Umeå University's logo

INTRODUCTION: Pain, comprising sensory and emotional elements, is influenced by pain catastrophizing, which magnifies pain and promotes helplessness and rumination. This study explores the relationship between pain catastrophizing and outcomes following selective nerve root blockade (SNRB) in patients with lumbar radicular pain (LRP).

METHODS: A prospective cohort study of 103 LRP patients, confirmed by MRI, was conducted. All participants underwent SNRB at Umeå University Hospital. Outcomes were measured using PROMIS-29 and the Pain Catastrophizing Scale (PCS) at baseline and several intervals up to 84 days post-intervention. Patients were categorized into responder (≥30% pain reduction) and non-responder groups and stratified into three groups based on baseline PCS scores. Changes in outcomes from baseline to 14 days post-SNRB were analyzed in relation to PCS groups. PCS changes over time were evaluated between responders and non-responders. Statistical analyses assessed PCS and outcome changes.

RESULTS: Baseline pain catastrophizing was not a significant predictor of pain response to SNRB. However, responders demonstrated significant reductions in pain catastrophizing following the intervention, suggesting that SNRB may influence cognitive coping mechanisms related to pain.

CONCLUSION: SNRB reduces pain catastrophizing in LRP patients, although baseline catastrophizing does not predict pain outcomes. Addressing catastrophizing remains important but may serve better as an outcome measure rather than a predictor of treatment response.

Coffin-Lowry syndrome (CLS) is a rare X-linked disorder marked by intellectual disability, craniofacial and skeletal anomalies, and progressive spinal deformities like scoliosis and hyperlordosis. Corrective posterior spinal fusion (PSF) surgery is often required. Mesocardia, a congenital anomaly where the heart is positioned centrally in the thorax, may affect perioperative hemodynamics, particularly in the prone surgical position. This report presents a case illustrating the perioperative challenges of PSF in a patient with both CLS and mesocardia.

A 17-year-old male with CLS, mesocardia, and severe scoliosis underwent PSF (T2-S2). During prone positioning, the patient experienced a gradual hemodynamic collapse, characterized by a decrease in oxygen saturation and a marked drop in both pulse rate and blood pressure. Repositioning to the supine position led to immediate recovery. Imaging ruled out pulmonary or vascular obstruction, pneumothorax, and embolism. The event was attributed to mechanical cardiac compression related to syndromic soft tissue laxity, thoracic deformity, mesocardia, and posterior soft-tissue release. Surgery was completed using a modified lateral oblique prone position, maintaining hemodynamic stability.

This case illustrates the importance of anticipating cardiopulmonary compromise due to anatomical and positional factors and that personalized surgical planning and modified positioning can be crucial in complex spinal deformity surgery in syndromic patients with thoracic abnormalities.

Study design: A prospective cohort study.

Objective: The aim was to investigate changes in lumbar lordosis (LL) and its association to changes in patient reported outcome measures (PROMs) after decompressive surgery for lumbar spinal stenosis (LSS).

Summary of background: Few studies have addressed change in LL after decompression surgery for LSS in relation to outcomes.

Method: Pre- and postoperative data from 310 patients having standing x-ray both before and 2 years after surgery were included. The patients were grouped based on the change in LL preoperatively to 2 years after surgery; group 1: <5 degrees (n=196), group 2: ≥5 <10 degrees (n=55) or group 3: ≥10 degrees (n=59) of change in LL. The changes in function, disability and pain were assessed by the Oswestry Disability Index (ODI), Numeric Rating Scale (NRS), and the Zurich claudication questionnaire (ZCQ). The three groups were compared regarding baseline variables using the ANOVA test for continuous variables and the chi-square test for categorical variables. The groups were further compared with a likelihood ratio test in relation to changes in PROMs 2 year after surgery and outcomes were adjusted for respective baseline PROMs, age, sex, smoking, BMI, Schizas and Pfirrmann scores.

Results: LL was significantly changed at group level 2 years after surgery with a mean difference of 2.2 (SD 9.4) degrees (P=0.001). The three LL change groups did not show any significant differences in patient characteristics, function, disability, and pain at baseline. The two groups with a change of more than 5 degrees in LL 2 year after surgery (group 2 and 3) had significantly greater improvements in ODI (P=0.022) and ZCQ function (P=0.016) in the adjusted analyses, but was not significant for back and leg pain

Conclusion: Changed LL after decompressive surgery for LSS was associated with improved ODI and physical function.

Background: Global demographics show a steady increase in the number of octogenarians. Consequently, the number of degenerative spine procedures in the elderly has significantly increased. This study aims to describe patient satisfaction, the patient-reported health-related quality-of-life, and complications, following posterior cervical laminectomy for degenerative cervical myelopathy (DCM) in octogenarians based on the national Swedish experience.

Methods: The national Swedish spine registry, Swespine was reviewed between January 2006 and December 2020 for patients who underwent laminectomy for DCM. Complication rates, patient satisfaction, and Patient-Reported Outcome Measures (PROMs) one year after surgery, were analyzed and compared between propensity score matched octogenarian (≥ 80) and younger adult cohorts (< 80 years).

Results: A total of 1,382 patients, 162 octogenarians, and 1,220 younger patients were identified. At one-year after surgery there were no significant difference in patient satisfaction rate or in any of the other PROMS (Eq. 5D, NRS neck pain, NRS arm pain, EQ-VAS, Neck Disability Index (NDI), the European Myelopathy Score (EMS). Complication rates were also comparable, 8.0% in octogenarians (n = 13) and 11% in younger adults (n = 51), respectively. The length of hospital stay was significantly longer in the octogenarian group, with a mean hospitalization of 5.08 days (SD ± 4.86) compared to 3.76 days (SD ± 3.93) in the younger adult cohort (p < 0.001).

Conclusions: Octogenarians undergoing cervical spine surgery for DCM experience outcomes comparable to younger adults in terms of satisfaction, pain relief, and quality of life, indicating that age alone should not hinder surgical treatment.

Level of evidence: IV, Retrospective observational cohort study.

PURPOSE: To describe the incidence of stroke in the first year after surgery for lumbar spinal stenosis (LSS).

METHODS: The study included 64,179 Swedish National Spine Register (Swespine) patients who underwent surgery for LSS between 2001 and 2020. The primary outcome was the diagnosis of stroke within the first year after surgery, as documented in the Swedish Stroke Register. The incidence was quantified as the number of strokes per 1,000 surgeries within a defined period, inclusive of the incidence rate (number of strokes/100,000 person-years). An adjusted Cox regression model was used to analyse whether age, sex, smoking, or surgery with implants further increased the risk of stroke.

RESULTS: In the first year after surgery, 426 patients (0.66%) developed a stroke. The risk of stroke was highest during the first 30 days (n=72, 0.11%). Stroke incidence was 1.1/1,000 surgeries during the first 30 days and 6.6/1,000 surgeries during the first year after surgery. The incidence rate during the initial 30 days was 1,394 strokes per 100,000 person-years, while the incidence rate during the first year was 660 strokes per 100,000 person-years. Smoking (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.31-2.52), age 65-74 years (HR, 2.65; 95% CI, 1.91-3.67), and age ≥75 years (HR, 6.04; 95% CI, 4.42-8.25) further increased the risk of stroke.

CONCLUSION: The incidence of stroke after LSS surgery was the highest during the first 30 days. However, the absolute number of strokes was small. The risk of stroke could be of minor concern for most of the patients even if older age and smoking were identified as risk factors.

BACKGROUND: Ankylosing spinal disorders (ASD) increase the risk of unstable cervical spine fractures, posing a significant mortality risk. Surgery is recommended for patients with neurological deficits, but the effectiveness of non-surgical treatment in those without deficits remains unclear. This study aimed to compare survival rates between surgical and non-surgical treatments of ASD-related cervical fractures in a matched cohort.

METHODS: The study analyzed data from the Swedish Fracture Registry (SFR) on adult patients treated for ASD-related cervical spine fractures between January 2015 and December 2021. Preoperative variables included age, sex, trauma type, neurological function, fracture morphology, and treatment method. Propensity score matching was conducted to compare outcomes between treatment groups, ensuring balanced comparison groups regarding age, sex, type of trauma, time from injury to admission, fracture type, level of injury, and neurological function.

RESULTS: In total, 357 adult patients with ASD-related cervical spine fractures were analyzed. Among them, 186 were treated surgically and 171 non-surgically. Treatment failure and conversion so surgical treatment was seen in 3.4% of the non-surgically treated patients. Most patients were male (80%), with a median age of 75 years. Fractures were mainly caused by low-energy trauma (69%). Most patients (92%) were ambulatory (Frankel grade D or E). In the unmatched analysis, surgically treated patients had significantly lower 1-year mortality rates (13% vs. 22%; p < 0.001), but after matching, there were no longer any difference between the two groups (16% vs. 22%; p = 0.44). These findings were also validated on Kaplan-Meier analysis. Multivariable logistic regression analysis identified high age as the only predictor for 30-day mortality (OR 1.14 [95% CI 1.09-1.22], p < 0.001).

CONCLUSION: Following propensity score matching, surgical and conservative management result in similar mortality outcomes for neurologically intact patients with ASD fractures. Age, rather than treatment approach, emerged as a stronger predictor of overall mortality. Nonetheless, treatment decisions should also consider other clinical outcomes beyond mortality, emphasizing the need for an individualized approach until more robust evidence is available.

PURPOSE: To validate the Swedish National Spine Registry (Swespine) for diagnostic accuracy and documentation of surgical procedures for central lumbar spinal stenosis (CLSS) and lumbar disc herniation (LDH), including an analysis of preoperative magnetic resonance imaging (MRI). Additionally, this study evaluates the accuracy and completeness of perioperative data and documented complications.

METHODS: Of 41,312 patients registered in Swespine for CLSS or LDH between January 2017 and December 2022, 800 were randomly selected from four hospitals. The electronic patient records were used as the gold standard. Radiological criteria for CLSS and LDH were established through a review of MRI scans.

RESULTS: The proportion of correctly classified diagnoses (PCC) was 98.5% for CLSS and 99.2% for LDH, while the PCC of the type of surgery was 99.7% and 98.5% in the CLSS and LDH cohorts, respectively. Preoperative MRI analysis showed that 94.2% of patients undergoing CLSS surgery at the narrowest spinal level were classified as Schizas C or D, with a mean cross-sectional area of 44.2 mm². In comparison, 85.0% of patients who underwent LDH surgery were classified with Pfirrman grade 3.

CONCLUSION: Swespine demonstrated high accuracy and completeness in diagnosing and surgically treating CLSS and LDH patients, as corroborated by preoperative MRI assessments. Most perioperative data, including complications, demonstrated acceptable to excellent registration. Improvements are recommended in the documentation of the American Society of Anaesthesiologists classification, patient weight and height, smoking status, use of implants and bone grafts, date of discharge, use of thromboprophylaxis, and previous surgeries.

Background: Low back pain, a common problem worldwide, causes more global disability than any other condition and is associated with high costs to society. This observational registry-based study describes the current trends in the medical treatment of neuropathic low back pain in the Swedish region of Västra Götaland, which has a population of 1.7 million. The study aims to; (1) identify the prevalence of neuropathic low back pain within the study population; (2) to explore the patterns of medical treatment utilization, including the prevalence and distribution of opioids (OG) and analgesics specified for neuropathic low back pain (NG) and (3) to evaluate the long-term trends and changes in medical treatment practice for neuropathic low back pain over the study period.

Methods: This study includes a descriptive analysis of aggregated data extracted from the Swedish primary care registry VEGA and the pharmaceutical prescription registry Digitalis between the years 2017 and 2021. The data were stratified by year, age, gender, pharmaceutical code (ATC), and sub-diagnoses and presented as the prevalence of unique patients retrieving prescribed medication within six months before or after a registered diagnosis of neuropathic low back pain. The pharmaceutical codes were furthermore grouped into two groups depending on their mechanism of action; opioid group (OG) and neuropathic group (NG).

Results: In all four diagnosis groups, more patients used opioid analgesics than neuropathic analgesics. The greatest difference between the opioid group and neuropathic group was in the lumbar spinal stenosis diagnosis group (67.1% vs. 40.6%), followed by the lumbar root canal stenosis diagnosis (65.9% vs. 44.2%), the nerve root and plexus compressions in intervertebral disc disorders diagnosis (57.5% vs. 40.8%), and lumbago with sciatica diagnosis (38.4% vs. 22.7%).

Conclusions: The trends suggest a general increase in the prescription rate and therefore patients’ use of neuropathic analgesics for neuropathic pain associated with the studied diagnoses. However, opioid treatment remains the most common. The results indicate that the treatment for neuropathic low back pain needs to be improved.

Purpose: The AOSpine classification divides thoracolumbar burst fractures into A3 and A4 fractures; nevertheless, past research has found inconsistent interobserver reliability in detecting those two fracture patterns. This systematic analysis aims to synthesize data on the reliability of discriminating between A3 and A4 fractures.

Methods: We searched PubMed, Scopus, and the Web of Science for studies reporting the inter- and intra-observer reliability of detecting thoracolumbar AO A3 and A4 fractures using computed tomography (CT). The search spanned 2013 to 2023 and included both primarily reliability and observational comparative studies. We followed the PRISMA guidelines and used the modified COSMIN checklist to assess the studies' quality. Kappa coefficient (k) values were categorized according to Landis and Koch, from slight to excellent.

Results: Of the 396 identified studies, nine met the eligibility criteria; all were primarily reliability studies except one observational study. Interobserver k values for A3/A4 fractures varied widely among studies (0.19-86). The interobserver reliability was poor in two studies, fair in one study, moderate in four studies, and excellent in two studies. Only two studies reported intra-observer reliability, showing fair and excellent agreement. The included studies revealed significant heterogeneity in study design, sample size, and interpretation methods.

Conclusion: Considerable variability exists in interobserver reliability for distinguishing A3 and A4 fractures from slight to excellent agreement. This variability might be attributed to methodological heterogeneity among studies, limitations of reliability analysis, or diagnostic pitfalls in differentiating between A3 and A4. Most observational studies comparing the outcome of A3 and A4 fractures do not report interobserver agreement, and this should be considered when interpreting their results.