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Reduced pain after surgery for cervical disc protrusion/stenosis: A 2 year clinical follow-up
Department Neuro-Orthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
National Social Insurance Hospital (Research and Rehabilitation Centre), Tranås, Sweden .
Department Rehabilitation Medicine, Ryhov Hospital, Jönköping, Sweden .
Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
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.

Place, publisher, year, edition, pages
2003. Vol. 25, no 18, 1033-1043 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-46387DOI: 10.1080/09638280310001596478PubMedID: 12944158OAI: diva2:267283
DOI not available, see link for full-text.Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2012-08-02Bibliographically approved
In thesis
1. 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
Open this publication in new window or tab >>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
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.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 621
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-28059 (URN)12823 (Local ID)91-7219-578-9 (ISBN)12823 (Archive number)12823 (OAI)
Public defence
2000-03-31, Berzeliussalen, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-25Bibliographically approved

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