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21. The McKenzie Method versus guideline-based advice in the treatment of sciatica: 24-month outcomes of a randomised clinical trial.

Author

Kilpikoski, Sinikka, Häkkinen, Arja H, Repo, Jussi P, Kyrölä, Kati, Multanen, Juhani, Kankaanpää, Markku, Vainionpää, Aki, Takala, Esa-Pekka, Kautiainen, Hannu, and Ylinen, Jari

Subjects
*RESEARCH, *PAIN measurement, *INTERVERTEBRAL disk displacement, *TERTIARY care, *MAGNETIC resonance imaging, *SCIATICA, *TREATMENT effectiveness, *RANDOMIZED controlled trials, *QUALITY of life, *RESEARCH funding, *PATIENT education, *LUMBAR vertebrae, *STATISTICAL sampling, *EDUCATIONAL outcomes, *HEALTH self-care, *BACK exercises
Abstract

Objective: To compare the effectiveness of a McKenzie Method intervention in patients with sciatica with guideline-based patient education. Design: Multi-centre, assessor-blinded, parallel-group, randomised trial Setting: Two tertiary hospitals providing operative spinal care. Subjects: Sciatica patients with magnetic resonance imaging-confirmed lumbar disc herniation compressing a nerve root. Interventions: The McKenzie group received specific back exercises for seven visits combined with an educational book, and the Control group received a single session of self-management guidance according to usual practices. Main measures: The primary outcome was the number of surgical operations. Secondary outcomes were pain measured using the Visual Analogue Scale, disability using the Oswestry Disability Index and health-related quality of life using a RAND-36 questionnaire at baseline and 24-month follow-up. Results: Altogether 66 patients, mean age of 43 years, of which 50% were females with long-lasting sciatica, mean 16 weeks, were randomised to two groups. Nineteen patients (29%) had surgery. There was no significant difference in surgery rates between the groups. Back and leg pain decreased, and disability improved in both groups. Health-related quality of life improved in six dimensions out of eight in both groups. There were no significant between-group changes in the patient-reported outcomes at the follow-up. Conclusions: Multiple sessions of McKenzie-based back exercises with a McKenzie-specific patient's educational book produced effects equal to guideline-based advice at long-term follow-up. However, the power of these results is diminished due to the small patient population and confounding factors. [ABSTRACT FROM AUTHOR]

Published
2024
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25. Intra- and Interrater Reliability of Sagittal Spinopelvic Parameters on Full-Spine Radiographs in Adults With Symptomatic Spinal Disorders

Author

Kati Kristiina Kyrölä, Järvenpää Salme, Järviluoma Tuija, Irmola Tero, Kauppinen Eero, and Häkkinen Arja

Subjects
Adult, Radiographic image, Scoliosis/diagnostic imaging, Software/standards, Reproducibility of results, Observer variation, Neurology. Diseases of the nervous system, RC346-429
Abstract

Background/Aims To evaluate the intra- and interrater reliability (I-IR) of sagittal spinopelvic parameters from digital full-spine plain radiographs with basic software tools in an unselected adult population with degenerative spinal complaints who were evaluated for surgery. Methods Forty-nine adult full-spine digital radiographs were measured twice by 3 independent observers, including an experienced spine surgeon, an experienced radiologist, and a resident orthopedic surgeon. Clinical picture archiving and communication system workstations and software tools were used and landmarks were set manually. The I-IR of the sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), and thoracic kyphosis in T4–T12 (TK) were assessed. Results The intrarater intraclass correlation coefficient (ICC) scores varied from 0.82 to 0.99. The interrater ICC scores ranged from 0.78 to 0.99. The intrarater standard error of measurement (SEM) values for SS, PT, PI, and TK varied from 0.8° to 5.0°, and the interrater SEM values ranged from 2.5° to 6.2°, depending on the parameter and the reading round. The I-IR SEM values for SVA varied from 2.2 to 5.7 mm and from 4.6 to 5.0 mm, respectively. Kappa values were >0.88 for all readers. The intrarater variability was the smallest for the most experienced rater. Conclusion The I-IR of measuring sagittal spinopelvic parameters on digital full-spine images with basic software tools was high. Parameters consisting of several anatomic landmarks were more liable to error. Rater experience had a positive influence on reliability and repeatability. Reader experience should be assessed before accepting measurements for surgical planning and the interpretation of surgical correction during postoperative follow-up.

Published
2018
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38. sj-docx-2-cre-10.1177_02692155231170687 - Supplemental material for Neck–Shoulder Region Training for Chronic Headache in Women: A Randomized Controlled Trial

Author

Rinne, Marjo, Garam, Sanna, Kukkonen-Harjula, Katriina, Tokola, Kari, Häkkinen, Arja, Ylinen, Jari, and Nikander, Riku

Subjects
FOS: Clinical medicine, 110604 Sports Medicine, FOS: Health sciences, 110904 Neurology and Neuromuscular Diseases, 110314 Orthopaedics
Abstract

Supplemental material, sj-docx-2-cre-10.1177_02692155231170687 for Neck–Shoulder Region Training for Chronic Headache in Women: A Randomized Controlled Trial by Marjo Rinne, Sanna Garam and Katriina Kukkonen-Harjula, Kari Tokola, Arja Häkkinen, Jari Ylinen, Riku Nikander in Clinical Rehabilitation

Published
2023
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39. sj-pdf-1-cre-10.1177_02692155231170687 - Supplemental material for Neck–Shoulder Region Training for Chronic Headache in Women: A Randomized Controlled Trial

Author

Rinne, Marjo, Garam, Sanna, Kukkonen-Harjula, Katriina, Tokola, Kari, Häkkinen, Arja, Ylinen, Jari, and Nikander, Riku

Subjects
FOS: Clinical medicine, 110604 Sports Medicine, FOS: Health sciences, 110904 Neurology and Neuromuscular Diseases, 110314 Orthopaedics
Abstract

Supplemental material, sj-pdf-1-cre-10.1177_02692155231170687 for Neck–Shoulder Region Training for Chronic Headache in Women: A Randomized Controlled Trial by Marjo Rinne, Sanna Garam and Katriina Kukkonen-Harjula, Kari Tokola, Arja Häkkinen, Jari Ylinen, Riku Nikander in Clinical Rehabilitation

Published
2023
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47. Postoperative Sagittal Balance Has Only a Limited Role in the Development of Adjacent Segment Disease After Lumbar Spine Fusion for Degenerative Lumbar Spine Disorders : A Subanalysis of the 10-year Follow-up Study

Author

Toivonen, Leevi A., Mäntymäki, Heikki, Häkkinen, Arja, Kautiainen, Hannu, Neva, Marko H., Tampere University, Department of Musculoskeletal Diseases, and Clinical Medicine

Subjects
degenerative spinal disease, adjacent segment disease, 3121 Internal medicine, leikkaushoito, lanneranka, selkäranka, selkäsairaudet, Humans, Orthopedics and Sports Medicine, sagittal balance, revisions, Prospective Studies, kirurgia, Retrospective Studies, Lumbar Vertebrae, ahtaumat, adjacent segment pathology, kipu, 3126 Surgery, anesthesiology, intensive care, radiology, Spinal Fusion, röntgenkuvaus, hoitotulokset, Lordosis, Neurology (clinical), lumbar spine fusion, Follow-Up Studies
Abstract

Study Design. Retrospective additional analysis of a prospective follow-up study. Objectives. We aimed to find out whether poor postoperative sagittal alignment increases revisions for adjacent segment disease (ASD) after lumbar spine fusion (LSF) performed for degenerative lumbar spine disease. Summary of Background Data. Revisions for ASD accumulate over time after LSF for degenerative lumbar spine disease. The etiology of ASD is considered multifactorial. Yet, the role of postoperative sagittal balance in this process remains controversial. Materials and Methods. A total of 215 consecutive patients who had undergone an elective LSF surgery for spinal stenosis with (80%) or without (20%) spondylolisthesis were analyzed. Spinal reoperations were collected from the hospital records. Preoperative and postoperative sagittal alignment were evaluated from standing radiographs. The risk of revisions for ASD was evaluated by Cox proportional hazards regression models. Results. We did not find the poor postoperative balance [pelvic incidence-lumbar lordosis (LL) >9°] to significantly increase the risk of revisions for ASD: crude hazard ratio (HR)=1.5 [95% confidence interval (CI): 0.8-2.7], adjusted (by age, sex, pelvic incidence, fusion length, and the level of the caudal end of fusion): HR=1.7 (95% CI: 0.9-3.3). We found higher LL outside the fusion segment (LL-segmental lordosis) to decrease the risk of revisions for ASD: HR=0.9 (95% CI: 0.9-1.0). Conclusion. Poor sagittal balance has only a limited role as a risk factor for the revisions for ASD among patients with degenerative spinal disease. However, the risk for ASD might be the greatest among patients with reduced spinal mobility. publishedVersion

Published
2022

48. Isthmic Spondylolisthesis is Associated with Less Revisions for Adjacent Segment Disease After Lumbar Spine Fusion Than Degenerative Spinal Conditions

Author

Toivonen, Leevi A., Mäntymäki, Heikki, Häkkinen, Arja, Kautiainen, Hannu, and Neva, Marko H.

Subjects
musculoskeletal diseases, spinal stenosis, Lumbar Vertebrae, adjacent segment disease, adjacent segment pathology, degenerative lumbar spine disorders, degenerative spondylolisthesis, isthmic spondylolisthesis, Spinal Fusion, Treatment Outcome, degenerative spinal disorders, Humans, Surgery, revisions, Prospective Studies, Spondylolisthesis, lumbar spine fusion, Follow-Up Studies, Retrospective Studies
Abstract

Elective lumbar spine fusions (LSFs) were prospectively followed-up for an average 9.7 years. The incidence of revisions for adjacent segment disease (ASD) was determined among patients with isthmic spondylolisthesis (IS) and degenerative lumbar spine disorders (DLSD). The incidence was 4.8% among patients with IS, while it was 20.5% among patients with degenerative disorders., Study Design. Prospective, follow-up study. Objective. We aim to compare the rate of revisions for ASD after LSF surgery between patients with IS and DLSD. Summary of Background Data. ASD is a major reason for late reoperations after LSF surgery. Several risk factors are linked to the progression of ASD, but the understanding of the underlying mechanisms is imperfect. If IS infrequently becomes complicated with ASD, it would emphasize the role of the ongoing degenerative process in spine in the development of ASD. Methods. 365 consecutive patients that underwent elective LSF surgery were followed up for an average of 9.7 years. Surgical indications were classified into 1) IS (n = 64), 2) DLSD (spinal stenosis with or without spondylolisthesis) (n = 222), and 3) other reasons (deformities, postoperative conditions after decompression surgery, posttraumatic conditions) (n = 79). All spinal reoperations were collected from hospital records. Rates of revisions for ASD were determined using Kaplan–Meier methods. Results. Altogether, 65 (17.8%) patients were reoperated for ASD. The incidences of revisions for ASD in subgroups were 1) 4.8% (95% CI: 1.6%–22.1%); 2) 20.5% (95% CI: 15.6%–26.7%); 3) 20.6% (95% CI: 12.9%–31.9%). After adjusting the groups by age, sex, fusion length, and the level of the caudal end of fusion, when comparing with IS group, the other groups had significantly higher hazard ratios (HR) for the revision for ASD [2) HR (95% CI) 3.92 (1.10–13.96), P = 0.035], [3) HR (95% CI) of 4.27 (1.11–15.54), P = 0.036]. Conclusion. Among patients with IS, the incidence of revisions for ASD was less than a 4th of that with DLSD. Efforts to prevent the acceleration of the degenerative process at the adjacent level of fusion are most important with DLSD. Level of Evidence: 3

Published
2021

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