D Grob

Schulthess Klinik, Zürich, Zürich, Zurich, Switzerland

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Publications (151)251.78 Total impact

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    ABSTRACT: BACKGROUND CONTEXT: Recent years have witnessed a shift in the assessment of spine surgical outcomes with a greater focus on the patient's perspective. However, this approach has not been widely extended to the assessment of complications. PURPOSE: The present study sought to quantify the patient-rated impact/severity of complications of spine surgery and directly compare the incidences of surgeon-rated and patient-reported complications. STUDY DESIGN: Prospective study of patients undergoing surgery for painful degenerative lumbar disorders, being operated in the Spine Center of an orthopedic hospital. PATIENT SAMPLE: A total of 2,303 patients (mean [standard deviation] age, 61.9 [15.1] years; 1,136 [49.3%] women and 1,167 [50.7%] men). OUTCOME MEASURES: Patients: Core Outcome Measures Index, self-rated complications, bothersomeness of complications, global treatment outcome, and satisfaction. Surgeons: Spine Tango surgery and follow-up documentation forms registering surgical details and complications. METHODS: Patients completed questionnaires before and 3 months after surgery. Surgeons documented complications before discharge and at the first postoperative follow-up, 6 to 12 weeks after surgery. RESULTS: In total, 615 out of 2,303 (27%) patients reported complications, with "bothersomeness" ratings of 1%, not at all; 22%, slightly; 26%, moderately; 34%, very; and 17%, extremely bothersome. Patients most commonly reported sensory disturbances (35% of those reporting a complication) or ongoing/new pain (27%) followed by wound healing problems (11%) and motor disturbances (8%). The surgeons documented complications in 19% of patients. There was a minimal overlap regarding the presence or absence of complications in any given patient. CONCLUSIONS: Most complications reported by the patient are perceived to be at least moderately bothersome and are, hence, not inconsequential. Surgeons reported lower complication rates than the patients did, and there was only moderate agreement between the ratings of the two. As with treatment outcome, complications and their severity should be assessed from both the patient's and the surgeon's perspectives.
    The spine journal: official journal of the North American Spine Society 03/2013; 13(6). DOI:10.1016/j.spinee.2013.01.047 · 2.43 Impact Factor
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    ABSTRACT: The last few decades have witnessed a paradigm shift in the assessment of outcome in spine surgery, with patient-centred questionnaires superseding traditional surgeon-based assessments. The assessment of complications after surgery and their impact on the patient has not enjoyed this same enlightened approach. This study sought to quantify the incidence and bothersomeness of patient-rated complications 1 year after surgery. Patients with lumbar degenerative disorders, operated with the goal of pain relief between October 2006 and September 2010, completed a questionnaire 1 year postoperatively enquiring about complications arising as a consequence of their operation. They rated the bothersomeness of any such complications on a 5-point scale. Global outcome of surgery and satisfaction at the 12-month follow-up were also rated on 5-point Likert scales. The multidimensional Core Outcome Measures Index (COMI) was completed preoperatively and at the 12-month follow-up. Of 2,282 patients completing the questionnaire (92% completion rate), 687 (30.1%) reported complications, most commonly sensory disturbances (36% of those with complications) or ongoing/new pain (26%), followed by motor problems (8%), pain plus neurological disturbances (11%), and problems with wound healing (6%). The corresponding "bothersomeness" ratings for these were: 1% not at all, 23% slightly, 27% moderately, 31% very, and 18% extremely bothersome. The greater the bothersomeness, the worse the global outcome (Rho = 0.51, p < 0.0001), patient satisfaction (Rho = 0.44, p < 0.0001) and change in COMI score (Rho = 0.52, p < 0.0001). Most complications reported by the patient are perceived to be at least moderately bothersome and hence are not inconsequential. Complications and their severity should be assessed from both the patient's and the surgeon's perspectives--not least to better understand the reasons for poor outcome and dissatisfaction with treatment.
    European Spine Journal 04/2012; 21(8):1625-32. DOI:10.1007/s00586-012-2261-8 · 2.07 Impact Factor
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    ABSTRACT: The term "segmental instability" of the lumbar spine is not clearly defined, especially as it relates to degenerative spondylolisthesis (DS) and rotational translation (RT). We investigated whether facet joint effusion on conventional supine MRI indicated increased abnormal motion in DS and RT. 160 patients (119 female, 41 male, mean age 68.8 years, range 38.8-89.3 years) who had undergone decompression only or decompression with instrumented fusion for degenerative spondylolisthesis with different degrees of narrowing of the spinal canal were identified retrospectively from our spine surgery database. All had preoperative upright X-rays in AP and lateral views as well as supine MRI. The imaging studies were assessed for the following parameters: percent of slippage, absolute value of facet joint effusion, facet angles, degree of facet degeneration and spinal canal central narrowing, disc height, presence of facet cysts and the presence of rotational translation in the AP X-ray. 40/160 patients showed no facet joint effusion, and in these the difference in the values for the % slip on upright X-ray and % slip on supine MRI was ≤3%. A further 12 patients also showed a difference ≤3%, but had some fluid in the joints (0.44 ± 0.38 mm). In 108 patients, the difference in the % slip measured on X-ray and on MRI was >3% (mean 10.6%, range 4-29%) and was associated with a mean facet effusion size of 2.15 ± 0.85 mm. The extent of effusion correlated significantly with the relative slippage difference between standing and supine positions (r = 0.64, p < 0.001), and the extent of the left/right difference in effusion was associated with the presence of rotational translation (RT 1.31 ± 0.8 mm vs. no-RT 0.23 ± 0.17 mm, p < 0.0001). Facet joint effusion is clearly correlated with spontaneous reduction of the extent of slippage in the supine position compared to the upright position. Also, the greater the difference in right and left facet effusion, the higher the likelihood of having a RT. Future studies should assess whether analysis of facet joint effusion measured on routine MRI can help in decision-making regarding the optimal surgical treatment to be applied (decompression alone or combined with fusion).
    European Spine Journal 09/2011; 21(2):276-81. DOI:10.1007/s00586-011-1993-1 · 2.07 Impact Factor
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    ABSTRACT: Clinical symptoms in lumbar degenerative spondylolisthesis (LDS) vary from predominantly radiating pain to severe mechanical low back pain. We examined whether the outcome of surgery for LDS varied depending on the predominant baseline symptom and the treatment administered [decompression with fusion (D&F) or decompression alone (D)]. 213 consecutive patients (69 ± 9 years; 155f, 58 m) participated. Inclusion criteria were LDS, maximum three affected levels, no previous surgery at the affected level, and D (N = 56) or D&F (N = 157) as the operative procedure. Pre-op and at 12 months' follow-up (FU), patients completed the multidimensional Core Outcome Measures Index (COMI) including 0-10 leg-pain (LP) and LBP scales. At 12 months' FU, patients rated global outcome which was then dichotomised into "good" and "poor". Pre-operatively, LBP and COMI scores were significantly worse (p < 0.05) in the D&F group than in the D group. The improvement in COMI at 12 months' FU was significantly greater for D&F than for D (p < 0.001) and was not influenced by the patient's declared "main problem" at baseline (back pain, leg pain, or neurological disturbances) (p > 0.05). There was a higher proportion (p = 0.01) of "good" outcomes at 12 months' FU in D&F (86%) than in D (70%). Multiple regression analysis, controlling for possible confounders, revealed treatment group to be the only significant predictor of outcome (adding fusion = better outcome). Our study indicated that LDS patients showed better patient-based outcome with instrumented fusion and decompression than with decompression alone, regardless of baseline symptoms. This may be due to the fact that the underlying slippage as the cause of the stenosis is better addressed with fusion.
    European Spine Journal 07/2011; 21(2):268-75. DOI:10.1007/s00586-011-1896-1 · 2.07 Impact Factor
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    ABSTRACT: Decompression surgery is a common and generally successful treatment for lumbar disc herniation (LDH). However, clinical practice raises some concern that the presence of concomitant low back pain (LBP) may have a negative influence on the overall outcome of treatment. This prospective study sought to examine on how the relative severity of LBP influences the outcome of decompression surgery for LDH. The SSE Spine Tango System was used to acquire the data from 308 patients. Inclusion criteria were LDH, first-time surgery, maximum 1 affected level, and decompression as the only procedure. Before and 12 months after surgery, patients completed the multidimensional Core Outcome Measures Index (COMI; includes 0-10 leg/buttock pain (LP) and LBP scales); at 12 months, global outcome was rated on a Likert scale and dichotomised into "good" and "poor" groups. In the "good" outcome group, mean baseline LP was 2.8 (SD 3.1) points higher than LBP; in the "poor" group, the corresponding value was 1.1 (SD 2.9) (p < 0.001 between groups). Significantly fewer patients with back pain as their "main problem" had a good outcome (69% good) when compared with those who reported leg/buttock pain (84% good) as the main problem (p = 0.04). In multivariate regression analyses (controlling for age, gender, co-morbidity), baseline LBP intensity was a significant predictor of the 12-month COMI score, and of the global outcome (each p < 0.05) (higher LBP, worse outcome). In conclusion, patients with more back pain showed significantly worse outcomes after decompression surgery for LDH. This finding fits with general clinical experience, but has rarely been quantified in the many predictor studies conducted to date. Consideration of the severity of concomitant LBP in LDH may assist in establishing realistic patient expectations before the surgery.
    European Spine Journal 07/2011; 20(7):1166-73. DOI:10.1007/s00586-010-1670-9 · 2.07 Impact Factor
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    Dieter Grob · Andrea Luca · Anne F Mannion ·
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    ABSTRACT: Fusion is used to address several types of abnormality of the atlantoaxial segment. Traditionally, outcome has been assessed by achieving solid bony union. Recently, however, patient-rated outcome instruments have been increasingly used, although these may be influenced by concomitant comorbidity. We therefore asked whether patients with rheumatoid arthritis (RA), with its associated comorbidity, had worse self-rated outcomes after C1-2 fusion than patients with osteoarthritis (OA). We retrospectively reviewed all 30 (23 OA and seven RA) prospectively followed patients in our local Spine Registry (part of the Spine Society of Europe Spine Tango Registry) who had undergone C1-2 fusion. Before surgery and 3 and 12 months later, patients completed the multidimensional Core Outcome Measures Index (COMI) questionnaire. Global outcome and satisfaction with treatment were also assessed. We found no group differences for duration of operation, blood loss, or perioperative surgical or general complications. Compared with the OA group, the RA group showed a better baseline COMI score and less improvement in the COMI from preoperatively to 12 months followup. However, the proportion of "good" global scores at 12 months followup was similarly high in both groups (87% OA and 86% RA) as was satisfaction (96% for OA versus 86% for RA). Symptoms and impairment were less severe in the RA group at baseline and showed less improvement after surgery, but the proportion of "good global outcomes" was similar in both groups, and the great majority of patients in both groups were satisfied with their treatment. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 03/2011; 469(3):702-7. DOI:10.1007/s11999-010-1548-5 · 2.77 Impact Factor
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    Anne F Mannion · R Denzler · J Dvorak · D Grob ·
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    ABSTRACT: As the average life expectancy of the population increases, surgical decompression of the lumbar spine is being performed with increasing frequency. It now constitutes the most common type of lumbar spinal surgery in older patients. The present prospective study examined the 5-year outcome of lumbar decompression surgery without fusion. The group comprised 159 patients undergoing decompression for degenerative spinal disorders who had been participants in a randomised controlled trial of post-operative rehabilitation that had shown no between-group differences at 2 years. Leg pain and back pain intensity (0-10 graphic rating scale), self-rated disability (Roland Morris), global outcome of surgery (5-point Likert scale) and re-operation rates were assessed 5 years post-operatively. Ten patients had died before the 5-year follow-up. Of the remaining 149 patients, 143 returned a 5-year follow-up (FU) questionnaire (effective return rate excluding deaths, 96%). Their mean age was 64 (SD 11) years and 92/143 (64%) were men. In the 5-year follow-up period, 34/143 patients (24%) underwent re-operation (17 further decompressions, 17 fusions and 1 intradural drainage/debridement). In patients who were not re-operated, leg pain decreased significantly (p < 0.05) from before surgery to 2 months FU, after which there was no significant change up to 5 years. Low back pain also decreased significantly by 2 months FU, but then showed a slight, but significant (p < 0.05), gradual increase of <1 point by 5-year FU. Disability decreased significantly from pre-operative to 2 months FU and showed a further significant decrease at 5 months FU. Thereafter, it remained stable up to the 5-year FU. Pain and disability scores recorded after 5 years showed a significant correlation with those at earlier follow-ups (r = 0.53-0.82; p < 0.05). Patients who were re-operated at some stage over the 5-year period showed significantly worse final outcomes for leg pain and disability (p < 0.05). In conclusion, pain and disability showed minimal change in the 5-year period after surgery, but the re-operation rate was relatively high. Re-operation resulted in worse final outcomes in terms of leg pain and disability. At the 5-year follow-up, the "average" patient experienced frequent, but relatively low levels of, pain and moderate disability. This knowledge on the long-term outcome should be incorporated into the pre-operative patient information process.
    European Spine Journal 11/2010; 19(11):1883-91. DOI:10.1007/s00586-010-1535-2 · 2.07 Impact Factor
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    A Luca · A F Mannion · D Grob ·
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    ABSTRACT: The aim of this study was to evaluate the influence of smoking on the outcome of patients undergoing surgery for degenerative spinal diseases, and to examine whether smoking had a differential impact on outcome, depending on the fusion technique used. The cohort included 120 patients treated with two different fusion techniques (translaminar screw fixation and TLIF). They were categorised with regard to their smoking habits at the time of surgery and completed the Core Outcome Measures Index at baseline and follow-up (FU) (3, 12 and 24 months FU); at FU they also rated the global outcome of surgery. The distribution of smokers was comparable in the two groups. For the TS group, the greater the number of cigarettes smoked, the less the reduction in pain intensity from pre-op to 24 months FU; the relationship was not significant for the TLIF group. The percentage of good global outcomes declined with time in the TS smokers such that by 24 months FU, there was a significant difference between TS smokers and TS-non-smokers. No such difference between smokers and non-smokers was evident in the TLIF group at any FU time. In conclusion, the TS technique was more vulnerable to the effects of smoking than was TLIF: possibly the more extensive stabilisation of the 360° fusion renders the environment less susceptible to the detrimental effects on bony fusion of cigarette smoking.
    European Spine Journal 10/2010; 20(4):629-34. DOI:10.1007/s00586-010-1594-4 · 2.07 Impact Factor
  • Dieter Grob · Andrea Luca ·

    European Spine Journal 10/2010; 19(10):1801-2. DOI:10.1007/s00586-010-1571-y · 2.07 Impact Factor
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    ABSTRACT: The contemporary assessment of spine surgical outcome primarily relies on patient-centered reports of symptoms and function. Such measures are considered to reduce bias compared with traditional surgeon-based outcome ratings. This study examined the agreement between patients' and surgeons' ratings of outcome 1 year after spine surgery. The study involved 404 patients (mean age 56.6 +/- 16.4 years; 259 women, 145 men) and their treating surgeons. At baseline and 12 months postoperatively patients completed the Core Outcome Measures Index (COMI) rating pain, function, quality of life, and disability. At 12 months postoperatively, they also rated the global outcome of surgery and their satisfaction with treatment. The surgeon, blinded to the patient's evaluation, rated the global outcome of surgery as excellent, good, fair, or poor. Seventy-six percent of the patients who were considered by the surgeon to have an excellent or good outcome achieved the minimum clinically important difference (MCID) of a 2.2-point reduction on the COMI; 24% achieved less than the MCID. There was a significant correlation between the surgeons' and patients' global outcome ratings (Spearman rho = 0.56; p < 0.0001). The degree of absolute agreement between them was significantly influenced by surgeon seniority: senior surgeons "overrated" the outcome in 24.5% of cases (compared with patients' ratings) and "underrated" it in 17.5% of cases. Junior surgeons overrated in 7.8% of cases and underrated in 43.8% of cases (p < 0.0001). Surgeon overrating occurred significantly more frequently for patients with a poor self-rated outcome (measured as global outcome, COMI score, or satisfaction with treatment). In a multivariate model, the independent variables "senior surgeon" and "patient dissatisfaction with care" were the most significant unique predictors of surgeon overrating of the global outcome (p < 0.0001; adjusted R(2) for the model = 0.16). Overall, agreement between surgeon and patient was reasonably good. The majority of patients who were rated as excellent/good by the surgeons had achieved the MCID in the prospectively measured COMI score. Discrepancies in outcome ratings were influenced by surgeon seniority and patient satisfaction. For a balanced view of the surgical result, outcomes should be assessed from the perspectives of both the patient and the surgeon.
    Journal of neurosurgery. Spine 05/2010; 12(5):447-55. DOI:10.3171/2009.11.SPINE09526 · 2.38 Impact Factor
  • D. Grob ·
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    ABSTRACT: Die zervikale Bandscheibe kann Ursache von Neurokompression oder Schmerzen durch Degeneration sein. Die chirurgischen Interventionen beinhalten Dekompression, Fusion, Bandscheibenersatz oder eine Kombination dieser Verfahren. Die Identifizierung des schmerzhaften Segments bei axialem Schmerz verlangt eine genaue Segmentdiagnostik und kann invasiv-diagnostische Maßnahmen (Gelenkinfiltration, Diskographie) erfordern, da die Bildgebung häufig nicht ausreicht. Bei einer Fusion nach Entfernung der Bandscheibe wird der Platzhalter in Form eines Cage oder autologen Beckenspans eingeführt. Alternativ kann bei intakten dorsalen Elementen eine Bandscheibenprothese eingesetzt werden. Bei vorliegender Neurokompression müssen die komprimierenden Strukturen (Bandscheibe, Osteophyten) entfernt werden. Bei korrekter Indikation und Operationstechnik kann an der Halswirbelsäule mit guten Resultaten gerechnet werden. The spinal intervertebral disc can cause neurocompression or pain as a result of degeneration. Surgical interventions, therefore, include decompression, fusion, disc replacement or a combination thereof. Identifying the painful segment in the case of axial pain requires accurate segment diagnosis and may require invasive diagnostic measures (joint infiltration, discography), since imaging is often not fluid enough. In the case of fusion following disc removal, the placeholder is substitued in the form of a cage or autologous iliac crest graft. Alternatively, when dorsal elements are intact, a disc prosthesis can be inserted. In the case of compression, removal of the compromised structures (disc, osteophytes) becomes necessary. If the indication is correctly made and the appropriate surgical technique used, good results can be expected from cervical spine surgery. SchlüsselwörterZervikale Bandscheibe-Zentrale Fusion-Plattenfixation-Diskusprothese-Dekompression KeywordsSpinal intervertebral disc-Central fusion-Plate fixation-Disc prosthesis-Decompression
    Der Orthopäde 03/2010; 39(3):335-347. DOI:10.1007/s00132-009-1580-x · 0.36 Impact Factor
  • D Grob ·
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    ABSTRACT: The spinal intervertebral disc can cause neurocompression or pain as a result of degeneration. Surgical interventions, therefore, include decompression, fusion, disc replacement or a combination thereof. Identifying the painful segment in the case of axial pain requires accurate segment diagnosis and may require invasive diagnostic measures (joint infiltration, discography), since imaging is often not fluid enough. In the case of fusion following disc removal, the placeholder is substitued in the form of a cage or autologous iliac crest graft. Alternatively, when dorsal elements are intact, a disc prosthesis can be inserted. In the case of compression, removal of the compromised structures (disc, osteophytes) becomes necessary. If the indication is correctly made and the appropriate surgical technique used, good results can be expected from cervical spine surgery.
    Der Orthopäde 02/2010; 39(3):335-47. · 0.36 Impact Factor
  • Dieter Grob · Andrea Luca · Anne F. Mannion ·
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    ABSTRACT: The common answer to treat degenerative changes of the lumbar spine is fusion. However, the usefulness of fusion is still controversial, indications are still uncertain, and there is an ongoing discussion about the negative influence of fusion on the adjacent segments. With this background, nonrigid instrumentation has been developed. The first 46 patients at our institution who were instrumented with Dynesys were retrospectively reviewed. Even though the concept of semirigid fixation in degenerative lumbar spine is appealing, the results concerning pain and global outcome show better results with solid fusion. More studies with randomisation of the patients are needed to make a finalized statement in clinical practice.
    12/2009: pages 227-231;
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    ABSTRACT: Randomised controlled trials (RCTs) of cervical disc arthroplasty vs fusion generally show slightly more favourable results for arthroplasty. However, RCTs in surgery often have limited external validity, since they involve a select group of patients who fit very rigid admission criteria and who are prepared to subject themselves to randomisation. The aim of this study was to examine whether the findings of RCTs are verified by observational data recorded in our Spine Center in association with the Spine Society of Europe Spine Tango surgical registry. Patients undergoing fusion/stabilisation or disc arthroplasty for degenerative cervical spinal disease were selected for inclusion. They completed a questionnaire pre-operatively and at 12 and 24 months follow-up (FU). The questionnaire comprised the multidimensional Core Outcome Measures Index (COMI; 0-10 scale) and, at FU, questions on global outcome and satisfaction with treatment (5-point scales, dichotomised to "good" and "poor"), re-operation and patient-rated complications. The surgeon completed a Spine Tango Surgery form. The outcome data from 266 (208 fusion, 58 arthroplasty) out of 284 eligible patients who had reached 12 months FU, and 169 (139 fusion, 30 arthroplasty) out of 178 who had reached 24 months FU, were included. Patients with cervical disc arthroplasty were younger [46 (SD 8) years vs 56 (SD 11) years for fusion; P < 0.05], had less comorbidity (P < 0.05), more often had only mono-segmental pathology (69% arthroplasty, 47% fusion) and only one type of degenerative pathology (69% arthroplasty, 46% fusion). Surgical complication rates were similar in each group (arthroplasty, 1.5%; fusion, 2.6%). The reduction in the COMI score was significantly greater in the arthroplasty group (at 12 months, 4.8 (SD 3.0) vs 3.7 (SD 2.9) points for fusion, and at 24 months 5.1 (SD 2.8) vs 3.8 (SD 2.9) points; each P < 0.05). In the arthroplasty group, a "good" global outcome was recorded in 90% patients (at 12 months) and 93% (at 24 months); in the fusion group the figures were 80 and 82%, respectively (group differences at each timepoint, P > 0.09). Satisfaction with treatment was similar in both groups (89-93%), at each timepoint. In multiple regression analysis, treatment group was of borderline significance as a unique predictor of the change in COMI at FU (P = 0.059 at 12 months, P = 0.055 at 24 months) in a model in which known confounders (age, comorbidity, number of affected levels) were controlled for. Being in the arthroplasty group was associated with an approximately 1-point greater reduction in the COMI score at FU. The results of this observational study appear to support those of the RCTs and suggest that, in patients with degenerative pathology of the cervical spine, disc arthroplasty is associated with a slightly better outcome than fusion. However, given the small size of the difference, its clinical relevance is questionable, especially in view of the a priori more favourable outcome expected in the arthroplasty group due to the more rigorous selection of patients.
    European Spine Journal 10/2009; 19(2):297-306. DOI:10.1007/s00586-009-1194-3 · 2.07 Impact Factor
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    ABSTRACT: In a prospective observational study we compared the two-year outcome of lumbar fusion by a simple technique using translaminar screws (n = 57) with a more extensive method using transforaminal lumbar interbody fusion and pedicular screw fixation (n = 63) in consecutive patients with degenerative disease of the lumbar spine. Outcome was assessed using the validated multidimensional Core Outcome Measures Index. Blood loss and operating time were significantly lower in the translaminar screw group (p < 0.01). The complication rates were similar in each group (2% to 4%). In all, 91% of the patients returned their questionnaire at two-years. The groups did not differ in Core Outcome Measures Index score reduction, 3.6 (sd 2.5) (translaminar screws) vs 4.0 (sd 2.8) (transforaminal lumbar interbody fusion) (p = 0.39); 'good' global outcomes, 78% (translaminar screws) vs 78% (transforaminal lumbar interbody fusion) (p = 0.99) or satisfaction with treatment, 82% (translaminar screws) vs 86% (transforaminal lumbar interbody fusion) (p = 0.52). The two fusion techniques differed markedly in their extent and the cost of the implants, but were associated with almost identical patient-orientated outcomes. Extensive three-point stabilisation is not always required to achieve satisfactory patient-orientated results at two years.
    The Bone & Joint Journal 10/2009; 91(10):1347-53. DOI:10.1302/0301-620X.91B10.22195 · 3.31 Impact Factor
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    Dieter Grob · Anne F Mannion ·

    European Spine Journal 09/2009; 18 Suppl 3(S3):277-8. DOI:10.1007/s00586-009-1090-x · 2.07 Impact Factor
  • Martin Aepli · Anne F Mannion · Dieter Grob ·
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    ABSTRACT: Retrospective clinical cohort study. To evaluate the long-term results after translaminar screw fixation of the lumbar spine in a large group of patients and to identify predictors of a good outcome. Translaminar screw fixation represents an alternative operative technique to transpedicular fixation systems for short-segment lumbar fusion. The strategy behind this technique is to block the facet joints with perforating screws. Although the method has been in use for more than 20 years, few studies reporting the long-term outcome in large groups of patients are to be found in the literature. The Core Outcome Measures Index, a multidimensional outcome questionnaire, was sent to 643 consecutive patients who had undergone lumbar fusion with translaminar screws between 1987 and 2004, for various degenerative conditions of the lumbar spine. Patients also rated the global outcome and their satisfaction with treatment. Disc height was measured from preoperative radiographs using the distortion compensated roentgen analysis method. 476 patients (74%) completed and returned the questionnaire. Multiple logistic regression analysis was used to identify factors associated with a good outcome. After an average follow-up period of 10 years (range: 2-20 years) 352 of 476 patients (74%) reported that the operation had either "helped a lot" or "helped" (good outcome); 124 of 476 patients (26%) declared that it "helped only little," "didn't help," or "made things worse" (poor outcome). Controlling for potential confounders, a preoperative disc height <80% of that reported for a normal population was the most significant unique predictor of a good outcome (OR = 14.86, 95% CI: 6.77-32.61, P < 0.0001). Translaminar screw fixation is a straightforward and effective technique for short-segment fusion in the lumbar spine. For patients with a strict indication for spondylodesis, intact posterior elements (lamina and facets) and a low preoperative disc height, translaminar screw fixation represents a successful fixation technique in the lumbar spine with good long-term results.
    Spine 07/2009; 34(14):1492-8. DOI:10.1097/BRS.0b013e3181a0934f · 2.30 Impact Factor
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    ABSTRACT: Prospective study. The present study compared different theories on the role of expectations in a group of patients undergoing lumbar decompression surgery. Patients' expectations of treatment are a potentially important predictor of self-rated outcome after surgery. Some studies suggest that high baseline expectations per se yield better outcomes, others maintain that the fulfillment of prior expectations is paramount, and still others assert that it is the actual improvement in symptom status that governs outcome, regardless of prior expectations. Hundred patients took part (33 F, 67 M; mean [SD] age, 65 [11] yrs). Before surgery, they completed a booklet containing the Roland-Morris (RM) disability questionnaire, 0-10 pain graphic rating scales (back and leg separately), and Likert-scales about the degree of improvement expected in various domains. Two and 12 months after surgery, questions were answered regarding the perceived improvement for each of these domains, the RM and pain scales were completed again, and the patients rated the global outcome on a 5-point Likert-scale. Compared with the actual improvement recorded at 12 months, prior expectations had been overly optimistic in about 40% patients for the domains leg pain, back pain, walking capacity, social life, mental well-being, and independence, and in 50% patients for everyday activities and sport. There was no significant relationship between baseline expectations and follow-up scores for back pain, leg pain, RM-disability (corrected for baseline values), or global outcome. Hierarchical multiple regression analysis revealed that "expectations being fulfilled" was the most significant predictor of global outcome. In this patient group, expectations of surgery were overly optimistic. Having one's expectations fulfilled was most important for a good outcome. The results emphasize the importance of assessing patient-orientated outcome in routine practice, and the factors that might influence it, such that realistic expectations can be established for patients before surgery.
    Spine 07/2009; 34(15):1590-9. DOI:10.1097/BRS.0b013e31819fcd52 · 2.30 Impact Factor
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    T Zweig · A F Mannion · D Grob · M Melloh · E Munting · A Tuschel · M Aebi · C Röder ·
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    ABSTRACT: The generic approach of the Spine Tango documentation system, which uses web-based technologies, is a necessity for reaching a maximum number of participants. This, in turn, reduces the potential for customising the Tango according to the individual needs of each user. However, a number of possibilities still exist for tailoring the data collection processes to the user's own hospital workflow. One can choose between a purely paper-based set-up (with in-house scanning, data punching or mailing of forms to the data centre at the University of Bern) and completely paper-free online data entry. Many users work in a hybrid mode with online entry of surgical data and paper-based recording of the patients' perspectives using the Core Outcome Measures Index (COMI) questionnaires. Preoperatively, patients can complete their questionnaires in the outpatient clinic at the time of taking the decision about surgery or simply at the time of hospitalisation. Postoperative administration of patient data can involve questionnaire completion in the outpatient clinic, the handing over the forms at the time of discharge for their mailing back to the hospital later, sending out of questionnaires by post with a stamped addressed envelope for their return or, in exceptional circumstances, conducting telephone interviews. Eurospine encourages documentation of patient-based information before the hospitalisation period and surgeon-based information both before and during hospitalisation; both patient and surgeon data should be acquired for at least one follow-up, at a minimum of three to six months after surgery. In addition, all complications that occur after discharge, and their consequences should be recorded.
    European Spine Journal 07/2009; 18 Suppl 3(S3):312-20. DOI:10.1007/s00586-009-1074-x · 2.07 Impact Factor

Publication Stats

4k Citations
251.78 Total Impact Points


  • 1987-2013
    • Schulthess Klinik, Zürich
      Zürich, Zurich, Switzerland
  • 2010
    • Spine Center, Thun
      Thun, Bern, Switzerland
  • 2005
    • Universität Bern
      • Institute for Evaluative Research in Medicine
      Berna, Bern, Switzerland
  • 1997
    • University of Zurich
      • Institute of Veterinary Anatomy
      Zürich, Zurich, Switzerland
  • 1995
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany
  • 1994
    • University Hospital Zürich
      Zürich, Zurich, Switzerland
  • 1991
    • Yale University
      • Department of Orthopaedics and Rehabilitation
      New Haven, CT, United States
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States