Return to Work after Surgery for Cervical Radiculopathy: A Nationwide Registry-based Observational Study

Study Design - An observational multicenter study. Summary of Background Data - Return to work (RTW) is increasingly used to assess the standard, benefit, and quality of health care. Objective - The aim of this study was to evaluate sick leave patterns among patients undergoing surgery for cervical radiculopathy and identify predictors of successful RTW using two nationwide databases. Materials and Methods - Data from the Norwegian Registry for Spine Surgery (NORspine) and the Norwegian Labour and Welfare Administration were linked on an individual level. We included patients between 18 and 60 years of age registered in NORspine from June 2012 through December 2019 that were temporarily out of the labor force for medical reasons at the time of surgery. We assessed types and grades of sickness benefits before and after surgery and conducted logistic regression analyses. Results - Among 3387 patients included in the study, 851 (25.1%) received temporary benefits one year before surgery. The proportion of recipients increased steadily towards surgery. Postoperatively the medical benefit payment decreased rapidly, and half of the patients had already returned to work by four months. The rate of RTW reached a plateau at one year. By the end of the third year, 2429 patients (71.7%) had returned to work. The number of sick days, categorized as 90 or less, during the year before surgery had the most powerful association with RTW at two years (odds ratio: 4.54, 95% CI: 3.42–6.03, P Conclusion - RTW after cervical radiculopathy surgery occurs primarily during the first year. The strongest predictor of RTW was fewer sick days before surgery. The clinical improvement after surgery had a lesser impact

Surgery for degenerative cervical myelopathy in the elderly: a nationwide registry-based observational study with patient-reported outcomes

Background - The aim of this study was to investigate whether clinical outcomes in patients aged ≥ 70 undergoing decompressive surgery for degenerative cervical myelopathy (DCM) differ from those of younger patients (50–70 years) at 1 year. Methods - Data were obtained from the Norwegian Registry for Spine Surgery (NORspine). Among 651 patients included, 177 (27.2%) were ≥ 70 years old. The primary outcome was change in the Neck Disability Index (NDI). Secondary outcomes were changes in the European Myelopathy Score (EMS), quality of life (EuroQoL EQ-5D), numeric rating scales (NRS) for headache, neck pain, and arm pain, and complications. Results - Significant improvements in all patient-reported outcomes (PROMs) were detected for both age cohorts at 1 year. For the two age cohorts combined, there was a statistically significant improvement in the NDI score (mean 9.2, 95% CI 7.7 to 10.6, P  Conclusion - Surgery for DCM was associated with significant improvement across a wide range of PROMs for both younger and elderly patients. Surgery for DCM should not be denied based on age alone

Surgery for degenerative cervical myelopathy in patients with rheumatoid arthritis and ankylosing spondylitis: a nationwide registry-based study with patient-reported outcomes

Purpose To compare patient-reported outcomes (PROMs) following surgery for degenerative cervical myelopathy (DCM) among patients with rheumatoid arthritis (RA) or ankylosing spondylitis (AS) versus those without rheumatic diseases. Methods Data were obtained from the Norwegian Registry for Spine Surgery. The primary outcome was change in the Neck Disability Index (NDI) at 1 year. Secondary endpoints included the European Myelopathy Score (EMS), quality of life (EuroQoL-5D [EQ-5D]), numeric rating scales (NRS) for headache, neck pain, and arm pain, and complications. Results Among 905 participants operated between 2012 and 2018, 35 had RA or AS. There were signifcant improvements in all PROMs at 1 year and no statistically signifcant diference between the cohorts in mean change in NDI (−0.64, 95% CI−8.1 to 6.8, P=.372), EQ-5D (0.10, 95% CI−0.04 to 0.24, P=.168), NRS neck pain (−0.8, 95% CI−2.0 to 0.4, P=.210), NRS arm pain (−0.6, 95% CI−1.9 to 0.7, P=.351), and NRS headache (−0.5, 95% CI−1.7 to 0.8, P=.460). Discussion and conclusion Our study adds to the limited available evidence that surgical treatment cannot only arrest further progression of myelopathy but also improve functional status, neurological outcomes, and quality of life in patients with rheumatic disease

Is surgery for recurrent lumbar disc herniation worthwhile or futile? A single center observational study with patient reported outcomes

Sammendrag Mål Undersøke resultat og komplikasjonsrate etter mikrodiskektomi for tilbakevendende lumbalprolaps Metode Prospektive data for pasienter operert ved avdelingen for Nevrokirurgi, St. Olavs Universitetssykehus, Norge, ble hentet fra Norwegian Registry for Spine Surgery fra Mai 2007 til Juli 2016. Alle pasienter gjennomgikk lumbal mikrodiskektomi. Primære endepunkt var ending i Oswestry Disability Index (ODI) etter ett år. Sekundære endepunkt var ending i livskvalitet målt med EuroQol 5 Dimensions (EQ-5D), rygg- og bensmerte målt med numerical rating scales (NRS), komplikasjoner, knivtid og lengde på sykehusoppholdet. Resultat 276 patienter ble inkludert i studien. Totalt 161 pasienter (58.3%) gjennomførte ett års oppfølging. Gjennomsnittlig bedring i ODI etter ett år var 27.1 poeng (95% CI 23.1 to 31.0, P <0.001). Gjennomsnittlig bedring i EQ-5D etter ett år var 0.47 poeng (95% CI 0.40 – 0.54, P <0.001), noe som representerer en stor effektstørrelse (Cohens D = 1.3). Gjennomsnittlig bedring i rygg- og bensmerte NRS var henholdsvis 4.3 poeng (95% CI 2.2 – 3.2, P <0.001) og 3.8 poeng (95% CI 2.8 – 3.9, P <0.001). Ni pasienter (3.3%) gjennomgikk intraoperative komplikasjoner, og 15 (5.5%9 av 160 pasienter rapporterte komplikasjoner innen tre måneder etter utskrivelse. Konklusjon Denne studien viser at pasienter som opereres for tilbakevendende prolaps i lumbalcolumna rapporterer signifikant klinisk bedring

Surgery for Degenerative Cervical Myelopathy: A Nationwide Registry-Based Observational Study With Patient-Reported Outcomes

BACKGROUND Indications and optimal timing for surgical treatment of degenerative cervical myelopathy (DCM) remain unclear, and data from daily clinical practice are warranted. OBJECTIVE To investigate clinical outcomes following decompressive surgery for DCM. METHODS Data were obtained from the Norwegian Registry for Spine Surgery. The primary outcome was change in the neck disability index (NDI) 1 yr after surgery. Secondary endpoints were the European myelopathy score (EMS), quality of life (EuroQoL 5D [EQ-5D]), numeric rating scales (NRS) for headache, neck pain, and arm pain, complications, and perceived benefit of surgery assessed by the Global Perceived Effect (GPE) scale. RESULTS We included 905 patients operated between January 2012 and June 2018. There were significant improvements in all patient-reported outcome measures (PROMs) including NDI (mean −10.0, 95% CI −11.5 to −8.4, P < .001), EMS (mean 1.0, 95% CI 0.8-1.1, P < .001), EQ-5D index score (mean 0.16, 95% CI 0.13-0.19, P < .001), EQ-5D visual analogue scale (mean 13.8, 95% CI 11.7-15.9, P < .001), headache NRS (mean −1.1, 95% CI −1.4 to −0.8, P < .001), neck pain NRS (mean −1.8, 95% CI −2.0 to −1.5, P < .001), and arm pain NRS (mean −1.7, 95% CI −1.9 to −1.4, P < .001). According to GPE scale assessments, 229/513 patients (44.6%) experienced “complete recovery” or felt “much better” at 1 yr. There were significant improvements in all PROMs for both mild and moderate-to-severe DCM. A total of 251 patients (27.7%) experienced adverse effects within 3 mo. CONCLUSION Surgery for DCM is associated with significant and clinically meaningful improvement across a wide range of PROMs

Surgery for Degenerative Cervical Myelopathy: A Nationwide Registry-Based Observational Study With Patient-Reported Outcomes

Background: Indications and optimal timing for surgical treatment of degenerative cervical myelopathy (DCM) remain unclear, and data from daily clinical practice are warranted. Objective: To investigate clinical outcomes following decompressive surgery for DCM. Methods: Data were obtained from the Norwegian Registry for Spine Surgery. The primary outcome was change in the neck disability index (NDI) 1 yr after surgery. Secondary endpoints were the European myelopathy score (EMS), quality of life (EuroQoL 5D [EQ5D]), numeric rating scales (NRS) for headache, neck pain, and arm pain, complications, and perceived benefit of surgery assessed by the Global Perceived Effect (GPE) scale. Results: We included 905 patients operated between January 2012 and June 2018. There were significant improvements in all patient-reported outcome measures (PROMs) including NDI (mean −10.0, 95% CI −11.5 to −8.4, P Conclusion: Surgery for DCM is associated with significant and clinically meaningful improvement across a wide range of PROMs

Cognition, innovations and knowledge spillovers

Recognition of the importance of social processes has formed the basis of much theorising surrounding the underlying factors that influence regional competitiveness and innovative performance. Social dynamics, for instance, are central to such concepts as innovative milieu and industrial districts as well as regional clusters and regional innovation systems. Much of this work has focused on the role of social networks and institutions. More recent discussions of the nature of regional innovation, however, have continued the quest to understand the social processes that underpin economic relations in terms of territorial knowledge networks, regional knowledge spillovers and knowledge domains. While research on institutions and social networks is very advanced at this stage, sociological research on cognitive processes in their social context is still in its infancy, with only a handful of attempts at systematic cognitive sociology. In this paper, we reflect on these ideas and explore the relevance and usefulness of recent sociological approaches to the innovative economy based on the concepts of cognitive frames and social fields. In particular, we develop theoretical model of cognition in social innovative processes, which explains, firstly, the role of cognition in social dynamics on micro, meso and macro level, secondly, the actual mechanisms behind the knowledge spillovers, thirdly, the mechanisms behind the bounded rationality that is hindering radical innovation, and finally, the relationship between developmental trajectories that lead to path-dependent lock-in and deliberative action leading to path-changing innovations

Surgery for Extraforaminal Lumbar Disc Herniation: A Single Center Comparative Observational Study

Background - Surgery on extraforaminal lumbar disc herniation (ELDH) is a commonly performed procedure. Operating on this type of herniation is known to come with more difficulties than on the frequently seen paramedian lumbar disc herniation (PLDH). However, no comparative data are available on the effectiveness and safety of this operation. We sought out to compare clinical outcomes at 1 year following surgery for ELDH and PLDH. Methods - Data were collected through the Norwegian Registry for Spine Surgery (NORspine). The primary outcome measure was change at 1 year in the Oswestry Disability Index (ODI). Secondary outcome measures were quality of life measured with EuroQol 5 dimensions (EQ-5D); and numeric rating scales (NRSs). Results - Data of a total of 1750 patients were evaluated in this study, including 72 ELDH patients (4.1%). One year after surgery, there were no differences in any of the patient reported outcome measurements (PROMs) between the two groups. PLDH and ELDH patients experienced similar changes in ODI (− 30.92 vs. − 34.00, P = 0.325); EQ-5D (0.50 vs. 0.51, P = 0.859); NRS back (− 3.69 vs. − 3.83, P = 0.745); and NRS leg (− 4.69 vs. − 4.46, P = 0.607) after 1 year. The proportion of patients achieving a clinical success (defined as an ODI score of less than 20 points) at 1 year was similar in both groups (61.5% vs. 52.7%, P = 0.204). Conclusions - Patients operated for ELDH reported similar improvement after 1 year compared with patients operated for PLDH

Pain During Sex Before and After Surgery for Lumbar Disc Herniation - A Multicenter Observational Study

Study Design. Observational multicenter study. Objective. The aim of this study was to evaluate changes in pain during sexual activity after surgery for lumbar disc herniation (LDH). Summary of Background Data. There are limited data available on sexual function in patients undergoing surgery for LDH. Methods. Data were retrieved from the Norwegian Registry for Spine Surgery. The primary outcome was change in pain during sexual activity at one year, assessed by item number eight of the Oswestry disability index (ODI) questionnaire. Secondary outcome measures included ODI, EuroQol-5D (EQ-5D), and numeric rating scale (NRS) scores for back and leg pain. Results. Among the 18,529 patients included, 12,103 (64.8%) completed 1-year follow-up. At baseline, 16,729 patients (90.3%) provided information about pain during sexual activity, whereas 11,130 (92.0%) among those with complete follow-up completed this item. Preoperatively 2586 of 16,729 patients (15.5%) reported that pain did not affect sexual activity and at 1 year, 7251 of 11,130 patients (65.1%) reported a normal sex-life without pain. Preoperatively, 2483 (14.8%) patients reported that pain prevented any sex-life, compared to 190 patients (1.7%) at 1 year. At baseline, 14,143 of 16,729 patients (84.5%) reported that sexual activity caused pain, and among these 7232 of 10,509 responders (68.8%) reported an improvement at 1 year. A multivariable regression analysis showed that having a life partner, college education, working until time of surgery, undergoing emergency surgery, and increasing ODI score were predictors of improvement in pain during sexual activity. Increasing age, tobacco smoking, increasing body mass index, comorbidity, back pain >12 months, previous spine surgery, surgery in two or more lumbar levels, and complications occurring within 3 months were negative predictors. Conclusion. This study clearly demonstrates that a large proportion of patients undergoing surgery for LDH experienced an improvement in pain during sexual activity at 1 year