The appropriate management of persisting pain after spine surgery: a European panel study with recommendations based on the RAND/UCLA method.

Purpose: Management of patients with persisting pain after spine surgery (PPSS) shows significant variability, and there is limited evidence from clinical studies to support treatment choice in daily practice. This study aimed to develop patient-specific recommendations on the management of PPSS.

Methods: Using the RAND/UCLA appropriateness method (RUAM), an international panel of 6 neurosurgeons, 6 pain specialists, and 6 orthopaedic surgeons assessed the appropriateness of 4 treatment options (conservative, minimally invasive, neurostimulation, and re-operation) for 210 clinical scenarios.

Percutaneous Interspinous Spacer vs Decompression in Patients with Neurogenic Claudication: An Alternative in Selected Patients?

Background: Standalone interspinous process devices (IPDs) to treat degenerative lumbar spinal stenosis with neurogenic intermittent claudication (NIC) have shown ambiguous results in the literature.

Objective: To show that a minimally invasive percutaneous IPD is safe and noninferior to standalone decompressive surgery (SDS) for patients with degenerative lumbar spinal stenosis with NIC.

Methods: A multicenter, international, randomized, controlled trial (RCT) was con- ducted.

Health-related quality of life in patients with surgically treated lumbar disc herniation: 2- and 7-year follow-up of 117 patients.

Background And Purpose: Health-related quality of life (HRQoL) instruments have been of increasing interest for evaluation of medical treatments over the past 10-15 years. In this prospective, long-term follow-up study we investigated the influence of preoperative factors and the change in HRQoL over time after lumbar disc herniation surgery.

Methods: 117 patients surgically treated for lumbar disc herniation (L4-L5 or L5-S1) were evaluated with a self-completion HRQoL instrument (EQ-5D) preoperatively, after 2 years (96 patients) and after 7 years (89 patients).

Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up.

Factors as age, sex, smoking, duration of leg pain, working status, type/level of disc herniation and psychosocial factors have been demonstrated to be of importance for short-term results after lumbar discectomy. There are few studies with long-term follow-up. In this prospective study of lumbar disc herniation patients undergoing surgery, the result was evaluated at 2 and 5-10 (mean 7.

Peridural scar and its relation to clinical outcome: a randomised study on surgically treated lumbar disc herniation patients.

A prospective randomised 2-year follow-up study on patients undergoing lumbar disc herniation surgery. The objective was to investigate the relationship between peridural scarring and clinical outcome, the scar development 6 and 24 months postoperatively by using MRI, and if ADCON-L (a bioresorbable carbohydrate polymer gel) has an effect on scar size and/or improve patients' outcome after lumbar disc herniation surgery. The association between peridural scarring and recurrent pain after lumbar disc herniation surgery is debated.

Three-dimensional radiological classification of lumbar disc herniation in relation to surgical outcome.

Centrally located lumbar disc herniations have been reported to be of predictive value for poor post-operative clinical outcome. One hundred and fifty patients undergoing lumbar disc herniation surgery were prospectively included. Herniation-related parameters, including the grading of contours, were assessed from pre-operative computed tomography (CT) and magnetic resonance imaging (MRI) images using a new three-dimensional grading system.

A radiostereometric analysis of the Bryan Cervical Disc prosthesis.

Study Design: Prospective, radiostereometric study of the Bryan Cervical Disc prosthesis (Medtronic Sofamor Danek, Memphis, TN) for the treatment of a single-level disc disease of the cervical spine.

Objective: To study the stability of the titanium endplates of the disc prosthesis at the interface between the bone and prosthesis.

Summary Of Background Data: Cervical disc prosthesis is a motion-sparing technology in which the longevity is dependent on initial fixation as well as secondary fixation with bone ingrowth into the surface of the device.

Autograft versus interbody fusion cage without plate fixation in the cervical spine: a randomized clinical study using radiostereometry.

A primary object with a fusion cage is avoidance of graft collapse with subsequent subsidence and malalignment of the cervical spine that is observed after bone grafting alone. No randomized studies exist that demonstrate the difference between these two methods in terms of graft subsidence and angulation of the fused segment. The size of the study population was calculated to be 24 patients to reach a significant difference at the 95% CI level.

Patients' satisfaction with provided care/information and expectations on clinical outcome after lumbar disc herniation surgery.

Study Design: A prospective study of patients undergoing lumbar disc herniation surgery.

Objectives: To assess patients' satisfaction with care/preoperative information, if expectations on surgical results and ability to return to work are related to baseline characteristics, and/or can predict self-reported outcome. Self-reported outcome was compared with objective outcome.

Comparing precision of distortion-compensated and stereophotogrammetric Roentgen analysis when monitoring fusion in the cervical spine.

Two methods to measure sagittal plane segmental motion in the cervical spine are compared. Translational and rotational motion was measured in nine cervical motion segments of nine patients by distortion-compensated (DCRA) as well as by stereophotogrammetric Roentgen analysis (RSA). To compare measurement precision of the new DCRA protocol with the established RSA technique under realistic clinical conditions and to discuss advantages and disadvantages of both methods in clinical studies.

Clinical application of a new three-dimensional radiological classification of lumbar disc herniations.

The results after lumbar discectomy are usually satisfactory. However, there is a group of patients with less favorable result. The predictive factors affecting the result are not fully understood.

Is increased segmental motion early after lumbar discectomy related to poor clinical outcome 5 years later?

The purpose of the study was to compare segmental motion in the early postoperative phase after lumbar discectomy to the outcome 5 years postoperatively. The study population had radiologically verified symptomatic L4-L5 or L5-S1 lumbar disc herniation and was referred with an indication for lumbar discectomy. Radiostereometry was performed in the supine and standing positions.

The effect of standard lumbar discectomy on segmental motion: 5-year follow-up using radiostereometry.

We measured the effects of lumbar discectomy on segmental motion over a period of 5 years. Twenty-four patients with lumbar disc herniation were treated by standard lumbar discectomy at the L4-L5 or L5-S1 level. Peroperatively, tantalum markers were inserted into L4, L5, and the sacrum.

Mobility provocation radiostereometry in anterior cervical spine fusions.

This study aimed to evaluate the use of mobility-provocation radiostereometry (RSA) in anterior cervical spine fusions and compare the results to deformation studies on the same patients and plain flexion-extension radiographs. Mobility-provocation RSA was used to evaluate anterior cervical spine fusions in 45 patients. The motions recorded at 3 and 12 months postoperatively were compared to RSA measurements of deformation of the fusion over time and to plain flexion-extension radiographs in the same patients taken 3 months postoperatively.

Outcome scores in degenerative cervical disc surgery.

Forty-six consecutive patients with neck pain and arm radiculopathy were treated with anterior cervical discectomy and fusion. All patients had neurological symptoms corresponding to a herniated disc and/or spondylosis at one or two cervical levels, verified by magnetic resonance imaging. The patients were stabilized with an anterior graft and randomized to either fixation with a CSLP plate or no internal fixation.

Recruitment of low threshold motor-units in the trapezius muscle in different static arm positions.

A prevailing hypothesis for development of myalgia symptoms in the trapezius muscle is based on observations that in stereotypic activation of muscle the same low-threshold motor-units are the first ones to be recruited, and that these units are active throughout the contraction, until total relaxation. The theory suggests that these units are the first ones in monotonous repetitive work to be subject to degenerative processes, causing pain. The present project was undertaken to evaluate to what extent recruitment of motor-units in the trapezius muscle is position-specific, i.

One-level cervical spine fusion. A randomized study, with or without plate fixation, using radiostereometry in 27 patients.

We randomized 27 consecutive patients undergoing 1-level cervical disc surgery to surgery with or without anterior plate fixation. The patients were studied with radiostereometry and clinically with visual analogue scores (VAS) for arm and neck pain. After 2 years, 1 patient had developed pseudoarthrosis, all other fusions were healed, but 1 patient showed substantial motions in the fusion area between the 1- and 2-year follow-ups.

Plate fixation adds stability to two-level anterior fusion in the cervical spine: a randomized study using radiostereometry.

This study evaluated whether addition of a cervical spine locking plate (CSLP) in two-level disc fusions improved the postoperative stability and reduced the time to healing. Radiostereometric analysis was used to obtain precise recordings of the three-dimensional motion between the fused vertebrae. Eighteen consecutive patients were operated on with excision of two adjacent cervical discs and anterior horseshoe grafting with autologous bone (Smith Robinson technique).

[Incidence of injuries resulting from physical violence in Reykjavik 1974-1991].

The purpose of this study was to research the incidence of injuries in Reykjavik among those who had been the victims of physical violence. The study examined the computer data on all injury cases resulting from physical violence among legal residents of Reykjavik, the capital area, who were treated at the Emergency Department (ED) of the Reykjavik City Hospital, University of Iceland, from the time period 1974-1991. Data for the year 1991 were analysed with respect to where and when the violence took place.