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Sandén, Bengt
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Publications (10 of 22) Show all publications
Iderberg, H., Willers, C., Borgstrom, F., Hedlund, R., Hagg, O., Moller, H., . . . Fritzell, P. (2019). Predicting clinical outcome and length of sick leave after surgery for lumbar spinal stenosis in Sweden: a multi-register evaluation. European spine journal, 28(6), 1423-1432
Open this publication in new window or tab >>Predicting clinical outcome and length of sick leave after surgery for lumbar spinal stenosis in Sweden: a multi-register evaluation
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2019 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 28, no 6, p. 1423-1432Article in journal (Refereed) Published
Abstract [en]

Purpose: Lumbar spinal stenosis (LSS) can be surgically treated, with variable outcome. Studies have linked socioeconomic factors to outcome, but no nation-wide studies have been performed. This register-based study, including all patients surgically treated for LSS during 2008-2012 in Sweden, aimed to determine predictive factors for the outcome of surgery.

Methods: Clinical and socioeconomic factors with impact on outcome in LSS surgery were identified in several high-coverage registers, e.g., the national quality registry for spine surgery (Swespine, FU-rate 70-90%). Multivariate regression analyses were conducted to assess their effect on outcome. Two patient-reported outcome measures, Global Assessment of leg pain (GA) and the Oswestry Disability Index (ODI), as well as length of sick leave after surgery were analyzed.

Results: Clinical and socioeconomic factors significantly affected health outcome (both GA and ODI). Some predictors of a good outcome (ODI) were: being born in the EU, reporting no back pain at baseline, a high disposable income and a high educational level. Some factors predicting a worse outcome were previous surgery, having had back pain more than 2years, having comorbidities, being a smoker, being on social welfare and being unemployed.

Conclusions: The study highlights the relevance of adding socioeconomic factors to clinical factors for analysis of patient-reported outcomes, although the causal pathway of most predictors' impact is unknown. These findings should be further investigated in the perspective of treatment selection for individual LSS patients. The study also presents a foundation of case mix algorithms for predicting outcome of surgery for LSS.

Keywords
Lumbar spinal stenosis, Regression analysis, Patient-reported outcome, Sick leave, Prediction algorithms, Spine surgery, Global assessment, Functional disability, Socioeconomic factors, Multi-register study
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-389615 (URN)10.1007/s00586-018-5842-3 (DOI)000471266200019 ()30511244 (PubMedID)
Available from: 2019-07-22 Created: 2019-07-22 Last updated: 2019-07-22Bibliographically approved
Pazarlis, K. A., Rostedt Punga, A., Schizas, N., Sandén, B., Michaëlsson, K. & Försth, P. (2019). Study protocol for a randomised controlled trial with clinical, neurophysiological, laboratory and radiological outcome for surgical versus non-surgical treatment for lumbar spinal stenosis: the Uppsala Spinal Stenosis Trial (UppSten). BMJ Open, 9, Article ID e030578.
Open this publication in new window or tab >>Study protocol for a randomised controlled trial with clinical, neurophysiological, laboratory and radiological outcome for surgical versus non-surgical treatment for lumbar spinal stenosis: the Uppsala Spinal Stenosis Trial (UppSten)
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, article id e030578Article in journal (Refereed) Published
Abstract [en]

Introduction: Symptomatic lumbar spinal stenosis is the most common indication for spinal surgery. However, more than one-third of the patients undergoing surgery for lumbar stenosis report dissatisfaction with the results. On the other hand, conservative treatment has shown positive results in some cases. This trial will compare the outcomes of surgical versus non-surgical treatment for lumbar stenosis. The study includes a multidimensional follow-up, aiming to study the association between outcome and other studied parameters, mainly electromyography and nerve conduction. Moreover, it may contribute to a better understanding of the pathophysiology of lumbar stenosis and to the development of future pharmacological treatments.

Methods and analysis: UppSten is a single-centre randomised controlled trial in which 150 patients with symptomatic lumbar spinal stenosis will be randomised into one of two treatment arms. The patients in the surgical arm will undergo laminectomy; the patients in the non-surgical arm will be given a structured physical training programme. The primary outcome of the study will be the Oswestry Disability Index. Secondary outcomes will include motor amplitude and degree of denervation activity obtained by means of nerve conduction studies and electromyography. Patient-reported outcome measures will be also used as secondary outcomes. Blood sample analysis and the investigation of potential inflammation markers are the additional secondary outcome parameters. Laboratory evaluation will include blood sample collection before the treatment initiation and after 6 months. Flavum ligament biopsies will be performed in the surgical group. Finally, tertiary outcomes will include neurophysiological measures, the objective walking ability and radiological evaluation.

Ethics and dissemination: The study is approved by the Local Ethics Committee (Dnr 2017-506), the Hospital's Clinical Trials Committee (2018-0001) and the National Biobank Council and Uppsala Biobank (BbA-827-2018-025). 

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2019
Keywords
lumbar spinal stenosis, spinal decompression, laminectomy, physical training, flavum ligament, neurophysiology, sagittal balance
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-402218 (URN)10.1136/bmjopen-2019-030578 (DOI)000502537200349 ()31434781 (PubMedID)
Available from: 2020-01-17 Created: 2020-01-17 Last updated: 2020-01-17Bibliographically approved
Christersson, A., Larsson, S. & Sandén, B. (2018). Clinical outcome after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: A prospective randomized study. Scandinavian Journal of Surgery, 107(1), 82-90
Open this publication in new window or tab >>Clinical outcome after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: A prospective randomized study
2018 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 107, no 1, p. 82-90Article in journal (Refereed) Published
Abstract [en]

Introduction: this study aimed to evaluate clinical results after plaster cast fixation for 10 days versus 1 month of moderately displaced and reduced distal radius fractures.Material and Methods: in a prospective randomized study, 109 patients with moderately displaced and conservatively treated distal radius fractures (age ≥50 years) were randomized 10 days after reduction to either removal of the plaster cast and immediate mobilization (active group) or to continued plaster cast fixation for another 3 weeks (control group). Grip strength, pincer strength, range of motion, and pain were assessed at 1, 4, and 12 months after reduction. Clinical outcome was evaluated using three functional assessment scores at 12 months.Results: treatment failed in 3/54 (6%) patients in the active group. one of these patients had the plaster cast reinstituted because of feelings of instability. the fractures in the other two patients displaced severely after mobilization and were therefore treated surgically. for the remaining 51 patients in the active group, the range of wrist motion was slightly better at 1 month compared with the controls, but there were no differences in grip or pincer strength or pain at the 1-month follow-up. there were no differences between the active and control group in any outcome at 4 or 12 months, including functional assessment scores at 12 months.Conclusion: treatment with mobilization 10 days after reduction of moderately displaced distal radius fractures resulted in a few treatment failures compared with none among controls. the only functional benefit for the remaining patients was a small and transient increase in range of motion at the 1-month follow-up. plaster cast removal 10 days after reduction in moderately displaced distal radius fractures is therefore not recommended.

National Category
Orthopaedics Surgery
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-334618 (URN)10.1177/1457496917731184 (DOI)000429935400013 ()
Available from: 2017-11-24 Created: 2017-11-24 Last updated: 2018-07-18Bibliographically approved
Försth, P., Svedniark, P., Noz, M. E., Maguire Jr, G. Q., Zeleznik, M. P. & Sandén, B. (2018). Motion Analysis in Lumbar Spinal Stenosis With Degenerative Spondylolisthesis A Feasibility Study of the 3DCT Technique Comparing Laminectomy Versus Bilateral Laminotomy. CLINICAL SPINE SURGERY, 31(8), E397-E402
Open this publication in new window or tab >>Motion Analysis in Lumbar Spinal Stenosis With Degenerative Spondylolisthesis A Feasibility Study of the 3DCT Technique Comparing Laminectomy Versus Bilateral Laminotomy
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2018 (English)In: CLINICAL SPINE SURGERY, ISSN 2380-0186, Vol. 31, no 8, p. E397-E402Article in journal (Refereed) Published
Abstract [en]

Study Design: This was a randomized radiologic biomechanical pilot study in vivo. Objective: The objectives of this study was to evaluate if 3-dimensional computed tomography is a feasible tool in motion analyses of the lumbar spine and to study if preservation of segmental midline structures offers less postoperative instability compared with central decompression in patients with lumbar spinal stenosis with degenerative spondylolisthesis. Summary of Background Data: The role of segmental instability after decompression is controversial. Validated techniques for biomechanical evaluation of segmental motion in human live subjects are lacking. Methods: In total, 23 patients (mean age, 68 y) with typical symptoms and magnetic resonance imaging findings of spinal stenosis with degenerative spondylolisthesis (> 3 mm) in 1 or 2 adjacent lumbar levels from L3 to L5 were included. They were randomized to either laminectomy (LE) or bilateral laminotomy (LT) (preservation of the midline structures). Documentation of segmental motion was made preoperatively and 6 months postoperatively with CT in provoked flexion and extension. Analyses of movements were performed with validated software. The accuracy for this method is 0.6 mm in translation and 1 degree in rotation. Patient-reported outcome measures were collected from the Swespine register preoperatively and 2-year postoperatively. Results: The mean preoperative values for 3D rotation and translation were 6.2 degrees and 1.8 mm. The mean increase in 3D rotation 6 months after surgery was 0.25 degrees after LT and 0.7 degrees after LE (P = 0.79) while the mean increase in 3D translation was 0.15 mm after LT and 1.1 mm after LE (P = 0.42). Both surgeries demonstrated significant improvement in patient-reported outcome measures 2 years postoperatively. Conclusions: The 3D computed tomography technique proved to be a feasible tool in the evaluation of segmental motion in this group of older patients. There was negligible increase in segmental motion after decompressive surgery. LE with removal of the midline structures did not create a greater instability compared with when these structures were preserved.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
Keywords
lumbar spinal stenosis, degenerative spondylolisthesis, instability, laminectomy, laminotomy, decompression, midline structures, 3DCT
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-367397 (URN)10.1097/BSD.0000000000000677 (DOI)000446526000013 ()29939843 (PubMedID)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2018-12-03Bibliographically approved
Robinson, Y., Sandén, B., Snellman, G., Triebel, J. & Strömqvist, F. (2017). Spine registries generate patient benefit in the century of big data [Letter to the editor]. The spine journal, 17(5), 755-756, Article ID S1529-9430(16)31245-1.
Open this publication in new window or tab >>Spine registries generate patient benefit in the century of big data
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2017 (English)In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 17, no 5, p. 755-756, article id S1529-9430(16)31245-1Article in journal, Letter (Other academic) Published
National Category
Orthopaedics Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-321942 (URN)10.1016/j.spinee.2016.12.100 (DOI)000401104500018 ()28431683 (PubMedID)
Available from: 2017-05-13 Created: 2017-05-13 Last updated: 2018-01-13Bibliographically approved
Triebel, J., Snellman, G., Sandén, B., Strömqvist, F. & Robinson, Y. (2017). Women do not fare worse than men after lumbar fusion surgery: Two-year follow-up results from 4,780 prospectively collected patients in the Swedish National Spine Register with lumbar degenerative disc disease and chronic low back pain.. The spine journal, 17(5), 656-662
Open this publication in new window or tab >>Women do not fare worse than men after lumbar fusion surgery: Two-year follow-up results from 4,780 prospectively collected patients in the Swedish National Spine Register with lumbar degenerative disc disease and chronic low back pain.
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2017 (English)In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 17, no 5, p. 656-662Article in journal (Refereed) Published
Abstract [en]

BACKGROUND CONTEXT: Proper patient selection is of outmost importance in surgical treatment of degenerative disc disease (DDD) with chronic low back pain (CLBP). Among other factors gender was previously found to influence lumbar fusion surgery outcome.

PURPOSE: This study investigates whether gender affects clinical outcome after lumbar fusion.

STUDY DESIGN: National registry cohort study PATIENT SAMPLE: Between 2001 and 2011, 2251 men and 2521 women were followed prospectively within the Swedish National Spine Registry (SWESPINE) after lumbar fusion surgery for DDD and CLBP.

OUTCOME MEASURES: Patient-reported outcome measures (PROM) visual analogue scale (VAS) for leg and back pain, Oswestry Disability Index (ODI), quality-of-life (QoL) parameter EQ5D and labour status and pain medication were collected preoperatively, 1 and 2 years after surgery.

METHODS: Gender-differences of baseline data and PROM improvement from baseline were analysed. The effect of gender on clinically important improvement of PROM was determined in a multivariate logistic regression model. Furthermore, gender-related differences in return-to-work were investigated.

RESULTS: Preoperatively women had worse leg pain (p<0.001), back pain (p=0.002), lower QoL (p<0.001) and greater disability than men (p=0.001). Postoperatively women presented greater improvement 2 years from baseline for pain, function and QoL (all p<0.01). Women had better chances of a clinically important improvement than men for leg pain (OR=1.39, 95% C.I.: 1.19-1.61, p<0.01) and back pain (OR=1.20,95% C.I.:1.03-1.40, p=0.02) as well as ODI (OR=1.24, 95% C.I.:1.05-1.47, p=0.01), but improved at a slower pace in leg pain (p<0.001), back pain (p=0.009), and disability (p=0.008). No gender differences were found in QoL and return-to-work at 2 years postoperatively.

CONCLUSIONS: Swedish women do not have worse results than men after spinal fusion surgery. Female patients present with worse pain and function preoperatively, but improve more than men do after surgery.

National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-307674 (URN)10.1016/j.spinee.2016.11.001 (DOI)000401104500006 ()27845232 (PubMedID)
Funder
Swedish Society of Medicine, SLS-257511
Available from: 2016-11-18 Created: 2016-11-18 Last updated: 2018-01-13Bibliographically approved
Försth, P., Olafsson, G., Carlsson, T., Frost, A., Borgstrom, F., Fritzell, P., . . . Sanden, B. (2016). A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis. New England Journal of Medicine, 374(15), 1413-1423
Open this publication in new window or tab >>A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis
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2016 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 374, no 15, p. 1413-1423Article in journal (Refereed) Published
Abstract [en]

BACKGROUND The efficacy of fusion surgery in addition to decompression surgery in patients who have lumbar spinal stenosis, with or without degenerative spondylolisthesis, has not been substantiated in controlled trials.

METHODS We randomly assigned 247 patients between 50 and 80 years of age who had lumbar spinal stenosis at one or two adjacent vertebral levels to undergo either decompression surgery plus fusion surgery (fusion group) or decompression surgery alone (decompression-alone group). Randomization was stratified according to the presence of preoperative degenerative spondylolisthesis (in 135 patients) or its absence. Outcomes were assessed with the use of patient-reported outcome measures, a 6-minute walk test, and a health economic evaluation. The primary outcome was the score on the Oswestry Disability Index (ODI; which ranges from 0 to 100, with higher scores indicating more severe disability) 2 years after surgery. The primary analysis, which was a per-protocol analysis, did not include the 14 patients who did not receive the assigned treatment and the 5 who were lost to follow-up.

RESULTS There was no significant difference between the groups in the mean score on the ODI at 2 years (27 in the fusion group and 24 in the decompression-alone group, P = 0.24) or in the results of the 6-minute walk test (397 m in the fusion group and 405 m in the decompression- alone group, P = 0.72). Results were similar between patients with and those without spondylolisthesis. Among the patients who had 5 years of follow-up and were eligible for inclusion in the 5-year analysis, there were no significant differences between the groups in clinical outcomes at 5 years. The mean length of hospitalization was 7.4 days in the fusion group and 4.1 days in the decompression-alone group (P< 0.001). Operating time was longer, the amount of bleeding was greater, and surgical costs were higher in the fusion group than in the decompression-alone group. During a mean follow-up of 6.5 years, additional lumbar spine surgery was performed in 22% of the patients in the fusion group and in 21% of those in the decompression-alone group.

CONCLUSIONS Among patients with lumbar spinal stenosis, with or without degenerative spondylolisthesis, decompression surgery plus fusion surgery did not result in better clinical outcomes at 2 years and 5 years than did decompression surgery alone.

National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-294662 (URN)10.1056/NEJMoa1513721 (DOI)000374128400005 ()27074066 (PubMedID)
Funder
Swedish Association of Local Authorities and RegionsMedtronic, Sweden
Available from: 2016-06-01 Created: 2016-05-26 Last updated: 2018-01-10Bibliographically approved
Försth, P., Michaëlsson, K. & Sandén, B. (2016). Fusion Surgery for Lumbar Spinal Stenosis REPLY [Letter to the editor]. New England Journal of Medicine, 375(6), 599-600
Open this publication in new window or tab >>Fusion Surgery for Lumbar Spinal Stenosis REPLY
2016 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 375, no 6, p. 599-600Article in journal, Letter (Other academic) Published
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-307905 (URN)10.1056/NEJMc1606502 (DOI)000382193100020 ()27509109 (PubMedID)
Available from: 2016-11-22 Created: 2016-11-22 Last updated: 2018-11-30
Försth, P., Michaëlsson, K. & Sandén, B. (2016). More on Fusion Surgery for Lumbar Spinal Stenosis [Letter to the editor]. New England Journal of Medicine, 375(18), 1806-1807
Open this publication in new window or tab >>More on Fusion Surgery for Lumbar Spinal Stenosis
2016 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 375, no 18, p. 1806-1807Article in journal, Letter (Refereed) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-307904 (URN)10.1056/NEJMc1610998#SA1 (DOI)000387007300031 ()27806224 (PubMedID)
Available from: 2016-11-22 Created: 2016-11-22 Last updated: 2018-11-30
Christersson, A., Larsson, S., Östlund, B. & Sandén, B. (2016). Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study. Journal of Orthopaedic Surgery and Research, 11, Article ID 145.
Open this publication in new window or tab >>Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study
2016 (English)In: Journal of Orthopaedic Surgery and Research, ISSN 1749-799X, E-ISSN 1749-799X, Vol. 11, article id 145Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this study was to examine whether reduced distal radius fractures can be treated with early mobilisation without affecting the radiographic results.

METHODS: In a prospective randomised study, 109 patients (mean age 65.8 (range 50-92)) with moderately displaced distal radius fractures were treated with closed reduction and plaster cast fixation for about 10 days (range 8-13 days) followed by randomisation to one of two groups: early mobilisation (n = 54, active group) or continued plaster cast fixation for another 3 weeks (n = 55, control group).

RESULTS: For three patients in the active group (6%), treatment proved unsuccessful because of severe displacement of the fracture (n = 2) or perceived instability (n = 1). From 10 days to 1 month, i.e. the only period when the treatment differed between the two groups, the active group displaced significantly more in dorsal angulation (4.5°, p < 0.001), radial angulation (2.0°, p < 0.001) and axial compression (0.5 mm, p = 0.01) compared with the control group. However, during the entire study period (i.e. from admission to 12 months), the active group displaced significantly more than the controls only in radial angulation (3.2°, p = 0.002) and axial compression (0.7 mm, p = 0.02).

CONCLUSIONS: Early mobilisation 10 days after reduction of moderately displaced distal radius fractures resulted in both an increased number of treatment failures and increased displacement in radial angulation and axial compression as compared with the control group. Mobilisation 10 days after reduction cannot be recommended for the routine treatment of reduced distal radius fractures.

TRIAL REGISTRATION: ClinicalTrail.gov, NCT02798614 . Retrospectively registered 16 June 2016.

National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-312927 (URN)10.1186/s13018-016-0478-7 (DOI)000391332600001 ()27871284 (PubMedID)
Available from: 2017-01-15 Created: 2017-01-15 Last updated: 2018-01-13Bibliographically approved
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