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  • 1.
    Löfgren, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Psychiatry. Linköping University, Faculty of Health Sciences.
    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 life2000Doctoral 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.

    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, p. 17-27Article 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.

    Keywords
    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, p. 19-31Article 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.

    Keywords
    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, p. 1908-1916Article 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.

    Keywords
    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, p. 403-408Article 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, p. 1033-1043Article 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, p. 39-48Article 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.

    Keywords
    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
  • 2.
    Löfgren, Håkan
    et al.
    Dept of Neuro-Orthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
    Johannsson, Valur
    National Social Insurance Hospital (Research and Rehabilitation Centre), Tranås, Sweden.
    Olsson, Tord
    Dept of Radiology, Högland Hospital, Eksjö-Nässjö, Sweden.
    Ryd, Leif
    Dept of Orthopedics, University Hospital, Lund, Sweden.
    Levander, Bo
    Dept of Neuro-Orthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
    Rigid Fusion After Cloward Operation for Cervical Disc Disease Using Autograft, Allograft, or Xenograft: A Randomized Study With Radiostereometric and Clinical Follow-Up Assessment2000In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 25, no 15, p. 1908-1916Article in journal (Refereed)
    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.

  • 3.
    Löfgren, Håkan
    et al.
    Department Neuro-Orthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
    Johansen, F.
    National Social Insurance Hospital (Research and Rehabilitation Centre), Tranås, Sweden .
    Skogar, O.
    Department Rehabilitation Medicine, Ryhov Hospital, Jönköping, Sweden .
    Levander, Bo
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Reduced pain after surgery for cervical disc protrusion/stenosis: A 2 year clinical follow-up2003In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 25, no 18, p. 1033-1043Article in journal (Refereed)
    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.

  • 4.
    Löfgren, Håkan
    et al.
    Department of Neuro-Orthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
    Larsson, Romy
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Larsson, Sven-Erik
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Outcome of surgery for cervical radiculopathy evaluated by determination of trapezius muscle microcirculation and electromyography2001In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 5, no 1, p. 39-48Article in journal (Refereed)
    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.

  • 5.
    Löfgren, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Neuroorthoped Ctr, Sweden; Dept Radiol, Sweden.
    Osman, Aras
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Neuroorthoped Ctr, Sweden; Dept Radiol, Sweden.
    Blomqvist, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Divison of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Neuroorthoped Ctr, Sweden; Dept Radiol, Sweden.
    Vavruch, Ludek
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Neuroorthoped Ctr, Sweden; Dept Radiol, Sweden.
    Sagittal Alignment After Laminectomy Without Fusion as Treatment for Cervical Spondylotic Myelopathy: Follow-up of Minimum 4 Years Postoperatively2019In: Global Spine Journal, ISSN 2192-5682, E-ISSN 2192-5690, article id UNSP 2192568219858302Article in journal (Refereed)
    Abstract [en]

    Objectives:

    The aims of this study were to evaluate the incidence of sagittal malalignment including kyphosis following cervical laminectomy without fusion as treatment for cervical spondylotic myelopathy and to assess any correlation between malalignment and clinical outcome.

    Study Design:

    Retrospective cohort study.

    Methods:

    In all, 60 patients were followed up with conventional radiography at an average of 8 years postoperatively. The cervical lordosis (C2-C7 Cobb angle), C2-C7 sagittal vertical axis (cSVA) and C7 slope were measured on both preoperative and postoperative images. Patients completed a questionnaire covering Neck Disability Index (NDI), visual analogue scale for neck pain, and general health (EQ-5D).

    Results:

    Mean C2-C7 Cobb angle was 8.6° (SD 9.0) preoperatively, 3.4° (10.7) postoperatively and 9.6° (14.5) at follow-up. Ultimately, 3 patients showed >20° cervical kyphosis. Mean cSVA was 16.3 mm (SD 10.2) preoperatively, 20.6 mm (11.8) postoperatively, and 31.6 mm (11.8) at follow-up. Mean C7 slope was 20.4° (SD 8.9) preoperatively, 18.4° (9.4) postoperatively, and 32.6° (10.2) at follow-up. The preoperative to follow-up increase in cSVA and C7 slope was statistically significant (both P < .0001), but not for cervical lordosis. The preoperative to follow-up change in cSVA correlated moderately with preoperative cSVA (r = 0.43, P = .002), as did the corresponding findings regarding C7 slope (r = 0.52, P = .0001). A comparison of radiographic measurements with clinical outcome showed no strong correlations.

    Conclusions:

    No preoperative to follow-up change in cervical lordosis was found in this group; 5.0% developed >20° kyphosis. No clear correlation between sagittal alignment and clinical outcome was shown.

  • 6.
    Löfgren, Håkan
    et al.
    Department of Neuroorthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
    Vallö Christiansen, J.
    MR-Center, Ryhov Hospital, Jönköping.
    Johannsson, V.
    National Social Insurance Hospital (Research and Rehabilitation Centre), Tranås, Sweden.
    Levander, Bo
    Department of Neuroorthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
    MRI and clinical course after anterior cervical decompression and fusion: A prospective two years longitudinal evaluation showing fibrous union of the bovine graft1999In: Neuro-Orthopedics, ISSN 0177-7955, Vol. 26, no 1, p. 19-31Article in journal (Refereed)
    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.

  • 7.
    Löfgren, Håkan
    et al.
    Department of Neuroorthopedics, Ryhov Hospital, Jönköping.
    Vallö Christiansen, J.
    MR-Center, Ryhov Hospital, Jönköping.
    Olsson, T.
    Department of Radiology, County Hospital, Eksjö-Nassjö, Sweden.
    Levander, Bo
    Department of Neuroorthopedics, Ryhov Hospital, Jönköping.
    Bone graft should not be omitted in cloward procedure for cervical radiculopathy1998In: Neuro-Orthopedics, ISSN 0177-7955, Vol. 23, no 1-2, p. 17-27Article in journal (Refereed)
    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.

  • 8.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Söderlund, Anne
    Mälardalen University, Västerås, Sweden.
    Engquist, Markus
    Ryhov Hospital, Jönköping, Sweden.
    Lind, Bengt
    University of Gothenburg, Sweden.
    Löfgren, Håkan
    Ryhov Hospital, Jönköping, Sweden.
    Vavruch, Ludek
    Ryhov Hospital, Jönköping, Sweden.
    Holtz, Anders
    Uppsala University Hospital, Sweden.
    Winström-Christersson, Annelie
    Ryhov Hospital, Jönköping, Sweden.
    Isaksson, Ingrid
    Ryhov Hospital, Jönköping, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Physical Function Outcome in Cervical Radiculopathy Patients After Physiotherapy Alone Compared With Anterior Surgery Followed by Physiotherapy: A Prospective Randomized Study With a 2-Year Follow-up2013In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 38, no 4, p. 300-307Article in journal (Refereed)
    Abstract [en]

    Study Design. Prospective randomized study.

    Objective. To investigate differences in physical functional outcome in patients with radiculopathy due to cervical disc disease, after structured physiotherapy alone (consisting of neck-specific exercises with a cognitive-behavioral approach) versus after anterior cervical decompression and fusion (ACDF) followed by the same structured physiotherapy program.

    Summary of Background Data. No earlier studies have evaluated the effectiveness of a structured physiotherapy program or postoperative physical rehabilitation after ACDF for patients with magnetic resonance imaging–verified nerve compression due to cervical disc disease.

    Methods. Our prospective randomized study included 63 patients with radiculopathy and magnetic resonance imaging–verified nerve root compression, who were randomized to receive either ACDF in combination with physiotherapy or physiotherapy alone. For 49 of these patients, an independent examiner measured functional outcomes, including active range of neck motion, neck muscle endurance, and hand-related functioning before treatment and at 3-, 6-, 12-, and 24-month follow-ups.

    Results. There were no significant differences between the 2 treatment alternatives in any of the measurements performed (P = 0.17–0.91). Both groups showed improvements over time in neck muscle endurance (P ≤ 0.01), manual dexterity (P ≤ 0.03), and right-handgrip strength (P = 0.01).

    Conclusion. Compared with a structured physiotherapy program alone, ACDF followed by physiotherapy did not result in additional improvements in neck active range of motion, neck muscle endurance, or hand-related function in patients with radiculopathy. We suggest that a structured physiotherapy program should precede a decision for ACDF intervention in patients with radiculopathy, to reduce the need for surgery.

  • 9.
    Ryd, Leif
    et al.
    Orthopedic Surgery, University Hospital, Lund, Sweden.
    Yuan, Xunhua
    Orthopedic Surgery, University Hospital, Lund, Sweden.
    Löfgren, Håkan
    Neuro-Orthopedics, Ryhovs Hospital, Jönköping, Sweden.
    Methods for determining the accuracy ofradiostereometric analysis (RSA)2000In: Acta Orthopaedica Scandinavica, ISSN 0001-6470, Vol. 71, no 4, p. 403-408Article in journal (Refereed)
    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.

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