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  • 1.
    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.

  • 2.
    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.

  • 3.
    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.

  • 4.
    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.

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