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Alhaug OK, Dolatowski FC, Kaur S, Lønne G. Postoperative complications after surgery for lumbar spinal stenosis, assessment using two different data sources. Acta Neurochir (Wien) 2024; 166:189. [PMID: 38653826 DOI: 10.1007/s00701-024-06086-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/03/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Lumbar spinal stenosis (LSS) is a prevalent disorder, and surgery for LSS is a common procedure. Postoperative complications occur after any surgery and impose costs for society and costs and additional morbidity for patients. Since complications are relatively rare, medical registries of large populations may provide valuable knowledge. However, recording of complications in registries can be incomplete. To better estimate the true prevalence of complications after LSS surgery, we reviewed two different sources of data and recorded complications for a sample of Norwegian LSS patients. METHODS 474 patients treated surgically for LSS during 2015 and 2016 at four hospitals reported to a national spine registry (NORspine). Postoperative complications were recorded by patients in NORspine, and we cross-referenced complications documented in NORspine with the patients´ electronic patient records (EPR) to re-test the complication rates. We performed descriptive statistics of complication rates using the two different data sources above, and analyzed the association between postoperative complications and clinical outcome with logistic regression. RESULTS The mean (95%CI) patient age was 66.3 (65.3-67.2) years, and 254 (53.6%) were females. All patients were treated with decompression, and 51 (10.7%) received an additional fusion during the index surgery. Combining the two data sources, we found a total rate for postoperative complications of 22.4%, the NORspine registry reported a complication rate of 15.6%, and the EPR review resulted in a complication rate of 16.0%. However, the types of complications were inconsistent across the two data sources. According to NORspine, the frequency of reoperation within 90 days was 0.9% and according to EPR 3.4%. The rates of wound infection were for NORspine 3.1% and EPR review 2.1%. There was no association between postoperative complication and patient reported outcome. CONCLUSION Postoperative complications occurred in 22% of LSS patients. The frequency of different postoperative complications differed between the two data sources.
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Affiliation(s)
- Ole Kristian Alhaug
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, PO Box 68, N-2313, Ottestad, Norway.
- Orthopaedic Department, Akershus University Hospital, PO Box 1000, N-1478, Loerenskog, Norway.
| | - Filip C Dolatowski
- Orthopaedic Department, Oslo University Hospital, PO Box 4956, N-0424, Oslo, Norway
| | - Simran Kaur
- Orthopedic Department, Martina Hansens Hospital, Dønskiveien 8, 1346, Gjettum, Norway
| | - Greger Lønne
- Innlandet Hospital Trust, PO Box 104, N-2381, Brumunddal, Norway
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Alhaug OK. Response to a letter to the editor regarding "predictors for failure after surgery for lumbar spinal stenosis: a prospective observational study". Spine J 2024; 24:558-559. [PMID: 38365327 DOI: 10.1016/j.spinee.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 02/18/2024]
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Alhaug OK, Dolatowski FC, Thyrhaug AM, Mjønes S, Dos Reis JABPR, Austevoll I. Long-term comparison of anterior (ALIF) versus transforaminal (TLIF) lumbar interbody fusion: a propensity score-matched register-based study. Eur Spine J 2024; 33:1109-1119. [PMID: 38078979 DOI: 10.1007/s00586-023-08060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/27/2023] [Accepted: 11/19/2023] [Indexed: 03/19/2024]
Abstract
PURPOSE Anterior (ALIF) and transforaminal (TLIF) lumbar interbody fusion have shown similar clinical outcomes at short- and medium-term follow-ups. Possible advantages of ALIF in the long run could be better disc height and lumbar lordosis and reduced risk of adjacent segment disease. We aimed to study if ALIF could be associated with superior clinical outcomes than TLIF at long-term follow-up. METHODS We analysed 535 patients treated with ALIF or TLIF of the L5-S1 spinal segment between 2007 and 2017 who completed long-term follow-up in a national spine registry database (NORspine). We defined treatment success after surgery as at least 30% improvement in Oswestry Disability Index (ODI) at long-term follow-up. Patients treated with ALIF and TLIF and who responded at long term were balanced by propensity score matching. The proportions of successfully treated patients within each group were compared by numbers and percentages with corresponding relative risk. RESULTS The mean (95%CI) age of the total study population was 50 (49-51) years, and 264 (49%) were females. The mean (95%CI) preoperative ODI score was 40 (39-42), and 174 (33%) had previous spine surgery. Propensity score matching left 120 patients in each treatment group. At a median (95%CI) of 92 (88-97) months after surgery, we found no difference in proportions successfully treated patients with ALIF versus TLIF (68 (58%) versus 77 (65%), RR (95%CI) = 0.88 (0.72 to1.08); p = 0.237). CONCLUSIONS This propensity score-matched national spine register study of patients treated with ALIF versus TLIF of the lumbosacral junction found no differences in proportions of successfully treated patients at long-term follow-up. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
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Affiliation(s)
- Ole Kristian Alhaug
- The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, PO Box 68, 2313, Ottestad, Norway.
- Norwegian University of Science and Technology, NTNU, PO Box 191, 7491, Trondheim, Norway.
- Orthopaedic Department, Akershus University Hospital, PO Box 1000, 1478, Loerenskog, Norway.
| | - Filip C Dolatowski
- Orthopaedic Department, Oslo University Hospital, PO Box 4956, 0424, Oslo, Norway
| | | | - Sverre Mjønes
- Orthopaedic Department, Akershus University Hospital, PO Box 1000, 1478, Loerenskog, Norway
| | | | - Ivar Austevoll
- Orthopaedic Department, Kysthospitalet in Hagavik, Haukeland University Hospital, 5217, Hagevik, Bergen, Norway
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Alhaug OK, Dolatowski FC, Lønne G. Response to letter to the editor regarding "Predictors for failure after surgery for lumbar spinal stenosis: a prospective observational study". Spine J 2023; 23:1944. [PMID: 38007252 DOI: 10.1016/j.spinee.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/06/2023] [Accepted: 08/12/2023] [Indexed: 11/27/2023]
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Kaur S, Alhaug OK, Dolatowski FC, Solberg TK, Lønne G. Characteristics and outcomes of patients who did not respond to a national spine surgery registry. BMC Musculoskelet Disord 2023; 24:164. [PMID: 36871007 PMCID: PMC9985292 DOI: 10.1186/s12891-023-06267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Loss to follow-up may bias outcome assessments in medical registries. This cohort study aimed to analyze and compare patients who failed to respond with those that responded to the Norwegian Registry for Spine Surgery (NORspine). METHODS We analyzed a cohort of 474 consecutive patients operated for lumbar spinal stenosis at four public hospitals in Norway during a two-year period. These patients reported sociodemographic data, preoperative symptoms, and Oswestry Disability Index (ODI), numerical rating scales (NRS) for back and leg pain to NORspine at baseline and 12 months postoperatively. We contacted all patients who did not respond to NORspine after 12 months. Those who responded were termed responsive non-respondents and compared to 12 months respondents. RESULTS One hundred forty (30%) did not respond to NORspine 12 months after surgery and 123 were available for additional follow-up. Sixty-four of the 123 non-respondents (52%) responded to a cross-sectional survey done at a median of 50 (36-64) months after surgery. At baseline, non-respondents were younger 63 (SD 11.7) vs. 68 (SD 9.9) years (mean difference (95% CI) 4.7 years (2.6 to 6.7); p = < 0.001) and more frequently smokers 41 (30%) vs. 70 (21%) RR (95%CI) = 1.40 (1.01 to 1.95); p = 0.044. There were no other relevant differences in other sociodemographic variables or preoperative symptoms. We found no differences in the effect of surgery on non-respondents vs. respondents (ODI (SD) = 28.2 (19.9) vs. 25.2 (18.9), MD (95%CI) = 3.0 ( -2.1 to 8.1); p = 0.250). CONCLUSION We found that 30% of patients did not respond to NORspine at 12 months after spine surgery. Non-respondents were somewhat younger and smoked more frequently than respondents; however, there were no differences in patient-reported outcome measures. Our findings suggest that attrition bias in NORspine was random and due to non-modifiable factors.
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Affiliation(s)
- Simran Kaur
- Department of Orthopedic Surgery, Martina Hansens Hospital, Sandvika, Norway.
| | - Ole Kristian Alhaug
- Innlandet Hospital Trust, Brumunddal, Norway.,Akershus University Hospital, Nordbyhagen, Norway.,Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Tore K Solberg
- Department of Neurosurgery & Norwegian Registry for Spine surgery, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, The Arctic University of Norway (UiT), Tromsø, Norway
| | - Greger Lønne
- Innlandet Hospital Trust, Brumunddal, Norway.,Norwegian University of Science and Technology, Trondheim, Norway
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Alhaug OK, Dolatowski F, Austevoll I, Mjønes S, Lønne G. Incidental dural tears associated with worse clinical outcomes in patients operated for lumbar spinal stenosis. Acta Neurochir (Wien) 2023; 165:99-106. [PMID: 36399189 PMCID: PMC9840573 DOI: 10.1007/s00701-022-05421-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Incidental dural (ID) tear is a common complication of spine surgery with a prevalence of 4-10%. The association between ID and clinical outcome is uncertain. Former studies found only minor differences in Oswestry Disability Index (ODI). We aimed to examine the association of ID with treatment failure after surgery for lumbar spinal stenosis (LSS). METHODS Between 2007 and 2017, 11,873 LSS patients reported to the national Norwegian spine registry (NORspine), and 8,919 (75.1%) completed the 12-month follow-up. We used multivariate logistic regression to study the association between ID and failure after surgery, defined as no effect or any degrees of worsening; we also compared mean ODI between those who suffered a perioperative ID and those who did not. RESULTS The mean (95% CI) age was 66.6 (66.4-66.9) years, and 52% were females. The mean (95% CI) preoperative ODI score (95% CI) was 39.8 (39.4-40.1); all patients were operated on with decompression, and 1125 (12.6%) had an additional fusion procedure. The prevalence of ID was 4.9% (439/8919), and the prevalence of failure was 20.6% (1829/8919). Unadjusted odds ratio (OR) (95% CI) for failure for ID was 1.51 (1.22-1.88); p < 0.001, adjusted OR (95% CI) was 1.44 (1.11-1.86); p = 0.002. Mean postoperative ODI 12 months after surgery was 27.9 for ID vs. 23.6 for no ID. CONCLUSION We demonstrated a significant association between ID and increased odds for patient-reported failure 12 months after surgery. However, the magnitude of the detrimental effect of ID on the clinical outcome was small.
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Affiliation(s)
- Ole Kristian Alhaug
- Innlandet Hospital Trust, Brumunddal, Norway.
- Akershus University Hospital, Nordbyhagen, Norway.
- Norwegian University of Science and Technology, Trondheim, Norway.
| | - Filip Dolatowski
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | | | - Greger Lønne
- Innlandet Hospital Trust, Brumunddal, Norway
- Norwegian University of Science and Technology, Trondheim, Norway
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Alhaug OK, Dolatowski FC, Solberg TK, Lønne G. Criteria for failure and worsening after surgery for lumbar spinal stenosis: a prospective national spine registry observational study. Spine J 2021; 21:1489-1496. [PMID: 33848690 DOI: 10.1016/j.spinee.2021.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/25/2021] [Accepted: 04/06/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Criteria for success after surgical treatment of lumbar spinal stenosis (LSS) have been defined previously; however, there are no clear criteria for failure and worsening after surgery as assessed by patient-reported outcome measures (PROMs). PURPOSE We aimed to quantify changes in standard PROMs that most accurately identified failure and worsening after surgery for LSS. STUDY DESIGN /SETTING Retrospective analysis of prospective national spine registry data with 12-months follow-up. PATIENT SAMPLE We analyzed 10,822 patients aged 50 years and older operated in Norway during a decade, and 8,258 (76%) responded 12 months after surgery. OUTCOME MEASURES (PROMS) We calculated final scores, absolute changes, and percentage changes for Oswestry Disability Index (ODI), Numeric Rating Scale (NRS) for back and leg pain (0-10), and EuroQol-5D (EQ-5D). These 12 PROM derivates were compared to the Global Perceived Effect (GPE), a 7-point Likert scale. METHODS We used ODI, NRS back and leg pain, and EQ-5D 12 months after surgery to identify patients with failure (no effect) and worsening (clinical deterioration). The corresponding GPE at 12-months was graded as failure (GPE=4-7) and worsening (GPE=6-7) and used as an external criterion. To quantify the most accurate cut-off values corresponding to failure and worsening, we calculated areas under the curves (AUCs) of receiver operating characteristics (ROC) curves for the respective PROM derivates. RESULTS Mean (95% CI) age was 68.3 (68.1 - 68.5) years, and 52% were females. There were 1,683 (20%) failures, and 476 (6%) patients were worse after surgery. The mean (95% CI) pre- and postoperative ODIs were 39.8 (39.5 - 40.2) and 23.7 (23.3 - 24.1), respectively. At 12 months, the mean difference (95% CI) in ODI was 16.1 (15.7 - 16.4), and the mean (95% CI) percentage improvement 38.8% (37.8 - 38.8). The PROM derivates identified failure and worsening accurately (AUC>0.80), except for the absolute change in EQ-5D. The ODI derivates were most accurate to identify both failure and worsening. We found that less than 20% improvement in ODI most accurately identified failure (AUC=0.89 [95% CI: 0.88 to 0.90]), and an ODI final score of 39 points or more most accurately identified worsening (AUC =0.91 [95% CI: 0.90 - 0.92]). CONCLUSIONS In this national register study, ODI derivates were most accurate to identify both failure and worsening after surgery for degenerative lumbar spinal stenosis. We recommend use of ODI percentage change and ODI final score for further studies of failure and worsening in elective spine surgery.
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Affiliation(s)
- Ole Kristian Alhaug
- Innlandet Hospital Trust, The Research Center for Age-Related Functional Decline and Disease, PO Box 68, N-2313, Ottestad, Norway; Orthopedic department, Akershus University Hospital, PO Box 1000, N-1478, Loerenskog, Norway; Norwegian University of Science and Technology, NTNU PO Box 191, N-7491 Trondheim, Norway.
| | - Filip C Dolatowski
- Orthopedic department, Oslo University Hospital, PO Box 4956, N-0424, Oslo, Norway
| | - Tore K Solberg
- Neurosurgical department, University hospital of North Norway, N-9038, Tromsoe, Norway
| | - Greger Lønne
- Innlandet Hospital Trust, The Research Center for Age-Related Functional Decline and Disease, PO Box 68, N-2313, Ottestad, Norway
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Alhaug OK, Berdal G, Husebye EE, Hvaal K. Flexor hallucis longus tendon transfer for chronic Achilles tendon rupture. A retrospective study. Foot Ankle Surg 2019; 25:630-635. [PMID: 30321934 DOI: 10.1016/j.fas.2018.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/31/2018] [Accepted: 07/09/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The transfer of Flexor Hallucis Longus Tendon (FHL) is an established method for the treatment of chronic Achilles tendon ruptures. An extensive examination of power, strength, endurance and complications related to this procedure is presented. METHODS 21 patients treated with open FHL transfer for chronic Achilles tendon rupture were studied retrospectively. Medical records were reviewed. The patients were examined with a test battery for triceps surae strength, functional tests and PROMs. RESULTS The median maximal concentric strength was equal,1300 vs 1336W, comparing affected with unaffected side. The endurance tests showed a larger difference, 219J vs. 2398J, respectively. The median AOFAS score was 87. 11 of 21 patients sustained one or more complications; the most common were infection, disturbed wound healing, and clawing of small toes. CONCLUSIONS Patients achieve almost normal maximal strength after open FHL transfer, but endurance is notably lower. The complication rate was high.
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Affiliation(s)
| | - Gøran Berdal
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Kjetil Hvaal
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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