Pub Date : 2004-04-01DOI: 10.1080/00016470410001708360
J O Fernberg, K Sundby Hall
The Scandinavian Sarcoma Group (SSG) started its first chemotherapy study in soft tissue sarcoma (STS) in 1981 (SSG I). This study evaluated single agent doxorubicin given adjuvant in a prospective randomized trial in patients with high-grade STS. Neither overall survival nor disease-free survival was improved. Combination chemotherapy was hereafter studied in a phase II study (1991-1994) combining ifosfamide and continuous infusion etoposide with growth factor support (SSG X). The response rate in previously untreated patients was high (42%), but complete remissions were few. Analysis made on patients operated after chemotherapy indicated improved survival in this subgroup. Meta-analyses of adjuvant chemotherapy for localised resectable STS in adults, including the SSG I trial, has indicated improved disease-free survival and a trend towards improved overall survival. Presently, SSG is testing whether such a benefit can be found for adjuvant ifosfamide and doxorubicin treatment given after primary surgery in selected patients with high-grade STS and other well defined unfavourable prognostic factors (SSG XIII).
{"title":"Chemotherapy in soft tissue sarcoma. The Scandinavian Sarcoma Group experience.","authors":"J O Fernberg, K Sundby Hall","doi":"10.1080/00016470410001708360","DOIUrl":"https://doi.org/10.1080/00016470410001708360","url":null,"abstract":"<p><p>The Scandinavian Sarcoma Group (SSG) started its first chemotherapy study in soft tissue sarcoma (STS) in 1981 (SSG I). This study evaluated single agent doxorubicin given adjuvant in a prospective randomized trial in patients with high-grade STS. Neither overall survival nor disease-free survival was improved. Combination chemotherapy was hereafter studied in a phase II study (1991-1994) combining ifosfamide and continuous infusion etoposide with growth factor support (SSG X). The response rate in previously untreated patients was high (42%), but complete remissions were few. Analysis made on patients operated after chemotherapy indicated improved survival in this subgroup. Meta-analyses of adjuvant chemotherapy for localised resectable STS in adults, including the SSG I trial, has indicated improved disease-free survival and a trend towards improved overall survival. Presently, SSG is testing whether such a benefit can be found for adjuvant ifosfamide and doxorubicin treatment given after primary surgery in selected patients with high-grade STS and other well defined unfavourable prognostic factors (SSG XIII).</p>","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":"75 311","pages":"77-86"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001708360","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24559787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2004-04-01DOI: 10.1080/00016470410001708250
T A Alvegård, H Bauer, C Blomqvist, A Rydholm, S Smeland
� � � � � � � � � � � � � � � � Musculoskeletal sarcomas call for multidisciplinary management by a “tumor team” of specialized orthopedic surgeons, radiologists, pathologists, tumor biologists (e.g. molecular and cytogenetics, DNA cytometry), cytologists, radiotherapists, and oncologists (Figure 1). Only a few such teams existed in Scandinavia during the 1970s. With the inception of the Scandinavian Sarcoma Group (SSG) in 1979, several new teams were started, each with regional responsibility for centralized treatment of sarcoma patients. Together, Denmark, Finland, Iceland, Norway and Sweden have a population of 25 million. These countries have similar social structures, with modern medical services covering all inhabitants and an effective registration of all cancer patients. The similarity of the
{"title":"The Scandinavian Sarcoma Group--background, organization and the SSG Register--the first 25 years.","authors":"T A Alvegård, H Bauer, C Blomqvist, A Rydholm, S Smeland","doi":"10.1080/00016470410001708250","DOIUrl":"https://doi.org/10.1080/00016470410001708250","url":null,"abstract":"� � � � � � � � � � � � � � � � Musculoskeletal sarcomas call for multidisciplinary management by a “tumor team” of specialized orthopedic surgeons, radiologists, pathologists, tumor biologists (e.g. molecular and cytogenetics, DNA cytometry), cytologists, radiotherapists, and oncologists (Figure 1). Only a few such teams existed in Scandinavia during the 1970s. With the inception of the Scandinavian Sarcoma Group (SSG) in 1979, several new teams were started, each with regional responsibility for centralized treatment of sarcoma patients. Together, Denmark, Finland, Iceland, Norway and Sweden have a population of 25 million. These countries have similar social structures, with modern medical services covering all inhabitants and an effective registration of all cancer patients. The similarity of the","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":"75 311","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001708250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24557089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2004-04-01DOI: 10.1080/00016470410001708350
T Böhling, P Bacchini, F Bertoni, B Bjerkehagen, H Domanski, L G Kindblom, J Meis-Kindblom, J Wejde
Both osteosarcoma and Ewingʼs sarcoma are highly malignant tumors, usually affecting children and adolescents. Before chemotherapy was introduced in the treatment of these tumors the prognosis was poor, but by intensified pre- and postoperative chemotherapy regimens the prognosis has improved dramatically. It soon became obvious that the tumor response to preoperative chemotherapy also served as a prognostic marker and today the postoperative chemotherapy treatment modality is based on the response rate. Those with a good tumor response receive a less intensive postoperative treatment than those whose tumor response has been poor (Picci 1997 et al., Bacci 2000 et al.). The Scandinavian sarcoma group (SSG), has since 25 years carried out several studies on both osteosarcoma and Ewingʼs sarcoma, some of them in collaboration with the Italian sarcoma group (ISG). The protocols for osteosarcoma SSG II, SSG VIII, ISG/SSG I, ISG/SSG II and SSG XIV, as well as the protocols for Ewingʼs sarcoma SSG IV, SSG IX, ISG/SSG III and ISG/SSG IV are described elsewhere (http://www.ssg-org.net/). In these protocols different methods of assessing the chemotherapy response have been used. Here, we will present and discuss the different methods.
{"title":"Diagnosis and tumor response in osteosarcoma and Ewing's sarcoma.","authors":"T Böhling, P Bacchini, F Bertoni, B Bjerkehagen, H Domanski, L G Kindblom, J Meis-Kindblom, J Wejde","doi":"10.1080/00016470410001708350","DOIUrl":"https://doi.org/10.1080/00016470410001708350","url":null,"abstract":"Both osteosarcoma and Ewingʼs sarcoma are highly malignant tumors, usually affecting children and adolescents. Before chemotherapy was introduced in the treatment of these tumors the prognosis was poor, but by intensified pre- and postoperative chemotherapy regimens the prognosis has improved dramatically. It soon became obvious that the tumor response to preoperative chemotherapy also served as a prognostic marker and today the postoperative chemotherapy treatment modality is based on the response rate. Those with a good tumor response receive a less intensive postoperative treatment than those whose tumor response has been poor (Picci 1997 et al., Bacci 2000 et al.). The Scandinavian sarcoma group (SSG), has since 25 years carried out several studies on both osteosarcoma and Ewingʼs sarcoma, some of them in collaboration with the Italian sarcoma group (ISG). The protocols for osteosarcoma SSG II, SSG VIII, ISG/SSG I, ISG/SSG II and SSG XIV, as well as the protocols for Ewingʼs sarcoma SSG IV, SSG IX, ISG/SSG III and ISG/SSG IV are described elsewhere (http://www.ssg-org.net/). In these protocols different methods of assessing the chemotherapy response have been used. Here, we will present and discuss the different methods.","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":"75 311","pages":"72-6"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001708350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24559786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2004-04-01DOI: 10.1080/00016470410001708320
V Söderlund
Most patients with symptoms from the locomotor system undergo radiological examination, among which a minority is found to have a lesion arousing the suspicion of neoplasia. The diagnosis of primary bone tumors is generally perceived as difficult. A main reason is the low incidence making it difficult to gain wide diagnostic experience. Basically, this can only be attained at referral centers. However, even for specialists the diagnosis of bone lesions may pose considerable difficulties because of highly variable macroand microfeatures (Figure 1). Hence, it is important to collect data from different diagnostic modalities while considering also age, clinical history and clinical findings. Most importantly, the diagnostic approach should entail both a macroand a microcharacterization. Over the last years, core needle biopsy and fine needle aspiration have gradually gained acceptance as a diagnostic alternative to open biopsy to circumvent associated inconveniences and risks (Hajdu 1971, Tehranzadeh et al. 1983, El-Khoury Combined radiology and cytology in the diagnosis of bone lesions—a review of 399 cases
{"title":"Combined radiology and cytology in the diagnosis of bone lesions--a review of 399 cases.","authors":"V Söderlund","doi":"10.1080/00016470410001708320","DOIUrl":"https://doi.org/10.1080/00016470410001708320","url":null,"abstract":"Most patients with symptoms from the locomotor system undergo radiological examination, among which a minority is found to have a lesion arousing the suspicion of neoplasia. The diagnosis of primary bone tumors is generally perceived as difficult. A main reason is the low incidence making it difficult to gain wide diagnostic experience. Basically, this can only be attained at referral centers. However, even for specialists the diagnosis of bone lesions may pose considerable difficulties because of highly variable macroand microfeatures (Figure 1). Hence, it is important to collect data from different diagnostic modalities while considering also age, clinical history and clinical findings. Most importantly, the diagnostic approach should entail both a macroand a microcharacterization. Over the last years, core needle biopsy and fine needle aspiration have gradually gained acceptance as a diagnostic alternative to open biopsy to circumvent associated inconveniences and risks (Hajdu 1971, Tehranzadeh et al. 1983, El-Khoury Combined radiology and cytology in the diagnosis of bone lesions—a review of 399 cases","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":"75 311","pages":"51-6"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001708320","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24559781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2004-04-01DOI: 10.1080/00016470410001708380
S Smeland, T Wiebe, T Böhling, O Brosjö, K Jonsson, T A Alvegård
During the past 15 years the Scandinavian Sarcoma Group has treated 140 patients with Ewing's sarcoma. Two protocols have been used. SSG IV included 52 patients between 1984 and 1990 and SSG IX, 88 patients since 1990. After 5 years of treatment, local recurrences occurred in 19% of the patients (M0 + M1) in the SSG IV group and 10% in the SSG IX group. Distant metastases developed in 57% of the M0-patients in the SSG IV group and in 33% in the SSG IX group. Tumor-related survival (overall) of M0-patients was 49% in SSG IV and 70% in SSG IX, and the metastasis-free survival rate 45% and 58%, respectively. Patients having a localized extremity tumor had a survival rate of 90% (SSG IX). In both treatment groups, good responders to chemotherapy had a better survival rate than poor ones (SSG IV, p < 0.02, GI-II vs. G II-IV and SSG IX, p < 0.003, GI-III vs. G IV). In conclusions local control and survival rates were better with SSG IX than SSG IV.
{"title":"Chemotherapy in osteosarcoma. The Scandinavian Sarcoma Group experience.","authors":"S Smeland, T Wiebe, T Böhling, O Brosjö, K Jonsson, T A Alvegård","doi":"10.1080/00016470410001708380","DOIUrl":"https://doi.org/10.1080/00016470410001708380","url":null,"abstract":"During the past 15 years the Scandinavian Sarcoma Group has treated 140 patients with Ewing's sarcoma. Two protocols have been used. SSG IV included 52 patients between 1984 and 1990 and SSG IX, 88 patients since 1990. After 5 years of treatment, local recurrences occurred in 19% of the patients (M0 + M1) in the SSG IV group and 10% in the SSG IX group. Distant metastases developed in 57% of the M0-patients in the SSG IV group and in 33% in the SSG IX group. Tumor-related survival (overall) of M0-patients was 49% in SSG IV and 70% in SSG IX, and the metastasis-free survival rate 45% and 58%, respectively. Patients having a localized extremity tumor had a survival rate of 90% (SSG IX). In both treatment groups, good responders to chemotherapy had a better survival rate than poor ones (SSG IV, p < 0.02, GI-II vs. G II-IV and SSG IX, p < 0.003, GI-III vs. G IV). In conclusions local control and survival rates were better with SSG IX than SSG IV.","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":"75 311","pages":"92-8"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001708380","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24558564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2004-04-01DOI: 10.1080/00016470410001708340
H Joensuu, L G Kindblom
Gastrointestinal stromal tumors (GISTs) may be defined as intraabdominal nonepithelial (mesenchymal) tumors that express the KIT protein or have an activating mutation in a class III receptor tyrosine kinase gene (KIT or PDGFRA). GISTs are diagnosed at a frequency of about 15 new cases annually per million, though small indolent GISTs are likely to occur more frequently in the general population. The clinical behavior is variable, and assessment of the malignancy potential is usually based mainly on the size and the proliferation characteristics of the tumor. The overwhelming majority of GISTs express the KIT protein, the transmembrane receptor tyrosine kinase for the stem cell factor. The majority of GISTs harbor a mutation in the KIT proto-oncogene that translates into constitutively activated KIT protein kinase, and a minority have mutated PDGFRA gene resulting in activated platelet-derived growth factor alpha receptor tyrosine kinase. Most GISTs respond to imatinib mesylate, which selectively inhibits both KIT and PDGFRA, and is now considered as the standard systemic therapy for advanced GIST. In contrast, responses to conventional chemotherapy are infrequent (generally less than 10%), but combination therapies with imatinib have not been explored. Research on adjuvant imatinib and novel targeted therapies is ongoing.
{"title":"Gastrointestinal stromal tumors--a review.","authors":"H Joensuu, L G Kindblom","doi":"10.1080/00016470410001708340","DOIUrl":"https://doi.org/10.1080/00016470410001708340","url":null,"abstract":"<p><p>Gastrointestinal stromal tumors (GISTs) may be defined as intraabdominal nonepithelial (mesenchymal) tumors that express the KIT protein or have an activating mutation in a class III receptor tyrosine kinase gene (KIT or PDGFRA). GISTs are diagnosed at a frequency of about 15 new cases annually per million, though small indolent GISTs are likely to occur more frequently in the general population. The clinical behavior is variable, and assessment of the malignancy potential is usually based mainly on the size and the proliferation characteristics of the tumor. The overwhelming majority of GISTs express the KIT protein, the transmembrane receptor tyrosine kinase for the stem cell factor. The majority of GISTs harbor a mutation in the KIT proto-oncogene that translates into constitutively activated KIT protein kinase, and a minority have mutated PDGFRA gene resulting in activated platelet-derived growth factor alpha receptor tyrosine kinase. Most GISTs respond to imatinib mesylate, which selectively inhibits both KIT and PDGFRA, and is now considered as the standard systemic therapy for advanced GIST. In contrast, responses to conventional chemotherapy are infrequent (generally less than 10%), but combination therapies with imatinib have not been explored. Research on adjuvant imatinib and novel targeted therapies is ongoing.</p>","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":"75 311","pages":"62-71"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001708340","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24559785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2004-04-01DOI: 10.1080/00016470410001708280
H Olsson
17 Incidence Soft tisssue sarcoma (SST) represents a heterogenous group of tumor diseases orginating from connective tissue accounting for less than 1 % of all malignant tumors in Sweden. With increasing age there is an increase in incidence (National Board of Health). Comprehensive reviews of the epidemiology of soft tissue sarcoma have previously been published (Tucker et al. 1982, Zahm and Fraumeni 1997 and Olsson 1999). The heterogenity of sarcoma types and the rarity of cases have hampered etiologically oriented studies. When excluding Kaposi sarcoma the incidence of other soft tissue sarcomas have not dramatically increased in developed western countries. Becasue of the inherent difficulty in classifying SST inter national variations and geographic patterns have not been evaluated in a meaningful way. Risk factors of SST are thus only partly known. Risk factors include a family history of cancer/ soft tissue sarcoma, certain genetic syndromes, exposure to ionizing irradiation, and exposure to certain chemicals such as vinyl chloride. Other factors associated with SST development include longstanding lymphedema, exposure to Thorotrast, arsenical pesticides and medications, herbicides, immunosuppressive drugs, alkylating agents, androgen-anabolic steroids, human immunodefi ciency virus, and exposure to human herpes virus type 8 (Zahm and Fraumeni 1997 and Olsson 1999). Further a tissue trauma has been discussed as a possible risk factor. Studies from our own group has suggested that oral contraceptive use is partly protective for STS in women (Olsson et al.
{"title":"An updated review of the epidemiology of soft tissue sarcoma.","authors":"H Olsson","doi":"10.1080/00016470410001708280","DOIUrl":"https://doi.org/10.1080/00016470410001708280","url":null,"abstract":"17 Incidence Soft tisssue sarcoma (SST) represents a heterogenous group of tumor diseases orginating from connective tissue accounting for less than 1 % of all malignant tumors in Sweden. With increasing age there is an increase in incidence (National Board of Health). Comprehensive reviews of the epidemiology of soft tissue sarcoma have previously been published (Tucker et al. 1982, Zahm and Fraumeni 1997 and Olsson 1999). The heterogenity of sarcoma types and the rarity of cases have hampered etiologically oriented studies. When excluding Kaposi sarcoma the incidence of other soft tissue sarcomas have not dramatically increased in developed western countries. Becasue of the inherent difficulty in classifying SST inter national variations and geographic patterns have not been evaluated in a meaningful way. Risk factors of SST are thus only partly known. Risk factors include a family history of cancer/ soft tissue sarcoma, certain genetic syndromes, exposure to ionizing irradiation, and exposure to certain chemicals such as vinyl chloride. Other factors associated with SST development include longstanding lymphedema, exposure to Thorotrast, arsenical pesticides and medications, herbicides, immunosuppressive drugs, alkylating agents, androgen-anabolic steroids, human immunodefi ciency virus, and exposure to human herpes virus type 8 (Zahm and Fraumeni 1997 and Olsson 1999). Further a tissue trauma has been discussed as a possible risk factor. Studies from our own group has suggested that oral contraceptive use is partly protective for STS in women (Olsson et al.","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":"75 311","pages":"16-20"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001708280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24558144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2004-04-01DOI: 10.1080/00016470410001708370
S Smeland, T Wiebe, O Brosjö, T Böhling, T A Alvegård
{"title":"Chemotherapy in Ewing's sarcoma. The Scandinavian Sarcoma Group experience.","authors":"S Smeland, T Wiebe, O Brosjö, T Böhling, T A Alvegård","doi":"10.1080/00016470410001708370","DOIUrl":"https://doi.org/10.1080/00016470410001708370","url":null,"abstract":"","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":"75 311","pages":"87-91"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001708370","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24558563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2004-01-01DOI: 10.1080/03008820410002057
F. Christensen
UNLABELLED Chronic low back pain (CLBP) has become one of the most common causes of disability in adults under 45 years of age and is consequently one of the most common reasons for early retirement in industrialised societies. Accordingly, CLBP represents an expensive drain on society's resources and is a very challenging area for which a consensus for rational therapy is yet to be established. The spinal fusion procedure was introduced as a treatment option for CLBP more than 70 years ago. However, few areas of spinal surgery have caused so much controversy as spinal fusion. The literature reveals divergent opinions about when fusion is indicated and how it should be performed. Furthermore, the significance of the role of postoperative rehabilitation following spinal fusion may be underestimated. There exists no consensus on the design of a program specific for rehabilitation. Ideally, for any given surgical procedure, it should be possible to identify not only possible complications relative to a surgical procedure, but also what symptoms may be expected, and what pain behaviour may be expected of a particular patient. The overall aims of the current studies were: 1) to introduce patient-based functional outcome evaluation into spinal fusion treatment; 2) to evaluate radiological assessment of different spinal fusion procedures; 3) to investigate the effect of titanium versus stainless steel pedicle screws on mechanical fixation and bone ingrowth in lumbar spinal fusion; 4) to analyse the clinical and radiological outcome of different lumbar spinal fusion techniques; 5) to evaluate complications and re-operation rates following different surgical procedures; and 6) to analyse the effect of different rehabilitation strategies for lumbar spinal fusion patients. The present thesis comprises 9 studies: 2 clinical retrospective studies, 1 clinical prospective case/reference study, 5 clinical randomised prospective studies and 1 animal study (Mini-pigs). In total, 594 patients were included in the investigation from 1979 to 1999. Each had prior to inclusion at least 2 years of CLBP and had therefore been subjected to most of the conservative treatment leg pain, due to localized isthmic spondylolisthesis grades I-II or primary or secondary degeneration. PATIENT-BASED FUNCTIONAL OUTCOME: Patients' self-reported parameters should include the impact of CLBP on daily activity, work and leisure time activities, anxiety/depression, social interests and intensity of back and leg pain. Between 1993 and 2003 approximately 1400 lumbar spinal fusion patients completed the Dallas Pain Questionnaire under prospective design studies. In 1996, the Low Back Pain Rating scale was added to the standard questionnaire packet distributed among spinal fusion patients. In our experience, these tools are valid instruments for clinical assessment of candidates for spinal fusion procedures. RADIOLOGICAL ASSESSMENT It is extremely difficult to interpret radiographs of both l
{"title":"Lumbar spinal fusion. Outcome in relation to surgical methods, choice of implant and postoperative rehabilitation.","authors":"F. Christensen","doi":"10.1080/03008820410002057","DOIUrl":"https://doi.org/10.1080/03008820410002057","url":null,"abstract":"UNLABELLED Chronic low back pain (CLBP) has become one of the most common causes of disability in adults under 45 years of age and is consequently one of the most common reasons for early retirement in industrialised societies. Accordingly, CLBP represents an expensive drain on society's resources and is a very challenging area for which a consensus for rational therapy is yet to be established. The spinal fusion procedure was introduced as a treatment option for CLBP more than 70 years ago. However, few areas of spinal surgery have caused so much controversy as spinal fusion. The literature reveals divergent opinions about when fusion is indicated and how it should be performed. Furthermore, the significance of the role of postoperative rehabilitation following spinal fusion may be underestimated. There exists no consensus on the design of a program specific for rehabilitation. Ideally, for any given surgical procedure, it should be possible to identify not only possible complications relative to a surgical procedure, but also what symptoms may be expected, and what pain behaviour may be expected of a particular patient. The overall aims of the current studies were: 1) to introduce patient-based functional outcome evaluation into spinal fusion treatment; 2) to evaluate radiological assessment of different spinal fusion procedures; 3) to investigate the effect of titanium versus stainless steel pedicle screws on mechanical fixation and bone ingrowth in lumbar spinal fusion; 4) to analyse the clinical and radiological outcome of different lumbar spinal fusion techniques; 5) to evaluate complications and re-operation rates following different surgical procedures; and 6) to analyse the effect of different rehabilitation strategies for lumbar spinal fusion patients. The present thesis comprises 9 studies: 2 clinical retrospective studies, 1 clinical prospective case/reference study, 5 clinical randomised prospective studies and 1 animal study (Mini-pigs). In total, 594 patients were included in the investigation from 1979 to 1999. Each had prior to inclusion at least 2 years of CLBP and had therefore been subjected to most of the conservative treatment leg pain, due to localized isthmic spondylolisthesis grades I-II or primary or secondary degeneration. PATIENT-BASED FUNCTIONAL OUTCOME: Patients' self-reported parameters should include the impact of CLBP on daily activity, work and leisure time activities, anxiety/depression, social interests and intensity of back and leg pain. Between 1993 and 2003 approximately 1400 lumbar spinal fusion patients completed the Dallas Pain Questionnaire under prospective design studies. In 1996, the Low Back Pain Rating scale was added to the standard questionnaire packet distributed among spinal fusion patients. In our experience, these tools are valid instruments for clinical assessment of candidates for spinal fusion procedures. RADIOLOGICAL ASSESSMENT It is extremely difficult to interpret radiographs of both l","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":"75 313 1","pages":"2-43"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"59830954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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