Biomedical subjects

T Tullberg

Publications and source records attributed to T Tullberg.

12 recordsLinked to original sources

PubMed2006

The addition of tramadol to morphine via patient-controlled analgesia does not lead to better post-operative pain relief after total knee arthroplasty.

BACKGROUND: Tramadol is used as an analgesic in post-operative pain treatment. Intravenous tramadol is often combined with morphine to achieve better pain relief and less side-effects after orthopaedic surgery. However, the available evidence is insufficient to support this combination. For this reason, we conducted the present non-commercial, randomized, double-blind clinical trial. METHOD: Sixty-three patients with osteoarthritis of the knee, selected for primary total knee arthroplasty (TKA), were randomized to receive saline or tramadol 100 mg/ml intravenously every 6 h during the first post-operative day (total, 400 mg/24 h). All patients had access to morphine via a patient-controlled analgesia (PCA) pump. RESULTS: Neither during the 6 h after the first dose nor during the first post-operative day could we detect any statistically significant difference with regard to pain intensity, sedation and nausea between patients treated with tramadol and the placebo group. However, the withdrawal rate caused by insufficient pain relief was greater in the tramadol group (7/31) than in the saline group (2/32). This difference did not reach statistical significance. In the group of patients who remained in the study for 24 h ('per protocol'), those randomized to receive tramadol had a significantly (P < 0.05) lower morphine consumption (20 mg or 31%) than the placebo group. CONCLUSION: Our study does not support the combination of tramadol and morphine via PCA for post-operative pain relief after primary TKA. In addition, our study indicates that morphine via PCA as the sole means of post-operative analgesia does not provide sufficient pain relief after TKA. Thus, other means of post-operative analgesia should be used following TKA.

Adult↗

PubMed1998

Failure of a carbon fiber implant. A case report.

STUDY DESIGN: Case report. OBJECTIVES: Failure of a carbon fiber implant. SUMMARY OF BACKGROUND DATA: To simplify the procedure of posterior lumbar interbody fusion, a carbon-fiber-reinforced polymer implant has been developed. The implant has ridges to resist retropulsion, struts to support weight, and a hollow area to allow packing of autologous bone graft. So far, no complications have been reported from the use of carbon implant as a fusion aid in spine surgery. METHODS: A patient with postoperative infection has been followed with computed tomography images and histologic examination from a reoperation. RESULTS: An entire nonunion across the width of the disc space and a clearly broken cage was visualized with computed tomography. The spinal canal was explored during a reoperation and the tissue surrounding the dura and nerves were all black. Microscopic examination showed a large quantity of carbon particulate debris. The authors have operated on approximately 100 patients so far and no other carbon cage has broken, to their knowledge. CONCLUSIONS: Carbon cages can break if a nonunion occurs and as a result free carbon particles move out to the spinal canal.

Adult↗

PubMed1998

Manipulation does not alter the position of the sacroiliac joint. A roentgen stereophotogrammetric analysis.

STUDY DESIGN: A roentgen stereophotogrammetric analysis study of patients with sacroiliac joint dysfunction. OBJECTIVES: To investigate whether manipulation can influence the position between the ilium and the sacrum, and whether positional tests for the sacroiliac joint are valid. SUMMARY OF BACKGROUND DATA: Sacroiliac joint dysfunction is a subject of controversy. The validity of different sacroiliac joint tests is unknown. Long-standing therapeutic tradition is to manipulate supposed dysfunctions of the sacroiliac joint. Many manual therapists claim that their good clinical results are a consequence of a reduction of subluxation. METHODS: Ten patients with symptoms and sacroiliac joint tests results indicating unilateral sacroiliac joint dysfunction were recruited. Twelve sacroiliac joint tests were chosen. The results of most of these tests were required to be positive before manipulation and normalized after manipulation. Roentgen stereophotogrammetric analysis was performed with the patient in the standing position, before and after treatment. RESULTS: In none of the 10 patients did manipulation alter the position of the sacrum in relation to the ilium, defined by roentgen stereophotogrammetric analysis. Positional test results changed from positive before manipulation to normal after. CONCLUSIONS: Manipulation of the sacroiliac joint normalized different types of clinical test results but was not accompanied by altered position of the sacroiliac joint, according to roentgen stereophotogrammetric analysis. Therefore, the positional test results were not valid. However, the current results neither disprove nor prove possible beneficial clinical effects achieved by manipulation of the sacroiliac joint. Because the supposed positive effects are not a result of a reduction of subluxation, further studies of the effects of manipulation should focus on the soft tissue response.

Adult↗

PubMed1998

Septic and aseptic post-operative discitis in the lumbar spine--evaluation by MR imaging.

PURPOSE: The aim of this study was to determine whether it was possible to differentiate septic from aseptic post-operative discitis in the lumbar spine by means of MR imaging. MATERIAL AND METHODS: The study was a retrospective evaluation of 12 patients with prior lumbar discectomy and suspected post-operative discitis displaying low-back pain and typical MR findings. Six patients had elevated serum C-reactive protein (CRP) (septic) and 6 had normal CRP (aseptic). We used MR imaging to assess the distribution and degree of changes in the disc, in adjacent bone marrow, and in surrounding soft tissue. RESULTS: Of the 6 patients with increased CRP levels, 3 had extensive MR changes typical of septic post-operative discitis: 1 found soon after surgery; 2 found later. The other 3 patients with septic discitis, who were examined in the early post-operative period, showed MR changes similar to those in the 6 patients with aseptic discitis. CONCLUSION: Suspicion of septic post-operative discitis should be confirmed by MR imaging, serum CRP, and disc puncture. MR imaging is not reliable as the sole method for distinguishing septic from aseptic discitis in the early post-operative stage.

Adult↗

PubMed1996

Fusion rate after posterior lumbar interbody fusion with carbon fiber implant: 1-year follow-up of 51 patients.

Problems associated with posterior lumbar interbody fusion (PLIF) have traditionally included the need for donor bone, prolonged healing time of donor bone, the difficulty of cutting precise bony channels, the risk of retropulsion of graft, postoperative collapse of the bone graft, and pseudarthrosis. To avoid these problems a carbon fiber reinforced polymer implant cage has been developed to facilitate interbody fusion. The aim of the present study was to evaluate the technical problems and fusion rate associated with these new device for PLIF. Between April 1991 and December 1993, 65 pairs of these implant cages were sold in Sweden. They were traced to six hospitals, where they had been used in the treatment of 51 patients operated on at a total of 65 levels. All PLIF were supplemented with VSP (Variable Screw Placement) instrumentation. All medical records were evaluated and all patients were examined with plain radiographs taken at least 1 year after surgery. If that investigation did not show a clear fusion they were also evaluated with CT (18 patients, 27 levels). No intraoperative problems with the device have been reported; 44 patients (86%) and 58 levels (89%) achieved successful fusion. All patients bar one maintained their immediately obtained postoperative disc height. CT with 1-mm slices and sagittal reconstruction is most helpful if radiographs are difficult to interpret.

Adult↗

PubMed1996

Postoperative lumbar MR imaging with contrast enhancement. Comparison between symptomatic and asymptomatic patients.

UNLABELLED: PURPOSE AND MATERIAL: Contrast-enhanced MR imaging of the spine after surgery for lumbar disk herniation almost always shows pathologic changes. To investigate to what extent these changes are correlated to patients' actual clinical symptoms, we compared the postoperative MR findings in 19 asymptomatic patients with 42 symptomatic patients (43 levels). METHODS: The asymptomatic patients underwent MR examination one year after surgery. Twenty-six of the symptomatic patients underwent MR one year or less after surgery, and in 16 patients (17 levels) MR was performed more than one year after surgery. RESULTS: Sixteen percent of the asymptomatic and 42% of the symptomatic patients had disk herniation at the level of previous surgery. Most of the herniated disks were found in the symptomatic patients less than one year after surgery. The amount of epidural scar tissue, displacement and thickening of nerve roots, and compression of the dural sac were also studied. Disk herniation as a probable cause of recurrent sciatica was a common finding among symptomatic patients examined one year or less after surgery. In comparing asymptomatic patients and symptomatic patients with more than one year between surgery and MR examination, no significant radiologic differences, including disk herniation, were found.

Adult↗

PubMed1994

Gadolinium-enhanced magnetic resonance imaging of 36 patients one year after lumbar disc resection.

A prospective study of 36 patients with radicular leg pain and lumbar herniation who underwent single-level disc resection is presented. Clinical follow-up was combined with a gadolinium-DPTA MRI examination, 1 year after surgery. Disc herniation was still present in eight patients and four of these did not have any significant radicular pain. Another 15 patients had a small protrusion at the site of the former herniation. Twenty-three patients showed evidence of scar tissue. The nerve root was displaced in 12 patients and was thickened in 16 patients, respectively. Clinically, 19 patients recovered from leg pain, 14 patients improved, and 3 patients remained unchanged compared with preoperative symptoms. There was no consistent correlation between postoperative back pain or radicular leg pain and MR findings.

Adolescent↗

PubMed1994

Comparison of contrast-enhanced computed tomography and gadolinium-enhanced magnetic resonance imaging one year after lumbar discectomy.

Computed tomography (CT) and magnetic resonance imaging (MRI) with intravenous contrast were performed on a prospective group of 35 consecutive patients 1 year after surgery for disc herniation. The aim of the study was to compare the two methods in the analysis of postoperative changes. Computed tomography showed, compared with MRI, more extensive scar tissue in 12 patients and increased deformation of the dural sac in 5 patients. However, the nerve root was better delineated by MRI, and this facilitated the assessment of root thickening in 13 patients and root displacement, which could not be seen by CT in seven patients. MRI revealed four small protrusions that were not visible with CT. The two methods were found to be of equal value in regard to findings such as disc herniations and foraminal stenosis, which might influence the surgeons decision to perform repeat surgery.

Adolescent↗

PubMed1993

A preoperative and postoperative study of the accuracy and value of electrodiagnosis in patients with lumbosacral disc herniation.

Twenty patients with a radicular syndrome, who underwent surgery for unilevel lumbosacral disc herniations verified by computed tomography were investigated with neurophysiologic tests (electromyograms, F-responses, dermatome somatosensory evoked potentials) preoperatively and 1 year postoperatively. At least one test revealed a pathologic abnormality preoperatively in 13 patients, but in 5 patients only the nerve root level corresponded to computed tomographic findings. Discordance between neurophysiologic and radiologic findings did not predict a surgical success rate. if all neurophysiologic tests were normal the outcome was significantly worse than if any of the tests showed an abnormality (P < 0.01). Four patients who were improved after surgery still had abnormal neurophysiologic findings. In conclusion, neurophysiology is not useful to diagnose the exact level of a nerve root lesion, but may reveal whether it is present. Electrodiagnosis is recommended if radiology and clinical testing conflict. If positive, it may then serve to justify surgical exploration.

Adult↗

PubMed1993

Radiographic changes after lumbar discectomy. Sequential enhanced computed tomography in relation to clinical observations.

Fifty patients, with single-level disc herniations verified by computed tomography, took part in a study where they were randomized to either microsurgery or standard surgery. The aim of the study was to describe the changes on a series of radiographic examinations after disc resection, and to relate these changes to clinical symptoms. The study was prospective and the patients were examined with contrast-enhanced computed tomography during the first postoperative week, after 1-2 months, and after 1 year. At 1 year after surgery 16 patients showed posterior disc protrusion, 47 showed scar tissue, and 13 showed nerve root displacement. Microsurgically operated patients did not show less scar tissue. None of the postoperative radiographic changes had any definite correlation to remaining back pain or leg pain.

Adult↗

PubMed1993

Does microscopic removal of lumbar disc herniation lead to better results than the standard procedure? Results of a one-year randomized study.

Sixty patients with single-level lumbar disc herniation confirmed by computerized tomography were studied in a randomized prospective study. The aim was to see if there was any difference between the microscopic removal of a disc herniation and the standard procedure. All patients were operated on by the same surgeon by either method. They were all followed up by an impartial observer at 3 weeks, 2 months, 6 months, and 1 year. There were no differences between the groups regarding perioperative bleeding, complications, inpatient stay, time off work, or end result. The authors concluded that the decision to use the operating microscope may be left to the surgeon, because it had no effect on the short-term results or those at 1 year.

Adolescent↗

PubMed1989

Cauda equina syndrome with normal lumbar myelography.

The consequences of signs of emergency compression of cauda equina in combination with a normal lumbar myelography are reported in 19 patients. Two of them had a tumor and a herniated disc, respectively, in the thoracic spine discovered by a second myelography. One patient was considered to have a hysterical paresis. In 3 patients the symptoms were attributed to diseases not related to the spine. Thirteen patients recovered spontaneously. We conclude that the prognosis for patients with signs of compression of the cauda equina is favorable provided the myelography is normal; surgical exploration is then not indicated. However, if severe unexplained symptoms persist and computed tomography is normal, myelography of the thoracic spine should be considered.

Acute Disease↗