Surgery for Extraforaminal Lumbar Disc Herniation: A single center comparative observational study

Bakgrunn: Kirurgi for ekstraforaminale lumbale skiveprolaps (ELS) er et ofte utført inngrep. Sammenlignet med de mer vanlige paramediane lumbale skiveprolapsene (PLS), er de ekstraforaminale kjent for å være utfordrende rent kirurgteknisk. Det finne ingen komparative studier som sammenligner kirurgiske resultater mellom disse to operasjonene. Mål: Å sammenligne klinisk resultater ett år etter kirurgi for ekstraforaminale og paramediane lumbale skiveprolaps. Metode: Data ble samlet inn gjennom Norsk register for Ryggkirurgi (NORspine). Det primære utfallsmålet var endring etter ett år i Oswestry Disability Index (ODI). Sekundære utfallsmål var endring i livskvalitet målt med EuroQol 5 Dimensions (EQ-5D) og endring i smerte målt i NRS (Numeric Rating Scale). Resultater: Data fra 1750 pasienten ble evaluert i denne studien. Totalt 72 pasienter med ELS og 1678 med PLS. Ett år etter operasjon var det ingen forskjeller i noen av de pasientrapporterte målingene (PROMs). Pasientene i begge gruppene (PLS vs ELS) opplevde sammenlignbare endringer i ODI (-30.92 vs -34.0, P=0.325); EQ-5D (0.50 vs 0.51, P=0.859); NRS Ryggsmerter (-3.69 vs -3.83, P=0.745); og NRS Beinsmerter (-4.69 vs -4.46, P=0.607) etter ett år. Andelen pasienter som oppnådde klinisk suksess (definert som en ODI-score på under 20 poeng) etter ett år, var lik i begge gruppene (61.5% vs 52.7%, P=0.204). Konklusjon: Pasienter som ble operert for ekstraforaminale lumbale skiveprolaps rapporterte lignende resultater ett år etter kirurgi sammenlignet med pasienter som ble operert for paramediane lumbale skiveprolaps

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

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

Risk of intracranial hemorrhage (RICH) in users of oral antithrombotic drugs: Nationwide pharmacoepidemiological study.

BACKGROUND:The risks of intracranial haemorrhage (ICH) associated with antithrombotic drugs outside clinical trials are gaining increased attention. The aim of this nationwide study was to investigate the risk of ICH requiring hospital admission in users of antithrombotic drugs. METHODS AND FINDINGS:Data from the Norwegian Patient Registry and Norwegian Prescription Database were linked on an individual level. The primary outcome was incidence rates of ICH associated with use of antithrombotic drugs. Secondary endpoints were risk of ICH and fatal outcome following ICH assessed by Cox models. Among 3,131,270 individuals ≥18 years old observed from 2008 through 2014, there were 729,818 users of antithrombotic medications and 22,111 ICH hospitalizations. Annual crude ICH rates per 100 person-years were 0.076 (95% CI, 0.075-0.077) in non-users and 0.30 (95% CI, 0.30-0.31) in users of antithrombotic medication, with the highest age and sex adjusted rates observed for aspirin-dipyridamole plus clopidogrel (0.44; 95% CI, 0.19-0.69), rivaroxaban plus aspirin (0.36; 95% CI, 0.16-0.56), warfarin plus aspirin (0.34; 95% CI, 0.26-0.43), and warfarin plus aspirin and clopidogrel (0.33; 95% CI, 0.073-0.60). With no antithrombotic medication as reference, the highest adjusted hazard ratios (HR) for ICH were observed for aspirin-dypiridamole plus clopidogrel (6.29; 95% CI 3.71-10.7), warfarin plus aspirin and clopidogrel (4.38; 95% CI 2.71-7.09), rivaroxaban plus aspirin (3.82; 95% CI, 2.46-5.95), and warfarin plus aspirin (3.40; 95% CI, 2.99-3.86). All antithrombotic medication regimens were associated with an increased risk of ICH, except dabigatran monotherapy (HR 1.20; 95% CI, 0.88-1.65) and dabigatran plus aspirin (HR 1.79; 95% CI, 0.96-3.34). Fatal outcome within 90 days was more common in users (2,603 of 8,055) than non-users (3,228 of 14,056) of antithrombotic medication (32.3% vs 23.0%, p<0.001), and was associated with use of warfarin plus aspirin and clopidogrel (HR 2.89; 95% CI, 1.49-5.60), warfarin plus aspirin (HR 1.37; 95% CI, 1.11-1.68), aspirin plus clopidogrel (HR 1.30; 95% CI, 1.05-1.61), and warfarin (HR 1.19; 95% CI, 1.09-1.31). Increased one-year mortality was observed in users of antithrombotic medication following hemorrhagic stroke, subdural hemorrhage, subarachnoid hemorrhage, and traumatic ICH (all p<0.001). Limitations include those inherent to observational studies including the inability to make causal inferences, certain assumptions regarding drug exposure, and the possibility of residual confounding. CONCLUSIONS:The real-world incidence rates and risks of ICH were generally higher than reported in randomized controlled trials. There is still major room for improvement in terms of antithrombotic medication safety (clinicaltrials.gov NCT02481011)