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  • 1. Anderberg, Leif
    et al.
    Annertz, MÃ¥rten
    Hedlund, Rune
    Hildingsson, Christer
    Karlberg, Mikael
    Lind, Bengt
    Ohlin, Acke
    Olerud, Claes
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    [Whiplash injury is not an indication for craniocervical fusion]2004In: Lakartidningen, ISSN 0023-7205, Vol. 101, no 9, p. 806-7; discussion 807Article in journal (Other scientific)
  • 2.
    Berg, Svante
    et al.
    Stockholm Spine Center, Löwenströmska Hospital, Upplands Väsby, Sweden.
    Tullberg, Tycho
    Stockholm Spine Center, Löwenströmska Hospital, Upplands Väsby, Sweden.
    Branth, Björn
    Stockholm Spine Center, Löwenströmska Hospital, Upplands Väsby, Sweden.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Tropp, Hans
    University Hospital, Linköping, Sweden.
    Total disc replacement compared to lumbar fusion: a randomised controlled trial with 2-year follow-up2009In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 18, no 10, p. 1512-19Article in journal (Refereed)
    Abstract [en]

    The study design includes a prospective, randomised controlled study comparing total disc replacement (TDR) with posterior fusion. The main objective of this study is to compare TDR with lumbar spinal fusion, in terms of clinical outcome, in patients referred to a spine clinic for surgical evaluation. Fusion is effective for treating chronic low back pain (LBP), but has drawbacks, such as stiffness and possibly adjacent level degradation. Motion-preserving options have emerged, of which TDR is frequently used because of these drawbacks. How the results of TDR compare to fusion, however, is uncertain. One hundred and fifty-two patients with a mean age of 40 years (21-55) were included: 90 were women, and 80 underwent TDR. The patients had not responded to a conservative treatment programme and suffered from predominantly LBP, with varying degrees of leg pain. Diagnosis was based on clinical examination, radiographs, MRI, and in unclear cases, diagnostic injections. Outcome measures were global assessment (GA), VAS for back and leg pain, Oswestry Disability Index, SF36 and EQ5D at 1 and 2 years. Follow-up rate was 100%, at both 1 and 2 years. All outcome variables improved in both groups between preoperative and follow-up assessment. The primary outcome measure, GA, revealed that 30% in the TDR group and 15% in the fusion group were totally pain-free at 2 years (P = 0.031). TDR patients had reached maximum recovery in virtually all variables at 1 year, with significant differences compared to the fusion group. The fusion patients continued to improve and at 2 years had results similar to TDR patients apart from numbers of pain-free. Complications and reoperations were similar in both groups, but pedicle screw removal as additive surgery, was frequent in the fusion group. One year after surgery, TDR was superior to spinal fusion in clinical outcome, but this difference had diminished by 2 years, apart from (VAS for back pain and) numbers of pain-free. The long-term benefits have yet to be examined.

  • 3. Bodon, Gergely
    et al.
    Glasz, Tibor
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Anatomical changes in occipitalization: is there an increased risk during the standard posterior approach?2013In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 22, no 3 suppl., p. 512-516Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    The purpose of this study was to examine the anatomic changes in a case of occipitalization of the atlas.

    METHODS:

    Occipitalization of the atlas was found accidentally in a 64-year-old male cadaver. Anatomic dissection was carried out to examine the posterior aspect of the upper cervical region and craniocervical junction. The occipitalized atlas was then harvested and macerated to study the bony anomaly.

    RESULTS:

    In this case of occipitalization, fusion was observed at both lateral masses and at the left posterior hemiarch of the atlas. We found the following soft tissue changes: the rectus capitis posterior minor muscle was lacking on the left side and was atrophic on the right, the obliquus capitis superior muscle was present on both sides showing moderate atrophy and fatty changes. The posterior atlanto-axial membrane was thinner and asymmetric, had a free edge on the right side. Lateral to this edge the dura was lying free. We believe that these changes of the posterior atlanto-axial membrane together with the increased distance between the fused posterior arch of the atlas and the lamina of the axis could cause the observed "dura bulge" at this level. The vertebral artery was entering the skull through a canal on the left side.

    CONCLUSIONS:

    In our case, occipitalization considerably changed the anatomy of the upper cervical spine and craniocervical junction. Special care must be taken when using the posterior approach to avoid neurovascular injury in cases with occipitalization.

  • 4. Bodon, Gergely
    et al.
    Patonay, Lajos
    Baksa, Gabor
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Applied anatomy of a minimally invasive muscle-splitting approach to posterior C1-C2 fusion: an anatomical feasibility study2014In: Surgical and Radiologic Anatomy, ISSN 0930-1038, E-ISSN 1279-8517, Vol. 36, no 10, p. 1063-1069Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    To describe the applied anatomy of a minimally invasive muscle-splitting approach used to reach the posterior aspect of the C1-C2 complex.

    SUMMARY OF BACKGROUND DATA:

    Atlantoaxial fusion using a midline posterior approach and polyaxial screw and rod system is widely used. Although minimally invasive variations of this technique have been recently reported, the complex applied anatomy of these approaches has not been described. The C1-C2 complex represents an unique challenge because of its bony and vascular anatomy. In this study, the applied anatomy and feasibility of this technique are examined on cadavers.

    METHODS:

    The microsurgical anatomy of the upper cervical spine is examined on a formalin-fixed and on a fresh cadaver. The muscle-splitting approach is performed on 12 fresh cadavers using this technique.

    RESULTS:

    The minimally invasive muscle-splitting approach is described in detail. Relevant anatomy and bony landmarks that aid screw placement in C1 and C2 could be well visualized. Using this approach, we were able to reach the lateral mass of the atlas and the inferior articular process and pars interarticularis of the axis in all of the nine cadavers. We placed mini polyaxial screws in C1 lateral mass and C2 pars interarticularis in four cadavers according to the technique described by Harms and Melcher.

    CONCLUSIONS:

    Using this approach, it was possible to reach the posterior aspect of C1 and C2; the relevant anatomy needed to perform a C1-C2 fusion could be well visualized.

  • 5.
    Cornefjord, Michael
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Alemany,
    Olerud, Claes
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Posterior fixation of subaxial cervical spine fractures in patients with ankylosing spondylitis.2004In: Eur Spine J, ISSN 0940-6719Article in journal (Refereed)
  • 6.
    Cornefjord, Michael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Henriques, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Alemany, Montserrat
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Posterior atlanto-axial fusion with the Olerud cervical fixation system for odontoid fractures and C1-C2 instability in reumathoid arthritis2003In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 12, no 1, p. 91-96Article in journal (Refereed)
    Abstract [en]

    In posterior C1-C2 fusion, traditional wire fixation gives poor stability. The bone quality is often insufficient to provide the competent structural bone graft that is required, and the introduction of sublaminar wires is somewhat dangerous. The stability is markedly improved by adding transarticular screws, but the drawbacks of structural bone graft and sublaminar wires remain. The C1 claw of the Olerud Cervical Fixation System improves C1-C2 fixation without relying on structural bone graft or compromising the spinal canal. The aim of this study was to evaluate radiological healing and possible complications in a consecutive series of C1-C2 fusions from our department operated with the C1 claw device. Twenty-six patients (14 women) with a mean age of 73 (range 37-93) years were included. The diagnoses were odontoid fracture in 18 patients, rheumatoid instability in 6, and odontoid non-union and os odontoideum in 1 each. The patients were followed clinically and with plain radiographs for an average of 15 (range 3-27) months. There were no neurological or vascular complications, and no secondary displacements or reoperations in the series. Twenty patients followed for 6-27 months were radiographically healed. Six patients died from unrelated causes 1-38 months postoperatively. Three of these patients had no radiographs later than the postoperative control, one had a healed odontoid fracture but resorbed bone graft at 8 months, while the remaining two patients were not healed, but showed no signs of healing disturbance at the time of death. On the basis of the findings of this study, posterior C1-C2 fusion with the Olerud Cervical Fixation System seems promising. No serious complications related to the surgical procedure were encountered. The stability of the implant obviates the use of a solid bone block as a graft and still allows a high frequency of fusion healing.

  • 7.
    Covaro, Augusto
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Manabe, Nodoka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Bobinski, Lukas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Robinson, Yohan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    The importance of the occipitocervical area in patients with ankylosing spondylitis analysis of a cohort of 86 cervical fractures in surgically treated patients2017In: Journal of Craniovertebral Junction and Spine, ISSN 0974-8237, E-ISSN 0976-9285, Vol. 8, no 4, p. 374-377Article in journal (Refereed)
    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.

  • 8.
    Eriksson, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Berg, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Shalabi, Adel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Hänni, Mari
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Low-dose CT of postoperative pelvic fractures: a comparison with radiography2019In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, no 1, p. 85-91Article in journal (Refereed)
    Abstract [en]

    Background Computed tomography (CT) is superior to conventional radiography (CR) for assessing internal fixation of pelvic fractures, but with a higher radiation exposure. Low-dose CT (LDCT) could possibly have a sufficient diagnostic accuracy but with a lower radiation dose. Purpose To compare postoperative diagnostic accuracy of LDCT and CR after open reduction and internal fixation of pelvic fracture. Material and Methods Twenty-one patients were examined with LDCT and CR 0-9 days after surgery. The examinations were reviewed by two musculoskeletal radiologists. Hardware, degree of fracture reduction, image quality, and reviewing time were assessed, and effective radiation dose was calculated. Inter-reader agreement was calculated. Results LDCT was significantly better than CR in determining whether hardware positioning was assessable ( P < 0.001). Acetabular congruence was assessable in all fractured patients with LDCT. In 12 of the 32 assessments with CR of patients with an acetabular fracture, joint congruence was not assessable due to overlapping hardware ( P = 0.001). Image quality was significantly higher for LDCT. Median time to review was 240 s for LDCT compared to 180 s for CR. Effective dose was 0.79 mSv for LDCT compared to 0.32 mSv for CR ( P < 0.001). Conclusion LDCT is more reliable than CR in assessing hardware position and fracture reduction. Joint congruency is sometimes not possible to assess with CR, due to overlapping hardware. The image quality is higher, but also the effective dose, with LDCT than with CR.

  • 9. Gulle, Eva
    et al.
    Skärvinge, Carola
    Runberg, Karin
    Robinson, Yohan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Pharmacological strategies to reduce pruritus during postoperative epidural analgesia after lumbar fusion surgery: a prospective randomized trial in 150 patients2011In: Patient safety in surgery, ISSN 1754-9493, Vol. 5, no 1, p. 10-Article in journal (Refereed)
    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.

  • 10.
    Henriques, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Cunningham, Bryan
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Shimamoto, Norimichi
    Lee, Guy
    Larsson, Sune
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    McAfee, Paul
    Biomechanical comparison of five different atlantoaxial posterior fixation techhniques2000In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 25, no 22, p. 2877-2883Article in journal (Refereed)
    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]

  • 11. Henriques, Thomas
    et al.
    Cunningham, Bryan W.
    Mcafee, Paul C.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    In vitro biomechanical evaluation of four fixation techniques for distractive-flexion injury stage 3 of the cervical spine2015In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, no 3, p. 198-206Article in journal (Refereed)
    Abstract [en]

    Purpose. Anterior plate fixation has been reported to provide satisfactory results in cervical spine distractive flexion (DF) injuries stages 1 and 2, but will result in a substantial failure rate in more unstable stage 3 and above. The aim of this investigation was to determine the biomechanical properties of different fixation techniques in a DF-3 injury model where all structures responsible for the posterior tension band mechanism are torn. Methods. The multidirectional three-dimensional stiffness of the subaxial cervical spine was measured in eight cadaveric specimens with a simulated DF-3 injury at C5-C6, stabilized with four different fixation techniques: anterior plate alone, anterior plate combined with posterior wire, transarticular facet screws, and a pedicle screw-rod construct, respectively. Results. The anterior plate alone did not improve stability compared to the intact spine condition, thus allowing considerable range of motion around all three cardinal axes (p > 0.05). The anterior plate combined with posterior wire technique improved flexion-extension stiffness (p = 0.023), but not in axial rotation and lateral bending. When the anterior plate was combined with transarticular facet screws or with a pedicle screws-rod instrumentation, the stability improved in flexion-extension, lateral bending, and in axial rotation (p < 0.05). Conclusions. These findings imply that the use of anterior fixation alone is insufficient for fixation of the highly unstable DF-3 injury. In these situations, the use of anterior fixation combined with a competent posterior tension band reconstruction (e.g. transarticular screws or a posterior pedicle screws-rod device) improves segmental stability.

  • 12.
    Henriques, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Bergman, Antonina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Jonsson, Halldor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Distractive flexion injuries of the subaxial cervical spine treated with anterior plate alone2004In: Journal of Spinal Disorders & Techniques, ISSN 1536-0652, E-ISSN 1539-2465, Vol. 17, no 1, p. 1-7Article in journal (Refereed)
    Abstract [en]

    The clinical and radiographic effect of anterior plate fixation alone was evaluated in 36 consecutive patients with distractive flexion (DF) injuries in the lower cervical spine. Mean follow-up time was 15 months. The aim of the present study was to determine whether anterior plate fixation alone provides sufficient stability when treating DF injuries in the cervical spine. Solid union was seen in 6 of 6 patients with stage 1 injury and in 15 of 17 patients with stage 2 injury. In the patients with stage 3 injury, 7 of 13 of the anterior fixations failed. These failures occurred mainly among the patients with severe neurologic injuries. We believe these findings substantiate the use of anterior plate alone for DF injuries at stage 1 and 2 but disqualify anterior plate fixation alone for DF injuries at stage 3, with neurologic injury present.

  • 13.
    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 University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    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 Japan2018In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 43, no 24, p. E1474-E1478Article in journal (Refereed)
    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

  • 14.
    MacDowall, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Canto Moreira, Nuno
    Department of Clinical Neuroscience (CNS), K8, Karolinska Universitetssjukhuset Solna, Stockholm.
    Marques, Catarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    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 University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Robinson, Yohan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Löfgren, Håkan
    Länssjukhuset Ryhov, Jönköping.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes2019In: Journal of Neurosurgery: Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 30, no 3, p. 323-331Article in journal (Refereed)
    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.

  • 15.
    MacDowall, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Robinson, Yohan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Skeppholm, Martin
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Anxiety and depression affect pain drawings in cervical degenerative disc disease2017In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 2, p. 99-107Article in journal (Refereed)
    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.

  • 16.
    MacDowall, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Robinson, Yohan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Skeppholm, Martin
    Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Pain drawings predict outcome of surgical treatment for degenerative disc disease in the cervical spine2017In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 3, p. 194-200Article in journal (Refereed)
    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.

  • 17.
    MacDowall, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Skeppholm, Martin
    Institutionen för lärande, informatik, management och etik. Department for learning, informatics, management and ethics.
    Lindhagen, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Robinson, Yohan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Löfgren, Håkan
    Department of Neuro-Orthopaedic Center, Jönköping, Sweden.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Artificial Disc Replacement versus Fusion in Patients with Cervical Degenerative Disc Disease with radiculopathy: 5-year Outcomes from the National Swedish Spine Register2019In: Journal of Neurosurgery: Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 30, no 2, p. 159-167Article in journal (Refereed)
    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.

  • 18.
    MacDowall, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    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 University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Robinson, Yohan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Effects of preoperative mental distress versus surgical modality, arthroplasty, or fusion on long-term outcome in patients with cervical radiculopathy2018In: Journal of Neurosurgery: Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 29, no 4, p. 371-379Article in journal (Refereed)
    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.

  • 19.
    MacDowall, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Skeppholm, Martin
    Institutionen för lärande, informatik, management och etik. Department for learning, informatics, management and ethics, Karolinska institutet, Stockholm, Sweden.
    Robinson, Yohan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Validation of the Visual Analogue Scale in the Cervical Spine2018In: Journal of Eurosurgery : Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 28, no 3, p. 227-235Article in journal (Refereed)
    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. 

  • 20.
    Manabe, Nodoka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Department of Orthopedic Surgery, Gunma Spine Center, Harunaso Hospital, Takasaki, Japan.
    Covaro, Augusto
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Department of Orthopedic Surgery, Hospital Universitari Dexeus, Barcelona, Spain.
    Bobinski, Lukas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Shimizu, Takachika
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Robinson, Yohan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    The Relationship between the Occipitocervical Junction and Thoracic Kyphosis in Ankylosing Spondylitis: A Retrospective Cohort Study of 86 Cervical Fractures in Surgically Treated Patients2019In: Asian Spine Journal, ISSN 1976-1902, E-ISSN 1976-7846, Vol. 13, no 1, p. 103-110Article in journal (Refereed)
    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.

  • 21.
    Robinson, Anna-Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Stockholm Spine Ctr, Stockholm, Sweden..
    Moller, Anders
    Skane Univ Hosp, Dept Orthopaed, Malmo, Sweden..
    Robinson, Yohan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    C2 Fracture Subtypes, Incidence, and Treatment Allocation Change with Age: A Retrospective Cohort Study of 233 Consecutive Cases2017In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 8321680Article in journal (Refereed)
    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.

  • 22.
    Robinson, Anna-Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Stockholm Spine Center, Upplands Väsby, Sweden.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Robinson, Yohan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Epidemiology of C2 Fractures in the 21st Century: A National Registry Cohort Study of 6,370 Patients from 1997 to 20142017In: Advances in Orthopedics, ISSN 2090-3464, E-ISSN 2090-3472, article id 6516893Article in journal (Refereed)
    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.

  • 23.
    Robinson, Anna-Lena