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An observational study on the outcome after surgery for lumbar disc herniation in adolescents compared with adults based on the Swedish Spine Register.

https://arctichealth.org/en/permalink/ahliterature268760
Source
Spine J. 2015 Jun 1;15(6):1241-7
Publication Type
Article
Date
Jun-1-2015
Author
Tobias Lagerbäck
Peter Elkan
Hans Möller
Anna Grauers
Elias Diarbakerli
Paul Gerdhem
Source
Spine J. 2015 Jun 1;15(6):1241-7
Date
Jun-1-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Back Pain - surgery
Female
Humans
Intervertebral Disc Displacement - surgery
Lumbar Vertebrae - surgery
Male
Middle Aged
Pain Measurement
Patient satisfaction
Registries
Sciatica - surgery
Sweden
Treatment Outcome
Young Adult
Abstract
Disc-related sciatica has a prevalence of about 2% in adults, but is rare in adolescents. If conservative treatment is unsuccessful, surgery is an option.
The aim of this study was to compare the outcomes of surgery for lumbar disc herniation in adolescents with adults in the Swedish Spine Register.
This is a prospective observational study: National Quality Register.
This study included 151 patients, 18 years or younger, 4,386 patients, 19-39 years, and 6,078 patients, 40 years or older, followed for 1-2 years after surgery.
The primary outcomes were patient satisfaction and global assessment of leg and back pain. Secondary outcomes were Visual Analog Scale (VAS) leg pain, VAS back pain, Oswestry disability index (ODI), and EuroQol-5 dimensions (EQ-5D).
Statistical analyses were performed with the Welch F test, the chi-square test, and the Wilcoxon signed-rank test.
At follow-up, 86% of the adolescents were satisfied compared with 78% in the younger adults and 76% in the older adults group (p
PubMed ID
25701544 View in PubMed
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Back pain and function 23 years after fusion for adolescent idiopathic scoliosis: a case-control study-part II.

https://arctichealth.org/en/permalink/ahliterature30724
Source
Spine. 2003 Sep 15;28(18):E373-83
Publication Type
Article
Date
Sep-15-2003
Author
Aina J Danielsson
Alf L Nachemson
Author Affiliation
Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg University, Sweden. danielsson.aina@telia.com
Source
Spine. 2003 Sep 15;28(18):E373-83
Date
Sep-15-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Back Pain - epidemiology - etiology
Bone Transplantation - methods
Case-Control Studies
Child
Cicatrix - epidemiology
Disease Progression
Follow-Up Studies
Humans
Internal Fixators
Intervertebral Disk - pathology
Lumbar Vertebrae - surgery
Pain Measurement
Patient satisfaction
Postoperative Complications - epidemiology - etiology
Pseudarthrosis - epidemiology - etiology
Questionnaires
Recovery of Function
Research Support, Non-U.S. Gov't
Scoliosis - complications - surgery
Spinal Fusion - instrumentation
Sweden - epidemiology
Thoracic Vertebrae - surgery
Time Factors
Treatment Outcome
Abstract
STUDY DESIGN: A consecutive series of patients with adolescent idiopathic scoliosis, treated between 1968 and 1977 before age 21 years with distraction and fusion using Harrington rods (surgically treated: n = 156; 145 females and 11 males) were followed-up at least 20 years after completion of the treatment. OBJECTIVES: To determine the long-term outcome in terms of back pain and function in patients surgically treated for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Few reports on long-term outcome of back pain and function have previously been presented for this group of patients. Results presented are not conclusive regarding effects on back pain and its correlation to a fusion extending into the lower lumbar spine. MATERIALS AND METHODS: One hundred forty-two (91%) of the patients were reexamined as part of an unbiased personal follow-up. This included a clinical examination and evaluation of curve size (Cobb method) and degenerative findings in full standing frontal and lateral radiographs. Validated questionnaires in terms of general and disease-specific quality of life aspects as well as present back and pain symptoms were used. One hundred thirty-nine had complete follow-up. An age- and sex-matched control group of 100 individuals was randomly selected and subjected to the same examinations. RESULTS: The deterioration of the curves was 3.5 degrees for all curves and eight (5.1%) of the patients treated with fusion had undergone some additional curve-related surgical procedure. The patients had significantly more degenerative disc changes than the controls. Lumbar pain, although mild (2.4 on visual analogue scale), was significantly more frequent among the patients than the controls (65 vs. 47%, P = 0.0079). Only 25% of the patients admitted daily pain, and analgesics were sparsely used. No major differences of back function and general health-related quality of life were noted between the patients or the controls. Except for having been on sick-leave ever because of the back (45% vs. 19%, P = 0.0040) no differences could be seen in sociodemographic variables between the groups. Furthermore, no differences could be found between patients fused to L3 or higher (n = 102) versus L4 or lower (n = 37). No correlation could be found between pain and its localization and various variables on the scoliotic curve, body mass index, or smoking. Persisting discomfort and/or sensory loss were noted significantly more often among the patients who had the autologous bone harvesting performed through a separate incision over the iliac crest (24.3%) than among those in whom this was performed through an elongated midline incision (4.6%, P = 0.0015). CONCLUSIONS: Minimal pain and no dysfunction occurred (mean) 23 years after fusion for adolescent idiopathic scoliosis compared with normal straight controls. Significantly more pain in the scar region occurred when bone graft from an incision over the posterior iliac crest was used for harvesting bone to the fusion compared with an incision performed as an elongation of the midline incision used for the scoliosis surgery.
PubMed ID
14501939 View in PubMed
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Clinical outcome after surgery for lumbar spinal stenosis in patients with insignificant lower extremity pain. A prospective cohort study from the Norwegian registry for spine surgery.

https://arctichealth.org/en/permalink/ahliterature299710
Source
BMC Musculoskelet Disord. 2019 Jan 22; 20(1):36
Publication Type
Clinical Trial
Journal Article
Observational Study
Date
Jan-22-2019
Author
Erland Hermansen
Tor Åge Myklebust
Ivar Magne Austevoll
Frode Rekeland
Tore Solberg
Kjersti Storheim
Oliver Grundnes
Jørn Aaen
Jens Ivar Brox
Christian Hellum
Kari Indrekvam
Author Affiliation
Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway. erland.hermansen@helse-bergen.no.
Source
BMC Musculoskelet Disord. 2019 Jan 22; 20(1):36
Date
Jan-22-2019
Language
English
Publication Type
Clinical Trial
Journal Article
Observational Study
Keywords
Aged
Cohort Studies
Decompression, Surgical - methods - trends
Female
Humans
Lower Extremity
Lumbar Vertebrae - surgery
Male
Middle Aged
Norway - epidemiology
Pain Measurement - methods - trends
Prospective Studies
Registries
Spinal Stenosis - diagnosis - epidemiology - surgery
Treatment Outcome
Abstract
Spinal stenosis is a clinical diagnosis in which the main symptom is pain radiating to the lower extremities, or neurogenic claudication. Radiological spinal stenosis is commonly observed in the population and it is debated whether patients with no lower extremity pain should be labelled as having spinal stenosis. However, these patients is found in the Norwegian Registry for Spine Surgery, the main object of the present study was to compare the clinical outcomes after decompressive surgery in patients with insignificant lower extremity pain, with those with more severe pain.
This study is based on data from the Norwegian Registry for Spine Surgery (NORspine). Patients who had decompressive surgery in the period from 7/1-2007 to 11/3-2013 at 31 hospitals were included. The patients was divided into four groups based on preoperative Numeric Rating Scale (NRS)-score for lower extremity pain. Patients in group 1 had insignificant pain, group 2 had mild or moderate pain, group 3 severe pain and group 4 extremely severe pain. The primary outcome was change in the Oswestry Disability Index (ODI). Successfully treated patients were defined as patients reporting at least 30% reduction of baseline ODI, and the number of successfully treated patients in each group were recorded.
In total, 3181 patients were eligible; 154 patients in group 1; 753 in group 2; 1766 in group 3; and 528 in group 4. Group 1 had significantly less improvement from baseline in all the clinical scores 12?months after surgery compared to the other groups. However, with a mean reduction of 8 ODI points and 56% of patients showing a reduction of at least 30% in their ODI score, the proportion of patients defined as successfully treated in group 1, was not significantly different from that of other groups.
This national register study shows that patients with insignificant lower extremity pain had less improvement in primary and secondary outcome parameters from baseline to follow-up compared to patients with more severe lower extremity pain.
PubMed ID
30669998 View in PubMed
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Coexistence of pain and depression predicts poor 2-year surgery outcome among lumbar spinal stenosis patients.

https://arctichealth.org/en/permalink/ahliterature143261
Source
Nord J Psychiatry. 2010 Dec;64(6):391-6
Publication Type
Article
Date
Dec-2010
Author
Sanna Sinikallio
Olavi Airaksinen
Timo Aalto
Soili M Lehto
Heikki Kröger
Heimo Viinamäki
Author Affiliation
Department of Rehabilitation, Kuopio University Hospital, Kuopio, Finland. sanna.sinikallio@kuh.fi
Source
Nord J Psychiatry. 2010 Dec;64(6):391-6
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Aged
Back Pain - psychology - surgery
Decompression, Surgical - psychology
Depressive Disorder - diagnosis - psychology
Disability Evaluation
Female
Finland
Follow-Up Studies
Humans
Lumbar Vertebrae - surgery
Male
Middle Aged
Nerve Compression Syndromes - psychology - surgery
Pain Measurement
Pain, Postoperative - psychology
Personality Inventory - statistics & numerical data
Polyradiculopathy - psychology - surgery
Prognosis
Psychometrics
Sick Role
Spinal Nerve Roots - surgery
Spinal Stenosis - psychology - surgery
Treatment Outcome
Abstract
Lumbar spinal stenosis is a common cause of back and leg pain with the most severe cases treated surgically. Regarding the surgery outcome, the importance of early postoperative depression and pain is unknown.
To examine whether the coexistence of pain and depressive symptoms on 3-month follow-up predicts the 2-year surgery outcome.
93 patients (mean age 62 years) with symptomatic lumbar spinal stenosis underwent decompressive surgery. They completed the same set of questionnaires, 3 months, 1 year and 2 years postoperatively. Depression was assessed with the 21-item Beck Depression Inventory (BDI). Physical functioning and pain were assessed with the Oswestry Disability Index, the Stucki Questionnaire, self-reported walking ability, the visual analogue scale (VAS) and pain drawing. Comparisons were made between groups according to the "misery" (i.e. the coexistence of elevated pain and depression on 3-month follow-up) status. Logistic regression analysis was used to examine the factors independently associated with a poor surgery outcome on 2-year follow-up.
The patients in the misery group (n=24) showed greater symptom severity and greater disability than the patients in the non-misery group (n=69) at all follow-up stages. No clinical improvement was seen in the misery group during the follow-up. An independent association was observed between belonging to the misery group and 2-year disability, symptom severity and poor walking capacity.
Even moderately increased VAS and BDI scores, when presenting simultaneously on an individual patient level during the early postoperative period, imply a strong clinical burden and a risk factor for poor recovery. The assessment of pain and depressive symptoms is encouraged.
PubMed ID
20504268 View in PubMed
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[Complaints regarding lumbar disk herniation treatment reported to the Norwegian Compensation System]

https://arctichealth.org/en/permalink/ahliterature71548
Source
Tidsskr Nor Laegeforen. 2002 Aug 10;122(18):1804-6
Publication Type
Article
Date
Aug-10-2002
Author
Ingjald Bjerkreim
Harald Steen
Author Affiliation
Norsk Pasientskadeerstatning Postboks 1733 Vika 0121 Oslo. ingjald.bjerkreim@rikshospitalet.no
Source
Tidsskr Nor Laegeforen. 2002 Aug 10;122(18):1804-6
Date
Aug-10-2002
Language
Norwegian
Publication Type
Article
Keywords
Adult
Aged
English Abstract
Female
Humans
Insurance Claim Review
Insurance, Liability - utilization
Intervertebral Disk Displacement - diagnosis - surgery - therapy
Lumbar Vertebrae - surgery
Male
Malpractice
Middle Aged
Norway
Patient Education
Postoperative Complications - diagnosis
Reoperation
Abstract
BACKGROUND, MATERIAL AND METHODS: Over the 1993-99 period the Norwegian Patient Compensation System made decisions in 4,041 orthopaedic treatment injury cases. 700 cases were randomly selected and analysed in order to elucidate the reasons for complaints. 58 cases were related to lumbar disc herniation treatment. RESULTS: Of these 58 cases, 52 complaints were lodged against hospitals; six against primary health care providers. Seven patients had been primarily observed or non-operatively treated; 55 were eventually operated on, eight with recurrent disease. Nearly all complaints were related to the outcome of surgery (72%) and delay of diagnosis/surgery (21%). Several serious complications occurred; one patient died. Five patients had cauda equina syndrome; a further seven had neurological deficits from distal spinal nerve roots. In 17 cases (29%) the complaints were accepted, while 41 complaints (71%) were rejected. INTERPRETATION: In lumbar disc herniations both surgery, observation and non-operative treatment may lead to severe complications. It is important to select the right patients for surgery and to provide good information.
PubMed ID
12362694 View in PubMed
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Cost-effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish Lumbar Spine Study: a multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group.

https://arctichealth.org/en/permalink/ahliterature180499
Source
Spine (Phila Pa 1976). 2004 Feb 15;29(4):421-34; discussion Z3
Publication Type
Article
Date
Feb-15-2004
Author
Peter Fritzell
Olle Hägg
Dick Jonsson
Anders Nordwall
Author Affiliation
Department of Orthopedic Surgery, Falun Hospital, Falun, Sweden. peter.fritzell@ltdalarna.se
Source
Spine (Phila Pa 1976). 2004 Feb 15;29(4):421-34; discussion Z3
Date
Feb-15-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Chronic Disease - economics
Cost-Benefit Analysis - statistics & numerical data
Disability Evaluation
Humans
Low Back Pain - economics - surgery
Lumbar Vertebrae - surgery
Middle Aged
Outcome and Process Assessment (Health Care) - statistics & numerical data
Pain Measurement - statistics & numerical data
Sensitivity and specificity
Sick Leave - economics - statistics & numerical data
Spinal Fusion - economics
Sweden
Treatment Outcome
Abstract
A cost-effectiveness study was performed from the societal and health care perspectives.
To evaluate the costs-effectiveness of lumbar fusion for chronic low back pain (CLBP) during a 2-year follow-up.
A full economic evaluation comparing costs related to treatment effects in patients with CLBP is lacking.
A total of 284 of 294 patients with CLBP for at least 2 years were randomized to either lumbar fusion or a nonsurgical control group. Costs for the health care sector (direct costs), and costs associated with production losses (indirect costs) were calculated. Societal total costs were identified as the sum of direct and indirect costs. Treatment effects were measured using patient global assessment of improvement, back pain (VAS), functional disability (Owestry), and return to work.
The societal total cost per patient (standard deviations) in the surgical group was significantly higher than in the nonsurgical group: Swedish kroner (SEK) 704,000 (254,000) vs. SEK 636,000 (208,000). The cost per patient for the health care sector was significantly higher for the surgical group, SEK 123,000 (60,100) vs. 65,200 (38,400) for the control group. All treatment effects were significantly better after surgery. The incremental cost-effectiveness ratio (ICER), illustrating the extra cost per extra effect unit gained by using fusion instead of nonsurgical treatment, were for improvement: SEK 2,600 (600-5,900), for back pain: SEK 5,200 (1,100-11,500), for Oswestry: SEK 11,300 (1,200-48,000), and for return to work: SEK 4,100 (100-21,400).
For both the society and the health care sectors, the 2-year costs for lumbar fusion was significantly higher compared with nonsurgical treatment but all treatment effects were significantly in favor of surgery. The probability of lumbar fusion being cost-effective increased with the value put on extra effect units gained by using surgery.
PubMed ID
15094539 View in PubMed
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Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain.

https://arctichealth.org/en/permalink/ahliterature81297
Source
Eur Spine J. 2007 May;16(5):657-68
Publication Type
Article
Date
May-2007
Author
Soegaard Rikke
Christensen Finn Bjarke
Christiansen Terkel
Bünger Cody
Author Affiliation
Spine Unit, Orthopaedic Research Lab., University Hospital of Aarhus, Aarhus, Denmark. rikke.sogaard@ki.au.dk
Source
Eur Spine J. 2007 May;16(5):657-68
Date
May-2007
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adult
Chronic Disease
Cost Allocation
Cost-Benefit Analysis
Denmark
Female
Follow-Up Studies
Hospital Costs
Hospitals, University - economics
Humans
Low Back Pain - economics - surgery
Lumbar Vertebrae - surgery
Male
Middle Aged
Outcome Assessment (Health Care) - economics
Regression Analysis
Spinal Fusion - economics - instrumentation
Abstract
Although cost-effectiveness is becoming the foremost evaluative criterion within health service management of spine surgery, scientific knowledge about cost-patterns and cost-effectiveness is limited. The aims of this study were (1) to establish an activity-based method for costing at the patient-level, (2) to investigate the correlation between costs and effects, (3) to investigate the influence of selected patient characteristics on cost-effectiveness and, (4) to investigate the incremental cost-effectiveness ratio of (a) posterior instrumentation and (b) intervertebral anterior support in lumbar spinal fusion. We hypothesized a positive correlation between costs and effects, that determinants of effects would also determine cost-effectiveness, and that posterolateral instrumentation and anterior intervertebral support are cost-effective adjuncts in posterolateral lumbar fusion. A cohort of 136 consecutive patients with chronic low back pain, who were surgically treated from January 2001 through January 2003, was followed until 2 years postoperatively. Operations took place at University Hospital of Aarhus and all patients had either (1) non-instrumented posterolateral lumbar spinal fusion, (2) instrumented posterolateral lumbar spinal fusion, or (3) instrumented posterolateral lumbar spinal fusion + anterior intervertebral support. Analysis of costs was performed at the patient-level, from an administrator's perspective, by means of Activity-Based-Costing. Clinical effects were measured by means of the Dallas Pain Questionnaire and the Low Back Pain Rating Scale at baseline and 2 years postoperatively. Regression models were used to reveal determinants for costs and effects. Costs and effects were analyzed as a net-benefit measure to reveal determinants for cost-effectiveness, and finally, adjusted analysis (for non-random allocation of patients) was performed in order to reveal the incremental cost-effectiveness ratios of (a) posterior instrumentation and (b) anterior support. The costs of non-instrumented posterolateral spinal fusion were estimated at DKK 88,285(95% CI 81,369;95,546), instrumented posterolateral spinal fusion at DKK 94,396(95% CI 89,865;99,574) and instrumented posterolateral lumbar spinal fusion + anterior intervertebral support at DKK 120,759(95% CI 111,981;133,738). The net-benefit of the regimens was significantly affected by smoking and functional disability in psychosocial life areas. Multi-level fusion and surgical technique significantly affected the net-benefit as well. Surprisingly, no correlation was found between treatment costs and treatment effects. Incremental analysis suggested that the probability of posterior instrumentation being cost-effective was limited, whereas the probability of anterior intervertebral support being cost-effective escalates as willingness-to-pay per effect unit increases. This study reveals useful and hitherto unknown information both about cost-patterns at the patient-level and determinants of cost-effectiveness. The overall conclusion of the present investigation is a recommendation to focus further on determinants of cost-effectiveness. For example, patient characteristics that are modifiable at a relatively low expense may have greater influence on cost-effectiveness than the surgical technique itself--at least from an administrator's perspective.
PubMed ID
16871387 View in PubMed
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Criteria for failure and worsening after surgery for lumbar disc herniation: a multicenter observational study based on data from the Norwegian Registry for Spine Surgery.

https://arctichealth.org/en/permalink/ahliterature292118
Source
Eur Spine J. 2017 10; 26(10):2650-2659
Publication Type
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Date
10-2017
Author
David A T Werner
Margreth Grotle
Sasha Gulati
Ivar M Austevoll
Greger Lønne
Øystein P Nygaard
Tore K Solberg
Author Affiliation
Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway. Mail@david-werner.com.
Source
Eur Spine J. 2017 10; 26(10):2650-2659
Date
10-2017
Language
English
Publication Type
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Keywords
Disability Evaluation
Follow-Up Studies
Humans
Intervertebral Disc Displacement - surgery
Lumbar Vertebrae - surgery
Norway
Pain Measurement
Patient Reported Outcome Measures
Postoperative Complications
Registries
Abstract
In clinical decision-making, it is crucial to discuss the probability of adverse outcomes with the patient. A large proportion of the outcomes are difficult to classify as either failure or success. Consequently, cutoff values in patient-reported outcome measures (PROMs) for "failure" and "worsening" are likely to be different from those of "non-success". The aim of this study was to identify dichotomous cutoffs for failure and worsening, 12 months after surgical treatment for lumbar disc herniation, in a large registry cohort.
A total of 6840 patients with lumbar disc herniation were operated and followed for 12 months, according to the standard protocol of the Norwegian Registry for Spine Surgery (NORspine). Patients reporting to be unchanged or worse on the Global Perceived Effectiveness (GPE) scale at 12-month follow-up were classified as "failure", and those considering themselves "worse" or "worse than ever" after surgery were classified as "worsening". These two dichotomous outcomes were used as anchors in analyses of receiver operating characteristics (ROC) to define cutoffs for failure and worsening on commonly used PROMs, namely, the Oswestry Disability Index (ODI), the EuroQuol 5D (EQ-5D), and Numerical Rating Scales (NRS) for back pain and leg pain.
"Failure" after 12 months for each PROM, as an insufficient improvement from baseline, was (sensitivity and specificity): ODI change 25 (0.89, 0.81), NRS back-pain change 5.5 (0.81, 0.87), NRS leg-pain change 4.5 (0.91, 0.85), EQ-5D change 0.63 (0.81, 0.85). Both a final raw score >48 for the ODI and an NRS >7.5 were indicators for "worsening" after 12 months, with acceptable accuracy.
The criteria with the highest accuracy for defining failure and worsening after surgery for lumbar disc herniation were an ODI percentage change score 48. These cutoffs can facilitate shared decision-making among doctors and patients, and improve quality assessment and comparison of clinical outcomes across surgical units. In addition to clinically relevant improvements, we propose that rates of failure and worsening should be included in reporting from clinical trials.
Notes
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PubMed ID
28616747 View in PubMed
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Decreasing Incidence of Lumbar Discectomy Surgery in Finland in 1997-2018.

https://arctichealth.org/en/permalink/ahliterature312180
Source
Spine (Phila Pa 1976). 2021 Mar 15; 46(6):383-390
Publication Type
Journal Article
Date
Mar-15-2021
Author
Ville T Ponkilainen
Heikki Mäntymäki
Tuomas T Huttunen
Ville M Mattila
Author Affiliation
Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland.
Source
Spine (Phila Pa 1976). 2021 Mar 15; 46(6):383-390
Date
Mar-15-2021
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Databases, Factual - trends
Diskectomy - trends
Female
Finland - epidemiology
Humans
Incidence
Intervertebral Disc Displacement - epidemiology - surgery
Lumbar Vertebrae - surgery
Male
Middle Aged
Patient Discharge - trends
Reoperation - trends
Retrospective Studies
Young Adult
Abstract
Retrospective register study.
The aim of this study was to assess the incidence and trends of lumbar disc surgeries in Finland from 1997 through 2018.
The evidence on lumbar spine discectomy has shifted from supporting surgical treatment toward nonoperative treatment. Still, the incidence of lumbar discectomy operations increased until the 1990?s. In the United States, the incidence began to decline after a downward turn in 2008, yet recent trends from countries with public and practically free health care are not widely known.
Data for this study were obtained from the Finnish nationwide National Hospital Discharge Register. The study population covered all patients 18 years of age or older in Finland during a 22-year period from January 1, 1997, to December 31, 2018.
A total of 65,912 lumbar discectomy operations were performed in Finland from 1997 through 2018. The annual population-based incidence of lumbar discectomy decreased 29% during the 22-year period, from 83 per 100,000 person-years in 1997 to 58 per 100,000 person-years in 2018. In addition, the incidence of microdiscectomy increased 12%, from 41 per 100,000 person-years in 1997 to 47 per 100,000 person-years in 2018, whereas the incidence of open discectomy decreased 71%, from 41 per 100,000 person-years in 1997 to 12 per 100,000 person-years in 2018. The total reoperation rate for microendoscopic, microscopic, and open discectomy surgeries was 16.3%, 15.3%, and 14.9%, respectively.
The nationwide incidence of lumbar discectomy decreased in Finland from 1997 through 2018. Additionally, the incidence of open discectomy is decreasing rapidly, whereas the incidence of microsurgical techniques is increasing.Level of Evidence: 3.
PubMed ID
33620183 View in PubMed
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Determinants of work disability following lumbar spine decompression surgery.

https://arctichealth.org/en/permalink/ahliterature300344
Source
Scand J Public Health. 2019 May; 47(3):281-292
Publication Type
Journal Article
Date
May-2019
Author
Mo Wang
Ellenor Mittendorfer-Rutz
Thomas E Dorner
Konstantinos A Pazarlis
Annina Ropponen
Pia Svedberg
Magnus Helgesson
Author Affiliation
1 Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
Source
Scand J Public Health. 2019 May; 47(3):281-292
Date
May-2019
Language
English
Publication Type
Journal Article
Keywords
Adult
Decompression, Surgical
Disabled persons - statistics & numerical data
Female
Humans
Lumbar Vertebrae - surgery
Male
Middle Aged
Pensions - statistics & numerical data
Prospective Studies
Risk factors
Sick Leave - statistics & numerical data
Socioeconomic Factors
Sweden
Work Capacity Evaluation
Young Adult
Abstract
Scientific knowledge about risk factors for work disability in terms of long-term sickness absence and disability pension following lumbar spine decompression surgery remains insufficient. This study aimed to investigate the associations between socio-demographic, work-related, and medical characteristics with subsequent long-term sickness absence (>90 days) and disability pension for individuals who underwent lumbar spine decompression surgery.
A prospective cohort study of all individuals aged 19-60 years with diagnosed dorsopathies, who underwent lumbar spine decompression surgery 2008-10 in Sweden ( n=7373) was performed. Univariate and multivariate hazard ratios with 95% confidence intervals regarding long-term sickness absence and disability pension with a 3-year follow-up period were estimated by Cox proportional regression.
Low educational level, being a non-European immigrant and preoperative sickness absence were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.8). Female sex was a risk factor for long-term sickness absence (hazard ratios: 1.3) whereas age >44 years and being a Nordic immigrant were risk factors for disability pension (hazard ratios: 1.9-2.6). Medical factors as common mental disorders, other mental disorders, prescribed psychiatric medication and somatic comorbidity were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.4). A simultaneous lumbar fusion surgery and high preoperative pain severity were risk factors for long-term sickness absence (hazard ratios 1.2-1.8).
To prevent long-term work disability after lumbar spine decompression surgery, specific focus is required on older and female patients, those with mental or somatic comorbidities, high levels of preoperative pain or sickness absence, with a simultaneous lumbar fusion surgery, a low educational level or a non-European immigrant background.
PubMed ID
29974820 View in PubMed
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