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Purpose. To quantify the risk of clinically overt venous thromboembolism (VTE) and major bleeding (MB) during the first year following surgery for lumbar spinal stenosis (LSS) relative to a matched population cohort.

Methods: This nationwide, retrospective cohort study utilized data from the Swedish National Spine Register (Swespine), including 77,145 patients who underwent surgical treatment for LSS between 2003 and 2023. These patients were matched 1:5 to 385,388 referents from the general population. Outcomes (VTE and MB) were identified through cross-linkage with the National Patient Register (NPR) and the Swedish Stroke Register (Riksstroke). Adjusted Cox piecewise regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for VTE and MB across prespecified postoperative intervals.

Results: Within the first 30 days after inclusion, patients exhibited substantially higher incidence rates of venous thromboembolism (VTE) and major bleeding (MB) compared with referents. The incidence rate of VTE was 30.39 per 1,000 person-years among patients versus 8.14 among referents, while the corresponding rates for MB were 88.78 and 31.87 per 1,000 person-years, respectively. Compared with referents, patients had a HR of 3.68 (95% CI, 3.05-4.44) for VTE and a HR of 2.52 (95% CI 2.27-2.80) for MB within the first 30 days after inclusion. The risk for VTE remained elevated through the 31–60-day interval (HR 2.09; 95% CI, 1.63-2.69), whereas the risk for MB declined sharply after the first month (HR 1.02; 95% CI 0.87-1.21).

Conclusion: Patients undergoing surgery for LSS face a significantly higher risk for VTE and MB compared to a matched population. This hazard was most acute during the first 30 postoperative days. While these risks decline sharply thereafter, the risk of VTE remains significantly elevated during the first 2 months following LSS surgery.

Purpose: Spinal metastasis as the first manifestation of lung cancer, presents challenges in diagnosis, prognosis, and treatment planning. This study aims to evaluate postoperative survival outcomes and to identify prognostic factors in treatment-naïve patients undergoing surgery for spinal metastases, focusing on clinical and molecular variables.

Methods: This retrospective cohort study included 149 patients who underwent surgery for spinal metastases from lung cancer between 2011 and 2023. Data were obtained from the Swedish National Register for Spine Surgery (Swespine) and the Swedish National Lung Cancer Register (SNLCR). Patients were grouped based on whether spinal metastasis was the initial manifestation of lung cancer or occurred during known disease. Kaplan–Meier analysis and Cox proportional hazards models were used to assess postoperative survival and prognostic factors.

Results: Of the 149 patients, 114 (77%) presented with spinal metastasis as the initial sign of lung cancer. Median survival in this group was 6 months, compared to 3 months in patients with a prior confirmed lung cancer diagnosis (p = 0.022). In the initial presentation group, longer survival after surgery was observed in patients with predictive biomarkers (8 vs. 5 months, p = 0.003), preserved ambulatory function (8 vs. 3 months, p = 0.002), and better WHO performance status (p < 0.001). In multivariable analysis, biomarker status, WHO performance status, ambulatory function, and age were independently associated with post-operative survival.

Conclusion: Patients undergoing surgery for spinal metastases as the initial manifestation of lung cancer form a distinct subgroup. Early functional and molecular assessment may improve patient selection and surgical outcome in this population.

Introduction: The workload in orthopedic outpatient departments is increasing while the available medical resources are often limited.

Research questions: Can reorganizing the outpatient work routines for referred patients with spinal disorders improve cost-effectiveness and patient's experience of care (PEC) without negatively affecting the waiting time required for the healthcare guarantee?

Material and methods: We compared our standard routine (control group) to a new routine (study group) for evaluating referrals of patients with spinal complaints. In the control group, the referral was first evaluated by a spinal surgeon, and when deemed indicated, a visit to a spinal surgeon was booked. In the study group, a spinal surgeon first evaluated all referral notes and either assigned a spinal surgeon or a physiotherapist to meet the patient, depending on certain criteria. If considered eligible for surgical intervention, the patient is appointed for a follow-up visit to the spinal surgeon. For both groups, calculations were made for the number of waiting days and visits, as well as the cost. Also, we compared the PEC between the two groups through telephone interviews.

Results: The number of waiting days and visits, as well as the cost, were significantly reduced (p < 0.01) in the study group. Also, the study group showed slightly higher mean values for the PEC components, with significant differences related to the waiting time, treatment with respect, and taking account of patient knowledge.

Discussion and conclusions: Reorganizing outpatient work routines could eliminate the need for locum doctors while maintaining patient satisfaction and reducing costs.

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.

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.

Introduction: Patient's experience of care (PEC) is crucial in enhancing and sustaining healthcare quality.

Research question: the primary aim of this study is to establish and assess a new questionnaire index designed to measure PEC following elective spinal surgery. This index serves as a tool to document, enhance, and maintain the quality of healthcare provided in this context.

Material and methods: The studied PEC index comprises 7 questions, each addressing different aspects of perioperative care. Our study involved 300 post-spinal surgery patients, sourced from the Swedish national register for spine surgery. Collected data included age, gender, education level, self-rated health, and primary language. The patients were contacted via telephone by trained interviewers, approximately 35 days after their surgery (with 60 patients re-interviewed after a few weeks). We employed linear regression, t-test, and ANOVA models to examine the associations between the PEC index and the documented variables.

Results: The PEC index demonstrated good internal consistency and reliability (Cronbach alpha = 0.76, interclass correlation coefficient = 0.87). Additionally, the utility measures indicated associations between the PEC index and factors such as higher age (p = 0.014), male gender (p = 0.012), and better self-rated health (p = 0.011).

Discussion and conclusion: The PEC index seems to be a promising tool with a clinically useful composite questionnaire for assessing PEC in patients undergoing elective spine surgery. In clinical settings, the index can accompany other outcome scores to evaluate and compare different diagnoses and management methods.

Introduction: Surgery for lumbar spinal stenosis (LSS) is one of the most common indications for elective spine surgery in developed countries and postoperative cerebrovascular complications must be taken into consideration. The main objective of this study was to determine and investigate the risk of stroke during the first year after surgery for LSS.

Materials and Methods: This retrospective register study included 64,179 patients from the Swedish spine register (Swespine) operated from 2001 through 2020 for central or lateral LSS. Outcomes were collected from the Swedish stroke register (Riksstroke). The primary outcome was the diagnosis of peri- or postoperative ischemic/hemorrhagic stroke within the first year after LSS surgery. The registers included background data like sex, age, smoking, and previous spine surgery, in addition to surgical/stroke care data like levels of decompression, surgery with instrumentation, type of stroke and length of hospitalisation. Initial analysis with histograms and a life table was used to present the hazard of stroke during the first year after surgery. An adjusted cox regression model was used to analyse the risk for stroke. The model was adjusted for age (<64, 65-74, ≥75), sex, smoking and whether implants were used or not.

Results: During the first year after surgery 426 patients (0,66%) developed a stroke. Out of these 37 (0,06%) were classified as hemorrhagic, 379 (0,59%) as ischemic and 10 (0,02%) as unclassified. The risk for stroke was highest during the first 30 days (n=72, (0,11%)). Smoking (HR, 1,82; 95% CI, 1,31-2,52; p<0,001), age 65-74 years (HR, 2,65; 95% CI, 1,91-3,67; p<0,001) and age ≥75 years (HR, 6,04; 95% CI, 4,42-8,25; p<0,001) were associated as risk factors for postoperative stroke. Surgery with implants was not associated with an increased risk (HR, 1,01; 95% CI, 0,73-1,40; p=0,967).

Conclusion: The peri- and postoperative risk for stroke during the first year after LSS surgery was 0,66% and increased age and smoking were identified as risk factors. The highest number of strokes occurred during the first 30 days and more specific, the first days after surgery. This study gives the basis for further research of cerebrovascular complications after LSS surgery.

Objective: The aim of this study was to assess the incidence and severity of kinesiophobia, and to determine the relationship between Tampa Scale of Kinesiophobia (TSK) scores, functional outcome and quality of life (QoL) 6-8 years after Total Hip Arthroplasty (THA).

Methods: 161 patients (78 male and 83 female) with unilateral primary osteoarthritis (OA) treated with THA between September 2010 and December 2013 were included in this study. Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and EQ-5D scores were measured preoperatively. At 6-8 years follow-up, these scores were repeated and TSK scores were also measured. According to the TSK, patients were divided into two groups for further comparisons and analysis: without kinesiophobia (TSK-score ≤ 36) and with kinesiophobia (TSK-score >36).

Results: There were 99 patients (61.5%) with no kinesiophobia (TSK score ≤ 36, TSK mean 28.4, SD 4.7) and 62 patients (38.5%) with kinesiophobia (TSK score > 36, TSK mean 42.8, SD 5.3). Patients with and without kinesiophobia were not statistically different regarding age, sex or body mass index. (P = 0.20, P = 0.99, P = 0.22, respectively). In the group with no kinesiophobia, the mean 6-8 years WOMAC was 12.4 (SD 15.6), while the absolute delta (Δ) value between preoperative and 6-8 years WOMAC was 46.2 (SD 20.4), compared to the group with kinesiophobia where the mean 6-8 years WOMAC was 32.2 (SD 23.4), while the absolute delta (Δ) value between preoperative and 6-8 years WOMAC was 32.3 (SD 25.5): both P < 0.001. The group with no kinesiophobia had a mean 6-8 years EQ-5D of 0.81 (SD 0.22), while the absolute delta (Δ) value between preoperative and 6-8 years EQ-5D was 0.44 (SD 0.26), compared to the group with kinesiopho-bia where the mean 6-8 years EQ-5D was 0.57 (SD 0.23), while the absolute delta (Δ) value between preoperative and 6-8 years EQ-5D was 0.33 (SD 0.26): P < 0.001 and P = 0.03, respectively. TSK scores were associated with worse WOMAC and EQ-5D scores, higher proportion of dependence on walking aids and increased THArelated adverse events (all P < 0.05).

Conclusion: This study has shown us that there is a high incidence of kinesiophobia 6-8 years after surgery and treating kinesiophobia early after THA might improve the outcome.

Level of Evidence: Level IV, Therapeutic Study.