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Disability after anterior decompression and fusion for cervical disc disease
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-6075-4432
Department of Neuro-Orthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
2002 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 4, no 3, 111-124 p.Article in journal (Refereed) Published
Abstract [en]

Few prospective studies on outcome have been conducted with respect to disability after anterior cervical decompression and fusion (ACDF), and the need for further rehabilitation after surgery is unknown. Thirty-four patients with cervical disc disease verified by magnetic resonance imaging were included before ACDF with a cervical carbon fibre intervertebral fusion cage. Measurements took place the day before, 6 months and 1 year after surgery, and consisted of both objective and subjective measurements. The results showed a significant improvement from surgery in neck muscle endurance in flexion, neck strength in lateral flexion, some of the pain variables, numbness, neck specific disability, change in general health and symptom satisfaction at the 1-year follow-up. Except for worsening in general health, there were no significant differences between the 6-month and the 1-year follow-up. Despite improvement in several of the variables, about one-third of the patients had deficits in the objective measurements and about two-thirds had deficits in the subjective variables. Only five patients were without neck problems according to average pain, the Neck Disability Index and general health. This suggests that there is still a great need for improvement both of the surgical procedure and the rehabilitation afterwards.

Place, publisher, year, edition, pages
2002. Vol. 4, no 3, 111-124 p.
Keyword [en]
Cervical radiculopathy, Neck, Outcome, Rehabilitation, Spine, Surgery
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-46883DOI: 10.1080/140381902320387531OAI: oai:DiVA.org:liu-46883DiVA: diva2:267779
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2013-09-03Bibliographically approved
In thesis
1. Functional analysis of the cervical spine: Reliability, reference data and outcome after anterior cervical decompression and fusion
Open this publication in new window or tab >>Functional analysis of the cervical spine: Reliability, reference data and outcome after anterior cervical decompression and fusion
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of the thesis was to investigate the reliability of the test procedure, and to obtain reference values for active range of motion (AROM) of the neck, neck-, and hand strength. Another aim was to perform a broad assessment of outcome in patients with cervical disc disease operated on by anterior cervical decompression and fusion (ACDF) and to identify predictive factors for a good outcome. For a broad assessment it is important to have reliable objective and subjective variables, and reference values obtained in healthy people.

Three studies concern reliability and reference values for neck AROM, neck strength, and hand strength of healthy individuals. One study concerns the outcome of 34 consecutively included patients six months and one year after ACDF, and any remaining deficits afterwards. One study is a prospective randomised study of 103 patients concerning prognostic factors (mean follow-up 19 months, SD 6, range 12-24 months) for a good outcome of ACDF, and any remaining deficits afterwards.

The intra-, and inter-tester reliability of neck AROM, neck strength, and hand strength obtained from 30-32 healthy volunteers were considered substantial to almost perfect (ICC-values 0.61-0.98) and can be used for comparisons between or within groups. The reference values obtained in 101 asymptomatic men and women aged 25-64 years showed that age was the most important factor to take into consideration when measuring neck AROM, and gender was most important for neck and hand strength measurements. The patients showed benefits from ACDF at the one-year follow-up in neck strength in lateral flexion, neck muscle endurance in flexion, pain, numbness, ADL, Neck Disability Index (NDI), sick leave, change in general health, and symptom satisfaction. Except for a deterioration in general health there were no significant differences between the six-month and the one-year followup. The most important predictor for low postoperative pain intensity was greater preoperative kyphosis.

The predictive value of segmental kyphosis is noteworthy and of potential clinical interest. Low preoperative pain intensity was the most important predictor for improved NDI. Non-smoking males with a greater segmental kyphosis at the level of surgical intervention, with less severe pain experience and better initial function, had the best prognosis for a successful outcome of ACDF. Although the patients experienced benefits from surgery in many of the variables, a large number still had remaining deficits. These studies support the need for improvements in the selection for and the treatment techniques in both surgery and physiotherapy in degenerative cervical disorders.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2002. 84 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 738
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-26343 (URN)10867 (Local ID)91-7373-182-X (ISBN)10867 (Archive number)10867 (OAI)
Public defence
2002-09-06, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2013-09-03Bibliographically approved

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Peolsson, AnneliVavruch, LudekÖberg, Birgitta

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