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Biomedical subjects

B Strömqvist

Publications and source records attributed to B Strömqvist.

At least 37 records · Page 2Linked to original sources
PubMed1996

MR imaging as the primary modality for neuroradiologic evaluation of the lumbar spine. Effects on cost and number of examinations.

PURPOSE: To evaluate the effects on cost, and number of primary and supplementary neuroradiologic examinations, after introducing MR imaging as the primary modality in the evaluation of the lumbar spine. MATERIAL AND METHODS: Two 5-month periods were compared: period 1--before MR; and period 2--after introduction of a 2nd MR device. In period 1, patients were examined with myelography and/or CT after referral from specialists only, whereas in period 2 both specialists and general practitioners could refer patients for MR imaging. The direct cost (neuroradiologic methods and hospitalization) and indirect cost (sick-leave and estimated loss of production caused by the diagnostic procedure) were estimated. RESULTS AND CONCLUSION: In period 1, investigations were started in 75 patients (62 myelographies and 13 CT examinations); in period 2, in 227 patients (198 MR, 21 CT, and 8 myelographies). The estimated total cost increased from SEK 825,000 to 1,265,000 (53%), the cost per investigated patient decreasing from 11,000 to 5565 (50%), and the cost of preoperative investigation per operated patient decreasing from 8616 to 5563 (35%). The number of supplementary examinations was unchanged.

Costs and Cost Analysis↗
PubMed1996

Neurologic signs in lumbar disc herniation. Preoperative affliction and postoperative recovery in 150 cases.

We studied prospectively 165 consecutive patients operated on for lumbar disc herniations. Neurologic examination was performed preoperatively and at 4, 12, and 24 months postoperatively according to a protocol. Preoperatively 69% of the patients showed a neurological disturbance corresponding to the level of disc herniation and 62% a corresponding sensory deficit. Recovery of the neurological deficit was seen in half of the cases at 2 years postoperatively, the main part of this improvement occurred within 4 months after the operation. Neurologic recovery correlated to a good surgical outcome, and a short history of disc herniation prior to the operation correlated to postoperative neurologic improvement. The straight leg raising test correlated to preoperative neurologic deficit, but not to postoperative recovery. Motor power disturbance of the extensor hallucis longus muscle recovered in more patients than reflex disturbances. Sensory disturbances had the lowest recovery rate. Our study demonstrates a correlation between routine postoperative neurologic findings and the patient's self-assessed outcome of surgery.

Adult↗
PubMed1996

Clinical appearance of contained and noncontained lumbar disc herniation.

In a prospective and consecutive study, we evaluated the incidence of common symptoms and neurologic disturbances in 200 patients operated on because of lumbar disc herniation by using a computer-coded protocol with pre- and perioperative registration. The preoperative occurrence of pain at rest, at night, and on coughing was registered. Use of analgesics and walking ability were registered as category data. At examination, a straight-leg-raising (SLR) test was graded in four categories, and results from neurologic findings were collected. At surgery, disc herniation was classified as extruded/sequestered herniation, prolapse, or focal protrusion. There were no significant differences concerning pain at rest or at night related to type of herniation. Pain on coughing was more common in extruded/sequestered herniations. Use of analgesics as well as severe reduction of walking capacity were significantly more common in patients with extrusion/sequestration. The highly restricted SLR test, as well as the crossed positive SLR test, were also significantly more common in patients with extruded/sequestered herniation, and this was also true for the incidence of relevant reflex/extensor hallucis longus (EHL) and sensory disturbance. In conclusion, the clinical appearance of lumbar disc herniation was most "aggressive" in extruded and sequestered disc herniation. The symptoms and signs in disc protrusion were less severe, whereas patients with prolapse had an "intermediate" appearance concerning symptoms and signs. The differences in incidence of common signs in noncontained versus contained herniation were statistically significant; these differences may be of clinical interest for patient selection and information as well as in pathophysiologic considerations.

Adult↗
PubMed1995

Motor affliction of the L5 nerve root in lumbar nerve root compression syndromes.

STUDY DESIGN: From a prospective and consecutive study on degenerative lumbar spine disorders containing 416 patients, all patients with a severely reduced or absent strength of the extensor hallucis longus muscle (n = 35) before surgery were identified. OBJECTIVES: The incidence, diagnosis, and recovery after surgery of patients with L5 root compression syndromes and a severely reduced or absent power before surgery of the big toe extensor was evaluated. SUMMARY OF BACKGROUND DATA: The L5 root is commonly involved in disc herniation and central and lateral spinal stenosis. Whether motor recovery occurs after root decompression is not fully known. METHODS: All patients underwent a conventional radiologic evaluation before surgery including one or more myelography, computed tomography scan, and magnetic resonance imaging. At examination before surgery, extensor hallucis longus-power was graded as normal, reduced, or severely reduced/absent, and the latter group is presented here. Surgical findings were registered. Clinical investigation was performed after 4, 12-, and 24-month follow-up periods. RESULTS: A pronounced extensor hallucis longus paresis was seen in disc herniation in 20 of 187 patients, in lateral spinal stenosis in 10 of 122 patients, and central spinal stenosis 5 of 107 patients. Improvement of the paresis after surgery was equally common in disc herniation (15 of 20 patients) and lateral spinal stenosis (7 of 10 patients). Complete restitution was more common in disc herniation. None of the five patients with central spinal stenosis improved concerning paresis at the follow-up period. Improvement was most common during the first 4 months after surgery. No correlation between age or preoperative symptom duration and recovery was noted in either group. CONCLUSION: The incidence of pronounced extensor hallucis longus paresis in lumbar nerve root compression varied between 5-11%. Recovery after surgery was common in disc herniation and lateral spinal stenosis but did not occur in central stenosis. Complete recovery was most common in disc herniation, and recovery occurred mainly during the first 4 months after surgery.

Adult↗
PubMed1995

No relationship between epidural fibrosis and sciatica in the lumbar postdiscectomy syndrome. A study with contrast-enhanced magnetic resonance imaging in symptomatic and asymptomatic patients.

STUDY DESIGN: Symptomatic patients were retrospectively analyzed and compared with a control group from an ongoing prospective and consecutive study. OBJECTIVES: To determine the presence and extent of epidural fibrosis in patients with and without recurrent sciatic pain after previous lumbar discectomy, contrast-enhanced magnetic resonance images were evaluated and correlated with surgical findings in the symptomatic patients. Recurrent hernia and bony stenosis were ruled out as the probable causative agent, as well as any morphologic explanation other than fibrosis. SUMMARY OF BACKGROUND DATA: Repeat surgical results for patients with the lumbar postdiscectomy syndrome with epidural fibrosis alone are often unfavorable. The pathogenic role of epidural fibrosis, however, has not been established. METHODS: The magnetic resonance images of eight patients with recurrent or persistent sciatic pain after lumbar discectomy were compared with those of eight asymptomatic patients constituting a control group. All were examined with magnetic resonance imaging on a 0.3 T unit before and after intravenous injection of gadolinium-DTPA, and clinically, 6 months to 4 years after surgery. The symptomatic patients subsequently underwent reoperation. RESULTS: Fourteen patients had focal or diffuse epidural fibrosis around the nerve root and/or the thecal sac at the operated level, whereas the postoperative findings for two patients were "normal," one in the operated and one in the control group. No difference between the groups regarding mass effect or affection of the nerve roots or thecal sac was noted. At reoperation of the eight symptomatic patients, fibrosis was the only pathologic finding in all cases except one, in which surgery confirmed the normal finding on magnetic resonance imaging. Six of the eight operated patients had recurrent or persistent symptoms within a year of the reoperation. CONCLUSION: No differences regarding the presence and extent of epidural fibrosis between the symptomatic and asymptomatic patients could be demonstrated with contrast-enhanced magnetic resonance imaging. The role of epidural fibrosis as the causative agent in the lumbar postdiscectomy syndrome is questioned.

Adult↗
PubMed1995

The straight leg raising test and the severity of symptoms in lumbar disc herniation. A preoperative evaluation.

STUDY DESIGN: In a prospective, consecutive study, correlation between the straight leg raising and other pain-related symptoms in lumbar disc herniation was evaluated preoperatively and postoperatively. OBJECTIVES: All patients were interviewed and examined preoperatively and at follow-up investigations 4 and 12 months postoperatively. SUMMARY OF BACKGROUND DATA: One-hundred-and-fifty consecutive patients underwent lumbar disc surgery. Mean patient age was 42 years (range, 21-81 years). Eighty-nine patients were men and 61 were women. Two herniations occurred at L2-L3, seven at L3-L4, 61 at L4-L5, and 80 at L5-S1. METHODS: Pain at rest, at night, and upon coughing was recorded. Consumption of analgesics was classified into three categories: 1) none, 2) intermittent, or 3) regular. Walking capacity was recorded as > 5 km, 1-5 km, 0.5-1 km, or < 0.5 km. The straight leg raising test was graded pos 0 degree-30 degrees, pos 30 degrees-60 degrees, pos > 60 degrees, or negative. At surgery, the herniation was classified as focal protrusion, subligamentous herniation, or perforation. The patient's assessment of outcome was graded into one of four categories. RESULTS: There was an almost linear correlation between a positive straight leg raising test and pain at rest, pain at night, pain upon coughing, and reduction of walking capacity. Regular consumption of analgesics was more common in patients who had a very restricted positive straight leg raising test (30 degrees). A positive straight leg raising test early postoperatively correlated with inferior outcome of the surgical procedure. CONCLUSION: The straight leg raising test as performed in clinical practice has a strong correlation with various parameters that signify the pain level of the patient. A positive straight leg raising test postoperatively correlates with inferior surgical outcome.

Adult↗
PubMed1995

Heat generation and heat protection in methylmethacrylate cementation of vertebral bodies. A cadaver study evaluating different clinical possibilities of dural protection from heat during cement curing.

For metastatic disease of the spine, anterior operations on the vertebral bodies often include methylmethacrylate cementation. The cement curing process may produce high temperatures in the surroundings, as demonstrated in joint replacement surgery, and there is a risk of thermal injury to the spinal nerves. In cadavers, we studied the heat arising during curing of cement on the dural sac, and the temperature of the cement surface was measured when the vertebral body was reconstructed using acrylic cement in the same way as in tumor surgery. The temperature increase on the surface of the dural sac during polymerization was between 4 degrees and 12 degrees C, depending on the amount of protection. Only a moderate temperature elevation was measured on the surface of the dural sac, provided that the posterior cortex of the vertebra was retained together with 0.5 cm of the spongious bone or a silicone membrane.

Bone Cements↗
PubMed1995

Influence of age on symptoms and signs in lumbar disc herniation.

In a prospective and consecutive study we evaluated the prevalence of pain-related symptoms, the results of the straight leg raising (SLR) test and neurological disturbances by age group in a total of 150 patients operated on due to lumbar disc herniation. On admission, all patients were interviewed, and pain at rest, at night and on coughing was recorded. Walking capacity was recorded under four categories: > 5 km, 1-5 km, 0.5-1 km and < 0.5 km. Results of the SLR test were also registered as category data: positive 0-30 degrees, positive 30-60 degrees, positive > 60 degrees or negative. Findings from examination of tendon reflexes and power of the extensor hallucis longus (EHL) muscle were registered, as were sensory disturbances. The above mentioned parameters were analysed separately for five different age groups: 20-29 years, 30-39 years, 40-49 years, 50-59 years and above 60 years of age. There was an age-related change in the prevalence of certain parameters. Highly restricted positive SLR test results and pain on coughing was most commonly found in the youngest patient group. With increasing age there was a decreasing prevalence of highly restricted positive SLR test results, while the prevalence of severe reduction of walking capacity increased. In short, the youngest patient group showed the most obvious clinical picture of disc herniation and, with increasing age, the clinical picture gradually changed towards the picture associated with spinal stenosis.

Adult↗
PubMed1995

Serial MRI in the early postoperative period after lumbar discectomy.

The aim of this study was to determine MRI findings in patients successfully operated upon for lumbar disc herniation. We investigated 20 patients with a successful outcome after L4-5 or L5-S1 disc operations clinically and with MRI preoperatively, and at 5 days, 6 weeks, and 4 months after surgery. Postoperatively, T1- and T2-weighted images were obtained. At 4 months gadolinium-enhanced images were added. Pronounced intraspinal MRI changes were seen during follow-up. Deformation of the dural sac was seen in 13 patients preoperatively, in 19 at 5 days after operation, in 15 at 6 weeks, and in 12 at 4 months. Nerve root involvement was seen in all cases both preoperatively and at 5 days after operation, in 17 at 6 weeks, and in 15 at 4 months. No correlation between symptoms or the straight leg raising test and the size or nature of the abnormal tissue in the spinal canal postoperatively could be demonstrated. It was concluded that early postoperative MRI after lumbar discectomy must be interpreted carefully, and that oedema and scar formation are probable reasons for difficulties in interpretation.

Adult↗
PubMed1995

Orthosis as prognostic instrument in lumbar fusion: no predictive value in 50 cases followed prospectively.

To evaluate pain relief in a lumbar orthosis as a predictor for good clinical results after solid fusion, all patients scheduled for such a surgical procedure were preoperatively encouraged to use an orthosis, soft or rigid, for 3 weeks. Grade of back pain relief as a percent using the orthosis was assessed by the patients and was registered before surgery. After surgery, at 1-year follow-up, patients with nonunion demonstrated radiographically were excluded from the series. Thus, 50 patients with solid fusion could be identified and followed for at least 2 years prospectively. At follow-up these 50 patients graded the pain relief induced by the fusion. In the preoperative corset test, 31 patients experienced significant back pain relief, meaning a reduction of at least 50%. No applicable correlation was found, however, between outcome in this corset test and the eventual clinical result expressed as improvement/no improvement after solid fusion. The two types of orthoses did not differ in this aspect. We conclude that the orthosis, rigid or soft, is not a useful instrument when selecting patients for lumbar fusion.

Adult↗
PubMed1994

Decompression for lateral lumbar spinal stenosis. Results and impact on sick leave and working conditions.

STUDY DESIGN: One hundred patients underwent lumbar nerve root decompression without fusion. All patients were registered preoperatively in a computer-coded protocol and followed at regular intervals: 4, 12, and 24 months after surgery. A number of subjective and objective variables were investigated including data on preoperative and postoperative working conditions and sick listing. Patients' opinions on pain relief were assessed using a 4-grade scale. OBJECTIVES: Surgical results and impact on sick leave and working conditions in patients who underwent surgery for lateral spinal stenosis were evaluated in a prospective, consecutive study. SUMMARY OF BACKGROUND DATA: Preoperatively, 81 of the patients were employed, 21 in sedentary work, 36 in moderately heavy work, and 24 in heavy work. The majority of the patients (78%) were off work (sick listed) with a mean duration of 13 months. Mean preoperative duration of sciatic pain was 2.5 years. METHODS: Working conditions were classified into one of three categories: sedentary, moderately heavy, and heavy work. Distribution of working conditions preoperatively and postoperatively was assessed in conjunction with duration of sick leave. Change of work category postoperatively was evaluated and related to preoperative working conditions. RESULTS: The effect of decompression for sciatica due to lateral spinal stenosis was gratifying in most cases with excellent results in 65% and fair in 23% of the patients concerning leg pain. The majority of patients employed preoperatively (73%) returned to work after a postoperative sick leave of 5.5 months. Patients who received disability pension postoperatively had significantly inferior surgical result concerning back pain and were also sick listed significantly longer preoperatively. CONCLUSION: Thus, lateral spinal stenosis was improved in the majority of patients (88%) who underwent surgery, and the majority of patients who were employed before surgery returned to work after.

Adult↗
PubMed1994

Lumbar spine surgery in the elderly. Complications and surgical results.

STUDY DESIGN: Diagnosis, postoperative complications, and surgical results in patients over 70 years old who underwent surgery for lumbar nerve root compression of a degenerative origin were evaluated in a prospective, consecutive study. SUMMARY OF BACKGROUND DATA: Of the 50 patients investigated, 43 suffered from central spinal stenosis, four from disc herniation, and three from lateral spinal stenosis. METHODS: All patients were investigated preoperatively and at 4, 12, and 24 months postoperatively. A number of subjective and objective variables were investigated and registered in a computer-coded protocol. Data gathered included intraoperative and postoperative complications, relevant diagnosis, and surgical results. Surgical procedures consisted of decompression with a facet-preserving technique in spinal stenosis and conventional open disc excision for disc herniation. Complications were classified as general (anesthetic, cardiopulmonary, and thromboembolic) and surgical. Patients' opinions on pain relief were assessed with a 4-grade scale. RESULTS: No anesthetic, cardiopulmonary, or thromboembolic complications were seen. Three surgical complications occurred: 1) a patient with spondylitis, 2) a patient with dural leakage with spontaneous recovery, and 3) a patient with postoperative cauda equina syndrome that resulted from peridural hematoma. During follow-up, two patients died from unrelated diseases and cerebrovascular lesions developed in two patients. Among the remaining 46 patients, 37 had improved by the 2-year follow-up and nine were unchanged. No patient deteriorated after the operation. CONCLUSION: Degenerative disorders of the lumbar spine in patients over 70 year old can be treated with no anesthetic complications and with 2-year results on par with those of decompressive surgery in younger patients.

Aged↗
PubMed1994

The European Spine Society AcroMed Prize 1994. Acute thermal nerve root injury.

Bone cement is sometimes used for vertebral body reconstruction following tumor removal. During such procedures, the polymerization of the methyl-metacrylate in the bone cement generates heat. Such temperature increase might cause damage to the nerve roots within the spinal canal. In the present study, pig cauda equina nerve roots were subjected to controlled temperature increases by means of a heat-generating probe. A temperature of 40 degrees C applied for 5 min did not cause any changes in nerve root function. However, 70 degrees C resulted in a complete block of nerve root function within 5 min. Histological nerve fiber damage was seen after exposure to 60 degrees C and 70 degrees C. The present study provides basic knowledge of heat-resistance properties of spinal nerve roots that might be directly applicable as guidelines for safety margins during surgical spine reconstruction procedures using bone cement.

Action Potentials↗
PubMed1994

Function after primary hemiarthroplasty and secondary total hip arthroplasty in femoral neck fracture.

Four to 12 years after primary treatment of femoral neck fracture with hemiarthroplasty in a group of Finnish patients and secondary total hip arthroplasty as a salvage procedure for healing complication after primary osteosynthesis in a group of Swedish patients, function was classified and the Nottingham Health Profile questionnaire was applied. The two groups were comparable with regard to age, sex, and social status. The patients with secondary total hip arthroplasty used walking aids to a lesser extent than the patients with hemiarthroplasty and experienced less problems in several aspects of life. Walking ability was considered unchanged, compared to prefracture, to a larger extent in the secondary total hip arthroplasty group. Thus, secondary total hip arthroplasty in patients with healing complication following primary osteosynthesis gives better long-term functional capacity than that obtained with a primary hemiarthroplasty.

Activities of Daily Living↗
PubMed1994

Posterolateral lumbar fusion. Outcome of 71 consecutive operations after 4 (2-7) years.

We report the outcome of 71 consecutive posterolateral lumbar fusions without spinal instrumentation. The indication for the operation was spondylolysis-olisthesis, degenerative disc disease/facet joint arthrosis, or pain after prior laminectomy. Concerning pain relief, 29/43 patients with spondylolysis-olisthesis were classified as good. The corresponding figures in the group with degenerative disc disease and/or facet joint arthrosis were 8/16 patients and in the group with pain post-laminectomy, 6/12 patients. No surgical complications were noted. In the total material 54 patients had a solid fusion, as defined by radiographic osseous trabecular bridging at all intended levels. One-level fusions tended to heal solidly in a higher frequency than two-level fusions. For the spondylolysis-olisthesis group, healed fusion correlated with a good clinical result. Such a correlation could not be verified for the other diagnostic groups. We conclude that non-instrumented posterolateral lumbar fusion is a valid method for treating low-grade spondylolysis-olisthesis, especially when the aim is to fuse a single level. Improved patient selection methods are required in fusion for degenerative disc disease and pain after laminectomy.

Adolescent↗
PubMed1993

Lumbar orthosis with unilateral hip immobilization. Effect on intervertebral mobility determined by roentgen stereophotogrammetric analysis.

To determine the additional stabilizing effect of unilateral hip fixation on external lumbar supports, nine patients with a posterolateral lumbosacral fusion without internal fixation were examined by roentgen stereophotogrammetric analysis. The roentgen stereophotogrammetric analysis was performed with the patients in supine and erect positions 1 month after surgery, that is, before fusion consolidation. Each patient was examined without lumbar support and with a molded, rigid thoracolumbosacral orthosis with extension to one thigh, thus immobilizing one hip. The additional hip immobilization had no consistent or significant stabilizing effect on the sagittal, vertical, or transverse intervertebral translations in the lower lumbar spine. This study using roentgen stereophotogrammetric analysis gave no support for including hip immobilization when using lumbar orthoses after spinal fusion in patients adequately cooperating to minimize gross body motions.

Adult↗