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Spondylolistes Karin Frennered fusion ingen sexuell dysfunktion (1 patient svarade ej). Inga spontana klagomål från tagstället (Frennered et al 1991). 3-7 % övergående eller bestående LV-påverkan efter op av höggradig spondylolistes (Möller 1999 RCT, Tiusanen et al 1995). Högre frekvens av kärl- (7 %), allmänkirurgiska (40 %) och sexuella komplikationer vid främre approach, transperitonealt (20 %) och retroperitonealt (6 %) (Rajarman et al 1999, Tiusanen e al 1995. Rökning ger lägre fusionsgrad (56 %) jämfört med icke rökare (100 %) (McGuire et al 1993). Prediktiva faktorer för utfall: Prediktiva faktorer för dåligt utfall var arbetsskada (Vaccaro et al 1997, Schnee et al 1997), rökning (Schnee et al 1997), tidigare kirurgi, fusion L4-L5, de som svarade dåligt på den preoperativa korsetten och patienter opererade över 45 år (Schnee et al 1997, Christensen et al 1996). Ekonomi: Inga studier på spondylolistes. Referenser: Bradford DS, Boachie-Adjei O. Treatment of severe spondylolisthesis by anterior and posterior reduction and stabilization. A long term follow-up study, J Bone Joint Surg Am. 1990;72(7):1060-6. Carragee EJ. Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective, randomized study. J Bone Joint Surg Am. 1997;79(8):1175-80. Christiansen FB et al: Radiological and functional outcome after anterior lumbar interbody spinal fusion. Eur Spine J 1996;5(5):293-8. Danielson BI, Frennered AK, IrstamLK: Radiologic progression of isthmic lumbar spondylolisthesis in young patients. Spine 1991;16(4):422-5. Frennered AK, Danielson BI, Nachemson AL. Mid term follow-up of young patients fused in situ for spondylolisthesis. Spine 1991;16(4):409-16. Frennered K. Isthmic spondylolisthesis among patients receiving disability pension under the diagnosis of chronic low back pain syndromes. Spine 1994;19(24):2766-9. Gaines RW, Nichols WK. Treatment of spondyloptosis by two stage L5 vertebrectomy and reduction of L4 onto S1, Spine 1985;10(7):680-6. 8 Harris IE, Weinstein SL. Long term follow-up of patients with grade III and IV spondylolysthesis. Treatment with and without posterior fusion, JBJ Surg Am, 1987;69(7):960-9. McGuire RA, Amundson GM. The use of primary internal fixation in spondylolisthesis. Spine 1993;18(12):1662-72. Muschik M, Zippel H, Perka C. Surgical management of severe spondylolisthesis in Children and adolescents. Anterior fusion in situ versus anterior spondylodesis with posterior transpedicular instrumentation and reduction. Spine 1997;22(17):2036-43. Möller H.:Isthmic Spondylolisthesis in Adults. A Randomized Controlled Trial. Thesis 1999. Poussa M, Schlenzka D, Seitsalo S et al. Surgical treatment of severe isthmic spondylolisthesis in adolescents: Reduction or fusion in situ. Spine 1993;18(7):894-901. Rajaraman V, Vingan R, Roth P et al. Visceral and vascular complications resulting from anterior lumbar interbody fusion. J Neurosurg 1999;91(suppl 1):60-4. Saraste H: Spondylolysis and spondylolisthesis, Thesis, 1984. Schlenzka D, Seitsalo S, Poussa M et al. Operative treatment of symptomatic spondylolysis and mild spondylolisthesis in young patients: direct repair of the defect or segmental spinal fusion. Eur Spine J 1993;2(2):104-12. Schnee CL,Freese A, Ansell LV. Outcome analysis for adults with spondylolisthesis treated with posterolateral fusion and transpedicular screw fixation. J Neurosurg 1997; 86(1):56-63. Seitsalo S, Osterman K, Hyvarinen H et al. Severe spondylolisthesis in children and adolescents. A long term review of fusion in situ. JBJS Br 1990;72(2):259- 65. Seitsalo S Operative and conservative treatment of moderate spondylolisthesis in young patients. JBJS Br 1990;72(5):908-13. Seitsalo S, Osterman K, Hyvarinen H et al. Progression of spondylolisthesis in children and adolescents. A long term follow-up of 272 patients. Spine 1991;16(4):417-21. O´Sullivan PB, Phyty GD, TwomeyLT et al. Evaluation of specific stabilizing exercise in the treament of chronic low back pain with radiologic disgnosis of spondylolysis or spondylolisthesis. Spine 1997;22(24):2959-67. Thomasen E. Intercorporal lumbar spondylodesis. 312 patients followed for 2-20 years. Acta orthop scand 1985;56(4):287-93. Tiusanen H, Seitsalo S, Osterman K et al. Retrograd ejaculation after anterior interbody lumbar fusion. Eur Spine J 1995;4(6):339-42. Vaccaro AR, Ring D, Scuderi G et al. Predictors of outcome in patients with chronic back pain and low-grade spondylolisthesis. Spine 1997;22(17):2030-5.
Scolios Anders Nordwall Prevalens: 2-3 % har scolios >10 gr, (65 % flickor) 0,3 % har scolios >30 gr (90 % flickor). Etiologi: Idiopatisk scolios: Okänd. Övrig skolios: förenad med neurologisk eller muskulär skada eller congenital deformitet. Naturalförlopp: Scolios 25-35 gr progredierande > 6 gr hos 45 % växande individer (Nachemson et al, 1995). Progress 1 gr/år vid scolios >50 gr thoracalt hos vuxna (Weinstein et al, 1981). Idiopatisk skolios: normal livslängd. Hjärtlungkomplikation hos icke-idiopatisk scolios ger förkortat liv (Pehrsson et al, 1992). Försämrad gång- och sittfunktion hos icke idiopatiska scolioser. Ökade ryggsmärtor hos vuxna scolios >50 gr L, Th- L (Kostuik et al 1981, Jackson et al, 1983). Behandlingsindikation: Idiopatisk scolios: Korsettbehandling: Progredierande skolios >25 - 30 gr - ≤40 gr hos växande individ. Operativ behandling: Progredierande skolios hos växande individ >40gr. Uttalad deformitet >50 gr hos vuxen. Icke-idiopatisk scolios: Som ovan samt uttalad imbalans/sittsnedhet hos individer med övriga grava handikapp. Behandlingsmål: Korrigera, stabilisera, balansera ryggen i tre plan. Förhindra progress av deformitet under fortsatta livet. Icke-kirurgisk behandling: Korsett effektiv hos 85 % idiopatisk scolios 25-35 gr för att förhindra progress (Nachemson et al 1995). Kirurgisk behandling: Harrington-metod: Korrigerad scolios 50 % (Cochran et al, 1983, Nordwall, 1973, Humke et al, 1995). Harrington + DTT: Korrigerad scolios 65 %. (Nordwall, 1985) Isola, CD- metod: Korrigerad scolios 57-69 % (Humke et al, 1995, Lenke et al, 1992). Kaneda främre fusionsmetod: Korrigerad scolios 71 % (Kaneda et al, 1997). Korrektionsförlust Harrington: 3,5 gr (11 %) 20 år postoperativt (Nordwall, 1973, Danielsson et al, 2001). Komplikationer: Infektion 1 % (Nordwall, 1973). Neurologisk medulla: 0.6 (Scol Res Soc 1971) (Cervellati et al, 1996). Tromboembolism: < 1% Instrumentdislokation postoperativt: 4 % (Nordwall, 1973). Pseudarthros: 1,9 % (Nordwall, 1973, Lenke et al, 1998, Danielsson et al 2001). Funktion postoperativt: Harrington: 86 % ”good” el ”very good” subj (Danielsson et al, 2000) CD: 95 % ”good” el “very good” subj (Humke et al, 1995,). Arbetsförmåga postoperativt normal hos 95 %. Smärta postoperativt f-u: 10 % (Humke et al, 1995, Danielsson et al, 2000). Cost-effectiveness: Saknas studier Referenser: Ascani E, Bartolozzi P, Logroscino CA et al. Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine 1986;11(8):784-9. Cervellati S, Bettini N, Bianco T et al. Neurological complications in segmental spinal instrumentation: analysis of 750 patients. Eur Spine J 1996;5(3):161-6. Cochran T, Irstam L, Nachemson A. Long-Term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion. Spine 1983;8(6):576-84. Danielsson A, Wiklund I, Pehrsson K et al. Health-Related Quality of Life in patients with adolescent idiopathic scoliosis – a matched follow-up at least twenty years after treatment with brace or surgery. In thesis: Outcome of treatment for scoliosis, Aina Danielsson, Göteborg 2000. Danielsson A, Nachemson A. Radiologic findings and curve progression 22 years after treatment for adolescent idiopathic scoliosis: comparison of brace and surgical treatment with matching control group of straight individuals. Spine. 2001;26(5):516-25. Dickson JH, Mirkovic S, Noble PC et al. Results of operative treatment of idiopathic scoliosis in adults. J Bone Joint Surg Am 1995;77(4):513-23. Humke T, Grob D, Scheier H et al. Cotrel- Dubousset and Harrington Instrumentation in idiopathic scoliosis: a comparison of long-term results. Eur Spine J 1995;4(5):280-3. Jackson RP, Simmons EH, Stripinis D. Incidence and severity of back pain in adult idiopathic scoliosis. Spine 1983;8(7):749-56. Kaneda K, Shono Y, Satoh S et al. Anterior correction of thoracic scoliosis with Kaneda anterior spinal system. A preliminary report. Spine 1997;22(12):1358-68. Kostuik JP, Bentivoglio J. The incidence of lowback pain in adult scoliosis. Spine 1981;6(3):268-73. 9
Page 1 and 2: Ryggsektionen, Ryg sektionen, Ortop
Page 3 and 4: INNEHÅLLSFÖRTECKNING CERVIKAL SPI
Page 5 and 6: metastaspatienter men med en betydl
Page 7: Spondylolistes Karin Frennered Prev
Page 11 and 12: Metastaser i kotpelaren med medull
Page 13 and 14: Lumbala Diskbråck Jan Willén Etio
Page 15 and 16: Lumbal Spinal Stenos Björn Rydevik
Page 17 and 18: Kronisk lumbago Olle Hägg Prevalen
Page 19 and 20: Instabila Cervikala Skador (traumat
Page 21 and 22: Frakturer i bröst- och ländryggen
Page 23: Ryggteamet Avd för Ortopedi Instit

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