, back pain > leg pain, back pain = leg pain) correlate to health related quality of life (HRQoL) and function in different morphological types of stenosis.SUMMARY OF BACKGROUND DATA: Degenerative lumbar spinal stenosis is considered a poorly defined clinical syndrome and knowledge of what uniquely characterizes the different morphological types of stenosis is lacking.METHODS: Using the Swedish Spine Register, we studied (1) the pain characteristics of patients with central spinal stenosis (CSS), lateral recess stenosis, and spinal stenosis with spondylolisthesis (2) how HRQoL and function correlate to leg and back pain.RESULTS: Grading leg pain higher than back pain was the most common pain constellation (49%) followed by grading back pain more than leg pain (39%). Twelve percent had the same intensity of leg and back pain. The type of stenosis grading the highest burden of back pain was spinal stenosis with spondylolisthesis (ratio = 0.93; [95% confidence interval, CI] = 0.92-0.95), followed by central spinal stenosis (ratio = 0.88; [95% CI] = 0.88-0.89). Lateral recess stenosis had the lowest burden of back pain (ratio = 0.85; [95% CI] = 0.83-0.87). The lowest HRQoL and function was found in spinal stenosis with spondylolisthesis (back pain = leg pain group) where 55% ([95% CI] = 50-59) of patients could not walk more than 100 m. Patients with lateral recess stenosis had better self-estimated walking distance.CONCLUSION: Back pain is generally experienced to a high extent by patients scheduled for spinal stenosis surgery. HRQoL and function are low preoperatively irrespective of whether back or leg pain is predominant. In this large patient material patients who grade their back and leg pain as likeworthy have significantly lower values for HRQoL and function compared to patients reporting predominant leg or back pain but the difference is not clinically relevant.
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| 3. |
- Sigmundsson, Freyr Gauti, 1972-
(author)
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Introduction
- 2014
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In: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 85, s. 3-
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Journal article (peer-reviewed)
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| 4. |
- Sigmundsson, Freyr Gauti, 1972-, et al.
(author)
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Prognostic factors in lumbar spinal stenosis surgery
- 2012
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In: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 83:5, s. 536-542
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Journal article (peer-reviewed)abstract
- BACKGROUND AND PURPOSE: A considerable number of patients who undergo surgery for spinal stenosis have residual symptoms and inferior function and health-related quality of life after surgery. There have been few studies on factors that may predict outcome. We tried to find predictors of outcome in surgery for spinal stenosis using patient- and imaging-related factors.PATIENTS AND METHODS: 109 patients in the Swedish Spine Register with central spinal stenosis that were operated on by decompression without fusion were prospectively followed up 1 year after surgery. Clinical outcome scores included the EQ-5D, the Oswestry disability index, self-estimated walking distance, and leg and back pain levels (VAS). Central dural sac area, number of levels with stenosis, and spondylolisthesis were included in the MRI analysis. Multivariable analyses were performed to search for correlation between patient-related and imaging factors and clinical outcome at 1-year follow-up.RESULTS: Several factors predicted outcome statistically significantly. Duration of leg pain exceeding 2 years predicted inferior outcome in terms of leg and back pain, function, and HRLQoL. Regular and intermittent preoperative users of analgesics had higher levels of back pain at follow-up than those not using analgesics. Low preoperative function predicted low function and dissatisfaction at follow-up. Low preoperative EQ-5D scores predicted a high degree of leg and back pain. Narrow dural sac area predicted more gains in terms of back pain at follow-up and lower absolute leg pain.INTERPRETATION: Multiple factors predict outcome in spinal stenosis surgery, most importantly duration of symptoms and preoperative function. Some of these are modifiable and can be targeted. Our findings can be used in the preoperative patient information and aid the surgeon and the patient in a shared decision making process.
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