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  • 1.
    Joelson, Anders
    et al.
    Örebro University, School of Medical Sciences. Department of Orthopedics, Örebro University Hospital, Örebro.
    Fritzell, Peter
    The National Swedish Spine Register (Swespine), Jonköping, Sweden; Futurum Academy for Health and Care, Länssjukhuset Ryhov, Jönköping, Sweden; Stockholm Center for Spine Surgery (RKC), Stockholm, Sweden.
    Hägg, Olle
    The National Swedish Spine Register (Swespine), Jönköping, Sweden; Spine Center Göteborg, Gothenburg, Sweden .
    Handling of missing items in the Oswestry disability index and the neck disability index: A study from Swespine, the National Swedish spine register2022In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 31, no 12, p. 3484-3491Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The Oswestry Disability Index (ODI) and the Neck Disability Index (NDI) scoring algorithms used by the Swedish spine register (Swespine) until April 2022 handled missing items somewhat differently than the original algorithms. The purpose of the current study was to evaluate possible differences in the ODI and NDI scores between the Swespine and the original scoring algorithms.

    METHODS: Patients surgically treated for degenerative conditions of the lumbar or cervical spine between 2003-2019 (lumbar) and 2006-2019 (cervical) were identified in Swespine. Preoperative and 1-year postoperative ODI/NDI data were used to evaluate differences between the Swespine and the original ODI/NDI algorithms with adjustment for at most 1 or 2 missing items using mean imputation.

    RESULTS: The preoperative as well as the 1-year postoperative ODI/NDI were approximately 1 unit out of 100 smaller for the Swespine algorithm, irrespective of adjustment model. The differences between preoperative and postoperative ODI/NDI scores were similar between the Swespine and the original scoring algorithms. There were occasional statistically significant differences between the preoperative-postoperative differences due to large sample sizes.

    CONCLUSIONS: The Swespine algorithms, used until April 2022, underestimated the ODI and NDI by approximately 1 out of 100 units compared with the original algorithms. In addition, there were no statistically significant differences between the original algorithms when adjusting for at most 1 or 2 missing items. The algorithm has now been changed, also for historical data.

  • 2.
    Johansson, Ann-Christin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Cornefjord, Michael
    Bergqvist, Leif
    Öhrvik, John
    Linton, Steven J.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Psychosocial stress factors among patients with lumbar disc herniation, scheduled for disc surgery in comparison with patients scheduled for arthroscopic knee surgery2007In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 16, no 7, p. 961-970Article in journal (Refereed)
    Abstract [en]

    Returning to work after disc surgery appears to be more heavily influenced by psychological aspects of work than by MR-identified morphological alterations. It is still not known whether psychosocial factors of importance for outcome after disc surgery are present preoperatively or develop in the postoperative phase. The aim of this study was to investigate the presence of work-related stress, life satisfaction and demanding life events, among patients undergoing first-time surgery for lumbar disc herniation in comparison with patients scheduled for arthroscopic knee surgery. Sixty-nine patients with disc herniation and 162 patients awaiting arthroscopy were included in the study, during the time period March 2003 to May 2005. Sixty-two percent of the disc patients had been on sick leave for an average of 7.8 months and 14 percent of the knee patients had been on sick leave for an average of 4.2 months. The psychosocial factors were investigated preoperatively using a questionnaire, which was a combination of the questionnaire of quality of work competence (QWC), life satisfaction (LiSat9) and life events as a modification of the social readjustment scale. There were no significant differences between the two groups in terms of work-related stress or the occurrence of demanding life events. The disc patients were significantly less satisfied with functions highly inter-related to pain and discomfort, such as present work situation, leisure-time, activities of daily living (ADL) function and sleep. Patients with disc herniation on sick leave were significantly less satisfied with their present work situation than knee patients on sick leave; this sub-group of patients with disc herniation also reported significantly higher expectations in relation to future job satisfaction than knee patients. The results indicate that psychosocial stress is not more pronounced preoperatively in this selected group of disc patients, without co-morbidity waiting for first-time disc surgery, than among knee patients awaiting arthroscopy. It was notable that the disc patients had high expectations in terms of improved job satisfaction after treatment by surgery.

  • 3.
    Johansson, Ann-Christin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Bergkvist, Leif
    Nilsson, Olle
    Cornefjord, Michael
    Clinic-based training in comparison to home-based training after first-time lumbar disc surgery: a randomised controlled trial2009In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 18, no 3, p. 398-409Article in journal (Refereed)
    Abstract [en]

    The effectiveness of physiotherapy after first-time lumbar disc surgery is still largely unknown. Studies in this field are heterogeneous and behavioural treatment principles have only been evaluated in one earlier study. The aim of this randomised study was to compare clinic-based physiotherapy with a behavioural approach to a home-based training programme regarding back disability, activity level, behavioural aspects, pain and global health measures. A total of 59 lumbar disc patients without any previous spine surgery or comorbidity participated in the study. Clinic-based physiotherapy with a behavioural approach was compared to home-based training 3 and 12 months after surgery. Additionally, the home training group was followed up 3 months after surgery by a structured telephone interview evaluating adherence to the exercise programme. Outcome measures were: Oswestry Disability Index (ODI), physical activity level, kinesiophobia, coping, pain, quality of life and patient satisfaction. Treatment compliance was high in both groups. There were no differences between the two groups regarding back pain disability measured by ODI 3 and 12 months after surgery. However, back pain reduction and increase in quality of life were significantly higher in the home-based training group. The patients in the clinic-based training group had significantly higher activity levels 12 months after surgery and were significantly more satisfied with physiotherapy care 3 months after surgery compared to the home-based training group. Rehabilitation after first-time lumbar disc surgery can be based on home training as long as the patients receive both careful instructions from a physiotherapist and strategies for active pain coping, and have access to the physiotherapist if questions regarding training arise. This might be a convenient treatment arrangement for most patients.

  • 4.
    Sigmundsson, Freyr Gauti
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.
    Joelson, Anders
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.
    Strömqvist, Fredrik
    Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden.
    Patients with no preoperative back pain have the best outcome after lumbar disc herniation surgery2022In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 31, no 2, p. 408-413Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Most patients with lumbar disc herniations requiring surgery have concomitant back pain. The purpose of the current study was to evaluate the outcome of surgery for lumbar disc herniations in patients with no preoperative back pain (NBP) compared to those reporting low back pain (LBP).

    METHODS: 15,418 patients surgically treated due to LDH with primary discectomy from 1998 until 2020 were included in the study. Self-reported low back pain assessed with a numerical rating scale (NRS) was used to dichotomize the patients in two groups, patients without preoperative back pain (NBP, NRS = 0, n = 1333, 9%) and patients with preoperative low back pain (LBP, NRS > 0, n = 14,085, 91%). Patient reported outcome measures (PROMs) collected preoperatively and one-year postoperatively were used to evaluate differences in outcomes between the groups.

    RESULTS: At the one-year follow-up, 89% of the patients in the NBP group were completely pain free or much better compared with 76% in the LBP group. Significant improvement regarding leg pain was seen in all measured PROMs in both groups oneyear after surgery. In the NBP group, 13% reported clinically significant back pain (NRS difference greater than Minimally Clinical Important Difference (MICD)) at the one-year follow-up.

    CONCLUSIONS: Patients without preoperative back pain are good candidates for LDH surgery. 13% of patients without preoperative back pain develop clinically significant back pain one-year after surgery.

  • 5.
    Sigmundsson, Freyr Gauti
    et al.
    Department of Orthopedics, Skåne University Hospital, Malmö, Sweden.
    Jönsson, Bo
    Department of Orthopedics, Skåne University Hospital, Malmö, Sweden.
    Strömqvist, Björn
    Department of Orthopedics, Skåne University Hospital, Malmö, Sweden.
    Determinants of patient satisfaction after surgery for central spinal stenosis without concomitant spondylolisthesis: a register study of 5100 patients2017In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 26, no 2, p. 473-480Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Satisfaction with the outcome of treatment is a widely used outcome measure but information about the determinants of patient satisfaction after surgery for central spinal stenosis (CSS) are lacking. The aim of the study was to analyze determinants of patient satisfaction 1 year after surgery for CSS without degenerative spondylolisthesis (DS).

    METHODS: This prospective register study included 5100 patients operated for CSS without DS. 88 % received decompression only (D) and 12 % had decompression and fusion (DF). The patient reported outcome measures were the EuroQol-5D, the Short-Form 36, the visual analogue scale for leg and back pain, the Oswestry disability index and the self-estimated walking distance. Logistic regression reporting odds ratios (OR) for being satisfied was utilized.

    RESULTS: There were significant baseline differences between satisfied and dissatisfied patients in all patient reported outcome measures except leg pain. Factors decreasing the likelihood for satisfaction included previous spine surgery OR: 0.4 (95 % CI: 0.3-0.5), smoking OR: 0.6 (95 % CI: 0.4-0.8), unemployment OR: 0.6 (95 % CI: 0.4-0.9), back pain exceeding 1 year OR: 0.6 (95 % CI: 0.4-0.9), back pain predominance OR: 0.7 (95 % CI: 0.5-0.8). Fusion surgery did not predict satisfaction OR: 1.3 (95 % CI: 0.9-1.9). Preoperative self-estimated walking distance >1000 m predicted satisfaction, OR: 2.4 (95 %: 1.6-3.6).

    CONCLUSIONS: Numerous factors have predictive value for satisfaction of outcome after surgery for CSS without DS. The results from this study can constitute background data in the shared decision making process when discussing surgery with patients suffering from CSS.

  • 6.
    Singh, Aman
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden.
    El-Hajj, Victor Gabriel
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden.
    Fletcher-Sandersjöö, Alexander
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
    Aziz, Nabeel
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Ghaith, Abdul Karim
    Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
    Tatter, Charles
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Stockholm Southern Hospital, Stockholm, Sweden.
    Blixt, Simon
    Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Gunnar
    Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden.
    Bydon, Mohamad
    Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
    Gerdhem, Paul
    Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Orthopedics and Hand Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Edström, Erik
    Örebro University, School of Medical Sciences. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden; Department of Medical Sciences, Örebro University, Örebro, Sweden.
    Elmi-Terander, Adrian
    Örebro University, School of Medical Sciences. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden; Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Medical Sciences, Örebro University, Örebro, Sweden.
    Predictors of failure after primary anterior cervical discectomy and fusion for subaxial traumatic spine injuries2024In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Traumatic subaxial fractures account for more than half of all cervical spine injuries. The optimal surgical approach is a matter of debate and may include anterior, posterior or a combined anteroposterior (360º) approach. Analyzing a cohort of patients initially treated with anterior cervical discectomy and fusion (ACDF) for traumatic subaxial injuries, the study aimed to identify predictors for treatment failure and the subsequent need for supplementary posterior fusion (PF).

    METHODS: A retrospective, single center, consecutive cohort study of all adult patients undergoing primary ACDF for traumatic subaxial cervical spine fractures between 2006 and 2018 was undertaken and 341 patients were included. Baseline clinical and radiological data for all included patients were analyzed and 11 cases of supplementary posterior fixation were identified.

    RESULTS: Patients were operated at a median of 2.0 days from the trauma, undergoing 1-level (78%), 2-levels (16%) and ≥ 3-levels (6.2%) ACDF. A delayed supplementary PF was performed in 11 cases, due to ACDF failure. On univariable regression analysis, older age (p = 0.017), shorter stature (p = 0.031), posterior longitudinal ligament (PLL) injury (p = 0.004), injury to ligamentum flavum (p = 0.005), bilateral facet joint dislocation (p < 0.001) and traumatic cervical spondylolisthesis (p = 0.003) predicted ACDF failure. On the multivariable regression model, older age (p = 0.015), PLL injury (p = 0.048), and bilateral facet joint dislocation (p = 0.010) remained as independent predictors of ACDF failure.

    CONCLUSIONS: ACDF is safe and effective for the treatment of subaxial cervical spine fractures. High age, bilateral facet joint dislocation and traumatic PLL disruption are independent predictors of failure. We suggest increased vigilance regarding these cases.

  • 7.
    Szigethy, Lilla
    et al.
    Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.
    Sigmundsson, Freyr Gauti
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics.
    Joelson, Anders
    Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.
    Surgically treated degenerative disk disease in twins2024In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 33, no 4, p. 1381-1384Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Previous studies have suggested that genetic factors are important in the development of degenerative disk disease (DDD). However, the concordance rates for the phenotypes requiring surgery are unknown. The purpose of this study was to determine the concordance rates for DDD requiring surgery by studying monozygotic (MZ) and dizygotic (DZ) twin pairs.

    METHODS: Patients, aged between 18 and 85 years, operated for DDD between 1996 and 2022 were identified in the national Swedish spine register (Swespine) and matched with the Swedish twin registry (STR) to identify MZ and DZ twins. Pairwise and probandwise concordance rates were calculated.

    RESULTS: We identified 11,207 patients, 53% women, operated for DDD. By matching the Swespine patients with the STR, we identified 121 twin pairs (37 MZ and 84 DZ) where one or both twins were surgically treated for DDD. The total twin incidence for operated DDD was 1.1%. For DDD requiring surgery, we found no concordant MZ pair and no concordant DZ pair where both twins were operated for DDD. When we evaluated pairs where at least one twin was operated for DDD, we found two concordant MZ pairs (the co-twins were operated for spinal stenosis) and two  concordant DZ pairs (one co-twin operated for spinal stenosis and one (co-twin operated for disk herniation).

    CONCLUSIONS: Our findings suggest that genetic factors are probably not a major etiologic component in most cases of DDD requiring surgery. The findings of this study can be used for counseling patients about the risk for requiring DDD surgery.

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