liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Outcome and bone grafts in surgical treatment of cervical disc disease: A clinical evaluation using MRI, radiostereometry and measurements of microcirculation and the quality of life
Linköping University, Department of Clinical and Experimental Medicine, Psychiatry. Linköping University, Faculty of Health Sciences.
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this thesis was to evaluate the outcome after surgical treatment of cervical disc disease and the influence of different bone grafting methods.

192 patients were studied, of which 149 were treated surgically. They all presented with radiculopathy and/ or myelopathy, and were subjected to an anterior cervical discectomy and fusion as described by Cloward, except for 8 patients operated with a posterior decompression.

43 patients due for surgery were prospectively randomized to fusion with either auto-, allo- or xenograft. 33 of these patients were then monitored by radiostereornetric analysis (RSA) after 6, 12 and 24-50 (mean 37) months, including conventional radiography at the final follow-up. All 43 patients were examined clinically, including pain rating pre- and postoperatively with a final follow-up by an unbiased observer. Mobility could be demonstrated by RSA in 9 patients after one year and at the final follow-up in 6, with no difference between bone grafts. Conventional radiography showed final mobility in only 1 out of these 6 patients. The clinical results were not influenced by whether mobility could be demon strated or not. There was a tendency towards better clinical results in the patients fused with an autograft.

13 patients operated without bone graft had a less favourable clinical outcome compared with 11 patients operated with autograft, retrospectively studied 6- 9 years postoperatively.

The normal postoperative course was followed prospectively in 25 consecutive patients by MRI and clinical reviews, preoperatively and 3 days, 3, 6, 12 and 24 months postoperatively. The results demonstrated that the decompression by an anterior procedure should not be evaluated by MRI until at least 3 months postoperatively. This is because surgical debris behind the bone dowel is impossible to distinguish from remaining osteophytes or disc fragments. MRI-findings of foraminal narrowing were common postoperatively among patients with no remaining radiculopathy. A rim sign was permanent with high signal enhancement around the bovine xenograft after i. v. contrast, indicating fibrous healing.

Surgically treated patients experienced a pain reduction as measured by visual analogue pain scales (VAS) and showed an improvement in clinical findings, when followed by unbiased observers at least 2 years after surgery. Some recurrence of pain and other symptoms was common 3 to 6 months postoperatively. The improvement in quality of life measured by Sickness Impact Profile (SIP) in 43 operated patients was mainly temporary, even if a sustained improvement after 2 years was observed among the operated patients that were referred directly to us.

No corresponding changes in pain, clinical findings or SIP were seen among 41 conservatively treated patients, matched for gender and age.

Measurements of microcirculation and electromyography in the trapezius muscles during increased static load before and 9 months after surgery (27 patients) showed a tendency towards increased microcirculation and increased muscle activation. There was a more evident response on the less painful side, as well as among the 8 patients operated using a posterior approach.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2000. , 58 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 621
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-28059Local ID: 12823ISBN: 91-7219-578-9 (print)OAI: oai:DiVA.org:liu-28059DiVA: diva2:248610
Public defence
2000-03-31, Berzeliussalen, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-25Bibliographically approved
List of papers
1. Bone graft should not be omitted in cloward procedure for cervical radiculopathy
Open this publication in new window or tab >>Bone graft should not be omitted in cloward procedure for cervical radiculopathy
1998 (English)In: Neuro-Orthopedics, ISSN 0177-7955, Vol. 23, no 1-2, 17-27 p.Article in journal (Refereed) Published
Abstract [en]

24 patients from a consecutively serie operated on by an one-level Cloward cervical procedure were retrospectively studied 3-9 years after the surgery. 13 patients had received a bone graft and 11 had not. The clinical results were improved after operation with bone graft; better sensation (p 0.001), better muscle strength (p 0.01) and less pain (p 0.02). Radiography and MRI showed a solid fusion in all the patients with bone graft and in none without. The occurrence of compression on the spinal cord or nerve roots in the adjacent segments as well as in the operated segments did not differ between the groups. We recommend bone graft to be included in the Cloward procedure.

Keyword
Adjacent segments, Bone graft, Cervical fusion, Cloward procedure
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79467 (URN)
Available from: 2012-08-02 Created: 2012-08-02 Last updated: 2012-08-02Bibliographically approved
2. MRI and clinical course after anterior cervical decompression and fusion: A prospective two years longitudinal evaluation showing fibrous union of the bovine graft
Open this publication in new window or tab >>MRI and clinical course after anterior cervical decompression and fusion: A prospective two years longitudinal evaluation showing fibrous union of the bovine graft
1999 (English)In: Neuro-Orthopedics, ISSN 0177-7955, Vol. 26, no 1, 19-31 p.Article in journal (Refereed) Published
Abstract [en]

Study design. Twenty-five consecutive patients were studied prospectively after one-level anterior cervical decompression and fusion according to Cloward with bovine bone graft. Objectives. To monitor, by MRI, the postoperative changes at the fused and adjacent levels together with the longitudinal clinical course. Summary of background data. MRI has become the primary preoperative examination of cervical disc disease/spondylosis, but experience of the normal postoperative findings is still limited. Methods. MRI was performed preoperative and after three days, three six, 12 and 24 months accompanied with clinical reviews. Results. Up to six months postoperatively, the surgical debris behind the bone dowel was impossible to distinguish from remaining parts of osteophytes or disc fragments. A rim sign was permanent with high signal around but only slight enhancement in the bone transplant after i.v. contrast. Twelve patients had foraminal stenosis at the operated level, but only two of them had radicular pain. There was small amounts of epidural scar tissue. Four patients developed a severe degeneration at the adjacent levels, all of which had had some changes preoperatively. Clinically, we found improvement in muscle strength and sensory function, lowered pain rating (VAS) and 19 patients experience a good outcome. Three to six months postoperatively there was a period with some recurrence of symptoms. Conclusions. The decompression by an anterior procedure should not be evaluated by MRI until at least three months postoperatively. Asymptomatic foraminal stenosis was common postoperatively. The bovine xenograft (SurgiboneR) had a fibrous healing. The clinical results were satisfactory as evaluated by an unbiased observer.

Keyword
Cervical vertebrae, Magnetic resonance imaging, Prospective studies, Spinal fusion, Transplantation heterologous
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79468 (URN)
Available from: 2012-08-02 Created: 2012-08-02 Last updated: 2012-08-02Bibliographically approved
3. Rigid Fusion After Cloward Operation for Cervical Disc Disease Using Autograft, Allograft, or Xenograft: A Randomized Study With Radiostereometric and Clinical Follow-Up Assessment
Open this publication in new window or tab >>Rigid Fusion After Cloward Operation for Cervical Disc Disease Using Autograft, Allograft, or Xenograft: A Randomized Study With Radiostereometric and Clinical Follow-Up Assessment
Show others...
2000 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 25, no 15, 1908-1916 p.Article in journal (Refereed) Published
Abstract [en]

Study Design. In this study, 43 patients scheduled for a single-level cervical Cloward procedure for disc disease were randomized prospectively to fusion with autograft, allograft, or xenograft.

Objective. To outline any differences in fusion over time in terms of final mobility and clinical outcome between the three bone grafts.

Summary of Background Data. Fusion is used to relieve pain from a spinal segment. The bovine xenograft gives a fibrous fusion in contrast to the solid bone fusion obtained with autograft from the iliac crest, but no definite differences in clinical outcome have been shown previously after surgery at a single level.

Methods. By use of radiostereometric analysis, 33 patients were observed after 6, 12, and 24 to 50 (mean, 37) months. All 43 patients underwent clinical examination, which involved pain rating before and after surgery, with a final follow-up assessment by an unbiased observer.

Results. Mobility could be demonstrated in 9 patients after 1 year and in 6 patients at the final follow-up assessment, without pain, and with no difference between bone grafts. The patients who received autograft experienced a greater reduction of pain than the patients treated with xenograft.

Conclusions. Most of the patients healed with a rigid fusion no matter which graft was used, but the healing process took longer than expected. The clinical results were not influenced by whether mobility could be demonstrated. There was a tendency toward better clinical results in the patients treated with autograft.

Keyword
bone transplantation, cervical vertebrae, photogrammetry, prospective studies, spinal fusion, transplantation autologous, transplantation heterologous, transplantation homologous
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27851 (URN)12609 (Local ID)12609 (Archive number)12609 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
4. Methods for determining the accuracy ofradiostereometric analysis (RSA)
Open this publication in new window or tab >>Methods for determining the accuracy ofradiostereometric analysis (RSA)
2000 (English)In: Acta Orthopaedica Scandinavica, ISSN 0001-6470, Vol. 71, no 4, 403-408 p.Article in journal (Refereed) Published
Abstract [en]

The problem of determining the noise level in any measuring system remains urgent. Radiostereometric analysis (RSA) is a radiographic system of unique accuracy which has applications in areas where minute motions or no motion at all occurs. Examples are micromotion between endoprostheses and bone and in fracture healing.

We have determined the accuracy of the RSA system as applied to a clinical series of spinal fusions, where the conditions for RSA were not optimal. Using the usual test-retest methodology on a phantom, we showed that its accuracy can be grossly overestimated in the individual case.

We found considerable variations in the accuracy in the individual case, depending on the rigid-body configuration. The overall accuracy, expressed as 3-D "vectors" for rotation and translation, respectively, correlated with the condition number, a method for characterizing the marker configuration. Indeed, the condition number explained as much as 92% of the variation in overall rotation. This condition number, however, cannot be used to analyze the accuracy of one degree of freedom of rotation alone. Mathematical simulation of the accuracy in the individual case of the individual dimension, using in-house software, showed that the accuracy (95% confidence) varied between 0.4 and 4.6 degrees of rotation about the transverse axis, corresponding to a clinical stress series of extension and flexion.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27861 (URN)10.1080/000164700317393420 (DOI)12621 (Local ID)12621 (Archive number)12621 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
5. Reduced pain after surgery for cervical disc protrusion/stenosis: A 2 year clinical follow-up
Open this publication in new window or tab >>Reduced pain after surgery for cervical disc protrusion/stenosis: A 2 year clinical follow-up
2003 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 25, no 18, 1033-1043 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To follow the clinical outcome after surgery for cervical radiculopathy caused by degenerative cervical disc disease and to compare it with the outcome after conservative treatment.

Method: Forty-three patients all awaiting surgery were studied prospectively. A control group of 39 conservatively treated patients were chosen, matched for gender and age. All patients rated their Sickness Impact Profile (SIP) and pain (VAS) and were clinically examined by unbiased observers initially and after 3, 9 and 24 months.

Results: Long-lasting pain reduction was noted both in the neck and in the arm for the operated patients, as well as improved sensory function and reduction of reflex disturbances. Their SIP showed a temporary improvement in the overall index, in the psychosocial dimension, in sleep/rest and home management, but only mobility remained improved. Among the operated patients referred directly to us, there was an improvement in SIP at the final follow-up. The control group's SIP indicated only a temporary improvement in sleep/rest.

Conclusions: Surgically treated patients experienced pain reduction which was partially maintained for at least 24 months. A sustained improvement in the health status measured by SIP was observed only among operated patients that were not referred via the social insurance offices.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-46387 (URN)10.1080/09638280310001596478 (DOI)12944158 (PubMedID)
Note
DOI not available, see link for full-text.Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
6. Outcome of surgery for cervical radiculopathy evaluated by determination of trapezius muscle microcirculation and electromyography
Open this publication in new window or tab >>Outcome of surgery for cervical radiculopathy evaluated by determination of trapezius muscle microcirculation and electromyography
2001 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 5, no 1, 39-48 p.Article in journal (Refereed) Published
Abstract [en]

Surgery for cervical radiculopathy was evaluated in 27 patients after anterior Cloward procedure (19 patients) or posterior decompression (eight patients). In addition, we examined 10 conservatively treated patients. Each patient was studied prospectively with regards to the effects on microcirculation in the local trapezius muscle during a fatiguing series of stepwise increased contractions. The right and left muscles were simultaneously examined pre-operatively and postoperatively after 9 months using laser-Doppler flowmetry and simultaneous surface electromyography (EMG). Preoperatively, a reduced microcirculation was found in the most painful side compared with the opposite side. This is in accordance with earlier reports on patients with chronic neurogenic neck pain, who also show reduced muscle tension on EMG. Postoperatively, the muscle blood flow became increased, but only in patients operated on via a posterior approach. A tendency at increased EMG-amplitude and reduced mean power frequency of the EMG was noted. These EMG signs of muscle fatigue suggest increased ability to exhaust the trapezius muscle postoperatively. The observed postoperative changes were consistently more frequent in the less painful side. We conclude from these objective measurements showing only a tendency at increased microcirculation and muscle tension postoperatively, that the effect on the trapezius muscle is limited. (C) 2001 European Federation of Chapters of the International Association for the Study of Pain.

Keyword
intervertebral disk displacement, cervical vertebrae, blood flow, laser-Doppler, electromyography, prospective studies
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-49185 (URN)10.1053/eujp.2000.0216 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12Bibliographically approved

Open Access in DiVA

No full text

Authority records BETA

Löfgren, Håkan

Search in DiVA

By author/editor
Löfgren, Håkan
By organisation
PsychiatryFaculty of Health Sciences
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 180 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf