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dc.contributor.authorFurunes, Håvard
dc.contributor.authorHellum, Christian
dc.contributor.authorEspeland, Ansgar
dc.contributor.authorBrox, Jens Ivar
dc.contributor.authorSmåstuen, Milada C
dc.contributor.authorBerg, Linda
dc.contributor.authorStorheim, Kjersti
dc.date.accessioned2019-03-14T09:08:12Z
dc.date.available2019-03-14T09:08:12Z
dc.date.issued2018-12-15
dc.description.abstract<p><i>Study Design</i>: A randomized controlled multicenter trial with 8-year follow-up.</p> <p><i>Objective</i>: The aim of this study was to assess the long-term development of adjacent disc degeneration (ADD) after lumbar total disc replacement (TDR) or nonoperative treatment, and to analyze the association between ADD development and clinical outcome.</p> <p><i>Summary of Background Data</i>: TDR was introduced as a motion-preserving alternative to spinal fusion, which has been reported to increase the risk of ADD. However, ADD may develop naturally regardless of any surgery, and no randomized study has assessed the long-term development of ADD after TDR versus nonoperative treatment.</p> <p><i>Methods</i>: The study included 126 of the 173 patients with chronic low back pain (LBP) originally included in a randomized study comparing TDR with multidisciplinary rehabilitation. Magnetic resonance imaging (MRI) of the lumbar spine was performed before treatment and at 8-year follow-up. ADD was categorized as increased or not increased based on an evaluation of Modic changes, disc height reduction, disc contour, herniation size, nucleus pulposus signal, and posterior high intensity zones. We used a χ<sup>2</sup> test or a Fisher exact test to compare crude proportions, and multiple linear regressions to analyze the association between increased ADD (yes/no) and change in Oswestry Disability Index (ODI) from pre-treatment to follow-up.</p> <p><i>Results</i>: ADD increased (for at least one ADD variable) in 23 of 57 patients (40%) treated nonoperatively, and 29 of 69 patients (42%) treated with TDR (P = 0.86). We found no significant associations between ADD increase and the change in ODI.</p> <p><i>Conclusion</i>: Increased ADD occurred with similar frequency after TDR and after nonoperative treatment, and was not related to the clinical outcome at 8-year follow-up.</p> <p><i>Level of Evidence</i>: 1en_US
dc.descriptionAccepted manuscript version of the following article: Furunes, H., Hellum, C., Espeland, A., Brox, J.I., Småstuen, M.C., Berg, L. & Storheim, K. (2018). Adjacent Disc Degeneration After Lumbar Total Disc Replacement or Non-operative Treatment: A Randomized Study With Eight-year Follow-up. <i>Spine, 43</i>(24), 1695-1703. Published version available at <a href=https://doi.org/10.1097/BRS.0000000000002712> https://doi.org/10.1097/BRS.0000000000002712</a>.en_US
dc.identifier.citationFurunes, H., Hellum, C., Espeland, A., Brox, J.I., Småstuen, M.C., Berg, L. & Storheim, K. (2018). Adjacent Disc Degeneration After Lumbar Total Disc Replacement or Non-operative Treatment: A Randomized Study With Eight-year Follow-up. <i>Spine, 43</i>(24), 1695-1703. https://doi.org/10.1097/BRS.0000000000002712en_US
dc.identifier.cristinIDFRIDAID 1596288
dc.identifier.doi10.1097/BRS.0000000000002712
dc.identifier.issn0362-2436
dc.identifier.issn1528-1159
dc.identifier.urihttps://hdl.handle.net/10037/14972
dc.language.isoengen_US
dc.publisherLippincott, Williams & Wilkinsen_US
dc.relation.journalSpine
dc.rights.accessRightsopenAccessen_US
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750en_US
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750en_US
dc.subjectadjacent disc degenerationen_US
dc.subjectlong-term follow-upen_US
dc.subjectlow back painen_US
dc.subjectnonoperative treatmenten_US
dc.subjecttotal disc replacementen_US
dc.titleAdjacent Disc Degeneration After Lumbar Total Disc Replacement or Non-operative Treatment: A Randomized Study With Eight-year Follow-upen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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