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  • 1.
    Alipour, Akbar
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Ghaffari, Mostafa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Shariati, Batoul
    Jensen, Irene
    Vingård, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Four-year incidence of sick leave because of neck and shoulder pain and its association with work and lifestyle2009Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 34, nr 4, s. 413-418Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN: Four-year prospective cohort study. OBJECTIVE: To find the incidence of sick leave because of neck and shoulder pain (NSP) in industrial workers, and its association with work and lifestyle risk factors. SUMMARY OF BACKGROUND DATA: Longitudinal studies to investigate NSP incidence and risk factors are rare, and even fewer have been conducted in middle- and low-income countries. METHODS: After inviting all full-time employees of an Iranian car manufacturing company with 18,031 employees to participate in a baseline study, they were followed for 4 years. New episodes of sick leave because of NSP have been calculated based on sickness absence registration between the years 2003 and 2007. The incidence was compared for participants and nonparticipants. The association between sick leave, physical, and psychosocial risk factors at work, and previous self-reported NSP, was calculated for the remaining population of baseline participants (12,184 employees) during a 4-year follow-up. RESULTS: During a 4-year follow-up of study subjects for the remaining participants of the baseline study, the incidence of sick leave was 0.8% (98 sick leave cases in 12,184 employees). For nonparticipants this incidence was 4.2% (130 cases in 3127 employees). In the final regression model for sick leave cases, the remaining factors for potential physical risk factors were repetitive work and sitting positions at work; for psychosocial factors unattractive work was the only significant remaining factor. CONCLUSION: The incidence of NSP based on sick leave is definitely very low compared with previous studies in high-income countries. This incidence varies between participants and nonparticipants. Risk factors for sick leave differ from risk factors for self-reported pain. A young population, job security, the insurance system, different health behaviors, and healthy worker bias, are all factors that may affect the results, and sick-leave as an outcome must be interpreted with more caution in middle- and low-income countries.

  • 2. Engquist, Markus
    et al.
    Lofgren, Hakan
    Oberg, Birgitta
    Holtz, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Peolsson, Anneli
    Soderlund, Anne
    Vavruch, Ludek
    Lind, Bengt
    Surgery Versus Nonsurgical Treatment of Cervical Radiculopathy A Prospective, Randomized Study Comparing Surgery Plus Physiotherapy With Physiotherapy Alone With a 2-Year Follow-up2013Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 38, nr 20, s. 1715-1722Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Design. Prospective randomized controlled trial. Objective. To study the outcome of anterior cervical decompression and fusion combined with a structured physiotherapy program compared with the same physiotherapy program alone for patients with cervical radiculopathy. Summary of Background Data. Knowledge concerning the effects of interventions for patients with cervical radiculopathy is scarce due to a lack of randomized studies. Methods. Sixty-three patients were randomized to surgery with postoperative physiotherapy (n = 31) or physiotherapy alone (n = 32). The surgical group was treated with anterior cervical decompression and fusion. The physiotherapy program included general/specific exercises and pain-coping strategies. The outcome measures were disability (Neck Disability Index), neck and arm pain intensity (visual analogue scale), and the patient's global assessment. Patients were followed for 24 months. Results. The result from the repeated-measures analysis of variance showed no significant between-group difference for Neck Disability Index (P = 0.23). For neck pain intensity, the repeated-measures analysis of variance showed a significant between-group difference during the study period in favor of the surgical group (P = 0.039). For arm pain intensity, no significant between-group differences were found according to the repeated-measures analysis of variance (P = 0.580). Eighty-seven percent of the patients in the surgical group rated their symptoms as "better/much better" at the 12-month follow-up compared with 62% in the nonsurgical group (P < 0.05). At 24 months, the corresponding figures were 81% and 69% (P = 0.28). The difference was significant only at the 12-month follow-up in favor of the surgical group. Significant reduction in Neck Disability Index, neck pain, and arm pain compared with baseline was seen in both groups (P < 0.001). Conclusion. In this prospective, randomized study of patients with cervical radiculopathy, it was shown that surgery with physiotherapy resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient's global assessment than physiotherapy alone, but the differences between the groups decreased after 2 years. Structured physiotherapy should be tried before surgery is chosen.

  • 3.
    Engquist, Markus
    et al.
    Ryhov Hosp, Dept Orthopaed, S-55185 Jonkoping, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden..
    Löfgren, Håkan
    Ryhov Hosp, Neuroorthoped Ctr, S-55185 Jonkoping, Sweden..
    Öberg, Birgitta
    Linkoping Univ, Fac Hlth Sci, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden..
    Holtz, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Pålsson, Anneli
    Linkoping Univ, Fac Hlth Sci, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden..
    Söderlund, Anne
    Malardalen Univ, Sch Hlth Care & Social Welf, Dept Physiotherapy, Vasteras, Sweden..
    Vavruch, Ludek
    Ryhov Hosp, Neuroorthoped Ctr, S-55185 Jonkoping, Sweden..
    Lind, Bengt
    Univ Gothenburg, Sahlgrenska Acad, Dept Orthopaed, Inst Clin Sci, Gothenburg, Sweden.;Spine Ctr Goteborg, Gothenburg, Sweden..
    Factors Affecting the Outcome of Surgical Versus Nonsurgical Treatment of Cervical Radiculopathy2015Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, nr 20, s. 1553-1563Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Design. Prospective randomized controlled trial. Objective. To analyze factors that may influence the outcome of anterior cervical decompression and fusion (ACDF) followed by physiotherapy versus physiotherapy alone for treatment of patients with cervical radiculopathy. Summary of Background Data. An understanding of patient-related factors affecting the outcome of ACDF is important for preoperative patient selection. No previous prospective, randomized study of treatment effect modifiers relating to outcome of ACDF compared with physiotherapy has been carried out. Methods. 60 patients with cervical radiculopathy were randomized to ACDF followed by physiotherapy or physiotherapy alone. Data for possible modifiers of treatment outcome at 1 year, such as sex, age, duration of pain, pain intensity, disability (Neck Disability Index, NDI), patient expectations of treatment, anxiety due to neck/arm pain, distress (Distress and Risk Assessment Method), self-efficacy (Self-Efficacy Scale) health status (EQ-5D), and magnetic resonance imaging findings were collected. A multivariate analysis was performed to find treatment effect modifiers affecting the outcome regarding arm/neck pain intensity and NDI. Results. Factors that significantly altered the treatment effect between treatment groups in favor of surgery were: duration of neck pain less than 12 months (P = 0.007), duration of arm pain less than 12 months (P = 0.01) and female sex (P = 0.007) (outcome: arm pain), low EQ-5D index (outcome: neck pain, P = 0.02), high levels of anxiety due to neck/arm pain (outcome: neck pain, P = 0.02 and NDI, P = 0.02), low Self-Efficacy Scale score (P = 0.05), and high Distress and Risk Assessment Method score (P = 0.04) (outcome: NDI). No factors were found to be associated with better outcome with physiotherapy alone. Conclusion. In this prospective, randomized study of patients with cervical radiculopathy, short duration of pain, female sex, low health quality, high levels of anxiety due to neck/arm pain, low self-efficacy, and a high level of distress before treatment were associated with better outcome from surgery. No factors were found to be associated with better outcome from physiotherapy alone.

  • 4.
    Gustavsson, Catharina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Denison, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    von Koch, Lena
    Karolinska Institutet, Department of Neurobiology, Care Science and Society.
    Self-management of persistent neck pain: 2-year follow-up of a randomized controlled trial of a multi-component group intervention in primary health care2011Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 36, nr 25, s. 2105-2115Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study design

    A 2-year follow-up of a randomized controlled trial.

    Objective

    To compare long-term effects of a) a multi-component pain and stress self-management group intervention (PASS) and b) individually administered physical therapy (IAPT) on patients with persistent tension-type neck pain in a primary health care (PHC) setting.

    Summary of Background Data

    In a previously reported short-term follow-up, PASS had better effects on pain control, pain-related self-efficacy, disability and catastrophizing than IAPT. Long-term effects of self-management interventions for persistent neck pain, e.g. maintenance of improvement and adherence to coping skills are sparsely investigated.

    Methods

    Persons with persistent tension-type neck pain seeking physical therapy treatment at nine PHC centers in Sweden were randomly assigned to either PASS or IAPT. Before intervention, at 10 and 20 weeks and at 1 and 2 years after the intervention, the participants completed a self-assessment questionnaire comprising: the Self-Efficacy Scale, the Neck Disability Index, the Coping Strategies Questionnaire, the Hospital Anxiety and Depression Scale and questions regarding neck pain and analgesics. Analyses were performed using linear mixed models for repeated measures.

    Results

    The study included 156 participants (PASS n=77, IAPT n=79). Between baseline, 10-week, 20-week, 1-year and 2-year follow-up, significant time by group interaction effects were found in favor of PASS regarding the primary outcomes ability to control pain (p<0.001) and self-efficacy for performing activities in spite of pain (p=0.002), and the secondary outcome catastrophic thinking (p<0.001) but not in neck pain related disability.

    Conclusions

    The initial treatment effects of a self-management group intervention were largely maintained over a 2 year follow-up period and with a tendency to have superior long-term effects as compared to individually administered physical therapy, in the treatment of persistent tension-type neck pain with regard to coping with pain, in terms of pain control, self-efficacy and catastrophizing.

  • 5.
    Henriques, Thomas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Cunningham, Bryan
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Shimamoto, Norimichi
    Lee, Guy
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    McAfee, Paul
    Biomechanical comparison of five different atlantoaxial posterior fixation techhniques2000Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 25, nr 22, s. 2877-2883Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN:

    Five different reconstructions of the atlantoaxial complex were biomechanically compared in vitro in a nondestructive test.

    OBJECTIVES:

    To determine whether non-bone graft-dependent one-point fixation affords stability levels equivalent to three-point reconstructions.

    SUMMARY OF BACKGROUND DATA:

    Previous investigations have demonstrated that three-point fixation, using bilateral transarticular screws in combination with posterior wiring, provide the most effective resistance to minimize motion around C1-C2. However, placement of transarticular screws is technically demanding. Posterior wiring techniques affording one-point fixation have failure rates of approximately 15%, with failure considered to be secondary to structural bone graft failures. One-point, non-bone graft-dependent fixations have not been tested.

    METHODS:

    Eight human cervical specimens, C0-C3 were loaded nondestructively. Unconstrained three-dimensional segmental motion was measured. The reconstructions tested were two one-point fixations, one two-point fixation, and two three-point fixations.

    RESULTS:

    Under axial rotation two and three-point reconstructions provided better stiffness than the one-point reconstructions (P < 0.05). During flexion-extension, higher stiffness levels were observed in one- and three-point fixations when compared with the intact spine (P < 0.05). In lateral bending no significant differences were observed among the six groups, although the trend was that reconstructions including transarticular screws provided greater stability than one-point fixations.

    CONCLUSION:

    The current findings substantiate the use of three-point fixation as the treatment of choice for C1-C2 instability. [l: atlantoaxial fixation, biomechanics, cervical spine, instability, spinal instrumentation, transarticular screws]

  • 6.
    Henriques, Thomas
    et al.
    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.
    Petren-Mallmin, M
    Ahl, T
    Letter to the editor2001Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 26, nr 21, s. 2404s. 2405-Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 7.
    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 Japan2018Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 43, nr 24, s. E1474-E1478Artikel i tidskrift (Refereegranskat)
    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

  • 8.
    Knutsson, Björn
    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.
    Obese patients report modest weight loss after surgery for lumbar spinal stenosis: a study from the Swedish spine register2014Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 39, nr 20, s. 1725-1730Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN:

    SWESPINE, the Swedish Spine Register, was used for this cohort study.

    OBJECTIVE:

    Our primary aim was to determine weight change in obese patients after surgery for lumbar spinal stenosis (LSS). Our secondary aim was to study any possible associations between weight loss after surgery and improvement in patient-related outcome measures (PROMs).

    SUMMARY OF BACKGROUND DATA:

    Only meager evidence is available as to how surgery for LSS affects weight and whether weight loss is associated with improvement in PROMs after surgery for LSS.

    METHODS:

    All obese patients who underwent surgery for LSS from January 1, 2006 through June 30, 2008 with a completed 2-year follow-up in SWESPINE were included. Data for weight were collected before surgery and then 1 and 2 years after surgery. The cohort was divided into 3 subclasses (weight stable, weight loss, or weight gain).

    RESULTS:

    Totally, 538 obese patients were enrolled. Mean weight loss was 1.9 kg (95% confidence interval, 1.5-2.3) 1 year after surgery and 2.0 kg (95% confidence interval, 1.5-2.4) after 2 years after surgery. Only 8% of the patients reported a clinically important weight loss (≥10%). No significant differences in PROMs were observed. The weight-stable group reported a mean improvement of 0.22 (standard deviation, 0.36) in EQ-5D, 14 (18) units in the Oswestry Disability Index, 18 (33) units in back pain (visual analogue scale), and 23 (36) units in leg pain (visual analogue scale). The corresponding changes in the weight-loss group were 0.23 (0.35) in EuroQol 5D, 15 (19) in Oswestry Disability Index, 27 (29) in back pain, and 31 (36) in leg pain.

    CONCLUSION:

    Modest weight loss was reported 1 and 2 years postsurgery; a small proportion (8%) of these patients reported a clinically important weight loss at the 2-year follow-up. The weight loss was unrelated to changes in PROMs.

    LEVEL OF EVIDENCE:

    3.

  • 9.
    Knutsson, Björn
    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.
    Obesity Is Associated With Inferior Results After Surgery for Lumbar Spinal Stenosis: A Study of 2633 Patients from the Swedish Spine Register2013Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 38, nr 5, s. 435-441Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Design

    A cohort study based on the Swedish Spine Register.

    Objective

    To determine the association between body mass index (BMI) and outcome of lumbar spine surgery for spinal stenosis.

    Summary of Background Data

    Several small studies have sought to evaluate the importance of obesity in relation to results after surgery for lumbar spinal stenosis (LSS) but the findings are inconsistent and relatively weak.

    Methods

    All patients who underwent surgery for LSS from January 1, 2006 to June 30, 2008 with a completed 2-year follow-up in the Swedish Spine Register were included. Logistic regression was used to assess the association between BMI and different outcomes.

    Results

    Of 2633 patients enrolled, 819 (31%) were normal weight, 1208 (46%) overweight and 606 (23%) obese. On average, all three BMI groups achieved significant improvements after surgery. A higher BMI, however, was associated with greater odds of dissatisfaction after surgery and inferior results at the 2-year follow-up. After adjusting for differences in baseline characteristics, the obese group demonstrated inferior function and quality of life (QoL) as measured by the Oswestry Disability Index (ODI) and the EuroQol group (EQ-5D), respectively. At the 2-year follow-up, obese patients had a mean ODI of 33 (95% confidence interval [CI], 31-34) and mean EQ-5D of 0.56 (95% CI, 0.54-0.59) compared with a mean ODI of 25 (95% CI 24-26) and mean EQ-5D of 0.64 (95% CI, 0.62-0.66) in the normal weight group. When compared with the normal weight patients, the adjusted odds ratio (OR) for dissatisfaction was 1.73 in the obese group (95% CI 1.36-2.19). Differences between the normal weight and overweight group were modest and therefore could not be considered clinically relevant.

    Conclusion

    Obese patients achieved significant pain reduction, better walking ability and improved QoL after surgical treatment for LSS. Nevertheless, obesity was associated with a higher degree of dissatisfaction and poorer outcomes after surgery for LSS.

  • 10.
    Knutsson, Björn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Sanden, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Sjoden, Goran
    Umea Univ, Dept Surg & Perioperat Sci, Umea, Sweden..
    Jarvholm, Bengt
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Body Mass Index and Risk for Clinical Lumbar Spinal Stenosis: A Cohort Study2015Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, nr 18, s. 1451-1456Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Design. A prospective cohort study that used a Swedish nationwide occupational surveillance program for construction workers (period of registration from 1971 to 1992). In all, 364,467 participants (mean age at baseline 34 yr) were included in the study. Objective. To determine whether overweight and obesity are associated with a higher risk of lumbar spinal stenosis (LSS). Summary of Background Data. During recent decades, LSS has become the most common indication for spine surgery, a change that coincides with a higher prevalence of obesity. Methods. A diagnosis of LSS was collected through individual linkage to the Swedish National Patient Register through December 31, 2011. Poisson regression models were employed to estimate multivariable-adjusted incidence rate ratios (IRRs) for LSS. Results. At baseline, 65% had normal weight (BMI [body mass index]: 18.5-24.99 kg/m(2)), 29% were overweight (BMI: 25-29.99 kg/m(2)), 5% were obese (BMI >= 30 kg/m(2)), and 2% were underweight (BMI <18.5 kg/m(2)). During 11,190,944 person-years of follow-up, with a mean of 31 years, 2381 participants were diagnosed with LSS. Compared with normal weight individuals, obese workers had an IRR of 2.18 (95% confidence interval, 1.87-2.53) for LSS and overweight workers had an IRR of 1.68 (95% confidence interval, 1.54-1.83). Workers who were underweight halved their risk of LSS (IRR: 0.52, 95% confidence interval, 0.30-0.90). Conclusion. Obese and overweight persons are at a higher risk of developing LSS. Furthermore, our results indicate that obesity might be a novel explanation for the increased number of patients with clinical LSS. Level of Evidence: 3

  • 11.
    Kristiansson, Per
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Discriminatory power of tests applied in back pain during pregnancy1996Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 21, nr 20, s. 2337-2344Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN

    A longitudinal, prospective, observational cohort study.

    OBJECTIVES

    To assess the relationship between clinical back status and reported pain locations during and after pregnancy.

    SUMMARY OF BACKGROUND DATA

    Back pain during pregnancy is a frequent clinical occurrence, even during the early stages of pregnancy. The cause is unclear. There are few data describing the results of a general physical examination of the back during pregnancy and there are no data on serial examinations. Such data could provide information about what structures cause the pain, which might have implications for the choice of treatment.

    METHODS

    A cohort of 200 consecutive women attending an antenatal clinic was observed throughout the pregnancy terms, and repeated measurements of back pain and its possible determinants were taken using questionnaires and physical examinations in a standardized way, including a series of tests of configuration, mobility, and pain provocation.

    RESULTS

    Pain provocation tests were better at discriminating among women who reported back pain from women who reported no back pain from tests of configuration or mobility. The discriminatory power of the tests was better in the lower part of the spine than in the upper part. The best discrimination was achieved by combining some of the tests.

    CONCLUSIONS

    The results indicate that not one but several pain-releasing structures may be involved. These are probably the various pelvic ligaments, which may form a functional unit. These findings may have therapeutic implications.

  • 12.
    Kristiansson, Per
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    von Schoultz, Bo
    Back pain during pregnancy: a prospective study1996Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 21, nr 6, s. 702-709Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN:

    A longitudinal, prospective, observational, cohort study.

    OBJECTIVES:

    To describe the natural history of back pain occurring during pregnancy and immediately after delivery.

    SUMMARY OF BACKGROUND DATA:

    Back pain during pregnancy is a frequent clinical problem even during the early stages of pregnancy. The cause is unclear.

    METHODS:

    A cohort of 200 consecutive women attending an antenatal clinic were followed throughout pregnancy with repeated measurements of back pain and possible determinants by questionnaires and physical examinations.

    RESULTS:

    Seventy-six percent reported back pain at some time during pregnancy. Sixty-one percent reported onset during the present pregnancy. In this group, the prevalence rate increased to 48% until the 24th week and then remained stable and declined to 9.4% after delivery. The reported pain intensity increased by pain duration. The pain score correlated closely to self-rated disability and days of sickness benefit.

    CONCLUSIONS:

    Back pain during pregnancy is a common complaint. The 30% with the highest pain score reported great difficulties with normal activities. The back pain started early in pregnancy and increased over time. Young women had more pain than older women. Back pain starting during pregnancy may be a special entity and may have another origin than back pain not related to pregnancy.

  • 13.
    Lundin, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Magnuson, Anders
    Axelsson, Kjell
    Nilsson, Olle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Samuelsson, Lars
    Corticosteroids peroperatively diminishes damage to the C-fibers in microscopic lumbar disc surgery2005Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 30, nr 21, s. 2362-2368Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN:

    A subgroup analysis of patient outcomes from a double-blind randomized controlled study comparing corticosteroid versus saline in microscopic lumbar disc surgery.

    OBJECTIVES:

    To study if the use of corticosteroids combined with surgery alleviates the damage to the nerve fibers in lumbar disc herniation.

    SUMMARY OF BACKGROUND DATA:

    The use of quantitative sensory testing can detect damage to the myelinated A-delta fibers (cold sense) and the unmyelinated C-fibers (warmth sense). Corticosteroids combined with surgery in lumbar disc surgery enhance the outcome after surgery in terms of less pain and more rapid rehabilitation.

    METHODS:

    Analyzing quantitative sensory testing before surgery and after 2 weeks and 2 years.

    RESULTS:

    In the corticosteroid group, we saw a statistically significant normalization for the warmth disturbance comparing with control group, which not was detected concerning the cold disturbance.

    CONCLUSIONS:

    The use of corticosteroids combined with surgery seems to protect some of the damage to the C-fibers in lumbar disc herniation.

  • 14. Luoma, Katariina
    et al.
    Riihimäki, Hilkka
    Luukkonen, Ritva
    Raininko, Raili
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi.
    Viikari-Juntura, Eira
    Lamminen, Antti
    Low back pain in relation to lumbar disc degeneration2000Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 25, nr 4, s. 487-92Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN: Cross-sectional magnetic resonance imaging (MRI) study. OBJECTIVES: To study the relation of low back pain (LBP) to disc degeneration in the lumbar spine. BACKGROUND DATA: Controversy still prevails about the relationship between disc degeneration and LBP. Classification of disc degeneration and symptoms varies, hampering comparison of study results. METHODS: Subjects comprised 164 men aged 40-45 years-53 machine drivers, 51 construction carpenters, and 60 office workers. The data of different types of LBP, individual characteristics, and lifestyle factors were obtained from a questionnaire and a structured interview. Degeneration of discs L2/L3-L5/S1 (dark nucleus pulposus and posterior and anterior bulge) was assessed with MRI. RESULTS: An increased risk of LBP (including all types) was found in relation to all signs of disc degeneration. An increased risk of sciatic pain was found in relation to posterior bulges, but local LBP was not related to disc degeneration. The risks of LBP and sciatic pain were strongly affected by occupation. CONCLUSIONS: Low back pain is associated with signs of disc degeneration and sciatic pain with posterior disc bulges. Low back pain is strongly associated with occupation.

  • 15. Luoma, Katariina
    et al.
    Vehmas, Tapio
    Raininko, Raili
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi.
    Luukkonen, Ritva
    Riihimäki, Hilkka
    Lumbosacral transitional vertebra: relation to disc degeneration and low back pain2004Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 29, nr 2, s. 200-5Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    STUDY DESIGN: Cross-sectional magnetic-resonance imaging (MRI) study. OBJECTIVE To investigate the relation of the lumbosacral transitional vertebra to signs of disc degeneration in MRI and to low back pain (LBP). SUMMARY OF BACKGROUND DATA: An association between the transitional vertebra and herniation in the disc above has been found in patients with LBP, but knowledge of the relation to other degenerative disc changes detected in MRI and to LBP is lacking. METHODS: MR images of the lumbar spine of 138 middle-aged working men and 25 healthy young men were evaluated. The presence and type of lumbosacral transitional vertebra and of degenerative changes in intervertebral discs were evaluated. The history of low back symptoms was obtained with a questionnaire from the middle-aged men. RESULTS: The prevalence of transitional vertebra was 30%. Transitional vertebra was associated with an increased risk of degenerative changes in the disc above among the young men and with a decreased risk in the disc below among the middle-aged men. Transitional vertebra, symmetric or asymmetric, was not associated with any type of LBP in the middle-aged men. CONCLUSIONS: Lumbosacral transitional vertebra increases the risk of early degeneration in the upper disc. This effect seems to be obscured by age-related changes in the middle age. The degenerative process is slowed down in the lower disc. For these effects, the presence of a transitional vertebra should be noticed when morphologic methods are used in research on lumbosacral spine. Transitional vertebra is not associated with any type of LBP.

  • 16. Luoma, Katariina
    et al.
    Vehmas, Tapio
    Riihimäki, Hilkka
    Raininko, Raili
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi.
    Disc height and signal intensity of the nucleus pulposus on magnetic resonance imaging as indicators of lumbar disc degeneration2001Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 26, nr 6, s. 680-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN: A cross-sectional magnetic resonance imaging (MRI) study of degeneration of the lumbar spine. OBJECTIVES: To compare the usefulness of disc height and that of T2-weighted signal intensity as indicators of disc degeneration. SUMMARY OF BACKGROUND DATA: Disc height and signal intensity have been used as indicators for disc degeneration. Their relation to each other and to early degeneration has not been well documented. There is evidence that physical load can affect disc height. METHODS: Forty-one machine operators, 41 construction carpenters, and 46 office workers, aged 40-45 years, and 22 students aged 18-20 years were examined with sagittal magnetic resonance imaging. All study participants were men. The mean value of the anterior and posterior disc height and the relative T2-weighted signal intensity of the nucleus pulposus of discs L2-L3 to L5-S1 were measured. RESULTS: Young men showed the lowest disc height but the highest relative signal intensity. Disc height showed an increasing trend from the office workers (sedentary) to blue-collar workers (more physical work) at all disc levels but L5-S1. Relative signal intensity showed a decreasing trend for these same worker types at all levels. In generalized linear modeling, signal intensity and the occupations, in reference to the young students, showed a significant effect on disc height. CONCLUSIONS: Relative signal intensity was lower in the middle-aged men than in the young men, indicating age-related disc degeneration. Despite the general positive association between disc narrowing and decreased relative signal intensity, disc narrowing may behave unexpectedly in relation to signal intensity and age. Signal intensity may be a more sensitive measure of disc degeneration. The validity of disc height as an indicator of early degeneration seems questionable.

  • 17. Peolsson, Anneli
    et al.
    Soderlund, Anne
    Engquist, Markus
    Lind, Bengt
    Lofgren, Hakan
    Vavruch, Ludek
    Holtz, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Winstrom-Christersson, Annelie
    Isaksson, Ingrid
    Oberg, Birgitta
    Physical Function Outcome in Cervical Radiculopathy Patients After Physiotherapy Alone Compared With Anterior Surgery Followed by Physiotherapy A Prospective Randomized Study With a 2-Year Follow-up2013Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 38, nr 4, s. 300-307Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Design. Prospective randomized study. Objective. To investigate differences in physical functional outcome in patients with radiculopathy due to cervical disc disease, after structured physiotherapy alone (consisting of neck-specific exercises with a cognitive-behavioral approach) versus after anterior cervical decompression and fusion (ACDF) followed by the same structured physiotherapy program. Summary of Background Data. No earlier studies have evaluated the effectiveness of a structured physiotherapy program or postoperative physical rehabilitation after ACDF for patients with magnetic resonance imaging-verified nerve compression due to cervical disc disease. Methods. Our prospective randomized study included 63 patients with radiculopathy and magnetic resonance imaging-verified nerve root compression, who were randomized to receive either ACDF in combination with physiotherapy or physiotherapy alone. For 49 of these patients, an independent examiner measured functional outcomes, including active range of neck motion, neck muscle endurance, and hand-related functioning before treatment and at 3-, 6-, 12-, and 24-month follow-ups. Results. There were no significant differences between the 2 treatment alternatives in any of the measurements performed (P = 0.17-0.91). Both groups showed improvements over time in neck muscle endurance (P = 0.01), manual dexterity (P < 0.03), and right-handgrip strength (P = 0.01). Conclusion. Compared with a structured physiotherapy program alone, ACDF followed by physiotherapy did not result in additional improvements in neck active range of motion, neck muscle endurance, or hand-related function in patients with radiculopathy. We suggest that a structured physiotherapy program should precede a decision for ACDF intervention in patients with radiculopathy, to reduce the need for surgery.

  • 18.
    Raininko, Raili
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi.
    Manninen, H.
    Battié, M. C.
    Gibbons, L. E.
    Gill, K.
    Fisher, L. D.
    Observer variability in the assessment of disc degeneration on MRI of the lumbar and thoracic spine1995Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 20, nr 9, s. 1029-35Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN. Intraobserver and interobserver reproducibility study. OBJECTIVE. This study investigates the variability in the interpretation of degenerative disc findings using magnetic resonance imaging. SUMMARY OF BACKGROUND DATA. Magnetic resonance imaging has been used for years in clinical diagnostics, primarily to investigate disc herniation and spinal stenosis. Less attention has been paid to other disc findings and their assessment reliability. METHODS. Three independent readers evaluated magnetic resonance images of the lumbar and the lower and middle thoracic spines of 122 subjects by grading 12 aspects of the intervertebral discs and adjacent endplates using written definitions and example images. Images of 20 subjects were reevaluated for the assessment of intraobserver agreement. RESULTS. Agreement was highest in the lower lumbar and poorest in the middle thoracic spine. Intraobserver agreement was generally fair to excellent for almost all variables in the lumbar and lower thoracic spine (most intraclass correlation and kappa coefficients for these regions were above 0.70). Interobserver agreement was notably lower than intraobserver agreement, except for osteophytes and endplate defects in some regions. CONCLUSIONS. Intraobserver agreement in the evaluation of disc degeneration was at an acceptable level, in general, in the lumbar and lower thoracic spine. However, assessments were substantially more variable between readers, which limits comparisons of evaluations between different readers.

  • 19.
    Rauschning, Wolfgang
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    New Perspectives in Spinal Anatomy2016Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 41, nr 7, s. A4-A5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Uppsala Cryoplaning Technique has been used for over 30 years to study normal spinal anatomy and pathologies such as trauma, degenerative conditions, tumors, and metastases (SDC Figure 1, http://links.lww.com/BRS/B105). A heavy-duty sledge cryomicrotome creates authentic anatomical images of slices from the surface of in situ fresh-frozen specimens at submillimeter intervals. This presentation is intended to improve understanding of anatomical structures of the spine among spine surgeons.

  • 20.
    Rauschning, Wolfgang
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Surgical Anatomy of the Spine, Revisited2017Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 42, nr 7, s. S1-S2Artikel i tidskrift (Refereegranskat)
  • 21.
    Robinson, Yohan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Robinson, Anna-Lena
    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.
    Complications and Survival after long Posterior Instrumentation of Cervical and Cervicothoracic Fractures related to Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis2015Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, nr 4, s. E227-E233Artikel i tidskrift (Refereegranskat)
    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.

  • 22.
    Robinson, Yohan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Willander, Johan
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Surgical stabilisation improves survival of spinal fractures related to ankylosing spondylitis2015Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, nr 21, s. 1697-1702Artikel i tidskrift (Refereegranskat)
    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.

  • 23.
    Sandén, Bengt
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Försth, Peter
    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.
    Smokers Show Less Improvement Than Nonsmokers Two Years after Surgery for Lumbar Spinal Stenosis: A study of 4555 Patients from the Swedish Spine Register2011Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 36, nr 13, s. 1059-1064Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Design. A cohort study based on the Swedish Spine Register.

    Objective. To determine the relation between smoking status and disability after surgical treatment for lumbar spinal stenosis.

    Summary of Background Data. Smoking and nicotine have been shown to inhibit lumbar spinal fusion and promote disc degeneration. No association, however, has previously been found between smoking and outcome after surgery for lumbar spinal stenosis. A large prospective study is therefore needed.

    Methods. All patients with a completed 2-year follow-up in the Swedish Spine Register operated for central lumbar stenosis before October 1, 2006 were included. Logistic regression was used to assess the association between smoking status and outcomes.

    Results. Of 4555 patients enrolled, 758 (17%) were current smokers at the time of surgery. Smokers had an inferior health-related Quality of Life at baseline. Nevertheless, adjusted for differences in baseline characteristics, the odds ratio (OR) for a smoker to end up dissatisfied at the 2-year follow-up after surgery was 1.79 [95% confidence interval (CI) 1.51-2.12]. Smokers had more regular use of analgesics (OR 1.86; 95% CI 1.55-2.23). Walking ability was less likely to be significantly improved in smokers with an OR of 0.65 (95% CI 0.51-0.82). Smokers had inferior Quality of Life also after taking differences before surgery into account, either when measured with the Oswestry Disability Index (ODI; P < 0.001), EuroQol (P < 0.001) or Short Form (36) Health Survey (SF-36) BP and SF-36 PF (P < 0.001). The differences in results between smokers and nonsmokers were evident, irrespective of whether the decompression was done with or without spinal fusion.

    Conclusion. Smoking is an important predictor for 2-year results after surgery for lumbar spinal stenosis. Smokers had less improvement after surgery than nonsmokers.

  • 24.
    Sandén, Bengt
    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.
    Johansson, Carina
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Improved bone-screw interface with hydroxyapatite coating: an in vivo study of loaded pedicle screws in sheep2001Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 26, nr 24, s. 2673-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN: An in vivo sheep model with loaded pedicle screws was used, wherein each animal served as its own control. OBJECTIVES: To examine the effects of hydroxyapatite (HA) coating on the bone-to-implant interface in loaded spinal instrumentations. SUMMARY OF BACKGROUND DATA: Spinal instrumentation improves the healing rate in spinal fusion, but screw loosening constitutes a problem. HA coating of other implants has resulted in favorable effects on the bone-to-implant interface. METHODS: Nine sheep were operated on with destabilizing laminectomies at two levels: L2-L3 and L4-L5. Each level was stabilized separately with a four-screw instrumentation. Uncoated screws (stainless steel) or the same type of screws coated with plasma-sprayed HA were used in either the upper or the lower instrumentation in a randomized fashion. The animals were killed at 6 or 12 weeks after surgery. The specimens were embedded in resin, ground to approximately 10 microm, and stained with toluidine blue. Histomorphometric evaluation was carried out in a Leitz Aristoplan (Wetzlar, Germany) light microscope equipped with a Leitz Microvid unit. RESULTS: The average percentage of bone-to-implant contact after 6 weeks was 69 +/- 10 for the HA-coated screws and 18 +/- 11 for the uncoated screws (P < 0.03), and after 12 weeks 64 +/- 31 (HA-coated) and 9 +/- 13 (uncoated, P < 0.02). The average bone volume in the area close to the screw was significantly higher for the HA-coated screws at both 6 and 12 weeks. CONCLUSIONS: HA coating improved the bone-to-implant interface significantly, indicating that HA coating can become useful for improving the purchase of pedicle screws.

  • 25. Skeppholm, Martin
    et al.
    Ingebro, Catarina
    Engstrom, Therese
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    The Dysphagia Short Questionnaire: An Instrument for Evaluation of Dysphagia: A Validation Study With 12 Months' Follow-up After Anterior Cervical Spine Surgery2012Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 37, nr 11, s. 996-1002Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Design. Prospective clinical validation study of questionnaire to assess dysphagia.

    Objective. To test validity and reliability of Dysphagia Short Questionnaire (DSQ), and also to determine levels of dysphagia over time after anterior cervical spine surgery (ACSS).

    Summary of Background Data. Dysphagia is common after ACSS but reports on the incidence vary widely between 1% and 79%, indicating an evaluation problem. Several tools for evaluation of dysphagia exist but common features are that they are cumbersome to use and usually are designed for patients with neurological or malignant diseases in the neck region. Others are not validated, for example, the Bazaz score. There is, thus, a need for a more adapted tool to evaluate dysphagia in patients undergoing ACSS.

    Methods. The DSQ was constructed in collaboration with a group of ear-nose-and-throat specialists. In a first validation study, 45 patients with stationary dysphagia for various reasons completed the DSQ twice 2 weeks apart, the M. D. Anderson Dysphagia Inventory (MDADI), the Bazaz score, and a quality-of-life score, the EQ-5D. To evaluate the utility of the DSQ, a second validation study was performed, where 111 subjects undergoing ACSS for degenerative disk disease completed the form preoperatively and at 4 weeks, 3 months, and 1 year after surgery.

    Results. In the first study, the DSQ correlated to MDADI (r = 0.59) and showed good reproducibility. The Bazaz score did not correlate to the DSQ, the MDADI, or the EQ-5 D. In the second study, dysphagia was present in a few patients already preoperatively. At 4 weeks, 85% of the patients reported dysphagia. The level had dropped significantly at 3 months and had returned to baseline levels at 1 year.

    Conclusion. We consider the DSQ to be a validated tool for the assessment of dysphagia in ACSS patients. Dysphagia after ACSS for cervical spondylosis is common but the symptoms on a group level are not very severe and are also temporary.

  • 26. Skeppholm, Martin
    et al.
    Olerud, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Comparison of dysphagia between cervical artificial disc replacement and fusion: data from a randomized controlled study with two years of follow-up2013Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 38, nr 24, s. E1507-E1510Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN

    Prospective randomized controlled trial.

    OBJECTIVE

    To determine and explain any differences in self-reported dysphagia between patients treated with artificial disc replacement and anterior cervical decompression and fusion (ACDF).

    SUMMARY OF BACKGROUND DATA

    Dysphagia after anterior cervical spine surgery has in previous studies been evaluated regarding different influencing factors. Surgical technique, number of treated levels, and type of implant has been shown to be of possible importance.

    METHODS

    One hundred thirty-six patients from a randomized controlled trial between artificial disc replacement and ACDF in 1 or 2 surgical levels were evaluated regarding dysphagia. Evaluation was done with the dysphagia short questionnaire preoperatively, at 4 weeks, 3 months, and 1 and 2 years postoperatively. Reconstruction in the artificial disc replacement group was performed with the Discover artificial disc. Bone graft and anterior plating was used in the ACDF group. Type of implant was blinded to the patients and the surgeon until time of implantation.

    RESULTS

    Demographics and dysphagia short questionnaire levels were similar in both groups preoperative. At 4 weeks of follow-up postoperatively, dysphagia was significantly higher in both groups than baseline levels, P < 0.01. No significant differences were seen between the groups until follow-up at 2 years, which showed significantly higher dysphagia short questionnaire levels in the ACDF group, P = 0.04. The difference was statistically significant in both patients treated with 1- and 2-level surgery, P = 0.029 and P = 0.032, respectively. A logistic regression model showed a stronger association to type of implant than to number of surgical levels. Duration of surgery was highly associated to number of surgical levels but did not differ significantly between types of implant.

    CONCLUSION

    Long-term postoperative dysphagia could be explained by bulk of implant or decreased motion in the cervical spine. However, it is doubtful if differences between the groups in this study can be interpreted as a clinically important difference.

  • 27. Solovieva, Svetlana
    et al.
    Lohiniva, Jaana
    Leino-Arjas, Päivi
    Raininko, Raili
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi.
    Luoma, Katariina
    Ala-Kokko, Leena
    Riihimäki, Hilkka
    COL9A3 gene polymorphism and obesity in intervertebral disc degeneration of the lumbar spine: evidence of gene-environment interaction2002Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 27, nr 23, s. 2691-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN: Cross-sectional. OBJECTIVES: To evaluate the interaction between the COL9A3 gene polymorphism and persistent obesity in relation to lumbar disc degeneration. SUMMARY OF BACKGROUND DATA: Obesity has been suggested to be a risk factor for disc degeneration. There is some indication for an association between collagen IX genes and lumbar disc disease characterized by sciatica. However, the interaction between those factors in their influences on the risk of disc degeneration has not been studied. METHODS: Blood samples from 135 middle-aged men who had undergone magnetic resonance imaging (MRI) of the lumbar spine were analyzed for the presence of an arginine to tryptophan change in the COL9A3 gene (Trp3 allele). The men represented three occupations: 41 were machine drivers, 42 were carpenters, and 52 were office workers. The discs L2/L3-L5/S1 were evaluated on MRI, using decreased signal intensity of the nucleus pulposus, posterior disc bulges, and decreased disc height as signs of disc degeneration. Based on self-reports on body height and weight currently and at the age of 25 years, obesity history was classified as no obesity, persistent obesity, and other. Rothman's synergy index was used as a measure of interaction between two factors. RESULTS: The Trp3 allele and persistent obesity acted synergistically to increase the risk of dark nucleus pulposus, posterior disc bulge, and decreased disc height at L4/L5; of multilevel posterior disc bulges; and of decreased disc height. From 45% to 71% of disc degeneration among persistently obese individuals with the Trp3 allele could be attributed to the synergism of these two factors. CONCLUSION: The effect of obesity on lumbar disc degeneration seems to be modified by the collagen IX gene polymorphism, so that people who carry the Trp3 allele are at increased risk if they are persistently obese.

  • 28. Solovieva, Svetlana
    et al.
    Noponen, Noora
    Männikkö, Minna
    Leino-Arjas, Päivi
    Luoma, Katariina
    Raininko, Raili
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi.
    Ala-Kokko, Leena
    Riihimäki, Hilkka
    Association between the aggrecan gene variable number of tandem repeats polymorphism and intervertebral disc degeneration2007Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 32, nr 16, s. 1700-1705Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN: Cross-sectional study. OBJECTIVE: To examine the association between an aggrecan variable number of tandem repeats (VNTR) polymorphism and intervertebral disc degeneration in middle-aged Finnish men. SUMMARY OF BACKGROUND DATA: An association between the aggrecan VNTR polymorphism and multilevel disc degeneration has been previously reported in young Japanese women. METHODS: Lumbar discs of 132 men representing 3 occupations (carpenters, machine drivers, and office workers) were evaluated on magnetic resonance imaging, using decreased signal intensity of the nucleus pulposus, disc bulges, and decreased disc height as signs of degeneration. The aggrecan gene VNTR region was analyzed by Southern hybridization. RESULTS: The allele A26 with 26 repeats was statistically significantly overrepresented among the persons with dark nucleus pulposus. Carrying 2 copies of the A26 allele increased the risk of dark nucleus pulposus (odds ratio = 2.77; 95% confidence interval, 1.24-6.16). Carrying the alleles with either less or more than 26 repeats decreased the risk of dark nucleus pulposus. The carpenters and machine drivers with the A26 allele had a statistically significantly higher risk of disc bulge and decreased disc height than the office workers without the allele. CONCLUSION: The findings provide additional support for the role of the aggrecan gene VNTR polymorphism in intervertebral disc degeneration.

  • 29. Stavridis, Stavros I.
    et al.
    Dehghani, Faramarz
    Korf, Horst-Werner
    Hailer, Nils P.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Cocultures of rat sensorimotor cortex and spinal cord slices to investigate corticospinal tract sprouting2009Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 34, nr 23, s. 2494-2499Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN: Experimental study of corticospinal axonal sprouting in an organotypic slice culture model. OBJECTIVE: To develop an in vitro model that simplifies the study of various factors regulating neuronal regeneration. SUMMARY OF BACKGROUND DATA: Spinal cord injury leads to permanent neurologic damage, mainly due to the inability of the adult central nervous system to regenerate. Much attention has been focused on promoting axonal regeneration and sprouting, either by exogenous administration of various neurotrophic factors or by the antagonization of factors inhibiting regeneration. METHODS: An in vitro system that allows coculture of slices from rat sensorimotor cortex and spinal cord (p4) was established. Two groups of cultures were investigated: In the first group, intact spinal cord slices were cultured adjacent to sensorimotor cortex slices, while in the second group the spinal cord slices were sagittally cut into halves, with the sectioned interface placed directly adjacent to the sensorimotor cortex, to prevent the spinal white matter from interference. Each group was further divided into 2 subgroups: The neurotrophin-3 (NT-3) group, where the culture medium contained 50 ng/mL NT-3 and the control group treated with normal culture medium. Sensorimotor cortex pyramidal neurons were anterogradely labeled with Mini-Ruby, a 10 kD biotinylated dextran amine. RESULTS: Cocultures of cortical and spinal cord tissue were propagated in vitro, and axonal sprouting occurred. The group of cocultures treated with NT-3 showed an improved cortical cytoarchitecture, and sprouting axons were more frequently observed. In NT-3-treated cocultures where spinal cord gray matter was directly opposed to cortical slices sprouting axons entered the adjacent spinal cord tissue. This phenomenon was not observed if spinal cord pia mater and white matter were opposed to the cortical slices, or if NT-3 was absent. CONCLUSION: Our data suggest that the absence of repellent factors such as white matter and the presence of neurotrophic factors promote axonal sprouting. Cocultures of sensorimotor cortex and spinal cord slices combined with anterograde axonal labeling could provide a valuable in vitro model for the simplified screening of factors influencing corticospinal tract regeneration.

  • 30.
    Torstensson, Thomas
    et al.
    Department of Physiotherapy, Sundsvall Hospital, Sunds- vall, Sweden;.
    Lindgren, Anne
    Department of Physiotherapy, Sundsvall Hospital, Sunds- vall, Sweden;.
    Kristiansson, Per
    Department of Clinical Medicine, Umeå University, Umeå, Sweden.
    Corticosteroid Injection Treatment to the IschiadicSpine Reduced Pain in Women With Long-LastingSacral Low Back Pain With Onset During Pregnancy: A Randomized, Double Blind, Controlled Trial2009Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 34, nr 21, s. 2254-2258Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Design

    Randomized double blind controlled clinical trial.Objective. To evaluate the pain relief effect of locally injected corticosteroid treatment in women with long-lasting sacral low back pain with onset during pregnancy.

    Summary of Background Data

    Pregnancy-related low back pain is a global problem. Almost 1 of 10 women still experienced disabling daily back pain 2 years after childbirth with high impact on the individual, family, and society. In spite of this, the sources of pain and effective treatment are uncertain.

    Methods

    Thirty-six women were allocated to injectiontreatment, with slow-release triamcinolone and lidocaine or saline and lidocaine, given at the sacrospinous ligament insertion on the ischial spine bilaterally with 4 weeks follow-up time. Primary outcome measure was reported pain intensity on visual analogue scale and secondary outcome measures number of pain-drawing locations and pain-provoking test results.'

    Results

    The triamcinolone treatment group had significantly reduced pain intensity, number of pain locations,and pain-provoking test results between baseline and follow-up as compared with the saline treatment group. The absolute median change of visual analogue scale score in the triamcinolone treatment group was 24 mm and in the saline group 4.5 mm (P‹0.05). A reducednumber of pain drawing locations was reported by16 of 18 women in the triamcinolone group as compared with 10 of 18 in the saline group (P‹0.05). In the triamcinolone treatment group, 17 of 18 women had an improved pain provocation test result as compared with 9 of 18 in the saline treatment group (P‹0.01).

    Conclusion

    The anatomic region around the sacrospinousligament insertion on the ischial spine is suggestedto be one source of long-lasting sacral low back pain withonset during pregnancy. The pain was relieved by slowrelease corticosteroid injection treatment to the ischial spine.

  • 31. Tullberg, T
    et al.
    Blomberg, Stefan
    Department of Orthopaedics, St. Göran's Hospital, Stockholm, Sweden.
    Branth, B
    Johnsson, R
    Manipulation does not alter the position of the sacroiliac joint: a roentgen stereophotogrammetric analysis1998Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 23, nr 10, s. 1124-1128, discussion 1129Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN

    A roentgen stereophotogrammetric analysis study of patients with sacroiliac joint dysfunction.

    OBJECTIVES

    To investigate whether manipulation can influence the position between the ilium and the sacrum, and whether positional tests for the sacroiliac joint are valid.

    SUMMARY OF BACKGROUND DATA

    Sacroiliac joint dysfunction is a subject of controversy. The validity of different sacroiliac joint tests is unknown. Long-standing therapeutic tradition is to manipulate supposed dysfunctions of the sacroiliac joint. Many manual therapists claim that their good clinical results are a consequence of a reduction of subluxation.

    METHODS

    Ten patients with symptoms and sacroiliac joint tests results indicating unilateral sacroiliac joint dysfunction were recruited. Twelve sacroiliac joint tests were chosen. The results of most of these tests were required to be positive before manipulation and normalized after manipulation. Roentgen stereophotogrammetric analysis was performed with the patient in the standing position, before and after treatment.

    RESULTS

    In none of the 10 patients did manipulation alter the position of the sacrum in relation to the ilium, defined by roentgen stereophotogrammetric analysis. Positional test results changed from positive before manipulation to normal after.

    CONCLUSIONS

    Manipulation of the sacroiliac joint normalized different types of clinical test results but was not accompanied by altered position of the sacroiliac joint, according to roentgen stereophotogrammetric analysis. Therefore, the positional test results were not valid. However, the current results neither disprove nor prove possible beneficial clinical effects achieved by manipulation of the sacroiliac joint. Because the supposed positive effects are not a result of a reduction of subluxation, further studies of the effects of manipulation should focus on the soft tissue response.

  • 32. Wood, Kirkham B.
    et al.
    Fritzell, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna.
    Dettori, Joseph R.
    Hashimoto, Robin
    Lund, Teija
    Shaffrey, Chris
    Effectiveness of Spinal Fusion Versus Structured Rehabilitation in Chronic Low Back Pain Patients With and Without Isthmic Spondylolisthesis: A Systematic Review2011Ingår i: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 36, nr 21, s. S110-S119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Design. Systematic review. Objective. To determine if the presence of isthmic spondylolisthesis modifies the effect of treatment (fusion vs. multidimensional supervised rehabilitation) in patients with chronic low back pain (CLBP). Summary of Background Data. Results of spinal surgery for CLBP are variable. It is unclear whether patients with CLBP and isthmic spondylolisthesis have more success with surgery versus a multidimensional supervised rehabilitation program when compared with those with CLBP but without spondylolisthesis. Methods. A systematic search was conducted in MEDLINE and the Cochrane Collaboration Library for articles published through January 2011. Randomized controlled trials (RCTs) were included that compared spine fusion versus multidimensional supervised rehabilitation in patients with and without isthmic spondylolisthesis. Standardized mean differences (SMDs) and risk differences were calculated for common outcomes, and then compared to determine potential heterogeneity of treatment effect. The final strength of the body of literature was expressed as "high," "moderate," or "low" confidence that the evidence reflects the true effect. Results. No studies were found that directly compared the two subgroups. Three RCTs compared fusion with supervised nonoperative care in patients with CLBP without isthmic spondylolisthesis; one RCT evaluated these treatments in patients with isthmic spondylolisthesis. There were study differences in patient characteristics, type of fusion, the nature of the rehabilitation, outcomes assessed, and length of follow-up. The SMDs for pain in favor of fusion were modest at 2 years for those without isthmic spondylolisthesis, but large in favor of fusion for those with isthmic spondylolisthesis compared with rehabilitation. Similarly, the SMDs for function in patients without isthmic spondylolisthesis compared with rehabilitation was small at 2 years, but appreciably higher in favor of fusion in patients with isthmic spondylolisthesis. Conclusion. The overall strength of evidence evaluating whether the presence of isthmic spondylolisthesis modifies the effect of fusion compared with rehabilitation patients with CLBP is "low." Fusion should be considered for patients with low back pain and isthmic spondylolisthesis who have failed nonoperative treatment. Clinical Recommendations. We recommend considering fusion for patients with isthmic spondylolisthesis and lower back pain who have failed nonoperative treatment. Recommendation: Weak.

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