Aims. The aim of this study was to determine if positive Waddell signs
were related to patients’ demographics or to perception of their
quality of life. Patients and Methods. This prospective cross-sectional study included 479 adult patients
with back pain from a university spine centre. Each completed SF-12
and Oswestry Disability Index (ODI) questionnaires and underwent
standard spinal examinations to elicit Waddell signs. The relationship
between Waddell signs and age,
Lumbar disc herniation (LDH) is uncommon in youth
and few cases are treated surgically. Very few outcome studies exist
for LDH surgery in this age group. Our aim was to explore differences
in
Background and purpose. Sleep disturbance is frequently reported by people with chronic low back pain (CLBP >12 weeks), but there is limited knowledge of their sleep quality compared to healthy people. While disturbed sleep influences patients' mood, quality of life and recovery, few studies have comprehensively investigated sleep in CLBP. This study investigated differences in sleep profiles of people with CLBP, compared to age- and
Purpose of study. Cauda Equina Syndrome (CES) is a surgical emergency. With Physiotherapists increasingly taking on first-contact and spinal triage roles, screening for CES must be as thorough and effective as possible. This study explores whether Physiotherapists are asking the correct questions, in the correct way and investigates their experiences when screening for this serious condition. Background. Thirty physiotherapists working in a community musculoskeletal service were purposively invited to participate in semi-structured interviews. Data was transcribed and thematically analysed. Methods and Results. All participants routinely asked bladder, bowel function and saddle anaesthesia screening questions although only 9 routinely asked about sexual function. Whether questions are asked in the correct way has never been studied. Sufficient depth of questioning was achieved by 63% of participants, 76% used lay terminology and 73% used explicit language. Only 43% framed the questions before asking them and only 16% combined all four dimensions. Whilst most participants (n = 25) felt comfortable asking general CES questions, 50% reported feeling uncomfortable when asking about sexual function. Issues around;
Aims. The aims of this study were to determine the rates of surgical complications, reoperations, and readmissions following herniated lumbar disc surgery, and to investigate the impact of sociodemographic factors and comorbidity on the rate of such unfavourable events. Patients and Methods. This was a longitudinal observation study. Data from herniated lumbar disc operations were retrieved from a large medical database using a combination of procedure and diagnosis codes from all public hospitals in Norway from 1999 to 2013. The impact of age,
Aims. The purpose of this study was to investigate the prevalence of
sarcopenia and to examine its impact on patients with degenerative
lumbar spinal stenosis (DLSS). Patients and Methods. This case-control study included two groups: one group consisting
of patients with DLSS and a second group of control subjects without
low back or neck pain and related leg pain. Five control cases were
randomly selected and matched by age and
Aims. Although we often encounter patients with an aortic aneurysm
who also have diffuse idiopathic skeletal hyperostosis (DISH), there
are no reports to date of an association between these two conditions
and the pathogenesis of DISH remains unknown. This study therefore
evaluated the prevalence of DISH in patients with a thoracic aortic
aneurysm (AA). Patients and Methods. The medical records of 298 patients who underwent CT scans for
a diagnosis of an AA or following high-energy trauma were retrospectively
examined. A total of 204 patients underwent surgery for an AA and
94 had a high-energy injury and formed the non-AA group. The prevalence
of DISH was assessed on CT scans of the chest and abdomen and the
relationship between DISH and AA by comparison between the AA and
non-AA groups. Results. The prevalence of DISH in the AA group (114/204; 55.9%) was higher
than that in the non-AA group (31/94; 33.0%). On multivariate analysis,
the factors of AA, male
Introduction. Patients with recurrent low back pain (LBP) exhibit changes in postural control. Stereotypical muscle activations resulting from external perturbations include anticipatory (APAs) and compensatory (CPAs) postural adjustments. This study aimed to determine differences in postural control strategies (APAs and CPAs) between those with and without lumbar disc degeneration (LDD) and LBP. Methods. Ninety-seven subjects participated in the study (mean age 50 years (SD 12)). 3T MRI was used to acquire T2 weighted images (L1-S1). LDD was determined using Pfirrmann grading and LBP using the numerical rating scale (NRS). A bespoke perturbation platform was designed to deliver postural perturbations. Electrical activity was analysed from 16 trunk and lower limb muscles during four typical APA and CPA epochs. A Kruskal-Wallis H test with Bonferroni correction for multiple comparisons was conducted. Results. Four groups were identified; ‘no LDD no pain’ (n = 19), ‘LDD no pain’ (n =38), ‘LDD pain’ (n =35) and ‘no LDD pain’ (n = 5). There was no significant difference in age or
Aims. Magnetically controlled growing rod (MCGR) systems use non-invasive
spinal lengthening for the surgical treatment of early-onset scoliosis
(EOS). The primary aim of this study was to evaluate the performance
of these devices in the prevention of progression of the deformity.
A secondary aim was to record the rate of complications. Patients and Methods. An observational study of 31 consecutive children with EOS, of
whom 15 were male, who were treated between December 2011 and October
2017 was undertaken. Their mean age was 7.7 years (2 to 14). The
mean follow-up was 47 months (24 to 69). Distractions were completed
using the tailgating technique. The primary outcome measure was
correction of the radiographic deformity. Secondary outcomes were
growth, functional outcomes and complication rates. Results. The mean Cobb angle was 54° (14° to 91°) preoperatively and 37°
(11° to 69°) at the latest follow-up (p < 0.001). The mean thoracic
kyphosis (TK) was 45° (10° to 89°) preoperatively and 42° (9° to
84°) at the latest follow-up. The mean T1–S1 height increased from
287 mm (209 to 378) to 338 mm (240 to 427) (p < 0.001) and the
mean sagittal balance reduced from 68 mm (-76 to 1470) preoperatively
to 18 mm (-32 to 166) at the latest follow-up. The mean coronal balance
was 3 mm (-336 to 64) preoperatively and 8 mm (-144 to 64) at the
latest follow-up. The mean increase in weight and sitting and standing
height at the latest follow-up was 45%, 10% and 15%, respectively.
The mean Activity Scale for Kids (ASKp) scores increased in all
domains, with only personal care and standing skills being significant
at the latest follow-up (p = 0.02, p = 0.03). The improvements in
Cobb angle, TK and T1-S1 heights were not related to
Aims. The aim of this study was to evaluate improvements in the quality
and safety of paediatric spinal surgery following the implementation
of a specialist Paediatric Spinal Surgical Team (PSST) in the operating
theatre. Patients and Methods. A retrospective consecutive case study of paediatric spinal operations
before (between January 2008 and December 2009), and after (between
January 2012 and December 2013) the implementation of PSST, was
performed. A comparative analysis of outcome variables including
surgical site infection (SSI), operating time (ORT), blood loss (BL),
length of stay (LOS), unplanned staged procedures (USP) and transfusion
rates (allogenic and cell-saver) was performed between the two groups.
The rate of complications during the first two postoperative years
was also compared between the groups. Results. There were 130 patients in the pre-PSST group and 277 in the
post-PSST group. The age,
Aims. There is little information about the optimum number of implants
to be used in the surgical treatment of idiopathic scoliosis. Retrospective
analysis of prospectively collected data from the Swedish spine
register was undertaken to discover whether more implants per operated
vertebra (implant density) leads to a better outcome in the treatment of
idiopathic scoliosis. The hypothesis was that implant density is
not associated with patient-reported outcomes, the correction of
the curve or the rate of reoperation. Patients and Methods. A total of 328 patients with idiopathic scoliosis, aged between
ten and 20 years at the time of surgery, were identified in the
Swedish spine register (Swespine) and had patient reported outcomes
including the Scoliosis Research Society 22r instrument (SRS-22r)
score, EuroQol 5 dimensions quality of life, 3 level (EQ-5D-3L)
score and a Viual Analogue Score (VAS) for back pain, at a mean
follow-up of 3.1 years and reoperation data at a mean follow-up
of 5.5 years. Implant data and the correction of the curve were
assessed from radiographs, preoperatively and a mean of 1.9 years
postoperatively. The patients were divided into tertiles based on
implant density. Data were analyzed with analysis of variance, logistic
regression or log-rank test. Some analyses were adjusted for
We conducted a prospective follow-up MRI study
of originally asymptomatic healthy subjects to clarify the development
of Modic changes in the cervical spine over a ten-year period and
to identify related factors. Previously, 497 asymptomatic healthy
volunteers with no history of cervical trauma or surgery underwent
MRI. Of these, 223 underwent a second MRI at a mean follow-up of
11.6 years (10 to 12.7). These 223 subjects comprised 133 men and 100
women with a mean age at second MRI of 50.5 years (23 to 83). Modic
changes were classified as not present and types 1 to 3. Changes
in Modic types over time and relationships between Modic changes
and progression of degeneration of the disc or clinical symptoms
were evaluated. A total of 31 subjects (13.9%) showed Modic changes at
follow-up: type 1 in nine, type 2 in 18, type 3 in two, and types 1
and 2 in two. Modic changes at follow-up were significantly associated
with numbness or pain in the arm, but not with neck pain or shoulder
stiffness. Age (≥ 40 years),
No previous studies have examined the physical
characteristics of patients with cauda equina syndrome (CES). We compared
the anthropometric features of patients who developed CES after
a disc prolapse with those who did not but who had symptoms that
required elective surgery. We recorded the age,
This study evaluates factors related to myelopathic
symptoms in patients with ossification of the posterior longitudinal
ligament (OPLL). A total of 87 patients with OPLL were included.
Of these, 53 (Group I) had no symptoms or presented with neck pain
and radiculopathy and 34 (Group II) had myelopathic symptoms.
Study design. A prospective study on predictive factors for the outcome of 164 patients with adult isthmic spondylolisthesis operated on with fusion between 1990 and 2003. Purpose. In view of the need to better select patients for fusion we investigated the use of the pain drawing (PD) and other potential factors for predicting the outcome of fusion. Background. Results on predictive factors of outcome after spinal fusion have been contradictory and large, well defined, patient samples with adequate observation times are lacking. Methods. QuestionnairesF including possible predictive factors as well as PDs were obtained preoperatively. Degree and level of slip were documented. Outcome was quantified by measurement of pain (VAS), Disability Rating Index (DRI), the Oswestry Disability Index and global assessment by the patient into “much better”, “better”, “unchanged” or “worse”. The 2-year follow up rate was 160/164 (98%). Results. In the total sample 49% of patients were much better, 25% better, 14% unchanged and 12% worse. Most factors investigated did not correlate with the outcome including; degree of slip, level of slip, fusion technique, age, smoking, drinking habits, weight, BMI, sciatica, laminectomy, marital status, level of education, type of domicile, possible immigrant status, dominant hand, births and number of children. The following preoperative factors correlated to a worse outcome in the univariate analysis: Not working, no regular exercise, female
We validated the North American Spine Society (NASS) outcome-assessment instrument for the lumbar spine in a computerised touch-screen format and assessed patients’ acceptance, taking into account previous computer experience, age and
Purpose and background. Identifying features in nonspecific low back pain (NSLBP) subjects that distinguish them from controls, or for elucidating subgroups, has proved elusive. Yet these would be helpful to monitor progress, improve management, and understand the nature of the condition. Previous work using quantitative videofluoroscopy (QF) has indicated that the distribution of motion between lumbar intervertebral joints is more uneven in those with a history of NSLBP. However, there maybe other features of these complex motion patterns yet to be revealed. A multivariate analysis was therefore carried out to explore other possible differences. Methods and results. Intervertebral motion data of L2/3 to L4/5, from a previously published study was used. This examined 40 patients with NSLBP and 40 healthy controls, matched for
Aims. The aims of this study were to evaluate the clinical and radiological
outcomes of instrumented posterolateral fusion (PLF) performed in
patients with rheumatoid arthritis (RA). . Methods. A total of 40 patients with RA and 134 patients without RA underwent
instrumented PLF for spinal stenosis between January 2003 and December
2011. The two groups were matched for age,
This study examined spinal fractures in patients
admitted to a Major Trauma Centre via two independent pathways,
a major trauma (MT) pathway and a standard unscheduled non-major
trauma (NMT) pathway. A total of 134 patients were admitted with
a spinal fracture over a period of two years; 50% of patients were
MT and the remainder NMT. MT patients were predominantly male, had
a mean age of 48.8 years (13 to 95), commonly underwent surgery
(62.7%), characteristically had fractures in the cervico-thoracic
and thoracic regions and 50% had fractures of more than one vertebrae,
which were radiologically unstable in 70%. By contrast, NMT patients
showed an equal
Hypovitaminosis D has been identified as a common
risk factor for fragility fractures and poor fracture healing. Epidemiological
data on vitamin D deficiency have been gathered in various populations,
but the association between vertebral fragility fractures and hypovitaminosis
D, especially in males, remains unclear. The purpose of this study
was to evaluate serum levels of 25-hydroxyvitamin D (25-OH D) in
patients presenting with vertebral fragility fractures and to determine
whether patients with a vertebral fracture were at greater risk
of hypovitaminosis D than a control population. Furthermore, we
studied the seasonal variations in the serum vitamin D levels of
tested patients in order to clarify the relationship between other
known risk factors for osteoporosis and vitamin D levels. We measured
the serum 25-OH D levels of 246 patients admitted with vertebral
fractures (105 men, 141 female, mean age 69 years, . sd. 8.5),
and in 392 orthopaedic patients with back pain and no fractures
(219 men, 173 female, mean age 63 years, . sd. 11) to evaluate
the prevalence of vitamin D insufficiency. Statistical analysis found
a significant difference in vitamin D levels between patients with
vertebral fragility fracture and the control group (p = 0.036).
In addition, there was a significant main effect of the tested variables:
obesity (p <
0.001), nicotine abuse (p = 0.002) and diabetes
mellitus (p <
0.001). No statistical difference was found between
vitamin D levels and
