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Lipplaa A, van der Wal RJP, Krol ADG, Peul WC, Bovée JVMG, Gelderblom H. Incidence and centralization of chordoma in the Netherlands: A nationwide study between 1991 and 2020. Cancer Epidemiol 2024; 89:102527. [PMID: 38277716 DOI: 10.1016/j.canep.2024.102527] [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: 07/05/2023] [Revised: 11/12/2023] [Accepted: 01/14/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Chordomas are rare malignant bone tumors arising in the axial skeleton, with an incidence of 0.3-0.88 per million inhabitants. We studied the annual incidence rate and centralization of treatment for chordoma in the Netherlands. METHODS We retrieved pathology excerpts from the PALGA nationwide Dutch Pathology Registry between 1991 and 2019 for patients with a chordoma to calculate incidence rates. From pathology reports we extracted patient age at diagnosis, sex, year of diagnosis, localization of primary tumor, histologic chordoma subtype (conventional including chondroid, poorly differentiated or dedifferentiated), center of diagnosis (bone tumor referral center (BTC) or other hospital), and partial identification of the BTCs. RESULTS A total of 420 individual chordoma patients were identified in the given time period. The incidence of chordoma increased from 0.593 per million inhabitants between 1991-1995 to 1.111 from 2015-2019 (P = 0.001). Median age at diagnosis was 63 years (range 1-95), 252 patients (60%) were male. The proportion of samples analyzed in a BTC either primarily or secondary, as a consultation, revision or referral, increased significantly from 29.3% to 84.4% (P < 0.001). Most primary and secondary samples were analyzed at the Leiden University Medical Center (LUMC, 54.4% and 57% respectively). CONCLUSIONS This study shows an increase in the standardized incidence of pathology proven chordoma in the Netherlands. We observed an increase in samples being analysed in the specialized BTCs as well, which is in line with current guidelines and will hopefully lead to more accurate diagnoses and optimal treatment plans for chordoma patients in specialized treatment centers.
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Affiliation(s)
- A Lipplaa
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - R J P van der Wal
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - A D G Krol
- Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands
| | - W C Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - J V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
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Lequin MB, Verbaan D, Schuurman PR, Tasche S, Peul WC, Vandertop WP, Bouma GJ. The long-term outcome of revision microdiscectomy for recurrent sciatica. Eur Spine J 2024:10.1007/s00586-024-08199-5. [PMID: 38512504 DOI: 10.1007/s00586-024-08199-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/29/2023] [Accepted: 02/17/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To study the long-term outcome of revision microdiscectomy after classic microdiscectomy for lumbosacral radicular syndrome (LSRS). METHODS Eighty-eight of 216 patients (41%) who underwent a revision microdiscectomy between 2007 and 2010 for MRI disc-related LSRS participated in this study. Questionnaires included visual analogue scores (VAS) for leg pain, RDQ, OLBD, RAND-36, and seven-point Likert scores for recovery, leg pain, and back pain. Any further lumbar re-revision operation(s) were recorded. RESULTS Mean (SD) age was 59.8 (12.8), and median [IQR] time of follow-up was 10.0 years [9.0-11.0]. A favourable general perceived recovery was reported by 35 patients (40%). A favourable outcome with respect to perceived leg pain was present in 39 patients (45%), and 35 patients (41%) reported a favourable outcome concerning back pain. The median VAS for leg and back pain was worse in the unfavourable group (48.0/100 mm (IQR 16.0-71.0) vs. 3.0/100 mm (IQR 2.0-5.0) and 56.0/100 mm (IQR 27.0-74.0) vs. 4.0/100 mm (IQR 2.0-17.0), respectively; both p < 0.001). Re-revision operation occurred in 31 (35%) patients (24% same level same side); there was no significant difference in the rate of favourable outcome between patients with or without a re-revision operation. CONCLUSION The long-term results after revision microdiscectomy for LSRS show an unfavourable outcome in the majority of patients and a high risk of re-revision microdiscectomy, with similar results. Based on also the disappointing results of alternative treatments, revision microdiscectomy for recurrent LSRS seems to still be a valid treatment. The results of our study may be useful to counsel patients in making appropriate treatment choices.
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Affiliation(s)
- M B Lequin
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - D Verbaan
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Saskia Tasche
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - W C Peul
- Department of Neurosurgery, University Neurosurgical Center Holland, UMC | HMC | HAGA, Leiden, The Hague, The Netherlands
| | - W P Vandertop
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - G J Bouma
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
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Hoogslag VDN, van Essen TA, Dijkman MD, Moudrous W, Schoonman GG, Peul WC. A multicentre retrospective cohort study on health-related quality of life after traumatic acute subdural haematoma: does cranial laterality affect long-term recovery? BMC Neurol 2022; 22:287. [PMID: 35915402 PMCID: PMC9341107 DOI: 10.1186/s12883-022-02790-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Traumatic acute subdural haematoma is a debilitating condition. Laterality intuitively influences management and outcome. However, in contrast to stroke, this research area is rarely studied. The aim is to investigate whether the hemisphere location of the ASDH influences patient outcome. Methods For this multicentre observational retrospective cohort study, patients were considered eligible when they were treated by a neurosurgeon for traumatic brain injury between 2008 and 2012, were > 16 years of age, had sustained brain injury with direct presentation to the emergency room and showed a hyperdense, crescent shaped lesion on the computed tomography scan. Patients were followed for a duration of 3-9 months post-trauma for functional outcome and 2-6 years for health-related quality of life. Main outcomes and measures included mortality, Glasgow Outcome Scale and the Quality of Life after Brain Injury score. The hypothesis was formulated after data collection. Results Of the 187 patients included, 90 had a left-sided ASDH and 97 had a right-sided haematoma. Both groups were comparable at baseline and with respect to the executed treatment. Furthermore, both groups showed no significant difference in mortality and Glasgow Outcome Scale score. Health-related quality of life, assessed 59 months (IQR 43-66) post-injury, was higher for patients with a right-sided haematoma (Quality of Life after Brain Injury score: 80 vs 61, P = 0.07). Conclusions This study suggests patients with a right-sided acute subdural haematoma have a better long-term health-related quality of life compared to patients with a left-sided acute subdural haematoma. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02790-3.
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Djuric N, Yang X, El Barzouhi A, Ostelo R, van Duinen SG, Lycklama À Nijeholt GJ, van der Kallen BFW, Peul WC, Vleggeert-Lankamp CLA. Lumbar disc extrusions reduce faster than bulging discs due to an active role of macrophages in sciatica. Acta Neurochir (Wien) 2020; 162:79-85. [PMID: 31802274 PMCID: PMC6942010 DOI: 10.1007/s00701-019-04117-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/23/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This retrospective observational histological study aims to associate the size and type of disc herniation with the degree of macrophage infiltration in disc material retrieved during disc surgery in patients with sciatica. METHODS Disc tissue of 119 sciatica patients was embedded in paraffin and stained with hematoxylin and CD68. Tissue samples were categorized as mild (0-10/cm2), moderate (10-100/cm2), and considerable (> 100/cm2) macrophage infiltration. All 119 patients received an MRI at baseline, and 108 received a follow-up MRI at 1-year. MRIs were reviewed for the size and type of the disc herniations, and for Modic changes in the vertebral endplates. RESULTS Baseline characteristics and duration of symptoms before surgery were comparable in all macrophage infiltration groups. The degree of macrophage infiltration was not associated with herniation size at baseline, but significantly associated with reduction of size of the herniated disc at 1-year post surgery. Moreover, the degree of macrophage infiltration was higher in extrusion in comparison with bulging (protrusion) of the disc. Results were comparable in patients with and without Modic changes. CONCLUSION Macrophage infiltration was positively associated with an extruded type of disc herniation as well as the extent of reduction of the herniated disc during 1-year follow-up in patients with sciatica. This is an indication that the macrophages play an active role in reducing herniated discs. An extruded disc herniation has a larger surface for the macrophages to adhere to, which leads to more size reduction.
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Affiliation(s)
- N Djuric
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, Netherlands.
| | - X Yang
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - A El Barzouhi
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - R Ostelo
- Department of Epidemiology, VU Medical Centre, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - S G van Duinen
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - W C Peul
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, Netherlands
- Department of Epidemiology, VU Medical Centre, Amsterdam, Netherlands
| | - C L A Vleggeert-Lankamp
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, Netherlands
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Zamanipoor Najafabadi AH, van de Mortel JPM, Lobatto DJ, Brandsma D, Peul WC, Taphoorn MJB, Dirven L, van Furth WR. P05.78 Improving quality of care of meningioma patients: initial evaluation of issues in care trajectories according to the Plan-Do-Study-Act Cycle. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A H Zamanipoor Najafabadi
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - J P M van de Mortel
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - D J Lobatto
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - D Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - W C Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, Netherlands
| | - M J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands
| | - L Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - W R van Furth
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
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Bakker SH, Jacobs WCH, Pondaag W, Gelderblom H, Nout RA, Dijkstra PDS, Peul WC, Vleggeert-Lankamp CLA. Chordoma: a systematic review of the epidemiology and clinical prognostic factors predicting progression-free and overall survival. Eur Spine J 2018; 27:3043-3058. [PMID: 30220042 DOI: 10.1007/s00586-018-5764-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 09/03/2018] [Accepted: 09/08/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The aim of this systematic review is to describe the epidemiology of chordoma and to provide a clear overview of clinical prognostic factors predicting progression-free and overall survival. METHODS Four databases of medical literature were searched. Separate searches were performed for each of the two objectives. Reference and citation tracking was performed. Papers were processed by two independent reviewers according to a protocol that included risk of bias analysis. Disagreement was resolved by discussion. Pooled analyses were planned if homogeneity of data would allow. RESULTS Incidence-incidence rates ranged between 0.18 and 0.84 per million persons per year and varied between countries and presumably between races. On average patients were diagnosed in their late fifties and gender data indicate clear male predominance. Two of the largest studies (n = 400 and n = 544) reported different anatomical distributions: one reporting the skull base and sacrococcygeal area affected in 32% and 29% of cases, whereas the other reporting that they were affected in 26% and 45% of cases, respectively. PROGNOSTIC FACTORS Statistically significant adverse prognostic factors predicting progression-free and overall survival include female sex, older age, bigger tumour size, increasing extent of tumour invasion, non-total resection, presence of metastasis, local recurrence, and dedifferentiated histological subtype. CONCLUSIONS Incidence rate and anatomical distribution vary between countries and presumably between races. Most chordomas arise in the skull base and sacrococcygeal spine, and the tumour shows clear male predominance. Multiple adverse prognostic factors predicting progression-free and overall survival were identified in subgroups of patients. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- S H Bakker
- Department of Neurosurgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - W C H Jacobs
- Department of Neurosurgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - W Pondaag
- Department of Neurosurgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - H Gelderblom
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - R A Nout
- Departmant of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - P D S Dijkstra
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - W C Peul
- Department of Neurosurgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - C L A Vleggeert-Lankamp
- Department of Neurosurgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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Zamanipoor Najafabadi AH, Peeters MC, Dirven L, Broekman ML, Peul WC, Taphoorn MJ, van Furth WR. P11.02 Health-related quality of life in meningioma patients - a systematic review. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zamanipoor Najafabadi AH, Dirven L, Broekman ML, Peul WC, Taphoorn MJ, van Furth WR. P11.01 Patient-reported outcome measures in meningioma research - lack of the patients perspective. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Scheele J, Enthoven WTM, Bierma-Zeinstra SMA, Peul WC, van Tulder MW, Bohnen AM, Berger MY, Koes BW, Luijsterburg PAJ. Characteristics of older patients with back pain in general practice: BACE cohort study. Eur J Pain 2013; 18:279-87. [PMID: 23868792 DOI: 10.1002/j.1532-2149.2013.00363.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although back pain is common among older people, limited information is available about the characteristics of these patients in primary care. Earlier research suggests that the severity of back symptoms increases with older age. METHODS Patients aged >55 years visiting a general practitioner with a new episode of back pain were included in the BACE study. Information on patients' characteristics, characteristics of the complaint and physical examination were derived from the baseline measurement. Cross-sectional differences between patients aged >55-74 and ≥75 years were analysed using an unpaired t-test, Mann-Whitney U-test or a chi-square test. RESULTS A total of 675 back pain patients were included in the BACE study, with a median age of 65 (interquartile range 60-71) years. Patients aged >55-74 years had a mean disability score (measured with the Roland Disability Questionnaire) of 9.4 [standard deviation (SD) 5.8] compared with 12.1 (SD 5.5) in patients aged ≥75 years (p ≤ 0.01). The older group reported more additional musculoskeletal disorders and more often had low bone quality (based on ultrasound measurement of the heel) than patients aged >55-74 years. Average back pain severity over the previous week showed no difference (p = 0.11) between the age groups, but severity of back pain at the moment of filling in the questionnaire was higher (p = 0.03) in the older age group. CONCLUSIONS In this study, older back pain patients reported more disabilities and co-morbidity. However, the clinical relevance of these differences for the course of the back pain episode in older patients remains a subject for further research.
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Affiliation(s)
- J Scheele
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Bollen L, de Ruiter GCW, Pondaag W, Arts MP, Fiocco M, Hazen TJT, Peul WC, Dijkstra PDS. Risk factors for survival of 106 surgically treated patients with symptomatic spinal epidural metastases. Eur Spine J 2013; 22:1408-16. [PMID: 23455954 DOI: 10.1007/s00586-013-2726-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 02/01/2013] [Accepted: 02/18/2013] [Indexed: 02/08/2023]
Abstract
PURPOSE Evaluation of risk factors for survival in patients surgically treated for symptomatic spinal epidural metastases (SEM). METHODS One hundred and six patients who were surgically treated for symptomatic SEM in a 10-year period in two cooperatively working hospitals were retrospectively studied for nine risk factors: age, gender, site of the primary tumor, location of the symptomatic spinal metastasis, functional and neurologic status, the presence of visceral metastases and the presence of other spinal and extraspinal bone metastases. Analysis was performed using the Kaplan-Meier method, univariate log-rank tests and Cox-regression models. RESULTS Overall median survival was 10.7 months (0.2-107.5 months). Overall 30-day complication rate was 33 %. Multivariate Cox-regression analysis showed that fast growing primary tumors (HR 3.1, 95 % CI 1.6-6.2, p = 0.001), the presence of visceral metastases (HR 1.7, 95 % CI 1.0-2.9, p = 0.033) and a low performance status (HR 2.7, 95 % CI 1.1-6.6, p = 0.025) negatively influenced the survival. CONCLUSION Primary tumor type, presence of visceral metastases and performance status are significant predictors for survival after surgery for symptomatic SEM and should be evaluated before deciding on the extent of treatment. More accurate prediction models are needed to select the best treatment option for the individual patient.
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Affiliation(s)
- L Bollen
- Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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Peul WC, Van Houwelingen HC, Van den Hout WB, Brand R, Eekhof JAH, Tans JTJ, Thomeer RTWM, Koes BW. [Early surgery or a wait-and-see policy in lumbosacral radicular syndrome: a randomized study]. Ned Tijdschr Geneeskd 2007; 151:2512-2523. [PMID: 18062596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To compare early surgery with expectative policy and later surgery if necessary in patients with sciatica that did not resolve within 6 weeks. DESIGN Randomized multicentre clinical trial (ISRCTN 26872154). METHODS Patients who had had severe sciatica for 6 to 12 weeks were randomized to early surgery or to prolonged conservative treatment with later surgery if necessary. The primary outcomes were the Roland Disability Questionnaire score, the visual-analogue scale for leg pain score, and the patient's report of their perceived recovery over the first year after randomization. Repeated measures analysis according to the intention-to-treat principle was used to analyse the outcome curves for both groups. RESULTS A total of 283 patients were included and randomized. Of 141 patients assigned to undergo early surgery, 125 (89%) underwent microdiscectomy after a mean of 2.2 weeks. Of 142 patients assigned to conservative treatment, 55 (39%) still had to undergo surgical treatment after a mean of 18.7 weeks. There was no significant overall difference in disability scores during the first year (p = 0.13). Leg pain lessened more quickly in patients assigned to early surgery (p < 0.001). Patients assigned to early surgery also reported a faster rate of perceived recovery (hazard ratio (HR): 1.97; 95% CI: 1.72-2.22; p < 0.001). In both groups, however, the probability of perceived recovery after 1 year of follow-up was 95%. CONCLUSIONS The 1-year outcomes were similar for patients assigned to early surgery and those assigned to extended conservative treatment with later surgery if necessary but the rates of reduction of leg pain and of perceived recovery were faster in those assigned to early surgery.
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Affiliation(s)
- W C Peul
- Leids Universitair Medisch Centrum, Postbus 9600, 2300 RC Leiden.
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Affiliation(s)
- B W Koes
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, Netherlands.
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van Rijn JC, Klemetso N, Reitsma JB, Bossuyt PM, Hulsmans FJ, Peul WC, den Heeten GJ, Stam J, Majoie CBLM. Observer variation in the evaluation of lumbar herniated discs and root compression: spiral CT compared with MRI. Br J Radiol 2006; 79:372-7. [PMID: 16632616 DOI: 10.1259/bjr/26216335] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Spiral CT is considered the best alternative for MRI in the evaluation of herniated discs. The purpose of this study was to compare radiological evaluation of spiral CT with MRI in patients suspected of herniated discs. 57 patients with lumbosacral radicular syndrome underwent spiral CT and 1.5 T MRI. Two neuroradiologists independently evaluated 171 intervertebral discs for herniation or "bulge" and 456 nerve roots for root compression, once after CT and once after MRI. We compared interobserver agreement using the kappa statistic and we performed a paired comparison between CT and MRI. For detection of herniated or bulging discs, we observed no significant difference in interobserver agreement (CT kappa 0.66 vs MRI kappa 0.71; p = 0.40). For root compression, we observed significantly better interobserver agreement at MRI evaluation (CT kappa 0.59 vs MRI kappa 0.78; p = 0.01). In 30 of 171 lumbar discs (18%) and in 54 of 456 nerve roots (12%), the observers disagreed on whether CT results were similar to MRI. In the cases without disagreement, CT differed from MRI in 6 discs (3.5%) and in 3 nerve roots (0.7%). For radiological evaluation of lumbar herniated discs, we found no evidence that spiral CT is inferior to MRI. For evaluating lumbar nerve root compression, spiral CT is less reliable than MRI.
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Affiliation(s)
- J C van Rijn
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, AZ, Amsterdam
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Schenk B, Brouwer PA, Peul WC, van Buchem MA. Percutaneous laser disk decompression: a review of the literature. AJNR Am J Neuroradiol 2006; 27:232-5. [PMID: 16418391 PMCID: PMC7976096] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- B Schenk
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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van Rijn JC, Klemetso N, Reitsma JB, Majoie CBLM, Hulsmans FJ, Peul WC, Bossuyt PM, Heeten GJD, Stam J. Symptomatic and asymptomatic abnormalities in patients with lumbosacral radicular syndrome: Clinical examination compared with MRI. Clin Neurol Neurosurg 2005; 108:553-7. [PMID: 16289310 DOI: 10.1016/j.clineuro.2005.10.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 09/16/2005] [Accepted: 10/09/2005] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the frequency of symptomatic and asymptomatic herniated discs and root compression in patients with lumbosacral radicular syndrome (LRS) and to correlate clinical localization with MRI findings. METHODS Fifty-seven patients with unilateral LRS were included in the study. Using the visual analogue scale, two physicians independently localized the most likely lumbar level of complaints. These clinical predictions of localizations were correlated with the MRI findings. RESULTS MRI showed abnormalities on the symptomatic side in 42 of 57 patients (74%). In 30% of the patients, MRI confirmed an abnormality at the exact same level as determined after clinical examination. On the asymptomatic side, MRI showed abnormalities in 19 of 57 patients (33%), 13 (23%) of these patients had asymptomatic root compression. CONCLUSIONS In more than two-thirds of the patients with unilateral LRS there was no exact match between the level predicted by clinical examination and MRI findings. These discrepancies complicate the decision whether or not to operate.
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Affiliation(s)
- Jeroen C van Rijn
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Room J1B-210, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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