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MacDowall, A., Canto Moreira, N., Marques, C., Skeppholm, M., Lindhagen, L., Robinson, Y., . . . Olerud, C. (2019). Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes. Journal of Neurosurgery: Spine, 30(3), 323-331
Open this publication in new window or tab >>Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes
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2019 (English)In: Journal of Neurosurgery: Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 30, no 3, p. 323-331Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE

The method of artificial disc replacement (ADR) has been developed as an alternative treatment to fusion surgery after decompression for cervical degenerative disc disease (DDD) with radiculopathy. Preserving the motion of ADR devices aims to prevent immobilization side effects such as adjacent-segment pathology (ASP). However, long-term follow-up evaluations using MRI are needed to investigate if this intent is achieved.

METHODS

The authors performed a randomized controlled trial with 153 patients (mean age 47 years) undergoing surgery for cervical radiculopathy. Eighty-three patients received an ADR and 70 patients underwent fusion surgery. Outcomes after 5 years were assessed using patient-reported outcome measures using the Neck Disability Index (NDI) score as the primary outcome; motion preservation and heterotopic ossification by radiography; ASP by MRI; and secondary surgical procedures.

RESULTS

Scores on the NDI were approximately halved in both groups: the mean score after 5 years was 36 (95% confidence interval [CI] 31–41) in the ADR group and 32 (95% CI 27–38) in the fusion group (p = 0.48). There were no other significant differences between the groups in six other patient-related outcome measures. Fifty-four percent of the patients in the ADR group preserved motion at the operated cervical level and 25% of the ADRs were spontaneously fused. Seventeen ADR patients (21%) and 7 fusion patients (10%) underwent secondary surgery (p = 0.11), with 5 patients in each group due to clinical ASP.

CONCLUSIONS

In patients with cervical DDD and radiculopathy decompression as well as ADR, surgery did not result in better clinical or radiological outcomes after 5 years compared with decompression and fusion surgery.

Keywords
artificial disc replacement, treatment outcome, Neck Disability Index, cervical radiculopathy, adjacent-segment pathology
National Category
Orthopaedics Neurology
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-345965 (URN)10.3171/2018.9.SPINE18659 (DOI)000462447900004 ()30641852 (PubMedID)
Projects
Cervical radiculopathy, studies on pain analysis and treatment
Note

Title in thesis list of papers: Artificial Disc Replacement versus Fusion in Patients with Cervical Degenerative Disc Disease with radiculopathy ‒ 5-year Outcomes

Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2019-04-16Bibliographically approved
MacDowall, A., Skeppholm, M., Lindhagen, L., Robinson, Y., Löfgren, H., Michaëlsson, K. & Olerud, C. (2019). Artificial Disc Replacement versus Fusion in Patients with Cervical Degenerative Disc Disease with radiculopathy: 5-year Outcomes from the National Swedish Spine Register. Journal of Neurosurgery: Spine, 30(2), 159-167
Open this publication in new window or tab >>Artificial Disc Replacement versus Fusion in Patients with Cervical Degenerative Disc Disease with radiculopathy: 5-year Outcomes from the National Swedish Spine Register
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2019 (English)In: Journal of Neurosurgery: Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 30, no 2, p. 159-167Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The long-term efficacy of artificial disc replacement (ADR) surgery compared with fusion after decompression for the treatment of cervical degenerative disc disease and radiculopathy has not previously been investigated in a population-based setting.

METHODS: All patients with cervical degenerative disc disease and radiculopathy who were in the national Swedish Spine Registry (Swespine) beginning in January 1, 2006, were eligible for the study. Follow-up information was obtained up to November 15, 2017. The authors compared, using propensity score matching, patients treated with anterior decompression and insertion of an ADR with patients who underwent anterior decompression combined with fusion surgery. The primary outcome was the Neck Disability Index (NDI), a patient-reported function score ranging from 0% to 100%, with higher scores indicating greater disability and a minimum clinically important difference of > 15%.

RESULTS: A total of 3998 patients (2018: 1980 women/men) met the inclusion criteria, of whom 204 had undergone arthroplasty and 3794 had undergone fusion. After propensity score matching, 185 patients with a mean age of 49.7 years remained in each group. Scores on the NDI were approximately halved in both groups after 5 years, but without a significant mean difference in NDI (3.0%; 95% CI -8.4 to 2.4; p = 0.28) between the groups. There were no differences between the groups in EuroQol-5 Dimensions or in pain scores for the neck and arm.

CONCLUSIONS: In patients with cervical degenerative disc disease and radiculopathy, decompression plus ADR surgery did not result in a clinically important difference in outcomes after 5 years, compared with decompression and fusion surgery.

Keywords
Cervical radiculopathy, Artificial disc replacement, Surgical treatment outcome, Anterior decompression and fusion
National Category
Orthopaedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-345976 (URN)10.3171/2018.7.SPINE18657 (DOI)000461013000002 ()30485205 (PubMedID)
Projects
Cervical radiculopathy, studies on pain analysis and treatment
Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2019-04-16Bibliographically approved
Manabe, N., Covaro, A., Bobinski, L., Shimizu, T., Olerud, C. & Robinson, Y. (2019). The Relationship between the Occipitocervical Junction and Thoracic Kyphosis in Ankylosing Spondylitis: A Retrospective Cohort Study of 86 Cervical Fractures in Surgically Treated Patients. Asian Spine Journal, 13(1), 103-110
Open this publication in new window or tab >>The Relationship between the Occipitocervical Junction and Thoracic Kyphosis in Ankylosing Spondylitis: A Retrospective Cohort Study of 86 Cervical Fractures in Surgically Treated Patients
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2019 (English)In: Asian Spine Journal, ISSN 1976-1902, E-ISSN 1976-7846, Vol. 13, no 1, p. 103-110Article in journal (Refereed) Published
Abstract [en]

Study Design: Retrospective analysis of prospectively collected data.

Purpose: To describe the radiological characteristics of the occipitocervical area in patients with ankylosing spondylitis (AS) using the novel measure X-angle and to describe the correlation between the ankylosed occipitoatlantoaxial (OAA) joint and thoracic kyphosis (TK).

Overview of Literature: AS affects the axial skeleton, leading to progressive ankylosis of all vertebral segments. The effect of ankylosis on the upper cervical area of these patients is not well documented.

Methods: All patients with complete ankylosis of the spinal column between C3 and T1, treated for cervical spinal fracture between 2007 and 2014, were eligible for inclusion in this study. The level of cervical fracture was identified. The T1-12 and T5-12 angles were measured using preoperative lateral radiography. The progressive degeneration of the C0-C1-C2 joints was evaluated via the new indicator X-angle, through the measurement of the angle of the C0-C1-C2 articulations in the coronal plane using computed tomography.

Results: We included 86 consecutive patients with AS (67 males) aged 69±12 years. The patients were divided into two groups according to the degenerative change in the C0-C1 joint (62 patients with a mobile joint and 24 patients with an ankylosed joint). There was no significant difference between the two groups in terms of age (p =0.094) and level of fracture (p =0.949). The most commonly affected level was C6. There was no requirement for revision due to non-union in any of the patients. There was a statistically significant difference observed in the T1-12, T5-12, and X-angles (p =0.004, 0.001, and <0.001, respectively). TK was greater in the ankylosed joint group than in the mobile joint group. The X-angle was also greater in the ankylosed joint group because of the vertical destruction of the OAA joint.

Conclusions: Thoracic hyperkyphosis resulted in degenerative changes in the C0-C1-C2 joint in patients with AS. The X-angle is a reliable method for measuring the integrity of the C0-C1-C2 joint in such patients.

Keywords
Ankylosing spondylitis, Atlanto-occipital joint, Kyphosis, Spinal fracture
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-372006 (URN)10.31616/asj.2018.0010 (DOI)000457550900014 ()30326690 (PubMedID)
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-03-08Bibliographically approved
Koller, H., Ames, C., Mehdian, H., Bartels, R., Ferch, R., Deriven, V., . . . Robinson, Y. (2018). Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project.. European spine journal, 28(2), 324-344
Open this publication in new window or tab >>Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project.
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2018 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 28, no 2, p. 324-344Article in journal (Refereed) Epub ahead of print
Abstract [en]

INTRODUCTION AND PURPOSE: Little information exists on surgical characteristics, complications and outcomes with corrective surgery for rigid cervical kyphosis (CK). To collate the experience of international experts, the CSRS-Europe initiated an international multi-centre retrospective study.

METHODS: Included were patients at all ages with rigid CK. Surgical and patient specific characteristics, complications and outcomes were studied. Radiographic assessment included global and regional sagittal parameters. Cervical sagittal balance was stratified according to the CSRS-Europe classification of sagittal cervical balance (types A-D).

RESULTS: Eighty-eight patients with average age of 58 years were included. CK etiology was ankylosing spondlitis (n = 34), iatrogenic (n = 25), degenerative (n = 9), syndromatic (n = 6), neuromuscular (n = 4), traumatic (n = 5), and RA (n = 5). Blood loss averaged 957 ml and the osteotomy grade 4.CK-correction and blood loss increased with osteotomy grade (r = 0.4/0.6, p < .01). Patients with different preop sagittal balance types had different approaches, preop deformity parameters and postop alignment changes (e.g. C7-slope, C2-7 SVA, translation). Correction of the regional kyphosis angle (RKA) was average 34° (p < .01). CK-correction was increased in patients with osteoporosis and osteoporotic vertebrae (POV, p = .006). 22% of patients experienced a major long-term complication and 14% needed revision surgery. Patients with complications had larger preop RKA (p = .01), RKA-change (p = .005), and postop increase in distal junctional kyphosis angle (p = .02). The POV-Group more often experienced postop complications (p < .0001) and revision surgery (p = .02). Patients with revision surgery had a larger RKA-change (p = .003) and postop translation (p = .04). 21% of patients had a postop segmental motor deficit and the risk was elevated in the POV-Group (p = .001).

CONCLUSIONS: Preop patient specific, radiographic and surgical variables had a significant bearing on alignment changes, outcomes and complication occurrence in the treatment of rigid CK.

Keywords
Cervical osteotomy, Cervical spine, Kyphosis, Rigid deformity
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-372005 (URN)10.1007/s00586-018-5835-2 (DOI)30483961 (PubMedID)
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-05-16Bibliographically approved
Elmekaty, M., Kotani, Y., El Mehy, E., Robinson, Y., El Tantawy, A., Sekiguchi, I. & Fujita, R. (2018). Clinical and Radiological Comparison between Three Different Minimally Invasive Surgical Fusion Techniques for Single-Level Lumbar Isthmic and Degenerative Spondylolisthesis: Minimally Invasive Surgical Posterolateral Fusion versus Minimally Invasive Surgical Transforaminal Lumbar Interbody Fusion versus Midline Lumbar Fusion. Asian Spine Journal, 12(5), 870-879
Open this publication in new window or tab >>Clinical and Radiological Comparison between Three Different Minimally Invasive Surgical Fusion Techniques for Single-Level Lumbar Isthmic and Degenerative Spondylolisthesis: Minimally Invasive Surgical Posterolateral Fusion versus Minimally Invasive Surgical Transforaminal Lumbar Interbody Fusion versus Midline Lumbar Fusion
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2018 (English)In: Asian Spine Journal, ISSN 1976-1902, E-ISSN 1976-7846, Vol. 12, no 5, p. 870-879Article in journal (Refereed) Published
Abstract [en]

Study Design: Retrospective cohort study.

Purpose: Comparison between three different minimally invasive surgical (MIS) fusion techniques for single-level lumbar spondylolisthesis.

Overview of Literature: There has been an increase in the development and utilization of MIS techniques for lumbar spine fusion. No study has compared the efficacy of MIS-posterolateral fusion (MIS-PLF), MIS-transforaminal lumbar interbody fusion (MIS-TLIF), and midline lumbar fusion (MIDLF) with modified cortical bone trajectory screws for lumbar spondylolisthesis.

Methods: Fifty-nine patients with single-level lumbar spondylolisthesis and a minimum follow-up period of 1 year were included in this study. The MIS-PLF, MIS-TLIF, and MIDLF groups included 22, 15, and 22 patients, respectively. The average age of the groups was 70.6, 49.3, and 62.7 years, respectively. The evaluation parameters were operation time, intraoperative bleeding, serum C-reactive protein (CAP) value, creatine kinase (CK) value, and overall functional outcome as per the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) score. The changes in the lumbar lordosis angle (LLA), segmental disc angle (SDA), and disc height were measured. Fusion rate, screw loosening, and loss of correction were also assessed.

Results: MIDLF showed a significantly shorter operation time (111 min), less bleeding amount (112.5 mL), and lower values of CRP and CK than the other two techniques. There was no significant difference in the JOABPEQ scores of the three groups. MIDLF resulted in a greater increase in the LLA and SDA postoperatively. MIDLF and MIS-TLIF resulted in a significant increase in the middle disc height compared with MIS-PLF. MIDLF showed a lower loss of correction after 6 months postoperatively (2.6%) than MIS-PLF (5.2%) and MIS-TLIF (4.2%). The fusion rate was 100% in the MIDLF and MIS-TLIF groups and 90% in the MIS-PLF group. Screw loosening occurred in 10% of the MIS-PLF cases, 7.14% of the MIS-TLIF cases, and 4.76% of the MIDLF cases.

Conclusions: MIDLF was the least invasive, and there was no significant difference between the three groups in terms of fusion, screw loosening, and clinical outcomes.

Place, publisher, year, edition, pages
KOREAN SOC SPINE SURGERY, 2018
Keywords
Thoracolumbar spine, Isthmic and degenerative spondylolisthesis, Minimally invasive spine surgery, Midline lumbar fusion, Modified cortical bone trajectory screw
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-365286 (URN)10.31616/asj.2018.12.5.870 (DOI)000444276300012 ()30213170 (PubMedID)
Available from: 2018-11-14 Created: 2018-11-14 Last updated: 2018-11-14Bibliographically approved
MacDowall, A., Skeppholm, M., Lindhagen, L., Robinson, Y. & Olerud, C. (2018). Effects of preoperative mental distress versus surgical modality, arthroplasty, or fusion on long-term outcome in patients with cervical radiculopathy. Journal of Neurosurgery: Spine, 29(4), 371-379
Open this publication in new window or tab >>Effects of preoperative mental distress versus surgical modality, arthroplasty, or fusion on long-term outcome in patients with cervical radiculopathy
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2018 (English)In: Journal of Neurosurgery: Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 29, no 4, p. 371-379Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE Several efforts have been made to investigate the long-term efficacy of artificial disc replacement surgery compared with that of fusion after decompression for the treatment of cervical degenerative disc disease and radiculopathy. However, research on the impact of mental distress on surgical treatment outcome has been sparse. The aim of the authors was to investigate the potential predictive value of preoperative risk factors in determining long-term outcome. METHODS A total of 153 patients (mean age 47 years) with single-or double-level cervical degenerative disc disease and radiculopathy were randomly assigned to undergo either anterior cervical discectomy and fusion (n = 70) or artificial disc replacement (n = 83). The primary outcome was the Neck Disability Index (NDI) score, a patient-reported function score that ranges from 0% to 100%; higher scores indicate greater disability. Preoperative variables such as sex, age, smoking status, employment status, having a strenuous job, neck pain duration, arm pain duration, amount of regular exercise, Hospital Anxiety and Depression Scale (HADS) score, NDI score, whether surgery was performed on 1 or 2 levels, and allocated treatment were analyzed in multiple linear regression models with the 5-year NDI score as the outcome. RESULTS A total of 47 (31%) patients had either a HADS anxiety or HADS depression score of 10 points or higher. High values on the preoperative HADS were a negative predictor of outcome (p = 0.009). Treatment allocation had no effect on 5-year NDI scores (p = 0.32). CONCLUSIONS Preoperative mental distress measured with the HADS affects long-term outcome in surgically treated patients with cervical radiculopathy.

Place, publisher, year, edition, pages
AMER ASSOC NEUROLOGICAL SURGEONS, 2018
Keywords
artificial disc replacement, Hospital Anxiety and Depression Scale, treatment outcome, Neck Disability Index, cervical radiculopathy
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-367408 (URN)10.3171/2018.2.SPINE171378 (DOI)000446246000004 ()30004317 (PubMedID)
Funder
Stockholm County Council
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2018-12-03Bibliographically approved
Robinson, Y., Lison Almkvist, V., Fahlstedt, M., Olerud, C. & Halldin, P. (2018). Finite element analysis of long posterior transpedicular instrumentation for cervicothoracic fractures related to ankylosing spondylitis. Global Spine Journal, 8(6), 570-578
Open this publication in new window or tab >>Finite element analysis of long posterior transpedicular instrumentation for cervicothoracic fractures related to ankylosing spondylitis
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2018 (English)In: Global Spine Journal, ISSN 2192-5682, E-ISSN 2192-5690, Vol. 8, no 6, p. 570-578Article in journal (Refereed) Published
Abstract [en]

Background: Spinal fractures related to AS are often treated by long posterior stabilisation. The biomechanical rationale behind is the neutralisation of long lever arms in the ankylosed spine to avoid non-union or neurological deterioration. Despite the widespread application of long posterior instrumentation it has never been investigated in a biomechanical model. The objective of this study is to develop a finite element model for spinal fractures related to AS and to establish a biomechanical foundation for long posterior stabilisation of cervicothoracic fractures related to ankylosing spondylitis (AS).

Methods: An existing finite element-model (consisting of two separately developed models) including the cervical and thoracic spine were adapted to the conditions of AS (all discs fused, C0-C1 and C1-C2 mobile) and a fracture at the level C6-C7 was simulated. Besides a normal spine (no AS, no fracture) and the uninstrumented fractured spine four different posterior transpedicular instrumentations were tested: 1. Fracture uninstrumented, 2. Short instrumentation C6-C7, 3. Medium instrumentation C5-T1, 4. Long instrumentation C3-T3, 5. Skipped level long instrumentation C3-C6-C7-T3.

Three loads (1.5g, 3.0g, 4.5g) were applied according to a specific load curve. Kinematic data such as the gap distance in the fracture site were obtained. Furthermore the stresses in the ossified parts of the discs were evaluated.

Findings: All posterior stabilisation methods could normalise the axial stability at the fracture site as measured with gap distance. With larger accelerations than 1.5g ,  it was seen that the longer instrumentations resulted in lesser maximal gap distance than the Short instrumentation. The maximum stress at the cranial instrumentation end (C3-C4) was slightly greater if every level was instrumented, than in the skipped level model. The skipped level instrumentation achieved similar rotatory stability as the long multilevel instrumentation.

Interpretation: The FE model developed simulated a spinal fracture at C6-C7 level. Skipping instrumentation levels without giving up instrumentation length also reduces the stresses in the ossified tissue within the range of the instrumentation and does not decrease the stability in a finite element model of a cervicothoracic fracture related to AS. Considering the risks associated with every additional screw placed, the skipped level instrumentation has advantages with regard to patient safety. The effects of the degree of osteoporosis, screw placement and pre-existing kyphosis on the construct stability were not investigated in this study and should be a matter of further research. 

National Category
Orthopaedics Bio Materials
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-307366 (URN)10.1177/2192568217745068 (DOI)000457230900005 ()30202710 (PubMedID)
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2019-02-18Bibliographically approved
Atesok, K., Tanaka, N., O'Brien, A., Robinson, Y., Pang, D., Deinlein, D., . . . Theiss, S. (2018). Posttraumatic Spinal Cord Injury without Radiographic Abnormality. Advances in Orthopedics, 2018, Article ID 7060654.
Open this publication in new window or tab >>Posttraumatic Spinal Cord Injury without Radiographic Abnormality
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2018 (English)In: Advances in Orthopedics, ISSN 2090-3464, E-ISSN 2090-3472, Vol. 2018, article id 7060654Article, review/survey (Refereed) Published
Abstract [en]

“Spinal Cord Injury without Radiographic Abnormality” (SCIWORA) is a term that denotes objective clinical signs of posttraumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. SCIWORA is most commonly seen in children with a predilection for the cervical spinal cord due to the increased mobility of the cervical spine, the inherent ligamentous laxity, and the large head-to-body ratio during childhood. However, SCIWORA can also be seen in adults and, in rare cases, the thoracolumbar spinal cord can be affected too. Magnetic resonance imaging (MRI) has become a valuable diagnostic tool in patients with SCIWORA because of its superior ability to identify soft tissue lesions such as cord edema, hematomas and transections, and discoligamentous injuries that may not be visualized in plain radiographs and CT. The mainstay of treatment in patients with SCIWORA is nonoperative management including steroid therapy, immobilization, and avoidance of activities that may increase the risk of exacerbation or recurrent injury. Although the role of operative treatment in SCIWORA can be controversial, surgical alternatives such as decompression and fusion should be considered in selected patients with clinical and MRI evidence of persistent spinal cord compression and instability.

Place, publisher, year, edition, pages
London: Hindawi Publishing Corporation, 2018
National Category
Neurology Orthopaedics
Research subject
Neurosurgery; Orthopaedics
Identifiers
urn:nbn:se:uu:diva-337858 (URN)10.1155/2018/7060654 (DOI)000422829800001 ()29535875 (PubMedID)
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2018-05-04Bibliographically approved
Hirasawa, A., Robinson, Y., Olerud, C., Wakao, N., Kamiya, M., Murotani, K. & Deie, M. (2018). Regional Differences in Diffuse Idiopathic Skeletal Hyperostosis: A Retrospective Cohort Study from Sweden and Japan. Spine, 43(24), E1474-E1478
Open this publication in new window or tab >>Regional Differences in Diffuse Idiopathic Skeletal Hyperostosis: A Retrospective Cohort Study from Sweden and Japan
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2018 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 43, no 24, p. E1474-E1478Article in journal (Refereed) Published
Abstract [en]

Study Design: We retrospectively reviewed computed tomography (CT) records of patients in Japan and Sweden, which are both aging populations. Objective. To research the influence of ethnicity and region on diffuse idiopathic skeletal hyperostosis (DISH) prevalence.

Summary of Background Data_ DISH can complicate nonsurgical treatment of spinal fractures and often requires surgical intervention. We previously reported a prevalence of DISH in Japan that was higher than that reported in other studies.

Methods: We retrospectively reviewed CT records of patients in Japan and Sweden, which have both aging populations. Patients undergoing whole body CT during trauma examinations at an acute outpatient clinic in Uppsala University Hospital in a 1-year period were eligible for inclusion. Excluded were those less than 40 and more than or equal to 90 years old, and those with previous spinal surgery. The prevalence of DISH by sex and age was determined according to radiographic criteria by Resnick. Results from Sweden were compared with the Japan data, which we previously reported.

Results: Age of the eligible subjects (265 men and 153 women) ranged from 40 to 89 years, with a mean age of 63.4 years. Among men, 86 (32.5%) were diagnosed with DISH, and the results by age (40s, 50s, 60s, 70s, and 80s) were: 6 (10.7%), 13 (22%), 35 (46.1%), 17 (34%), and 15 (62.5%) patients, respectively. Among women, 16 (10.5%) had DISH, and the results by age were as follows: 1 (2.6%), 1 (3.3%), 2 (6.7%), 6 (22.2%), and 6 (22.2%) patients, respectively. These results did not differ from those previously published for Japan (Fisher exact test, men: P = 1, 0.27, 0.12, 0.06, and 1, respectively; women: P = 0.49, 0.62, 0.5, 0.8, and 0.3, respectively).

Conclusion: The presented cohort study revealed that ethnicity and region may not be notable factors of DISH prevalence, since patients from both Japan and Sweden had similar DISH prevalence.

Level of Evidence: 3

Keywords
aging, diffuse idiopathic skeletal hyperostosis, east Asia, ethnicity, north Europe, obesity, ossification, overweight, prevalence, region, sex
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-355522 (URN)10.1097/BRS.0000000000002752 (DOI)000452187300007 ()29916957 (PubMedID)
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-01-22Bibliographically approved
Elmekaty, M., ElMehy, E., Försth, P., MacDowall, A., El Elemi, A., Hosni, M. & Robinson, Y. (2018). Safety of a novel modular cage for transforaminal lumbar interbody fusion: clinical cohort study in 20 patients with degenerative disc disease. SICOT-J, 4, Article ID 24.
Open this publication in new window or tab >>Safety of a novel modular cage for transforaminal lumbar interbody fusion: clinical cohort study in 20 patients with degenerative disc disease
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2018 (English)In: SICOT-J, ISSN 2426-8887, Vol. 4, article id 24Article in journal (Refereed) Published
Abstract [en]

Introduction: Transforaminal lumbar interbody fusion (TLIF) is used to reconstruct disc height and reduce degenerative deformity in spinal fusion. Patients with osteoporosis are at high risk of TLIF cage subsidence; possibly due to the relatively small footprint compared to anterior interbody devices. Recently, modular TLIF cage with an integral rail and slot system was developed to reduce cage subsidence and allow early rehabilitation. Objective: To study the safety of a modular TLIF device in patients with degenerative disc disorders (DDD) with regard to surgical complications, non-union, and subsidence. Methods: Patients with DDD treated with a modular TLIF cage (Polyetheretherketone(PEEK), VTI interfuse S) were analysed retrospectively with one-year follow-up. Lumbar sagittal parameters were collected preoperatively, postoperatively and at one year follow-up. Cage subsidence, fusion rate, screw loosening and proportion of endplate coverage were assessed in computed tomography scan. Results: 20 patients (age 66 +/- 10 years, 65% female, BMI 28 +/- 5 kg/m(2)) with a total of 37 fusion levels were included. 15 patients had degenerative spondylosis and 5 patients had degenerative scoliosis. The cages covered >60% of the vertebral body diameters. Lumbar lordosis angle and segmental disc angle increased from 45.2 +/- 14.5 and 7.3 +/- 3.6 to 52.7 +/- 9.1 and 10.5 +/- 3.5 (p=0.029 and 0.0002) postoperatively for each parameter respectively without loss of correction at one year follow up. One case of deep postoperative infection occurred (5%). No cage subsidence occurred. No non-union or screw loosening occurred. Conclusions: The modular TLIF cage was safe with regard to subsidence and union-rate. It restored and maintained lumbar lordosis angle, segmental disc angle and disc height, which can be attributed to the large footprint of this modular cage.

Place, publisher, year, edition, pages
EDP SCIENCES S A, 2018
Keywords
TLIF, Cage subsidence, Large footprint, Modular cage
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-360001 (URN)10.1051/sicotj/2018019 (DOI)000436637900001 ()29956661 (PubMedID)
Available from: 2018-09-14 Created: 2018-09-14 Last updated: 2018-09-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2724-6372

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