Repair of distal biceps brachii tendon ruptures: long term retrospective follow-up for two-incision technique

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenINTRODUCTION: Rupture of the distal tendon of the biceps muscle is a rare injury. If unrepaired the patient will be left with weakness of supination of the arm and flexion in the elbow. Long term results for the 2-incision approach for tendon reinsertion are few but in this study we describe the long term, clinical, functional, and subjective results of surgical repair using the 2-incision method described by Boyd and Anderson. MATERIAL AND METHODS: All patients who were operated at FSA hospital during the years 1986-2000 because of rupture of the distal tendon of the biceps muscle were asked to participate in the study. Twelve of 16 patients accepted and answered the DASH questionnaire. Strength was tested with handheld dynamometer and ROM where measured. Radiograph was taken of the affected arm. RESULTS: From 1986 through 2006 we operated on 16 patients because of rupture of the distal biceps tendon, one female and 15 male. Mean age at the time of rupture was 46 years (24-53).The average follow up were seven years (1-17). Ten of 12 patients were operated within two weeks from the injuries. No difference in strength was found between operated and non-operated arms. Late repair was associated with high DASH score and poor subjective results. Six patients developed heterotopic ossification but none of them developed radioulnar synostosis. One reoperation because entrapment of the median nerve was done. CONCLUSIONS: Despite heterotopic ossification and a small ROM deficit the Boyd and Anderson technique for repair of distal biceps ruptures yields good long term results in a low volume rural hospital. Early diagnosis and tendon reinsertion is of great importance to avoid persistent anterior elbow pain and poor subjective results.Inngangur: Slit á fjærsin tvíhöfðavöðva upphandleggs (biceps brachi) er sjaldgæfur áverki og árangur af aðgerðum því lítt þekktur. Lýst er árangri af aðgerðum þar sem fjærsin tvíhöfðavöðva upphandleggs er endurfest með aðgerð kenndri við Boyd og Anderson. Þá eru notaðar tvær leiðir til að komast að sininni og endurfesta. Efniviður og aðferðir: Þeir sem höfðu slitið fjærsin tvíhöfðavöðva upphandleggs á árunum 1986-2006 og gengist undir aðgerð á Sjúkrahúsi Akureyrar voru beðnir að taka þátt í rannsókninni sem fólst í líkamsskoðun, hreyfiferils- og styrktarmælingum, svörun spurningalista og rö ntgenmyndatöku af olnboga og framhandlegg. Niðurstöður: Sextán manns (15 karlar, 1 kona), meðalaldur 46 ár (24-53) gengust undir aðgerð þar sem sinin var endurfest með aðferð Boyds og Andersons. Tólf sjúklingar samþykktu að taka þátt í rannsókninni, allt rétthendir karlmenn. Tíu af 12 sjúklingum gengust undir aðgerðina innan tveggja vikna frá áverkanum (0-80 dagar). Allar sinarnar greru eftir að þær voru endurfestar. Munur var ekki tölfræðilega marktækur á styrk í aðgerðararmi og þeim armi sem ekki var gerð aðgerð á. Meðal DASH-stigun var 11,7 sem telst lágt. Helmingur sjúklinga hafði merki um beinnýmyndun í mjúkvefjum. Ályktun: Þrátt fyrir beinnýmyndun í mjúkvefjum og væga hreyfiskerðingu í aðgerðararminum virðist langtímaárangur aðgerðartækni þeirra Boyds og Andersons góður. Rétt greining og aðgerð fljótlega eftir áverka virðist vera lykilatriði til þess að sjúklingum farnist vel

Prognostic factors in lumbar spinal stenosis surgery. A prospective study of imaging- and patient-related factors in 109 patients who were operated on by decompression

Background and purpose A considerable number of patients who undergo surgery for spinal stenosis have residual symptoms and inferior function and health-related quality of life after surgery. There have been few studies on factors that may predict outcome. We tried to find predictors of outcome in surgery for spinal stenosis using patient- and imaging-related factors. Patients and methods 109 patients in the Swedish Spine Register with central spinal stenosis that were operated on by decompression without fusion were prospectively followed up 1 year after surgery. Clinical outcome scores included the EQ-5D, the Oswestry disability index, self-estimated walking distance, and leg and back pain levels (VAS). Central dural sac area, number of levels with stenosis, and spondylolisthesis were included in the MRI analysis. Multivariable analyses were performed to search for correlation between patient-related and imaging factors and clinical outcome at 1-year follow-up. Results Several factors predicted outcome statistically significantly. Duration of leg pain exceeding 2 years predicted inferior outcome in terms of leg and back pain, function, and HRLQoL. Regular and intermittent preoperative users of analgesics had higher levels of back pain at follow-up than those not using analgesics. Low preoperative function predicted low function and dissatisfaction at follow-up. Low preoperative EQ-5D scores predicted a high degree of leg and back pain. Narrow dural sac area predicted more gains in terms of back pain at follow-up and lower absolute leg pain. Interpretation Multiple factors predict outcome in spinal stenosis surgery, most importantly duration of symptoms and preoperative function. Some of these are modifiable and can be targeted. Our findings can be used in the preoperative patient information and aid the surgeon and the patient in a shared decision making process

Determinants of outcome in lumbar spinal stenosis surgery.

Lumbar spinal stenosis (LSS) is a degenerative disorder of the spine that predominantly affects the elderly. LSS is the most common spinal disorder leading to surgery in Sweden. Recent randomized controlled studies have showed better outcome with surgery compared to conservative treatment. However, after surgery, health related quality of life (HRQoL) and function continue to be inferior to that of the background population. Many patients experience residual leg or back pain and 60-70% of patients are satisfied with the outcome. Knowledge on what characterizes the different subtypes of spinal stenosis and to which extent the stenosis type influences pain, function and HRQoL is lacking. Little is also known about the relationship between degree of stenosis and outcome. In earlier studies, patients with predominant back pain (back pain ≥ leg pain) reported inferior outcomes, but the role of spinal fusion in patients with predominant back or leg pain has not been investigated. For this thesis two clinical databases were used. A Department of Orthopedics in Lund database which included radiological data (MRI) and patient related outcome measures for 140 patients and the Swedish Spine Register which contains data on more than 15,000 patients operated for three different forms of LSS; lateral recess stenosis (LRS), central spinal stenosis (CSS) and LSS with degenerative spondylolisthesis (DS). In Study I, we showed spinal measurements, including central dural sac area, multilevel stenosis, and DS to have a limited correlation to pain, function and HRQoL. In Study II, we showed preoperative duration of symptoms exceeding two years and poor preoperative function to predict poor outcome of surgery. Back pain was often experienced by patients scheduled for spinal stenosis surgery and HRQoL and function was low irrespective of whether back or leg pain was predominant in LRS, CSS and DS (Study III). In Study IV, predominant back pain (PB) was associated with inferior outcome of surgery for CSS. In Study IV, patients with PB operated with fusion had a marginally better outcome than patients decompressed only. However, this advantage diminished when we adjusted for confounders. At the two year follow-up no significant benefit for fusion was observed. In Study V, DS patients with fusion and PB benefited from fusion compared with patients with decompression only as the fused patients improved more in terms of leg and back pain as well as function at the one year follow-up. Patients with predominant leg pain appeared to have better outcome in terms of back pain with fusion but significant baseline differences in back pain between the treatment groups precluded firm conclusions regarding this benefit. In conclusion, decompression supplemented with fusion may lead to improved outcome in highly selected patients with CSS and predominant back pain. Further studies are needed to identify this subgroup. Adding fusion leads to superior one year outcome in DS patients with predominant back pain. Degree of dural sac stenosis has limited impact on symptoms and outcome but early surgery for LSS should be considered, before severe functional deterioration occurs

The Impact of Pain on Function and Health Related Quality of Life in Lumbar Spinal Stenosis: A Register Study of 14.821 patients.

Study Design. Descriptive register studyObjective. To describe preoperative levels of leg and back pain in patients operated for lumbar spinal stenosis and to obtain information on how three different pain constellations (back pain leg pain, back pain = leg pain) correlate to HRQoL and function in different morphological types of stenosis.Summary of Background Data. Degenerative lumbar spinal stenosis is considered to be a poorly defined clinical syndrome and knowledge of what uniquely characterizes the different morphological types of stenosis is lacking.Methods. Using the Swedish Spine Register we studied 1) the pain characteristics of patients with central spinal stenosis (CSS), lateral recess stenosis (LRS) and spinal stenosis with spondylolisthesis (SSS) 2) how HRQoL and function correlate to leg and back pain.Results. Grading higher leg than back pain was the most common pain constellation (49%) followed by grading more back than leg pain (39%). 12% had the same intensity of leg and back pain. The type of stenosis grading the highest burden of back pain was SSS (ratio = 0.93; [95%CI] = 0.92-0.95), followed by CSS (ratio = 0.88; [95%CI] = 0.88- 0.89). LRS had the lowest burden of back pain (ratio = 0.85; [95%CI] = 0.83-0.87). The lowest HRQoL and function was found in SSS (back pain = leg pain group) were 55% ([95%CI] = 50-59) of patients could not walk more than 100m. Patients with lateral recess stenosis had better self-estimated walking distance.Conclusion. Back pain is generally experienced to a high extent by patients scheduled for spinal stenosis surgery. HRQoL and function are low preoperatively irrespective of whether back or leg pain is predominant. In this large patient material patients who grade back and leg pain as likeworthy have significantly lower values for HRQoL and function but the difference is not clinically relevant

Pisa-heilkenni – sjúkratilfelli

This case report describes a 66-year old woman with Parkinson´s disease and a subacute onset lateral postural deformity. She experienced severe back pain and reduced walking ability. She was diagnosed with Pisa syndrome and sagittal and coronal imbalance was observed on radiographs. Posterior reconstructive surgery was performed from sacrum to Th10. Post operatively, sagittal and coronal imbalance was improved and maintained at the two year follow-up. The patient remained pain free and improvements in walking ability were sustained. The caveats of spine surgery in Parkinson´s patients are discussed and the importance of goal oriented surgery in terms of improvements in sagittal and coronal balance

Patients with no preoperative back pain have the best outcome after lumbar disc herniation surgery

Purpose: Most patients with lumbar disc herniations requiring surgery have concomitant back pain. The purpose of the current study was to evaluate the outcome of surgery for lumbar disc herniations in patients with no preoperative back pain (NBP) compared to those reporting low back pain (LBP). Methods: 15,418 patients surgically treated due to LDH with primary discectomy from 1998 until 2020 were included in the study. Self-reported low back pain assessed with a numerical rating scale (NRS) was used to dichotomize the patients in two groups, patients without preoperative back pain (NBP, NRS = 0, n = 1333, 9%) and patients with preoperative low back pain (LBP, NRS > 0, n = 14,085, 91%). Patient reported outcome measures (PROMs) collected preoperatively and one-year postoperatively were used to evaluate differences in outcomes between the groups. Results: At the one-year follow-up, 89% of the patients in the NBP group were completely pain free or much better compared with 76% in the LBP group. Significant improvement regarding leg pain was seen in all measured PROMs in both groups oneyear after surgery. In the NBP group, 13% reported clinically significant back pain (NRS difference greater than Minimally Clinical Important Difference (MICD)) at the one-year follow-up. Conclusions: Patients without preoperative back pain are good candidates for LDH surgery. 13% of patients without preoperative back pain develop clinically significant back pain one-year after surgery

Pisa Syndrome - case report

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadSextíu og sex ára kona með Parkinson-sjúkdóm leitaði til bæklunarlækna vegna erfiðra bakverkja. Konan hafði á skömmum tíma fengið hryggskekkju og göngugeta hennar hafði samtímis skerst. Konan var greind með hryggþröng (spinal stenosis) og hið sjaldgæfa Pisa-heilkenni sem stundum er fylgifiskur Parkinson-sjúkdóms. Í skurðaðgerð var hryggskekkjan rétt af og tveimur árum síðar var konan verkjalaus og göngugeta hennar hafði batnað verulega. Vandamál tengd bakskurðaðgerðum hjá fólki með Parkinson-sjúkdóm eru flókin og mikilvægt er að rétt aðgerð sé framkvæmd frá byrjun. Hér er lýst skurðmeðferð hjá konu með Parkinson-sjúkdóm og Pisa-heilkenni.This case report describes a 66-year old woman with Parkinson´s disease and a subacute onset lateral postural deformity. She experienced severe back pain and reduced walking ability. She was diagnosed with Pisa syndrome and sagittal and coronal imbalance was observed on radiographs. Posterior reconstructive surgery was performed from sacrum to Th10. Post operatively, sagittal and coronal imbalance was improved and maintained at the two year follow-up. The patient remained pain free and improvements in walking ability were sustained. The caveats of spine surgery in Parkinson´s patients are discussed and the importance of goal oriented surgery in terms of improvements in sagittal and coronal balance