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  • 1.
    Atesok, Kivanc
    et al.
    University of Alabama at Birmingham, Birmingham, USA.
    Tanaka, Nobuhiro
    Hiroshima University, Hiroshima, Japan.
    O'Brien, Andrew
    Royal Victoria Hospital and Royal Belfast Hospital for Sick Children, Belfast, UK.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Pang, Dachling
    University of California, Davis, USA; Kaiser Permanente Hospitals, Oakland, USA; Great Ormond Street Hospital For Children, London, UK.
    Deinlein, Donald
    University of Alabama at Birmingham, Birmingham, USA.
    Manoharan, Sakthivel Rajaram
    University of Alabama at Birmingham, Birmingham, USA.
    Pittman, Jason
    University of Alabama at Birmingham, Birmingham, USA.
    Theiss, Steven
    University of Alabama at Birmingham, Birmingham, USA.
    Posttraumatic Spinal Cord Injury without Radiographic Abnormality2018Inngår i: Advances in Orthopedics, ISSN 2090-3464, E-ISSN 2090-3472, Vol. 2018, artikkel-id 7060654Artikkel, forskningsoversikt (Fagfellevurdert)
    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.

  • 2.
    Carrwik, Christian
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Murakami, Hideki
    Kanazawa University, Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa, Japan.
    Willander, Johan
    Gävle University, Department of Psychology, Gävle, Sweden.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Potential harms of interventions for spinal metastatic disease2017Inngår i: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, nr 7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

    The primary objective of this review is to compare the potential harms of treatment for spinal metastatic disease for the following treatments:

    1. Surgical intervention.

    2. Surgical intervention with radiation therapy.

    3. Radiation therapy alone.

    Our secondary objectives are:

    1. comparing the harms of different surgical methods;

    2. comparing the harms between different radiation protocols.

  • 3.
    Covaro, Augusto
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Manabe, Nodoka
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Bobinski, Lukas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    The importance of the occipitocervical area in patients with ankylosing spondylitis analysis of a cohort of 86 cervical fractures in surgically treated patients2017Inngår i: Journal of Craniovertebral Junction and Spine, ISSN 0974-8237, E-ISSN 0976-9285, Vol. 8, nr 4, s. 374-377Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study Design: This was a retrospective analysis of prospectively collected data.

    Objective: The effect of C0-C1-C2 cervical ankylosis in patients with ankylosing spondylitis (AS) is not documented. The objective of this study is to describe the radiological characteristics of the occipitocervical junction in patients with AS operated for a cervical fracture and to correlate them with their clinical evolution.

    Materials and Methods: Analysis of patients with ankylosing spondylitis (AS) treated in a single institution of a cervical vertebral fracture between 2007 and 2014 who were prospectively followed through the SWESPINE registry. The integrity of the C0-€“C1-€“C2 joints was determined and classified into fused and nonfused joints. By determining the angle between C0-€“C1 and C1-€“C2 joints in the coronal view of the computed tomography scan (X-angle), the progressive degeneration of these joints was described. Intra- and inter-observer reliability of this test was determined. The instruments of health-related quality of life (QOL) and disability were EQ5D and Oswestry disability index (ODI), respectively.

    Results: A total of 86 patients with AS treated surgically for cervical fracture had complete facet ankylosis between C3 and T1 due to their pathology. Mean age 69.2 years (standard deviation [SD]: 11.7). The most common level of fracture was in C5-C6. In 24 patients, the C0-C1 joint was fused, and in 15 patients, C1-C2 joint was fused. The intra- and inter-class reliabilities for X-angle measurement were very high (intraclass correlation coefficients = 0.94; 0.92). The mean X-angle was 125° (SD: 12) in nonfused patients and 136° (SD: 14) in fused patients (p < 0.001). There were no differences in QOL and disability at 2 years between the two groups: EQ5D-index of 0.54 and 0.55 (p = 0.5), ODI of 26.4 and 24, (p = 0.35) respectively. 

    Conclusions: X-angle is a reliable measure for joint integrity C0-€“C1-€C2 in patients with AS. Total cervical ankylosis including the C0-C1-C2 segments is not related to poorer QOL and disability in these patients.

  • 4. Cristancho, Edgar
    et al.
    Reyes, Orlando
    Serrato, Mauricio
    Mora, María Mercedes
    Rojas, Joel Alberto
    Robinson, Yohan
    Institute of Sports Medicine, Charité, University Medicine Berlin.
    Böning, Dieter
    Arterial oxygen saturation and hemoglobin mass in postmenopausal untrained and trained altitude residents2007Inngår i: High Altitude Medicine & Biology, ISSN 1527-0297, E-ISSN 1557-8682, Vol. 8, nr 4, s. 296-306Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Because of lacking ventilatory stimulation by sex hormones in postmenopausal women (PW), one might expect a lowered arterial oxygen saturation (S(O(2))) in hypoxia and therefore a stronger erythropoietic reaction than in young women (YW). Nine untrained (UTRPW) and 11 trained (TRPW) postmenopausal altitude residents (2600 m) were compared to 16 untrained (UTRYW) and 16 trained young women (TRYW) to check this hypothesis and to study the combined response to hypoxia and training. S(O(2)) was decreased in PW (89.2% +/- 2.2 vs. 93.6 +/- 0.7% in YW, p < 0.01). Hb mass, however, was similar in UT (UTRYW: 9.2 +/- 0.9 g/kg(1), UTRPW: 8.7 +/- 1.0 g/kg). But if body fat rise with age was excluded by relation to fat-free mass, Hb mass was increased in UTRPW (+1.2 g/kg, p < 0.05) compared to UTRYW. Training caused a similar rise of Hb mass in PW and YW (0.3 g/kg per mL/kg x min(1) rise in V(O(2peak))). There was no difference in erythropoietin among the groups. Ferritin was higher in PW than YW. The results show that female hormones and fitness level have to be considered in studies on erythropoiesis at altitude. The role of erythropoietin during chronic hypoxia still has to be clarified.

  • 5.
    Elmekaty, Mohamed
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Tanta Univ, Tanta, Egypt.
    ElMehy, Emad
    Tanta Univ, Orthoped & Traumatol Dept, Tanta, Egypt.
    Försth, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    MacDowall, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    El Elemi, Ahmed
    Tanta Univ, Orthoped & Traumatol Dept, Tanta, Egypt.
    Hosni, Mohamed
    Tanta Univ, Orthoped & Traumatol Dept, Tanta, Egypt.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Safety of a novel modular cage for transforaminal lumbar interbody fusion: clinical cohort study in 20 patients with degenerative disc disease2018Inngår i: SICOT-J, ISSN 2426-8887, Vol. 4, artikkel-id 24Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 6.
    Elmekaty, Mohamed
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Steel Mem Muroran Hosp, Spine & Spinal Cord Ctr, Muroran, Hokkaido, Japan;Tanta Univ, Fac Med, Dept Orthoped Surg, Tanta, Egypt.
    Kotani, Yoshihisa
    Steel Mem Muroran Hosp, Spine & Spinal Cord Ctr, Muroran, Hokkaido, Japan.
    El Mehy, Emad
    Tanta Univ, Fac Med, Dept Orthoped Surg, Tanta, Egypt.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    El Tantawy, Ahmed
    Tanta Univ, Fac Med, Dept Orthoped Surg, Tanta, Egypt.
    Sekiguchi, Ivan
    Steel Mem Muroran Hosp, Spine & Spinal Cord Ctr, Muroran, Hokkaido, Japan.
    Fujita, Ryo
    Steel Mem Muroran Hosp, Spine & Spinal Cord Ctr, Muroran, Hokkaido, Japan.
    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 Fusion2018Inngår i: Asian Spine Journal, ISSN 1976-1902, E-ISSN 1976-7846, Vol. 12, nr 5, s. 870-879Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 7. Fakler, Johannes K
    et al.
    Robinson, Yohan
    Department of Trauma and Reconstructive Surgery, Charité University Medical School, Berlin.
    Heyde, Christoph E
    John, Thilo
    Errors in handling and manufacturing of orthopaedic implants: the tip of the iceberg of an unrecognized system problem?2007Inngår i: Patient safety in surgery, ISSN 1754-9493, Vol. 1, nr 1, s. 5-Artikkel i tidsskrift (Fagfellevurdert)
  • 8. Gulle, Eva
    et al.
    Skärvinge, Carola
    Runberg, Karin
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Pharmacological strategies to reduce pruritus during postoperative epidural analgesia after lumbar fusion surgery: a prospective randomized trial in 150 patients2011Inngår i: Patient safety in surgery, ISSN 1754-9493, Vol. 5, nr 1, s. 10-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Epidural analgesia with bupivacain, epinephrine and fentanyl provides excellent pain control after lumbar fusion surgery, but pruritus and motor block are frequent side effects. Theoretically epidural ropivacain combined with oral oxycodone could decrease the incidence of these side effects. The two regimens were compared in a prospective randomized trial.

    PATIENTS AND METHODS:

    150 patients (87 women) treated with posterior instrumented lumbar fusion were included. The mean age was 51 +/- 11 years. 76 were randomized to bupivacain, epinephrine and fentanyl (group B) and 74 to ropivacain and oxycodone (group R). Pruritus, motor block and pain were measured 6 hours after surgery, thereafter 6 times per day for 5 days. Any pain breakthrough episode was registered whenever it occurred.

    RESULTS:

    The epidural treatment could be performed in 143 patients (72 in group B and 71 in group R). Disturbing pruritus occurred in 53 patients in group B compared to 12 in group R (p < 0.0001). Motor blockade was most frequent on day 1, occurring in 45% of the patients with no difference between the groups. Both regimes gave good pain control with average VAS under 40, but the pain relief was statistically better in group B. The number of pain breakthrough episodes did not differ between the groups.

    CONCLUSIONS:

    Pruritus could be reduced with a combination of epidural ropivacain and oral oxycodone, at the price of a slightly higher pain level. Ropivacaine was not found to be superior to bupivacaine with regard to motor blocks.

  • 9. Heyde, Christoph E
    et al.
    Robinson, Yohan
    Klinik für Ortopädische- Unfall- und Wiederherstellungschirurgie, Charité-Campus Benjamin Franklin, Berlin.
    Kayser, Ralph
    John, Thilo
    Fatale komplexe HWS-Verletzung bei M. Bechterew nach Sturz mit dem Rennrad2007Inngår i: Sportverletzung, Sportschaden, ISSN 0932-0555, E-ISSN 1439-1236, Vol. 21, nr 3, s. 148-151Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [de]

    Patienten mit ankylosierender Spondylitis sind durch die Kyphose, die Einsteifung und den häufig osteoporotischen Knochen der Wirbelsäule im Rahmen von Stürzen für Verletzungen der Halswirbelsäule besonders prädestiniert. Dabei besteht ein überdurchschnittlich hohes Risiko für neurologische Komplikationen. Vorgestellt wird ein Patient mit M. Bechterew, der bei einem Sturz mit dem Rennrad eine komplexe HWS-Verletzung erlitt. Trotz umgehender operativer Versorgung kam es im weiteren Verlauf zum Tod des Patienten durch einen schweren hypoxischen Hirnschaden. Vor dem Hintergrund dieses fatalen Verlaufes sollen die Empfehlungen zur sportlichen Betätigung bei M. Bechterew und die sich daraus für die veränderte Wirbelsäule ergebenden Gefahren diskutiert werden.

  • 10. Heyde, Christoph-E.
    et al.
    Fakler, Johannes K.
    Hasenboehler, Erik
    Stahel, Philip F.
    John, Thilo
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Tschoeke, Sven K.
    Kayser, Ralph
    Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis2008Inngår i: Patient safety in surgery, ISSN 1754-9493, Vol. 2, s. 15-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    ABSTRACT: Patients with ankylosing spondylitis are at significant risk for sustaining cervical spine injuries following trauma predisposed by kyphosis, stiffness and osteoporotic bone quality of the spine. The risk of sustaining neurological deficits in this patient population is higher than average. The present review article provides an outline on the specific injury patterns in the cervical spine, diagnostic algorithms and specific treatment modalities dictated by the underlying disease in patients with ankylosing spondylitis. An emphasis is placed on the risks and complication patterns in the treatment of these rare, but challenging injuries.

  • 11.
    Heyde, Christoph-E.
    et al.
    Universitätsklinikum Leipzig AöR, Klinik u. Poliklinik für Orthopädie, Unfallchirurgie u. Plastische Chirurgie, Bereich Wirbelsäulenchirurgie.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Deszöe, Jeszenszky
    Wirbelsäulenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, CH-8808 Zürich, Schweiz.
    Ätiologie und Pathogenese der Spondylodiszitis2017Inngår i: Die Wirbelsäule, ISSN 2509-8241, Vol. 01, nr 04, s. 237-244Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [de]

    Die Häufigkeit der unspezifischen „pyogenen“ und der verschiedenen Formen der spezifischen Spondylodiszitiden nimmt zu. Die Gründe dafür sind vielfältig. Diese Erkrankungen sind auch heute noch mit einer relevanten Morbidität und Mortalität vergesellschaftet. Die Diagnose erfolgt aufgrund der unspezifischen klinischen Manifestation häufig verzögert. Die Kenntnis der Epidemiologie, der Ätiologie und der Pathogenese der verschiedenen Formen der Spondylodiszitis kann die frühzeitige Diagnose und damit den Beginn der Therapie als auch die Therapie an sich erleichtern. In diesem Artikel werden deshalb epidemiologische Daten und wesentliche Aspekte der Ätiologie und Pathogenese der unspezifischen pyogenen Spondylodiszitis sowie der verschiedenen Formen der spezifischen Spondylodiszitis bei Tuberkulose, bei Brucellose und bei Pilzinfektionen diskutiert.

  • 12.
    Heyde, Christoph-E.
    et al.
    Klinik und Poliklinik für Orthopädische Chirurgie der Universität Leipzig.
    Tschöke, Sven-Kevin
    Klinik und Poliklinik für Orthopädische Chirurgie der Universität Leipzig.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Kayser, Ralph
    Klinik und Poliklinik für Orthopaedie und Orthopädische Chirurgie des Klinikums Greifswald.
    Kyphoplastie: Indikation und praktische Durchführung2012Inngår i: Internistische Praxis, ISSN 0020-9570, Vol. 52, nr 3, s. 561-572Artikkel i tidsskrift (Fagfellevurdert)
  • 13. Heyde, Christoph-Eckhard
    et al.
    Tschöke, Sven-Kevin
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Kayser, Ralph
    Kyphoplastie: Indikation und Durchführung2013Inngår i: Chirurgische Praxis, ISSN 0009-4846, Vol. 76, nr 1, s. 63-74Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The minimally invasive procedure of kyphoplasty has become an established method of treatment in both osteoporotic compression fractures and malignant osteolytic lesions of the spine. In cautious consideration of the correct indication and technical implementation, kyphoplasty is a safe procedure with low risk of complications. In comparison to conservative treatment regimens, postoperative clinical outcome parameters have shown promising results in pain reduction and the improvement of function and quality of life in both short-term and mid-term evaluations. However, kyphoplasty as a surgical procedure shall always be considered a component within the overall therapeutic concept. Thus, a comprehensive medical attendance and the consistent treatment of the underlying disease are essential to a successful therapeutic outcome.

  • 14. Heyde, Christoph-Eckhard
    et al.
    Tschöke, Sven-Kevin
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Kayser, Ralph
    Kyphoplastie: Indikation und praktische Durchführung. [Kyphoplasty. Indication and practical guidelines]2012Inngår i: Tägliche Praxis, ISSN 0494-464X, Vol. 53, nr 4, s. 799-810Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The minimally invasive procedure of kyphoplasty has become an established method of treatment in both osteoporotic compression fractures and malignant osteolytic lesions of the spine. In cautious consideration of the correct indication and technical implementation, kyphoplasty is a safe procedure with low risk of complications. In comparison to conservative treatment regimens, postoperative clinical outcome parameters have shown promising results in pain reduction and the improvement of function and quality of life in both short-term and mid-term evaluations. However, kyphoplasty as a surgical procedure shall always be considered a component within the overall therapeutic concept. Thus, a comprehensive medical attendance and the consistent treatment of the underlying disease are essential to a successful therapeutic outcome.

  • 15.
    Hirasawa, Atsuhiko
    et al.
    Aichi Med Univ, Dept Spine Ctr, Nagakute, Aichi, Japan; Aichi Med Univ, Dept Orthopaed Surg, Nagakute, Aichi, Japan.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Wakao, Norimitsu
    Aichi Med Univ, Dept Spine Ctr, Nagakute, Aichi, Japan.
    Kamiya, Mitsuhiro
    Aichi Med Univ, Dept Spine Ctr, Nagakute, Aichi, Japan; Aichi Med Univ, Dept Orthopaed Surg, Nagakute, Aichi, Japan.
    Murotani, Kenta
    Aichi Med Univ, Div Biostat, Clin Res Ctr, Nagakute, Aichi, Japan.
    Deie, Masataka
    Aichi Med Univ, Dept Orthopaed Surg, Nagakute, Aichi, Japan.
    Regional Differences in Diffuse Idiopathic Skeletal Hyperostosis: A Retrospective Cohort Study from Sweden and Japan2018Inngår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 43, nr 24, s. E1474-E1478Artikkel i tidsskrift (Fagfellevurdert)
    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

  • 16. Hostmann, Arwed
    et al.
    Jasse, Kerstin
    Schulze-Tanzil, Gundula
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Oberholzer, Andreas
    Ertel, Wolfgang
    Tschoeke, Sven K
    Biphasic onset of splenic apoptosis following hemorrhagic shock: critical implications for Bax, Bcl-2, and Mcl-1 proteins2008Inngår i: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 12, nr 1, s. R8-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: The innate immune response to trauma hemorrhage involves inflammatory mediators, thus promoting cellular dysfunction as well as cell death in diverse tissues. These effects ultimately bear the risk of post-traumatic complications such as organ dysfunction, multiple organ failure, or adult respiratory distress syndrome. In this study, a murine model of resuscitated hemorrhagic shock (HS) was used to determine the apoptosis in spleen as a marker of cellular injury and reduced immune functions. METHODS: Male C57BL-6 mice were subjected to sham operation or resuscitated HS. At t = 0 hours, t = 24 hours, and t = 72 hours, mice were euthanized and the spleens were removed and evaluated for apoptotic changes via DNA fragmentation, caspase activities, and activation of both extrinsic and intrinsic apoptotic pathways. Spleens from untreated mice were used as control samples. RESULTS: HS was associated with distinct lymphocytopenia as early as t = 0 hours after hemorrhage without regaining baseline levels within the consecutive 72 hours when compared with sham and control groups. A rapid activation of splenic apoptosis in HS mice was observed at t = 0 hours and t = 72 hours after hemorrhage and predominantly confirmed by increased DNA fragmentation, elevated caspase-3/7, caspase-8, and caspase-9 activities, and enhanced expression of intrinsic mitochondrial proteins. Accordingly, mitochondrial pro-apoptotic Bax and anti-apoptotic Bcl-2 proteins were inversely expressed within the 72-hour observation period, thereby supporting significant pro-apoptotic changes. Solely at t = 24 hours, expression of the anti-apoptotic Mcl-1 protein shows a significant increase when compared with sham-operated and control animals. Furthermore, expression of extrinsic death receptors were only slightly increased. CONCLUSION: Our data suggest that HS induces apoptotic changes in spleen through a biphasic caspase-dependent mechanism and imply a detrimental imbalance of pro- and anti-apoptotic mitochondrial proteins Bax, Bcl-2, and Mcl-1, thereby promoting post-traumatic immunosuppression.

  • 17. Koller, Heiko
    et al.
    Ames, Christopher
    Mehdian, Hossein
    Bartels, Ronald
    Ferch, Rüdiger
    Deriven, V
    Toyone, H
    Shaffrey, C
    Smith, Justin
    Hitzl, W
    Schröder, Johannes
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project.2018Inngår i: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 28, nr 2, s. 324-344Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 18. Li, Qinghu
    et al.
    Dong, Jinlei
    Yang, Yongliang
    Wang, Guodong
    Wang, Yonghui
    Liu, Ping
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Zhou, Dongsheng
    Retroperitoneal packing or angioembolization for haemorrhage control of pelvic fractures-Quasi-randomized clinical trial of 56 haemodynamically unstable patients with Injury Severity Score ≥332016Inngår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 47, nr 2, s. 395-401Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: Both retroperitoneal pelvic packing and primary angioembolization are widely used to control haemorrhage related to pelvic fractures. It is still unknown which protocol is the safest. The primary aim of this study is to compare survival and complications of pelvic packing and angioembolization in massive haemorrhage related to pelvic fractures.

    METHODS: Patients with haemodynamically unstable pelvic fractures were quasi-randomized to either pelvic packing (PACK) or angiography (ANGIO) using the time of admission as separator. Physiological markers of haemorrhage, time to intervention, procedure/surgical time, transfusion requirements, complications and early mortality were recorded and analyzed.

    RESULTS: 29 patients were randomized to PACK and 27 patients to ANGIO. The Injury Severity Score (ISS) in the ANGIO group was lower than in the PACK group (43±7 vs 48±6) (p<0.01). The median time from admission to angiography for the ANGIO group was 102min (range 76-214), and longer than 77min (range 43-125) from admission to surgery for the PACK group (p<0.01). The procedure time for the ANGIO group was 84min (range 62-105); while the surgical time was 60min (range 41-92) for the PACK group (p<0.001). The ANGIO group received 6.4 units packed red blood cells (range 4-10) in the first 24h after angiography. The PACK group required 5.2 units (range 3-10) in the first 24h after leaving the operating theatre (p=0.124). 9 patients in the ANGIO group underwent pelvic packing for persistent bleeding. 6 patients in the PACK group required pelvic angiography after pelvic packing for ongoing hypotension following packing (p=0.353). 5 patients in the ANGIO group died (2 from exsanguination), while 4 in the PACK group died (none from exsanguination) (p=0.449). Complications occurred without differences in both groups.

    CONCLUSIONS: Compared with angioembolization, pelvic packing has shorter time to intervention and surgical time. Thus pelvic packing is the more rapid treatment of severe pelvic trauma than pelvic angioembolization. It is suitable for patients with haemodynamic instability at centers where the interventional radiology staff is not in-house at all times.

    REGISTRATION: ClinicalTrials.gov (NCT02535624) and ISRCTN registry (ISRCTN91713422).

  • 19.
    MacDowall, Anna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Canto Moreira, Nuno
    Department of Clinical Neuroscience (CNS), K8, Karolinska Universitetssjukhuset Solna, Stockholm.
    Marques, Catarina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Skeppholm, Martin
    Karolinska Inst, Med Management Ctr, Hlth Econ & Hlth Evaluat Res Grp, Dept Learning Informat Management & Eth LIME, Stockholm, Sweden;Sophiahemmets Sjukhus, Ctr Spine Surg Stockholm, Stockholm, Sweden.
    Lindhagen, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Löfgren, Håkan
    Länssjukhuset Ryhov, Jönköping.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes2019Inngår i: Journal of Neurosurgery: Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 30, nr 3, s. 323-331Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 20.
    MacDowall, Anna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Skeppholm, Martin
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Anxiety and depression affect pain drawings in cervical degenerative disc disease2017Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, nr 2, s. 99-107Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Pain drawings have been frequently used in the preoperative evaluation of spine patients. Until now most investigations have focused on low back pain patients, even though pain drawings are used in neck pain patients as well. The aims of this study were to investigate the pain drawing and its association to preoperative demographics, psychological impairment, and pain intensity. Methods: We carried out a post hoc analysis of a randomized controlled trial, comparing cervical disc replacement to fusion for radiculopathy related to degenerative disc disease. Preoperatively the patients completed a pain drawing, the Hospital Anxiety and Depression Scale (HADS), and a visual analogue scale (VAS). The pain drawing was evaluated according to four established methods, now modified for cervical conditions. Comparisons were made between the pain drawing and age, sex, smoking, and employment status as well as HADS and VAS. Results: Included were 151 patients, mean age of 47 years, female/male: 78/73. Pain drawing results were not affected by age, sex, smoking, and employment status. Patients with non-neurogenic pain drawings according to the modified method by Ransford had higher points on HADS-anxiety, HADS-depression, and HADS-total. Patients with markings in the head region had higher score on HADS-depression. Markings in the neck and lower arm region were associated with high values of VAS-neck and VAS-arm. Conclusions: Pain drawings were affected by both pain intensity and anxiety/depression in cervical spine patients. Therefore, the pain drawing can be a useful tool when interpreting the patients' pain in correlation to psychological impairment and pain location.

  • 21.
    MacDowall, Anna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Skeppholm, Martin
    Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Pain drawings predict outcome of surgical treatment for degenerative disc disease in the cervical spine2017Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, nr 3, s. 194-200Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Pain drawings have been frequently used in the preoperative evaluation of spine patients. For lumbar conditions comprehensive research has established both the reliability and predictive value, but for the cervical spine most of this knowledge is lacking. The aims of this study were to validate pain drawings for the cervical spine, and to investigate the predictive value for treatment outcome of four different evaluation methods.

    METHODS: We carried out a post hoc analysis of a randomized controlled trial, comparing cervical disc replacement to fusion for radiculopathy related to degenerative disc disease. A pain drawing together with Neck Disability Index (NDI) was completed preoperatively, after 2 and 5 years. The inter- and intraobserver reliability of four evaluation methods was tested using κ statistics, and its predictive value investigated by correlation to change in NDI.

    RESULTS: Included were 151 patients, mean age of 47 years, female/male: 78/73. The interobserver reliability was fair for the modified Ransford and Udén methods, good for the Gatchel method, and very good for the modified Ohnmeiss method. Markings in the shoulder and upper arm region on the pain drawing were positive predictors of outcome after 2 years of follow-up, and markings in the upper arm region remained a positive predictor of outcome even after 5 years of follow-up.

    CONCLUSIONS: Pain drawings were a reliable tool to interpret patients' pain prior to cervical spine surgery and were also to some extent predictive for treatment outcome.

  • 22.
    MacDowall, Anna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Skeppholm, Martin
    Institutionen för lärande, informatik, management och etik. Department for learning, informatics, management and ethics.
    Lindhagen, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Löfgren, Håkan
    Department of Neuro-Orthopaedic Center, Jönköping, Sweden.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Artificial Disc Replacement versus Fusion in Patients with Cervical Degenerative Disc Disease with radiculopathy: 5-year Outcomes from the National Swedish Spine Register2019Inngår i: Journal of Neurosurgery: Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 30, nr 2, s. 159-167Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 23.
    MacDowall, Anna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Skeppholm, Martin
    Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth LIME, Hlth Econ & Hlth Evaluat Res Grp, Stockholm, Sweden;Sophiahemmet Sjukhus, Ctr Spine Surg Stockholm, Stockholm, Sweden.
    Lindhagen, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Effects of preoperative mental distress versus surgical modality, arthroplasty, or fusion on long-term outcome in patients with cervical radiculopathy2018Inngår i: Journal of Neurosurgery: Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 29, nr 4, s. 371-379Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 24.
    MacDowall, Anna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Skeppholm, Martin
    Institutionen för lärande, informatik, management och etik. Department for learning, informatics, management and ethics.
    Lindhagen, Lars
    Uppsala Clinical Research.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Preoperative mental distress is more important for long-term outcome than the difference between surgical modalities, arthroplasty or fusion in patients with cervical radiculopathy2018Inngår i: Journal of Neurosurgery: Spine, ISSN 1547-5654Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Several efforts have been made to investigate the long-term efficacy of artificial disc replacement surgery compared with fusion after decompression for the treatment of cervical degenerative disc disease and radiculopathy. However, research about the impact of mental distress on surgical treatment outcome is sparse. Our aim was to investigate the potential predictive value of preoperative risk factors to long-term outcome.

    METHODS: We randomly assigned 153 patients (mean age 47 years) with single- or double-level cervical degenerative disc disease and radiculopathy to receive either anterior cervical discectomy and fusion (n=70) or artificial disc replacement (ADR, n=83). The primary outcome was the Neck Disability Index (NDI), a patient-reported function score that ranges from 0 to 100%, with higher scores indicating greater disability. Preoperative variables such as sex, age, smoking, employment status, strenuous job, neck pain duration, arm pain duration, exercise, Hospital Anxiety and Depression Scale (HADS) scores, NDI and if one- or two-levels of surgery were performed as well as the allocated treatment were analyzed in multiple linear regression models with 5-year NDI as outcome.

    RESULTS: There were 47 patients (32%) with either HADS anxiety or HADS depression scores of 10 points or more. High values on preoperative HADS were negative predictors of outcome (P = 0.009). Treatment allocation had no effect on 5-year NDI (P = 0.32).

    CONCLUSION: Preoperative mental distress measured with HADS score affects long-term outcome in surgically treated patients with cervical radiculopathy.

    Trial registration: The study was registered at ISRCTN (registration number: 44347115).

  • 25.
    MacDowall, Anna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Skeppholm, Martin
    Institutionen för lärande, informatik, management och etik. Department for learning, informatics, management and ethics, Karolinska institutet, Stockholm, Sweden.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Validation of the Visual Analogue Scale in the Cervical Spine2018Inngår i: Journal of Eurosurgery : Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 28, nr 3, s. 227-235Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The Visual analogue scale (VAS) is frequently used to measure treatment outcome in patients with cervical spine disorders. The minimum clinically important difference (MCID) is the smallest change in a score that has clinical importance to the patient. Although it has been established for other medical fields, knowledge of the VAS MCID for the cervical spine is sparse, and it has rarely been considered in relation to measurement noise. The goals in this study were as follows: 1) to validate the VAS-neck and VAS-arm instruments for the cervical spine (e.g. repeatability); 2) to investigate the possible influence of predictive factors and the Hospital Anxiety and Depression Scale (HADS) score on repeatability; and 3) to compute the MCID with five different methods.

    Methods: A post hoc analysis of a prospective randomized controlled trial with 151 patients undergoing surgery for cervical radiculopathy due to degenerative disc disease (DDD) was performed. Information on age, sex, smoking habits, exercise and employment status, HADS score, and VAS-neck and VAS-arm scores was gathered before surgery and after 1 year. The VAS was applied twice on every occasion with 15 minutes in-between. Repeatability and the association with predictors and HADS score were analyzed using the one-sample t-test, linear regression models and Spearman correlation. The MCID was calculated with the following methods: average change, change difference, receiver operating characteristic curve, effect size, and minimum detectable change (MDC).

    Results: The repeatability in VAS-neck was 8.1 mm and in VAS-arm 10.4 mm. Less consistent values on the VAS correlated to female sex and higher values on HADS. For VAS-neck the MCID ranged from 4.6 to 21.4 and for VAS-arm it ranged from 1.1 to 29.1. The highest MCID came from the MDC method, which was the only method that gave values above the measurement noise in both VAS-neck and VAS-arm.

    Conclusions: Measurement noise in VAS-neck and VAS-arm for the cervical spine was influenced by female sex and HADS score. The only method to compute MCID that consistently gave results above the measurement noise in VAS-neck and VAS-arm was the MDC. 

  • 26.
    Manabe, Nodoka
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Department of Orthopedic Surgery, Gunma Spine Center, Harunaso Hospital, Takasaki, Japan.
    Covaro, Augusto
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Department of Orthopedic Surgery, Hospital Universitari Dexeus, Barcelona, Spain.
    Bobinski, Lukas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Shimizu, Takachika
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    The Relationship between the Occipitocervical Junction and Thoracic Kyphosis in Ankylosing Spondylitis: A Retrospective Cohort Study of 86 Cervical Fractures in Surgically Treated Patients2019Inngår i: Asian Spine Journal, ISSN 1976-1902, E-ISSN 1976-7846, Vol. 13, nr 1, s. 103-110Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 27.
    Matthiessen, Christian
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Epidemiology of atlas fractures-a national registry-based cohort study of 1,537 cases2015Inngår i: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 15, nr 11, s. 2332-2337Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND CONTEXT: The epidemiology of fractures of the first cervical vertebra-the atlas-has not been well documented. Previous studies concerning atlas fractures focus on treatment and form a weak platform for epidemiologic study.

    PURPOSE: This study aims to provide reliable epidemiologic data on atlas fractures.

    STUDY DESIGN: This was a national registry-based cohort study.

    PATIENT SAMPLE: A total of 1,537 cases of atlas fractures between 1997 and 2011 from the Swedish National Patient Registry (NPR).

    OUTCOME MEASURES: The outcome measures were annual incidence and mortality.

    METHODS: Data from the NPR and the Swedish Cause of Death Registry were extracted, including age, gender, diagnosis, comorbidity, treatment codes, and date of death. The Charlson Comorbidity Index was calculated and a survival analysis performed.

    RESULTS: A total of 869 (56.5%) cases were men, and 668 (43.5%) were women. The mean age of the entire population was 64 years. The proportion of atlas fractures of all registered cervical fractures was 10.6%. In 19% of all cases, there was an additional fracture of the axis, and 7% of all cases had additional subaxial cervical fractures. Patients with fractures of the axis were older than patients with isolated atlas fractures. The annual incidence almost doubled during the study period, and in 2011, it was 17 per million inhabitants. The greatest increase in incidence occurred in the elderly population.

    CONCLUSIONS: Atlas fractures occurred predominantly in the elderly population. Further study is needed to determine the cause of the increasing incidence.

  • 28. Przkora, René
    et al.
    Robinson, Yohan
    Schmidt, Oliver I
    Ertel, Wolfgang
    Gahr, Ralf H
    Kayser, Ralph
    Heyde, Christoph E
    Operative treatment of unstable odontoid fractures in the geriatric population2006Inngår i: Topics in Spinal Cord Injury Rehabilitation, ISSN 1082-0744, E-ISSN 1945-5763, Vol. 12, nr 2, s. 12-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    Odontoid fractures, often in combination with C1 fractures, are a common fracture of the cervical spine in geriatric patients. The optimal treatment of this fracture in this patient population is often controversial. We report the surgical outcome of unstable type II odontoid fractures in the elderly.

    Method:

    8 patients (median age, 80.5 years; range, 72-93) with unstable type II odontoid fractures according to the Anderson and d'Alonzo classification were included in this prospective study. 2 patients sustained a C1 fracture (1 had an unstable type III fracture according to the Gehweiler classification, and 1 had a stable type III fracture). There were no neurological complications. All patients were classified as ASA class III. 7 patients were treated with anterior odontoid double-screw compression osteosynthesis followed by a firm neck support for 6 weeks. 1 patient with an unstable C1 and C2 fracture was treated with an occipital cervical (C2) fusion in combination with a C1-C2 fusion according to Magerl technique. Follow-up was 18 months.

    Results:

    No deaths occurred during the study period. All patients demonstrated fracture healing at followup. Median length of hospital stay was 31.4 days (range, 16-64). Preexisting comorbidities complicated final outcome in 2 patients, both of whom received a temporary tracheostomy for respiratory failure.

    Conclusion:

    Type II odontoid fracture healing can occur predictably with anterior double-screw compression osteosynthesis. The outcome in this patient population may be complicated by preexisting medical comorbidities.

  • 29. Reinke, Marcus
    et al.
    Robinson, Yohan
    Ertel, Wolfgang
    Kayser, Ralph
    Heyde, Christoph E
    Brown-Séquard syndrome caused by a high velocity gunshot injury: a case report2007Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 45, nr 8, s. 579-582Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN:

    Case report.

    OBJECTIVE:

    To present an unusual traumatic neurologic pathology caused by gunshot injury.

    SETTING:

    Spine unit of Department of Trauma and Orthopaedic Surgery, University Medical School, Charité - Campus Benjamin Franklin, Berlin, Germany.

    METHOD AND RESULT:

    A 35-year-old male sustained a gunshot injury from a machine gun. The projectile caused a fracture of the left pedicle of Th10. The spinal cord was indirectly damaged by cavitation that caused a Brown-Séquard syndrome (BSS). After a microscopically assisted posterior revision at T9/10 with removal of bullet and bone fragments from the spinal canal and debridement of the bullet cavity via extended fenestrectomy the patient gained his motor function back. The sensory deficit remained unchanged.

    CONCLUSION:

    BSS can be caused by bullet-related injury of the spinal canal with no direct damage of neural structures. The initial treatment is always based on the total injury pattern. Possible spinal cord injuries are only clarified after restitution of vital functions. Decompression of neural structures in shotgun injury is indicated in incomplete paraplegia, injury of intra-abdominal hollow organs or high velocity bullet wounds. Through debridement and decompression of neural structures and chronic damage caused by foreign body granulomas can be prevented. Secondary destabilization of the spine should be avoided.

  • 30.
    Robinson, Anna-Lena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Stockholm Spine Ctr, Stockholm, Sweden..
    Moller, Anders
    Skane Univ Hosp, Dept Orthopaed, Malmo, Sweden..
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    C2 Fracture Subtypes, Incidence, and Treatment Allocation Change with Age: A Retrospective Cohort Study of 233 Consecutive Cases2017Inngår i: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, artikkel-id 8321680Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The currently available data on the distribution of C2 fracture subtypes is sparse. This study was designed to identify the proportions of the second cervical vertebra (C2) fracture subtypes and to present age and gender specific incidences of subgroups. A dataset of all patients treated between 2002 and 2014 for C2 fractures was extracted from the regional hospital information system. C2 fractures were classified into odontoid fractures types 1, 2, and 3, Hangman's fractures types 1, 2, and 3, and atypical C2 fractures. 233 patients (female 51%, age 72 +/- 19 years) were treated for a C2 fracture. Odontoid fractures were found in 183 patients, of which 2 were type 1, 127 type 2, and 54 type 3, while 26 of C2 fractures were Hangman's fractures and 24 were atypical C2 fractures. In the geriatric subgroup 89% of all C2 fractures were odontoid, of which 71% were type 2 and 29% type 3. There was an increasing incidence of odontoid fractures types 2 and 3 from 2002 to 2014. 40% of C2 fractures were treated surgically. This study presents reliable subset proportions of C2 fractures in a prospectively collected regional cohort. Knowledge of these proportions facilitates future epidemiological studies of C2 fractures.

  • 31.
    Robinson, Anna-Lena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Stockholm Spine Center, Upplands Väsby, Sweden.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Epidemiology of C2 Fractures in the 21st Century: A National Registry Cohort Study of 6,370 Patients from 1997 to 20142017Inngår i: Advances in Orthopedics, ISSN 2090-3464, E-ISSN 2090-3472, artikkel-id 6516893Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. C2 fractures are a common injury in the elderly population. Treatment is often complicated due to osteoporosis and patient comorbidity. This study aims to investigate the incidence and treatment trend of C2 fractures in Sweden. Methods. Patients with the principal and secondary diagnosis of fracture of the second vertebrae (ICD-10: S12.1) between 1997 and 2014 were identified in the Swedish National Patient Registry (NPR). Results. Between 1997 and 2014, 6,370 patients with a C2 fracture (51% male; age: ) were identified in the NPR. The incidence of C2 fractures increased from 3 to 6 per 100,000 (; ), mainly due to an increase of incidence in the geriatric subgroup (≥70 years). The percentage of surgically treated patients decreased from 1997 to 2014 (; ). Younger age, male gender, spinal cord injury, and earlier year of admission were associated with surgical treatment assignment.Discussion. This study documents a rising incidence of C2 fractures in the elderly during the last two decades in Sweden. Greater awareness of fractures, improved diagnostics, coding, and a higher activity level of the patients are plausible causes. The declining trend of surgical treatment warrants further study.

  • 32.
    Robinson, Anna-Lena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Stockholm Spine Center, Löwenströmska Sjukhuset, 194 89 Upplands-Väsby, Sweden.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Department of Research and Development, Swedish Armed Forces Centre for Defence Medicine, Box 5155, 425 05 Västra Frölunda, Sweden.
    Surgical treatment improves survival of elderly with axis fracture: a national population-based multi-registry cohort study2018Inngår i: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 18, s. 1853-1860Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Context

    Fractures of the axis (C2) are the most common cervical spinal injuries in the elderly population. Several authors have reported improved survival among elderly patients with C2 fractures when treated surgically.

    Purpose

    We aimed to analyze whether surgery improves survival of elderly with C2 fractures.

    Study Design/Setting

    An observational population-based longitudinal multi-registry study was carried out.

    Patient Sample

    Swedish Patient Registry 1997 to 2014 and Swedish Cause of Death Registry 1997 to 2014 served as source of patient sample.

    Outcome measures

    Survival after C2 fracture according to non-surgical and surgical treatment was the outcome measure.

    Methods

    We included all patients treated for the primary diagnosis of C2 fracture (10th revision of the International Statistical Classification of Diseases and Related Health Problems or ICD-10: S12.1) at an age ≥70 years and receiving treatment at a health-care facility. Non-surgical treatment comprises cervical collar or halo-vest treatment. Surgical treatment was identified in the Swedish patient registry extract using the Swedish classification of procedural codes. Survival was determined using the Kaplan-Meier method. Comorbidity was determined using the Charlson Comorbidity Index.

    Results

    Of the included 3,375 elderly patients with C2 fractures (43% men, aged 83±7 years), 22% were treated surgically. Surgical treatment was assigned based on age, gender, and year of treatment. The 1-year survival of 2,618 non-surgically treated patients was 72% (n=1,856), and 81% (n=614) for the 757 surgically treated (p<.001, relative risk reduction=11%). Adjusted for age, gender, comorbidity, and year of injury, surgically treated patients had greater survival than non-surgically treated patients (hazard ratio=0.88, 95% confidence interval: 0.79–0.97). Among those above 88 years of age (95% confidence interval: 85–92), surgical treatment lost its effect on survival.

    Conclusions

    Despite the frailty of elderly patients, the morbidity of cervical external immobilization with a rigid collar seemingly weighs greater than surgical morbidity, even in octogenarians. For those above 88 years of age, non-surgical treatment should be primarily attempted.

  • 33.
    Robinson, Anna-Lena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Stockholm Spine Ctr, Stockholm, Sweden;Lowenstromska Hosp, Stockholm Spine Ctr, S-19489 Stockholm, Upplands Vasby, Sweden.
    Schmeiser, Gregor
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Schon Clin Hamburg Eilbek, Hamburg, Germany.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Armed Forces Ctr Def Med, Dept Res & Dev, Gothenburg, Sweden.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Surgical vs. non-surgical management of displaced type-2 odontoid fractures in patients aged 75 years and older: study protocol for a randomised controlled trial2018Inngår i: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 19, artikkel-id 452Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Displaced odontoid fractures in the elderly are treated non-surgically with a cervical collar or surgically with C1-C2 fusion. Due to the paucity of evidence, the treatment decision is often left to the discretion of the expert surgeon.

    Methods: The Uppsala Study on Odontoid Fracture Treatment (USOFT) is a multicentre, open-label, randomised controlled superiority trial evaluating the clinical superiority of the surgical treatment of type-2 odontoid fractures, with a 1-year Neck Disability Index (NDI) as the primary endpoint. Fifty consecutive patients aged >= 75 years, with displaced type-2 odontoid fracture, are randomised to non-surgical or surgical treatment. Excluded are patients with an American Society of Anaesthesiologists (ASA) score >= 4, dementia nursing care or anatomical cervical anomalies. The minimal clinically important difference of the NDI is 3.5 points. A minimum of 16 patients are needed in each group to test the superiority with 80% power. By considering a 1-year mortality forecast of 29%, up to 25 participants are recruited in each group. The non-surgical group is fitted with a rigid cervical collar for 12 weeks. The surgical group is treated with a posterior C1-C2 fusion. All participants are monitored with regard to the NDI, EuroQol score (EQ-5D), socio-demographics and computed tomography (CT) at the time of injury, at 6 weeks, 3 months and 12 months. At 12 months, a dynamic radiographical investigation of upper cervical stability is performed. The secondary endpoints are: EQ-5D score, activities of daily living (ADL), bony union, upper cervical stability and mortality.

    Discussion: USOFT is the first randomised controlled trial comparing non-surgical and surgical management of type-2 odontoid fractures in the elderly. Using the NDI and EQ-5D as endpoints, future value-based decisions may consider quality-adjusted life years gained. Major limitations are (1) the allocation bias of the open-label study design, (2) that only higher training levels of all core specialties of spine surgery are included in the surgical treatment arm and (3) that only one type of surgical stabilisation is investigated (posterior C1-C2 fusion), while other methods are not included in this study.

  • 34.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Evidence-based management of anaemia in severely injured patients2008Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, nr 5, s. 587-90Artikkel i tidsskrift (Fagfellevurdert)
  • 35. Robinson, Yohan
    Indirekte Bestimmung des Erythrozytenalters bei männlichen Sportlern2005Doktoravhandling, monografi (Annet vitenskapelig)
  • 36.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Kotfrakturincidensen ökar hos patienter med ankyloserande spondylit2013Inngår i: BestPractice: reumatologi, ISSN 1903-6582, Vol. 5, nr 16, s. 17-19Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [sv]

    Sammanfattningsvis kunde en ökad incidens av kotfrakturer vid ankyloserande spondylit hittas de senaste två decennierna, och detta trots förbättrad medicinsk terapi. Därmed fortsätter restriktionerna vad gäller fysisk aktivitet för patienter med ankyloserande spondylit att gälla även i dag (tabell 1). Vi måste därför informera våra patienter om att det kan finnas typiska biomekaniska påfrestningar även vid subjektiv symtomfrihet.

  • 37.
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Spinal fractures related to ankylosing spondylitis: Epidemiology, clinical outcome and biomechanics2017Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: Spinal fractures related to ankylosing spondylitis (AS) are often associated with serious complications. Therefore, knowledge of the incidence, best treatment, outcome, and prevention would assist in improving current guidelines.

    Objectives: This thesis aims at (1) analysing the complications and mortality of surgical treatment, (2) mapping the incidence and treatment modalities for these patients in Sweden, as well as (3) investigating the putative preventive effect of biological disease modifying anti-rheumatic drug (bDMARD) therapy on spinal fractures related to AS.

    Methods: Merged multiple national registries were used to identify predictors of mortality and spinal fractures in patients with AS. Beyond that a finite element model (FEM) was designed to simulating a cervicothoracic fracture related to AS.

    Results and Conclusions: During the last two decades an increase of the incidence of vertebral fractures in patients with AS was observed. With the introduction of bDMARD treatment of AS was revolutionised and quality of life and function improved.  It seems that the improved quality of life and function in these patients does not correlate with a reduced fracture risk. Still, for the first time a beneficial effect of bDMARD with regard to spinal fracture occurrence was provided. The risk of spinal fractures was not reduced, but the debut of a spinal fracture was delayed with bDMARD. Since for this study the observation interval was only a decade, a future follow-up should revisit the effect of bDMARD on spinal fractures related to AS.

    Furthermore, it was shown that posterior stabilisation is an effective method for restoring stability without the necessity of additional external fixation. Most likely the early rehabilitation reduced pulmonary complications, which in turn reduced early mortality of these fractures. The FEM could be used to identify the most appropriate implant configuration, since no well-established cadaver models exist.

    Clinical Trial Registration: ClinicalTrials.gov, Identifier NCT02840695.

    Delarbeid
    1. Increased occurrence of spinal fractures related to ankylosing spondylitis: a prospective 22-year cohort study in 17,764 patients from a national registry in Sweden.
    Åpne denne publikasjonen i ny fane eller vindu >>Increased occurrence of spinal fractures related to ankylosing spondylitis: a prospective 22-year cohort study in 17,764 patients from a national registry in Sweden.
    2013 (engelsk)Inngår i: Patient Safety in Surgery, ISSN 1754-9493, E-ISSN 1754-9493, Vol. 7, nr 2Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    BACKGROUND: Ankylosing spondylitis (AS) is a rheumatoid disease leading to progressive ossification of the spinal column. Patients suffering from AS are highly susceptible to unstable vertebral fractures and often require surgical stabilisation due to long lever arms. Medical treatment of these patients improved during the last decades, but until now it is unknown whether the annual number of spinal fractures changed during the last years. Since the annual count of fracture is an effective measure for efficacy of injury prevention and patient safety in AS patients, the current recommendations of activity have to be revised accordingly.

    METHODS: Data for all patients with AS treated as inpatients between 01/01/1987 and 31/12/2008 were extracted from the Swedish National Hospital Discharge Registry (SNHDR). The data in the registry are collected prospectively, recording all inpatient admissions throughout Sweden. The SNHDR uses the codes for diagnoses at discharge according to the Swedish versions of the International Classification of Diseases (ICD-9 and ICD-10).

    RESULTS: During the years from 1987 to 2008 17,764 patients with AS were treated as inpatients; of these 724 patients were treated due to spinal fractures. The annual number of cervical, thoracic and lumbar fractures in the registry increased until 2008 (r = 0.94).

    CONCLUSIONS: Despite the improved treatment of AS the annual number of vertebral fractures requiring inpatient care increased during the last two decades. Possible explanations are population growth, greater awareness of fractures, improved diagnostics, improved emergency care reducing fatalities, and a higher activity level of patients receiving modern medical therapy. Obviously the improvement of medical treatment did not reduce the susceptibility of these patients to unstable fractures. Thus the restrictive injury prevention recommendations for patients with AS cannot be defused, but must be critically revised to improve patient safety.

    HSV kategori
    Forskningsprogram
    Epidemiologi
    Identifikatorer
    urn:nbn:se:uu:diva-196499 (URN)10.1186/1754-9493-7-2 (DOI)23294597 (PubMedID)
    Tilgjengelig fra: 2013-03-11 Laget: 2013-03-10 Sist oppdatert: 2018-01-11bibliografisk kontrollert
    2. Complications and Survival after long Posterior Instrumentation of Cervical and Cervicothoracic Fractures related to Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis
    Åpne denne publikasjonen i ny fane eller vindu >>Complications and Survival after long Posterior Instrumentation of Cervical and Cervicothoracic Fractures related to Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis
    2015 (engelsk)Inngår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, nr 4, s. E227-E233Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    STUDY DESIGN: 

    Prospective cohort study.

    OBJECTIVE: 

    This study investigates the results of long posterior instrumentation with regard to complications and survival.

    SUMMARY OF BACKGROUND DATA: 

    Fractures of the cervical spine and the cervicothoracic junction related to ankylosing spinal disease (ASD) endanger both sagittal profile and spinal cord. Both anterior and posterior stabilization methods are well established, and clear treatment guidelines are missing.

    METHODS: 

    Forty-one consecutive patients with fractures of the cervicothoracic junction related to ASD were treated by posterior instrumentation. All patients were followed prospectively for 2 years using a standardized protocol.

    RESULTS: 

    Five patients experienced postoperative infections, 3 patients experienced postoperative pneumonia, 2 patients required postoperative tracheostomy, and 1 patient had postoperative cerebrospinal fluid leakage due to accidental durotomy. No patient required reoperation due to implant failure or nonunion. Mean survival was 52 months (95% confidence interval: 42-62 mo). Survival was affected by patient age, sex, smoking, and spinal cord injury.

    CONCLUSION: 

    Patients with ASD experiencing a fracture of the cervicothoracic region are at high risk of developing complications. The posterior instrumentation of cervical spinal fractures related to ASD is recommended due to biomechanical superiority. Level of Evidence: 4.

    HSV kategori
    Forskningsprogram
    Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-238966 (URN)10.1097/BRS.0000000000000726 (DOI)000349767500008 ()25494322 (PubMedID)
    Tilgjengelig fra: 2014-12-17 Laget: 2014-12-17 Sist oppdatert: 2018-01-11bibliografisk kontrollert
    3. Surgical stabilisation improves survival of spinal fractures related to ankylosing spondylitis
    Åpne denne publikasjonen i ny fane eller vindu >>Surgical stabilisation improves survival of spinal fractures related to ankylosing spondylitis
    2015 (engelsk)Inngår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, nr 21, s. 1697-1702Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    STUDY DESIGN: National registry cohort studyObjective. To investigate the effect of surgical stabilisation on survival of spinal fractures related to ankylosing spondylitis (AS).

    SUMMARY OF BACKGROUND DATA: Spinal fractures related to AS are associated with considerable morbidity and mortality. Multiple studies suggest a beneficial effect of surgical stabilisation in these patients.

    METHODS: In the Swedish patient registry all patients treated in an inpatient facility are registered with diagnosis and treatment codes. The Swedish mortality registry collects date and cause of death for all fatalities. Registry extracts of all patients with AS and spinal fractures including date of death and treatment were prepared and analysed for epidemiological purposes.

    RESULTS: 17297 individual patients with AS were admitted to treatment facilities in Sweden between 1987 and 2011. 990 patients with AS (age 66±14 years) had 1131 spinal fractures, of which 534 affected cervical, 352 thoracic, and 245 lumbar vertebrae. 13% had multiple levels of injuries during the observed period. Surgically treated patients had a greater survival than those treated non-surgically (HR = 0.79, p = 0.029). Spinal cord injury was the major factor contributing to mortality in this cohort (HR = 1.55, p<0.001). The proportion of surgically treated spinal fractures increased linearly during the last decades (r = 0.92, p<0.001) and was 64% throughout the observed years.

    CONCLUSIONS: Spinal cord injury threatened the survival of patients with spinal fractures related to AS. Even though surgical treatment is associated with a considerable complication rate, it improved the survival of spinal fractures related to AS.

    Emneord
    ankylosing spondylitis; epidemiology; incidence; mortality; national registry; spinal cord injury; spinal fracture; spinal fusion; surgical treatment; survival
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-262361 (URN)10.1097/BRS.0000000000001115 (DOI)000369221200018 ()26267824 (PubMedID)
    Tilgjengelig fra: 2015-09-14 Laget: 2015-09-14 Sist oppdatert: 2018-01-11bibliografisk kontrollert
    4. Biological disease-modifying anti-rheumatic treatment delayed spinal fractures related to ankylosing spondylitis: National multi-registry cohort study from the Swedish Patient Registry and the Swedish Prescribed Drugs Registry
    Åpne denne publikasjonen i ny fane eller vindu >>Biological disease-modifying anti-rheumatic treatment delayed spinal fractures related to ankylosing spondylitis: National multi-registry cohort study from the Swedish Patient Registry and the Swedish Prescribed Drugs Registry
    (engelsk)Manuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Objective

    Ankylosing spondylitis (AS) is associated with increased spinal fracture risk due to loss of elasticity in spinal motion segments. With the introduction of biological disease modifying anti-rheumatic drugs (bDMARD) treatment for AS patients the individual course of the disease has been decelerated.  This study aims to clarify whether the improved medical therapy reduced the spinal fracture incidence.

    Methods

    Included were all patients with the diagnosis of AS 1987 to 2014 from the Swedish Patient Registry. From the Swedish Prescribed Drug Registry the Anatomical Therapeutic Chemical codes for bDMARD, non-steroidal anti-inflammatory drugs (NSAID), methotrexate (MTX) and sulfasalazine were extracted and numbers of prescriptions and years of treatment counted since 2005.

    Results                

    12297 patients with ankylosing spondylitis were included between 1987 and 2014 (age 67±19, 67% male). Of these 291 had spinal fractures between 2011 and 2014. The number of prescriptions of bDMARD increased during the last decade, but not of MTX, sulfasalazine and NSAID. 64% of all AS patients used NSAID, 13% used bDMARD, 13% used MTX, and 10% used sulfasalazine. A multivariate analysis of patients with spinal fractures 2011-2014 found bDMARD delaying spinal fracture debut by 1.24 years per year of bDMARD treatment (p=0.028). The use of bDMARD had no significant effect on spinal fracture risk (OR=0.93, 95%-C.I.=0.85-1.01, p=0.09).

    Conclusion

    This study failed to demonstrate a beneficial effect on spinal fracture risk for AS patients treated with bDMARD during the last decade. Still bDMARD treatment delayed spinal fracture occurrence, which is promising with regard to results from future studies.

    Trial registration

    ClinicalTrials.gov, Identifier NCT02840695.

    HSV kategori
    Forskningsprogram
    Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-307365 (URN)
    Tilgjengelig fra: 2016-11-14 Laget: 2016-11-14 Sist oppdatert: 2018-01-13
    5. Finite element analysis of long posterior transpedicular instrumentation for cervicothoracic fractures related to ankylosing spondylitis
    Åpne denne publikasjonen i ny fane eller vindu >>Finite element analysis of long posterior transpedicular instrumentation for cervicothoracic fractures related to ankylosing spondylitis
    Vise andre…
    2018 (engelsk)Inngår i: Global Spine Journal, ISSN 2192-5682, E-ISSN 2192-5690, Vol. 8, nr 6, s. 570-578Artikkel i tidsskrift (Fagfellevurdert) 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. 

    HSV kategori
    Forskningsprogram
    Ortopedi
    Identifikatorer
    urn:nbn:se:uu:diva-307366 (URN)10.1177/2192568217745068 (DOI)000457230900005 ()30202710 (PubMedID)
    Tilgjengelig fra: 2016-11-14 Laget: 2016-11-14 Sist oppdatert: 2019-02-18bibliografisk kontrollert
  • 38.
    Robinson, Yohan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Abdelrazek, Mohamed
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Management of Anterior Column Defects in Pyogenic Spondylodiscitis.: A Systematic Review2015Inngår i: Global Spine Journal, ISSN 2192-5682, E-ISSN 2192-5690, Vol. 5, nr 1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction

    Study design: systematic review.

    Study Rationale: The surgical treatment of the anterior column defect in spondylodiscitis has been controversial for a long time and continues to remain so. Many techniques are described to manage the anterior column defect either through a posterior only method, anterior only method, or a combination of both. Many of the systematic reviews trying to investigate the best evidence for management involve tubercular and pyogenic, also all spinal column levels including cervical spine in their inclusion criteria regarding the differences in pathology, biomechanics, and natural history.

    Objectives

    The objective of the article is to present the difference in effectiveness and long-term reliability of all techniques which focus only on pyogenic infections in thoracolumbar segments.

    Material and Methods

    A systematic review of literature was performed using PubMed, ISI Web of Science, and Ovid Medline databases using the same search phrase: (anterior OR vertebral body OR defect) AND (spondylodiscitis OR discitis), further search was applied through reviewing references of the included search results. Articles were reviewed by the authors based on predetermined inclusion and exclusion criteria.

    Results

    PubMed search yielded 303 results, Ovid Medline yielded 451 results, and ISI Web of Science yielded 279 results. After title review and exclusion of duplication and non-English or German language articles, 32 articles were included and after final full text review 12 articles were included and presented. Three groups were formulated: anterior, posterior, and combined. Comparison included VAS, ODI, healing percentage, kyphosis correction and its maintenance, CRP, neurology, and complications.

    Conclusion

    There is a significant superiority of the combined anterior and posterior techniques in maintenance of kyphosis correction on the long-term follow-up, otherwise, due to the diversity of the criteria of evaluation of results in different articles, more clinical research should be directed to investigate the results of surgical management of anterior column defects in pyogenic thoracolumbar levels in particular.

  • 39.
    Robinson, Yohan
    et al.
    Charité – Campus Benjamin Franklin, Institute of Sports Medicine, Berlin, Germany.
    Cristancho, Edgar
    Böning, Dieter
    An optimized method for the assay of the red blood cell-age-related enzyme aspartate aminotransferase2004Inngår i: Laboratory Hematology, ISSN 1080-2924, E-ISSN 1523-6528, Vol. 10, nr 3, s. 144-146Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Three methods of preparation of red blood cell concentrate for erythrocyte aspartate aminotransferase measurement were compared: (1) filtration of whole blood through a cellulose column (n = 36); (2) washing of whole blood and aspiration of buffy coat after centrifugation (n = 48); (3) optimized method with washing without aspiration of buffy coat (n = 229).

  • 40.
    Robinson, Yohan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Cristancho, Edgar
    Böning, Dieter
    Die Hypoferritinämie des Sportlers ist kein sicheres Indiz für Eisenmangel [High Serum Ferritin Levels Have Low Sensitivity for Iron Deficiency in Athletes]2010Inngår i: Deutsche Zeitschrift für Sportmedizin, ISSN 0344-5925, Vol. 61, nr 6, s. 141-145Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Iron deficiency is commonly diagnosed by serum ferritin [sFer] determination, iron deficiency anaemia from reduced mean cellular volume (MCV). [sFer] shows a high variance if inflammation or liver dysfunction are present. Athletes often present with hypoferritinaemia. This study was designed to evaluate the relation of total body haemoglobin mass (tHb) which is commonly elevated in athletes to [sFer]. In the present study 56 trained (TR), 72 moderately trained (MT) and 31 untrained (UT) male individuals were investigated for peak oxygen uptake (VO2max), serum iron, [sFer] soluble transferrin receptor [sTfr], serum erythropoietin [EPO], haemoglobin concentration [Hb] haematocrit (Het), MCV blood volume (BV), and plama volume (PV). TR and UT individuals differed significantly in VO2max, tHb, PV, and BV (all p<0.01). [sFer] correlated negatively with tHb (r=-0.31,p<0.05), BV (r=-0.38,p<0.05) and max (r=-0.54,p<0.01) but not with EPO, [Fe], [sTfr], MCV, [Hb], Het, and PV. Since a negative correlation of [sFer] and tub was found, an iron storage shift from the reticuloendothelial system (RES) to the erythroid system could have occurred. This is only pathological if functional iron deficiency occurs, as suggested by increased [sTfr]. Possible causes of functional iron deficiency are gastrointestinal microhaemorrhage, menstrual blood loss and EPO-doping. True iron deficiency should be treated by dietary means or iron supplementation. Iron misuse instead has severe side-effects and uncritical addition of iron to the athlete's nutrition should be avoided.

  • 41.
    Robinson, Yohan
    et al.
    Charité – Campus Benjamin Franklin, Centre of Trauma and Reconstructive Surgery, Berlin, Germany.
    Cristancho, Edgar
    Böning, Dieter
    Erythrocyte aspartate aminotransferase activity as a possible indirect marker for stimulated erythropoiesis in male and female athletes2007Inngår i: Laboratory Hematology, ISSN 1080-2924, E-ISSN 1523-6528, Vol. 13, nr 2, s. 49-55Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A reliable and cost-effective screening test for erythropoietin (EPO) doping is still unavailable. Thus a new approach by estimating mean red blood cell (RBC) age by means of erythrocyte aspartate aminotransferase activity (eAST) was developed. We investigated 201 women and 169 men residing at low altitude for peak oxygen uptake, EPO, and eAST. Additionally, we investigated 63 women and 42 men residing at 2600 m above sea level for EPO and eAST. Furthermore, 22 female and 28 male patients with renal failure receiving recombinant human EPO (rhEPO) were investigated for eAST levels. There was no difference in eAST between trained (women, 2.9+/-0.7 U x gHb(-1); men, 2.5+/-0.4 U x gHb(-1)), moderately trained (women, 2.8+/-0.6 U x gHb(-1); men, 2.4+/-0.4 U x gHb(-1)), and untrained subjects (women, 3.0+/-0.5 U x gHb(-1); men, 2.5+/-0.4 U.gHb-1) at low altitude. Participants receiving rhEPO had a dose-dependent increase in eAST (r=0.25; P< .05). Trained high-altitude residents (women, 2.8+/-0.8 U x gHb(-1); men, 3.0+/-1.1 U x gHb(-1)) had higher eAST than untrained high-altitude residents (women, 2.5+/-0.6 U.gHb-1; men, 2.4+/-0.4 U x gHb(-1); P< .05). Since eAST was sensitive to RBC rejuvenation, eAST elevation could indicate EPO use in lowlanders. eAST values above the 95% confidence interval (>3.3 U x gHb(-1) for men; >4.1 U x gHb(-1) for women) are suspected of EPO use.

  • 42.
    Robinson, Yohan
    et al.
    Charite´–Campus Benjamin Franklin, Institute for Sports Medicine, Berlin, Germany.
    Cristancho, Edgar
    Böning, Dieter
    Intravascular hemolysis and mean red blood cell age in athletes2006Inngår i: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 38, nr 3, s. 480-483Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Since the observation that mechanical stress causes red blood cell (RBC) destruction, foot-strike hemolysis has been used to explain sports anemia and RBC rejuvenation in athletes. Recently gained knowledge questions the importance of mechanical RBC trauma on RBC hemolysis in athletes.

    METHODS: Male athletes (N = 90) and untrained male controls (N = 58) were investigated for aerobic performance, hematological parameters, serum erythropoietin concentration (EPO), soluble transferrin receptor concentration (sTFR), and erythrocyte aspartate aminotransferase activity (eAST).

    RESULTS: On hard floor running disciplines (HFR, N = 26, short- and long-distance runners, triathletes) showed a lower eAST (P < 0.001) and thus no younger RBC population than not on hard floor running athletes (NHFR, N = 64, cyclists, soccer players, others) or the untrained control group (N = 58). HFR had higher but still normal EPO (P < 0.01) and no higher sTFR.

    CONCLUSION: Because intravascular hemolysis occurs in swimmers, cyclists, and runners, and mean RBC age is not reduced in runners, mechanisms other than foot-strike hemolysis have to be considered as well. Possible reasons are intramuscular destruction, osmotic stress, and membrane lipid peroxidation caused by free radicals released by activated leukocytes. Intravascular hemolysis can even be regarded as physiological means to provide heme and proteins for muscle growth.

  • 43.
    Robinson, Yohan
    et al.
    Klinik für Unfall- und Wiederherstellungschirurgie, Charité – Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin.
    Heyde, Christoph E
    Kayser, Ralph
    Diagnostik und Therapie der thorakalen Spondylodiszitis2007Inngår i: Manuelle Medizin, ISSN 0025-2514, E-ISSN 1433-0466, Vol. 45, s. 17-20Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Due to the increase in patients with multiple co-morbidities and immigration from developing countries the incidence of thoracic spondylodiscitis has not decreased. The diagnosis of thoracic spondylodiscitis is based on clinical findings, laboratory diagnostics and radiological imaging, including X-ray and MRI. Surgical therapy includes radical debridement, correction of deformity and adequate stabilisation, even though the use of titanium implants is discussed controversially. Additionally antibiotic therapy according to the resistance spectrum is necessary. Early diagnosis and therapy enable healing without severe complications.

  • 44.
    Robinson, Yohan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Heyde, Christoph E.
    Tschöke, Sven K.
    Mont, Michael A.
    Seyler, Thorsten M.
    Ulrich, Slif D.
    Evidence supporting the use of bone morphogenetic proteins for spinal fusion surgery2008Inngår i: Expert review of medical devices, ISSN 1743-4440, Vol. 5, nr 1, s. 75-84Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Bone morphogenetic proteins (BMPs) are capable of promoting bone healing and even induce de novo osteogenesis. Their clinical application in spinal fusion surgery has recently increased in popularity. This is especially true for the use of BMPs in combination with artificial bone substitutes that have the capability to replace autologous bone graft, which can be associated with severe harvesting complications. This review will examine the use of BMP-2 and BMP-7 as commercially available products that have proven their osteoinductive capacity in spinal fusion. We will perform an overview of the literature for scientific evidence supporting the use of these new technologies. Despite their high osteoinductive potency, the use of BMPs does not replace proper surgical stabilization in spinal fusion. Safety issues with BMPs are osteoclast activation, postoperative swelling and hyperostosis. Despite these issues, manufacturers continue to expend more effort concerning proper application, dosage and carriers for these devices for spinal fusion, both presently and in the future.

  • 45.
    Robinson, Yohan
    et al.
    Charité – Campus Benjamin Franklin, Klinik für Unfall- und Wiederherstellungschirurgie, Berlin.
    Hostmann, Arwed
    Matenov, Alexander
    Ertel, Wolfgang
    Oberholzer, Andreas
    Erythropoiesis in multiply injured patients2006Inngår i: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 61, nr 5, s. 1285-1291Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Posttraumatic anemia in multiply injured patients is caused by hemorrhage, reduced red blood cell survival, and impaired erythropoiesis. Trauma-induced hyperinflammation causes impaired bone-marrow function by means of blunted erythropoietin (EPO) response, reduced iron availability, suppression and egress of erythroid progenitor cells. To treat posttraumatic anemia in severely injured patients, symptomatic therapy by blood transfusion is not sufficient. Furthermore, EPO, iron, and the use of red cell substitutes should be considered. The posttraumatic systemic inflammatory response syndrome (SIRS) induces posttraumatic anemia. Thus, a worsening of SIRS by a "second-hit" through blood transfusion ought to be avoided.

  • 46.
    Robinson, Yohan
    et al.
    Charite´ – Campus Benjamin Franklin, Centrum fu¨r Unfallund Wiederherstellungschirurgie, Berlin.
    Kayser, Ralph
    Ertel, Wolfgang
    Heyde, Christoph E
    Traumatic cervical instability in martial arts2007Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 17, nr 1, s. 92-93Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Severe injuries in martial arts are rare and only few spinal injuries have been reported so far.

    Objective: To sensitise for cervical spine instability even after low impact sports trauma.

    Case: A 27-years old male athlete tried to escape a headlock during a jujitsu fight and reported acute neck pain. Neurologically the patient remained intact. Conventional X-ray, CT and MRI revealed discoligamental instability at C6/7. Thus an anterior fusion at C6/7 was performed with excellent 2-years follow-up result.

    Conclusions: Only relatively little force is needed to disrupt cervical spinal ligaments if torsion is involved. Sports physicians need to recognise the discipline-related injury-patterns and martial arts-schools should re-evaluate their rules of safety concerning cervical spine-injuries.

  • 47.
    Robinson, Yohan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Lison Almkvist, Viktor
    KTH Stockholm.
    Fahlstedt, Madelen
    KTH Stockholm.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Halldin, Peter
    KTH Stockholm.
    Finite element analysis of long posterior transpedicular instrumentation for cervicothoracic fractures related to ankylosing spondylitis2018Inngår i: Global Spine Journal, ISSN 2192-5682, E-ISSN 2192-5690, Vol. 8, nr 6, s. 570-578Artikkel i tidsskrift (Fagfellevurdert)
    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. 

  • 48.
    Robinson, Yohan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Matenov, Alexander
    Tschöke, S. K.
    Weimann, A.
    Oberholzer, Andreas
    Ertel, Wolfgang
    Hostmann, Arvid
    Impaired erythropoiesis after haemorrhagic shock in mice is associated with erythroid progenitor apoptosis in vivo2008Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, nr 5, s. 605-13Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Multiply traumatised patients often suffer from blood loss and from subsequent therapy-resistant anaemia, possibly mediated by apoptosis, necrosis, or humoral factors. Therefore, the underlying mechanisms were investigated in bone marrow (BM) and peripheral blood in a murine resuscitated haemorrhagic shock (HS) model. METHODS: In healthy male mice, pressure-controlled HS was induced for 60 min. The BM was analysed for Annexin-V, 7-amino-actinomycin D, apoptotic enzymes (caspases-3/7, -8, and -9), expression of death receptors (CD120a, CD95), mitochondrial proteins (Bax, Bcl-2, Bcl-x), as well as erythropoietin (EPO) receptor (EPO-R). Blood cell count, peripheral EPO, and tumour necrosis factor-alpha response were additionally monitored. RESULTS: Twenty-four and 72 h after HS, EPO and EPO-R were strongly up-regulated in peripheral blood and BM, respectively. Decreasing numbers of erythroid progenitors in BM after HS correlated with significant apoptotic changes confirmed by increased caspases-3/7, -8, -9 activity in total BM, death receptor CD95 and CD120a expression on erythroid progenitors, and down-regulated mitochondrial Bcl-2 expression in total BM. Erythroid progenitors in peripheral blood were found to be increased after 72 h. CONCLUSION: Despite the massive EPO response and up-regulation of EPO-R, BM erythroblasts (EBs) decreased. This could be due to deficient maturation of erythroid progenitors. Furthermore, the increased intrinsic and extrinsic apoptosis activation suggests programmed death of erythroid progenitors. We propose that both apoptosis and negatively regulated erythropoiesis contribute to BM dysfunction, while erythroid progenitor egress plays an additional role.

  • 49.
    Robinson, Yohan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Sandén, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Instrumentation in lumbar fusion improves back pain but not quality of life 2 years after surgery2013Inngår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 84, nr 1, s. 7-11Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and purpose Instrumented and non-instrumented methods of fusion have been compared in several studies, but the results are often inconsistent and conflicting. We compared the 2-year results of 3 methods of lumbar fusion when used in degenerative disc disease (DDD), using the Swedish Spine Register (SWESPINE). Methods All patients registered in SWESPINE for surgical treatment of DDD between January 1, 2000 and October 1, 2007 were eligible for the study. Patients who had completed the 2-year follow-up were included in the analysis. The outcomes of 3 methods of surgical fusion were assessed. Results Of 1,310 patients enrolled, 115 had undergone uninstrumented fusion, 620 instrumented posterolateral fusion, and 575 instrumented interbody fusion. Irrespective of the surgical procedure, quality of life (QoL) improved and back pain diminished. Change in QoL and functional disability and return to work was similar in the 3 groups. Patients who had undergone uninstrumented fusion had more back pain than the patients with instrumented interbody fusion at the 2-year follow-up (p = 0.02), although the difference was only 7 visual analog scale (VAS) units (95% CI: 1-13) on a 100-point scale. Moreover, 83% of the patients with uninstrumented fusion used analgesics at the end of follow-up as compared to 68% of the patients who had undergone surgery with one of the 2 instrumented fusion techniques. Interpretation In comparison with instrumented interbody fusion, uninstrumented fusion was associated with higher levels of back pain 2 years after surgery. We found no evidence for differences in QoL between uninstrumented fusion and instrumented interbody fusion.

  • 50.
    Robinson, Yohan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Biological disease-modifying anti-rheumatic treatment delayed spinal fractures related to ankylosing spondylitis: National multi-registry cohort study from the Swedish Patient Registry and the Swedish Prescribed Drugs RegistryManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Objective

    Ankylosing spondylitis (AS) is associated with increased spinal fracture risk due to loss of elasticity in spinal motion segments. With the introduction of biological disease modifying anti-rheumatic drugs (bDMARD) treatment for AS patients the individual course of the disease has been decelerated.  This study aims to clarify whether the improved medical therapy reduced the spinal fracture incidence.

    Methods

    Included were all patients with the diagnosis of AS 1987 to 2014 from the Swedish Patient Registry. From the Swedish Prescribed Drug Registry the Anatomical Therapeutic Chemical codes for bDMARD, non-steroidal anti-inflammatory drugs (NSAID), methotrexate (MTX) and sulfasalazine were extracted and numbers of prescriptions and years of treatment counted since 2005.

    Results                

    12297 patients with ankylosing spondylitis were included between 1987 and 2014 (age 67±19, 67% male). Of these 291 had spinal fractures between 2011 and 2014. The number of prescriptions of bDMARD increased during the last decade, but not of MTX, sulfasalazine and NSAID. 64% of all AS patients used NSAID, 13% used bDMARD, 13% used MTX, and 10% used sulfasalazine. A multivariate analysis of patients with spinal fractures 2011-2014 found bDMARD delaying spinal fracture debut by 1.24 years per year of bDMARD treatment (p=0.028). The use of bDMARD had no significant effect on spinal fracture risk (OR=0.93, 95%-C.I.=0.85-1.01, p=0.09).

    Conclusion

    This study failed to demonstrate a beneficial effect on spinal fracture risk for AS patients treated with bDMARD during the last decade. Still bDMARD treatment delayed spinal fracture occurrence, which is promising with regard to results from future studies.

    Trial registration

    ClinicalTrials.gov, Identifier NCT02840695.

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