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Jens Ivar Brox - One of the best experts on this subject based on the ideXlab platform.

  • no difference in long term trunk muscle strength cross sectional area and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus Cognitive Intervention and exercises
    The Spine Journal, 2011
    Co-Authors: Anne Froholdt, Anne Keller, Inger Holm, Ragnhild Gunderson, Olav Reikeraas, Jens Ivar Brox
    Abstract:

    BACKGROUND CONTEXT: Reduced muscle strength and density observed at 1 year after lumbar fusion may deteriorate more in the long term. PURPOSE: To compare the long-term effect of lumbar fusion and Cognitive Intervention and exercises on muscle strength, cross-sectional area, density, and self-rated function in patients with chronic low back pain (CLBP) and disc degeneration. STUDY DESIGN: Randomized controlled study with a follow-up examination at 8.5 years (range, 7–11 years). PATIENTS AND METHODS: Patients with CLBP and disc degeneration randomized to either instrumented posterolateral fusion of one or both of the two lower lumbar levels or a 3-week Cognitive Intervention and exercise program were included. Isokinetic muscle strength was measured by a Cybex 6000 (Cybex-Lumex, Inc., Ronkonkoma, NY, USA). All patients had previous experience withthetestprocedure.Thebackextension(E)flexion(F)musclesweretested,andtheE/Fratioswere calculated.Cross-sectionalareaanddensityofthebackmusclesweremeasuredattheL3–L4segment by computed tomography. Patients rated their function by the General Function Score. OUTCOME MEASURES: Trunk muscle strength, cross-sectional area, density, and self-rated function. RESULTS: Fifty-five patients (90%) were included at long-term follow-up. There were no significant differences in cross-sectional area, density, muscle strength, or self-rated function between the two groups. The Cognitive Intervention and exercise group increased trunk muscle extension significantly (p!.05), and both groups performed significantly better on trunk muscle flexion tests (p!.01) at long-term follow-up. On average, self-rated function improved by 56%, crosssectional area was reduced by 8.5%, and muscle density was reduced by 27%. CONCLUSION: Although this study did not assess the morphology of muscles likely damaged by surgery, trunk muscle strength and cross-sectional area above the surgical levels are not different between those who had lumbar fusion or Cognitive Intervention and exercises at 7- to 11-year follow-up. 2011 Elsevier Inc. All rights reserved.

  • predictors of change in trunk muscle strength for patients with chronic low back pain randomized to lumbar fusion or Cognitive Intervention and exercises
    Pain Medicine, 2008
    Co-Authors: Anne Keller, Jens Ivar Brox, Olav Reikeras
    Abstract:

    Objectives. We have previously reported in two randomized controlled trials that Cognitive Intervention and exercises more effectively improved isokinetic trunk muscle strength than lumbar fusion and postoperative rehabilitation in patients with chronic low back pain. The aim of the present study was to predict changes in muscle strength as regard to changes in pain, function, fear-avoidance beliefs (self-rated questionnaires), changes in cross-sectional area and density of the back muscles and treatment. Methods. We assessed 1) isokinetic trunk muscle strength; 2) cross-sectional area and density of back muscles by computer-tomography (CT); and 3) pain, function, fear-avoidance beliefs, and self- efficacy for pain in the included patients at baseline and 1-year follow-up. Multiple regression analysis was performed with change in muscle strength as dependent variables, and changes in area/density and self-rated symptoms and treatment as independent variables. Results. The correlations between the change in muscle strength and change in both cross-sectional area and density were weak ( r < 0.1) and nonsignificant and these variables were not included in the multiple regression analysis. The change in pain, change in fear-avoidance beliefs, change in self-efficacy for pain and treatment explained 46% of the change in muscle strength, with change in pain and treatment as significant predictors. Conclusion. Our results emphasize the central role of pain and treatment for the improvements in muscle strength in patients with chronic low back pain.

  • lumbar instrumented fusion compared with Cognitive Intervention and exercises in patients with chronic back pain after previous surgery for disc herniation a prospective randomized controlled study
    Pain, 2006
    Co-Authors: Jens Ivar Brox, Roger Sorensen, Oystein P Nygaard, Aage Indahl, Anne Keller, Tor Ingebrigtsen, Inger Holm, Olav Reikeras, Oliver Grundnes, Johan Emil Lange
    Abstract:

    Abstract The effectiveness of lumbar fusion for chronic low back pain after surgery for disc herniation has not been evaluated in a randomized controlled trial. The aim of the present study was to compare the effectiveness of lumbar fusion with posterior transpedicular screws and Cognitive Intervention and exercises. Sixty patients aged 25–60 years with low back pain lasting longer than 1 year after previous surgery for disc herniation were randomly allocated to the two treatment groups. Experienced back surgeons performed transpedicular fusion. Cognitive Intervention consisted of a lecture intended to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The primary outcome measure was the Oswestry Disability Index (ODI). Outcome data were analyzed on an intention-to-treat basis. Ninety-seven percent of the patients, including seven of eight patients who had either not attended treatment ( n  = 5) or changed groups ( n  = 2), completed 1-year follow-up. ODI was significantly improved from 47 to 38 after fusion and from 45 to 32 after Cognitive Intervention and exercises. The mean difference between treatments after adjustment for gender was −7.3 (95% CI −17.3 to 2.7, p  = 0.15). The success rate was 50% in the fusion group and 48% in the Cognitive Intervention/exercise group. For patients with chronic low back pain after previous surgery for disc herniation, lumbar fusion failed to show any benefit over Cognitive Intervention and exercises.

  • trunk muscle strength cross sectional area and density in patients with chronic low back pain randomized to lumbar fusion or Cognitive Intervention and exercises
    Spine, 2004
    Co-Authors: Anne Keller, Jens Ivar Brox, Astrid Friis, Inger Holm, Ragnhild Gunderson, Olav Reikeras
    Abstract:

    Study design A randomized study. Objectives To compare muscle strength, cross-sectional area, and density of the back muscles in two categories of patients with chronic low back pain, randomized to either lumbar fusion or Cognitive Intervention and exercises. Summary of background data In two clinical trials, patients with chronic low back pain plus disc degeneration and postlaminectomy syndrome, respectively, were randomized to either lumbar fusion or Cognitive Intervention and exercises. We have previously reported that results for the primary outcome were similar at the 1-year follow-up examination. Methods As the treatment alternatives and test procedures were identical, the two trials were merged into one. A total of 124 patients 25 to 60 years of age were included. Muscle strength, measured by isokinetic test device and by the Biering-Sorensen Test, was measured in 112 patients, and the cross-sectional area and density of the back muscles were measured in 61 patients at the inclusion and at the 1-year follow-up examination. Results The exercise group performed significantly better in muscle strength than did the lumbar fusion group, with the mean difference at 184 Nm (95% confidence interval, 64-303 Nm; P = 0.003) and for the Biering-Sorensen Test 21 seconds (95% confidence interval, 6-36 seconds; P = 0.006). The density at L3-L4 decreased in the lumbar fusion group but remained unchanged in the exercise group. The mean difference was 5.3 HU (95% confidence interval, 1.1-9.5 HU; P = 0.01). The cross-sectional area was unchanged in both groups. Conclusions Patients with chronic low back pain who followed Cognitive Intervention and exercise programs improved significantly in muscle strength compared with patients who underwent lumbar fusion. In the lumbar fusion group, density decreased significantly at L3-L4 compared with the exercise group.

  • randomized clinical trial of lumbar instrumented fusion and Cognitive Intervention and exercises in patients with chronic low back pain and disc degeneration
    Spine, 2003
    Co-Authors: Jens Ivar Brox, Roger Sorensen, Astrid Friis, Oystein P Nygaard, Aage Indahl, Anne Keller, Tor Ingebrigtsen, Hege R Eriksen, Inger Holm, Anne Kathrine Koller
    Abstract:

    Study design Single blind randomized study. Objectives To compare the effectiveness of lumbar instrumented fusion with Cognitive Intervention and exercises in patients with chronic low back pain and disc degeneration. Summary of background data To the authors' best knowledge, only one randomized study has evaluated the effectiveness of lumbar fusion. The Swedish Lumbar Spine Study reported that lumbar fusion was better than continuing physiotherapy and care by the family physician. Patients and methods Sixty-four patients aged 25-60 years with low back pain lasting longer than 1 year and evidence of disc degeneration at L4-L5 and/or L5-S1 at radiographic examination were randomized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy, or Cognitive Intervention and exercises. The Cognitive Intervention consisted of a lecture to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The main outcome measure was the Oswestry Disability Index. Results At the 1-year follow-up visit, 97% of the patients, including 6 patients who had either not attended treatment or changed groups, were examined. The Oswestry Disability Index was significantly reduced from 41 to 26 after surgery, compared with 42 to 30 after Cognitive Intervention and exercises. The mean difference between groups was 2.3 (-6.7 to 11.4) (P = 0.33). Improvements inback pain, use of analgesics, emotional distress, life satisfaction, and return to work were not different. Fear-avoidance beliefs and fingertip-floor distance were reduced more after nonoperative treatment, and lower limb pain was reduced more after surgery. The success rate according to an independent observer was 70% after surgery and 76% after Cognitive Intervention and exercises. The early complication rate in the surgical group was 18%. Conclusion The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration randomized to Cognitive Intervention and exercises, or lumbar fusion.

Anne Keller - One of the best experts on this subject based on the ideXlab platform.

  • no difference in long term trunk muscle strength cross sectional area and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus Cognitive Intervention and exercises
    The Spine Journal, 2011
    Co-Authors: Anne Froholdt, Anne Keller, Inger Holm, Ragnhild Gunderson, Olav Reikeraas, Jens Ivar Brox
    Abstract:

    BACKGROUND CONTEXT: Reduced muscle strength and density observed at 1 year after lumbar fusion may deteriorate more in the long term. PURPOSE: To compare the long-term effect of lumbar fusion and Cognitive Intervention and exercises on muscle strength, cross-sectional area, density, and self-rated function in patients with chronic low back pain (CLBP) and disc degeneration. STUDY DESIGN: Randomized controlled study with a follow-up examination at 8.5 years (range, 7–11 years). PATIENTS AND METHODS: Patients with CLBP and disc degeneration randomized to either instrumented posterolateral fusion of one or both of the two lower lumbar levels or a 3-week Cognitive Intervention and exercise program were included. Isokinetic muscle strength was measured by a Cybex 6000 (Cybex-Lumex, Inc., Ronkonkoma, NY, USA). All patients had previous experience withthetestprocedure.Thebackextension(E)flexion(F)musclesweretested,andtheE/Fratioswere calculated.Cross-sectionalareaanddensityofthebackmusclesweremeasuredattheL3–L4segment by computed tomography. Patients rated their function by the General Function Score. OUTCOME MEASURES: Trunk muscle strength, cross-sectional area, density, and self-rated function. RESULTS: Fifty-five patients (90%) were included at long-term follow-up. There were no significant differences in cross-sectional area, density, muscle strength, or self-rated function between the two groups. The Cognitive Intervention and exercise group increased trunk muscle extension significantly (p!.05), and both groups performed significantly better on trunk muscle flexion tests (p!.01) at long-term follow-up. On average, self-rated function improved by 56%, crosssectional area was reduced by 8.5%, and muscle density was reduced by 27%. CONCLUSION: Although this study did not assess the morphology of muscles likely damaged by surgery, trunk muscle strength and cross-sectional area above the surgical levels are not different between those who had lumbar fusion or Cognitive Intervention and exercises at 7- to 11-year follow-up. 2011 Elsevier Inc. All rights reserved.

  • predictors of change in trunk muscle strength for patients with chronic low back pain randomized to lumbar fusion or Cognitive Intervention and exercises
    Pain Medicine, 2008
    Co-Authors: Anne Keller, Jens Ivar Brox, Olav Reikeras
    Abstract:

    Objectives. We have previously reported in two randomized controlled trials that Cognitive Intervention and exercises more effectively improved isokinetic trunk muscle strength than lumbar fusion and postoperative rehabilitation in patients with chronic low back pain. The aim of the present study was to predict changes in muscle strength as regard to changes in pain, function, fear-avoidance beliefs (self-rated questionnaires), changes in cross-sectional area and density of the back muscles and treatment. Methods. We assessed 1) isokinetic trunk muscle strength; 2) cross-sectional area and density of back muscles by computer-tomography (CT); and 3) pain, function, fear-avoidance beliefs, and self- efficacy for pain in the included patients at baseline and 1-year follow-up. Multiple regression analysis was performed with change in muscle strength as dependent variables, and changes in area/density and self-rated symptoms and treatment as independent variables. Results. The correlations between the change in muscle strength and change in both cross-sectional area and density were weak ( r < 0.1) and nonsignificant and these variables were not included in the multiple regression analysis. The change in pain, change in fear-avoidance beliefs, change in self-efficacy for pain and treatment explained 46% of the change in muscle strength, with change in pain and treatment as significant predictors. Conclusion. Our results emphasize the central role of pain and treatment for the improvements in muscle strength in patients with chronic low back pain.

  • lumbar instrumented fusion compared with Cognitive Intervention and exercises in patients with chronic back pain after previous surgery for disc herniation a prospective randomized controlled study
    Pain, 2006
    Co-Authors: Jens Ivar Brox, Roger Sorensen, Oystein P Nygaard, Aage Indahl, Anne Keller, Tor Ingebrigtsen, Inger Holm, Olav Reikeras, Oliver Grundnes, Johan Emil Lange
    Abstract:

    Abstract The effectiveness of lumbar fusion for chronic low back pain after surgery for disc herniation has not been evaluated in a randomized controlled trial. The aim of the present study was to compare the effectiveness of lumbar fusion with posterior transpedicular screws and Cognitive Intervention and exercises. Sixty patients aged 25–60 years with low back pain lasting longer than 1 year after previous surgery for disc herniation were randomly allocated to the two treatment groups. Experienced back surgeons performed transpedicular fusion. Cognitive Intervention consisted of a lecture intended to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The primary outcome measure was the Oswestry Disability Index (ODI). Outcome data were analyzed on an intention-to-treat basis. Ninety-seven percent of the patients, including seven of eight patients who had either not attended treatment ( n  = 5) or changed groups ( n  = 2), completed 1-year follow-up. ODI was significantly improved from 47 to 38 after fusion and from 45 to 32 after Cognitive Intervention and exercises. The mean difference between treatments after adjustment for gender was −7.3 (95% CI −17.3 to 2.7, p  = 0.15). The success rate was 50% in the fusion group and 48% in the Cognitive Intervention/exercise group. For patients with chronic low back pain after previous surgery for disc herniation, lumbar fusion failed to show any benefit over Cognitive Intervention and exercises.

  • trunk muscle strength cross sectional area and density in patients with chronic low back pain randomized to lumbar fusion or Cognitive Intervention and exercises
    Spine, 2004
    Co-Authors: Anne Keller, Jens Ivar Brox, Astrid Friis, Inger Holm, Ragnhild Gunderson, Olav Reikeras
    Abstract:

    Study design A randomized study. Objectives To compare muscle strength, cross-sectional area, and density of the back muscles in two categories of patients with chronic low back pain, randomized to either lumbar fusion or Cognitive Intervention and exercises. Summary of background data In two clinical trials, patients with chronic low back pain plus disc degeneration and postlaminectomy syndrome, respectively, were randomized to either lumbar fusion or Cognitive Intervention and exercises. We have previously reported that results for the primary outcome were similar at the 1-year follow-up examination. Methods As the treatment alternatives and test procedures were identical, the two trials were merged into one. A total of 124 patients 25 to 60 years of age were included. Muscle strength, measured by isokinetic test device and by the Biering-Sorensen Test, was measured in 112 patients, and the cross-sectional area and density of the back muscles were measured in 61 patients at the inclusion and at the 1-year follow-up examination. Results The exercise group performed significantly better in muscle strength than did the lumbar fusion group, with the mean difference at 184 Nm (95% confidence interval, 64-303 Nm; P = 0.003) and for the Biering-Sorensen Test 21 seconds (95% confidence interval, 6-36 seconds; P = 0.006). The density at L3-L4 decreased in the lumbar fusion group but remained unchanged in the exercise group. The mean difference was 5.3 HU (95% confidence interval, 1.1-9.5 HU; P = 0.01). The cross-sectional area was unchanged in both groups. Conclusions Patients with chronic low back pain who followed Cognitive Intervention and exercise programs improved significantly in muscle strength compared with patients who underwent lumbar fusion. In the lumbar fusion group, density decreased significantly at L3-L4 compared with the exercise group.

  • randomized clinical trial of lumbar instrumented fusion and Cognitive Intervention and exercises in patients with chronic low back pain and disc degeneration
    Spine, 2003
    Co-Authors: Jens Ivar Brox, Roger Sorensen, Astrid Friis, Oystein P Nygaard, Aage Indahl, Anne Keller, Tor Ingebrigtsen, Hege R Eriksen, Inger Holm, Anne Kathrine Koller
    Abstract:

    Study design Single blind randomized study. Objectives To compare the effectiveness of lumbar instrumented fusion with Cognitive Intervention and exercises in patients with chronic low back pain and disc degeneration. Summary of background data To the authors' best knowledge, only one randomized study has evaluated the effectiveness of lumbar fusion. The Swedish Lumbar Spine Study reported that lumbar fusion was better than continuing physiotherapy and care by the family physician. Patients and methods Sixty-four patients aged 25-60 years with low back pain lasting longer than 1 year and evidence of disc degeneration at L4-L5 and/or L5-S1 at radiographic examination were randomized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy, or Cognitive Intervention and exercises. The Cognitive Intervention consisted of a lecture to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The main outcome measure was the Oswestry Disability Index. Results At the 1-year follow-up visit, 97% of the patients, including 6 patients who had either not attended treatment or changed groups, were examined. The Oswestry Disability Index was significantly reduced from 41 to 26 after surgery, compared with 42 to 30 after Cognitive Intervention and exercises. The mean difference between groups was 2.3 (-6.7 to 11.4) (P = 0.33). Improvements inback pain, use of analgesics, emotional distress, life satisfaction, and return to work were not different. Fear-avoidance beliefs and fingertip-floor distance were reduced more after nonoperative treatment, and lower limb pain was reduced more after surgery. The success rate according to an independent observer was 70% after surgery and 76% after Cognitive Intervention and exercises. The early complication rate in the surgical group was 18%. Conclusion The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration randomized to Cognitive Intervention and exercises, or lumbar fusion.

Olav Reikeras - One of the best experts on this subject based on the ideXlab platform.

  • predictors of change in trunk muscle strength for patients with chronic low back pain randomized to lumbar fusion or Cognitive Intervention and exercises
    Pain Medicine, 2008
    Co-Authors: Anne Keller, Jens Ivar Brox, Olav Reikeras
    Abstract:

    Objectives. We have previously reported in two randomized controlled trials that Cognitive Intervention and exercises more effectively improved isokinetic trunk muscle strength than lumbar fusion and postoperative rehabilitation in patients with chronic low back pain. The aim of the present study was to predict changes in muscle strength as regard to changes in pain, function, fear-avoidance beliefs (self-rated questionnaires), changes in cross-sectional area and density of the back muscles and treatment. Methods. We assessed 1) isokinetic trunk muscle strength; 2) cross-sectional area and density of back muscles by computer-tomography (CT); and 3) pain, function, fear-avoidance beliefs, and self- efficacy for pain in the included patients at baseline and 1-year follow-up. Multiple regression analysis was performed with change in muscle strength as dependent variables, and changes in area/density and self-rated symptoms and treatment as independent variables. Results. The correlations between the change in muscle strength and change in both cross-sectional area and density were weak ( r < 0.1) and nonsignificant and these variables were not included in the multiple regression analysis. The change in pain, change in fear-avoidance beliefs, change in self-efficacy for pain and treatment explained 46% of the change in muscle strength, with change in pain and treatment as significant predictors. Conclusion. Our results emphasize the central role of pain and treatment for the improvements in muscle strength in patients with chronic low back pain.

  • lumbar instrumented fusion compared with Cognitive Intervention and exercises in patients with chronic back pain after previous surgery for disc herniation a prospective randomized controlled study
    Pain, 2006
    Co-Authors: Jens Ivar Brox, Roger Sorensen, Oystein P Nygaard, Aage Indahl, Anne Keller, Tor Ingebrigtsen, Inger Holm, Olav Reikeras, Oliver Grundnes, Johan Emil Lange
    Abstract:

    Abstract The effectiveness of lumbar fusion for chronic low back pain after surgery for disc herniation has not been evaluated in a randomized controlled trial. The aim of the present study was to compare the effectiveness of lumbar fusion with posterior transpedicular screws and Cognitive Intervention and exercises. Sixty patients aged 25–60 years with low back pain lasting longer than 1 year after previous surgery for disc herniation were randomly allocated to the two treatment groups. Experienced back surgeons performed transpedicular fusion. Cognitive Intervention consisted of a lecture intended to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The primary outcome measure was the Oswestry Disability Index (ODI). Outcome data were analyzed on an intention-to-treat basis. Ninety-seven percent of the patients, including seven of eight patients who had either not attended treatment ( n  = 5) or changed groups ( n  = 2), completed 1-year follow-up. ODI was significantly improved from 47 to 38 after fusion and from 45 to 32 after Cognitive Intervention and exercises. The mean difference between treatments after adjustment for gender was −7.3 (95% CI −17.3 to 2.7, p  = 0.15). The success rate was 50% in the fusion group and 48% in the Cognitive Intervention/exercise group. For patients with chronic low back pain after previous surgery for disc herniation, lumbar fusion failed to show any benefit over Cognitive Intervention and exercises.

  • trunk muscle strength cross sectional area and density in patients with chronic low back pain randomized to lumbar fusion or Cognitive Intervention and exercises
    Spine, 2004
    Co-Authors: Anne Keller, Jens Ivar Brox, Astrid Friis, Inger Holm, Ragnhild Gunderson, Olav Reikeras
    Abstract:

    Study design A randomized study. Objectives To compare muscle strength, cross-sectional area, and density of the back muscles in two categories of patients with chronic low back pain, randomized to either lumbar fusion or Cognitive Intervention and exercises. Summary of background data In two clinical trials, patients with chronic low back pain plus disc degeneration and postlaminectomy syndrome, respectively, were randomized to either lumbar fusion or Cognitive Intervention and exercises. We have previously reported that results for the primary outcome were similar at the 1-year follow-up examination. Methods As the treatment alternatives and test procedures were identical, the two trials were merged into one. A total of 124 patients 25 to 60 years of age were included. Muscle strength, measured by isokinetic test device and by the Biering-Sorensen Test, was measured in 112 patients, and the cross-sectional area and density of the back muscles were measured in 61 patients at the inclusion and at the 1-year follow-up examination. Results The exercise group performed significantly better in muscle strength than did the lumbar fusion group, with the mean difference at 184 Nm (95% confidence interval, 64-303 Nm; P = 0.003) and for the Biering-Sorensen Test 21 seconds (95% confidence interval, 6-36 seconds; P = 0.006). The density at L3-L4 decreased in the lumbar fusion group but remained unchanged in the exercise group. The mean difference was 5.3 HU (95% confidence interval, 1.1-9.5 HU; P = 0.01). The cross-sectional area was unchanged in both groups. Conclusions Patients with chronic low back pain who followed Cognitive Intervention and exercise programs improved significantly in muscle strength compared with patients who underwent lumbar fusion. In the lumbar fusion group, density decreased significantly at L3-L4 compared with the exercise group.

Inger Holm - One of the best experts on this subject based on the ideXlab platform.

  • no difference in long term trunk muscle strength cross sectional area and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus Cognitive Intervention and exercises
    The Spine Journal, 2011
    Co-Authors: Anne Froholdt, Anne Keller, Inger Holm, Ragnhild Gunderson, Olav Reikeraas, Jens Ivar Brox
    Abstract:

    BACKGROUND CONTEXT: Reduced muscle strength and density observed at 1 year after lumbar fusion may deteriorate more in the long term. PURPOSE: To compare the long-term effect of lumbar fusion and Cognitive Intervention and exercises on muscle strength, cross-sectional area, density, and self-rated function in patients with chronic low back pain (CLBP) and disc degeneration. STUDY DESIGN: Randomized controlled study with a follow-up examination at 8.5 years (range, 7–11 years). PATIENTS AND METHODS: Patients with CLBP and disc degeneration randomized to either instrumented posterolateral fusion of one or both of the two lower lumbar levels or a 3-week Cognitive Intervention and exercise program were included. Isokinetic muscle strength was measured by a Cybex 6000 (Cybex-Lumex, Inc., Ronkonkoma, NY, USA). All patients had previous experience withthetestprocedure.Thebackextension(E)flexion(F)musclesweretested,andtheE/Fratioswere calculated.Cross-sectionalareaanddensityofthebackmusclesweremeasuredattheL3–L4segment by computed tomography. Patients rated their function by the General Function Score. OUTCOME MEASURES: Trunk muscle strength, cross-sectional area, density, and self-rated function. RESULTS: Fifty-five patients (90%) were included at long-term follow-up. There were no significant differences in cross-sectional area, density, muscle strength, or self-rated function between the two groups. The Cognitive Intervention and exercise group increased trunk muscle extension significantly (p!.05), and both groups performed significantly better on trunk muscle flexion tests (p!.01) at long-term follow-up. On average, self-rated function improved by 56%, crosssectional area was reduced by 8.5%, and muscle density was reduced by 27%. CONCLUSION: Although this study did not assess the morphology of muscles likely damaged by surgery, trunk muscle strength and cross-sectional area above the surgical levels are not different between those who had lumbar fusion or Cognitive Intervention and exercises at 7- to 11-year follow-up. 2011 Elsevier Inc. All rights reserved.

  • lumbar instrumented fusion compared with Cognitive Intervention and exercises in patients with chronic back pain after previous surgery for disc herniation a prospective randomized controlled study
    Pain, 2006
    Co-Authors: Jens Ivar Brox, Roger Sorensen, Oystein P Nygaard, Aage Indahl, Anne Keller, Tor Ingebrigtsen, Inger Holm, Olav Reikeras, Oliver Grundnes, Johan Emil Lange
    Abstract:

    Abstract The effectiveness of lumbar fusion for chronic low back pain after surgery for disc herniation has not been evaluated in a randomized controlled trial. The aim of the present study was to compare the effectiveness of lumbar fusion with posterior transpedicular screws and Cognitive Intervention and exercises. Sixty patients aged 25–60 years with low back pain lasting longer than 1 year after previous surgery for disc herniation were randomly allocated to the two treatment groups. Experienced back surgeons performed transpedicular fusion. Cognitive Intervention consisted of a lecture intended to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The primary outcome measure was the Oswestry Disability Index (ODI). Outcome data were analyzed on an intention-to-treat basis. Ninety-seven percent of the patients, including seven of eight patients who had either not attended treatment ( n  = 5) or changed groups ( n  = 2), completed 1-year follow-up. ODI was significantly improved from 47 to 38 after fusion and from 45 to 32 after Cognitive Intervention and exercises. The mean difference between treatments after adjustment for gender was −7.3 (95% CI −17.3 to 2.7, p  = 0.15). The success rate was 50% in the fusion group and 48% in the Cognitive Intervention/exercise group. For patients with chronic low back pain after previous surgery for disc herniation, lumbar fusion failed to show any benefit over Cognitive Intervention and exercises.

  • trunk muscle strength cross sectional area and density in patients with chronic low back pain randomized to lumbar fusion or Cognitive Intervention and exercises
    Spine, 2004
    Co-Authors: Anne Keller, Jens Ivar Brox, Astrid Friis, Inger Holm, Ragnhild Gunderson, Olav Reikeras
    Abstract:

    Study design A randomized study. Objectives To compare muscle strength, cross-sectional area, and density of the back muscles in two categories of patients with chronic low back pain, randomized to either lumbar fusion or Cognitive Intervention and exercises. Summary of background data In two clinical trials, patients with chronic low back pain plus disc degeneration and postlaminectomy syndrome, respectively, were randomized to either lumbar fusion or Cognitive Intervention and exercises. We have previously reported that results for the primary outcome were similar at the 1-year follow-up examination. Methods As the treatment alternatives and test procedures were identical, the two trials were merged into one. A total of 124 patients 25 to 60 years of age were included. Muscle strength, measured by isokinetic test device and by the Biering-Sorensen Test, was measured in 112 patients, and the cross-sectional area and density of the back muscles were measured in 61 patients at the inclusion and at the 1-year follow-up examination. Results The exercise group performed significantly better in muscle strength than did the lumbar fusion group, with the mean difference at 184 Nm (95% confidence interval, 64-303 Nm; P = 0.003) and for the Biering-Sorensen Test 21 seconds (95% confidence interval, 6-36 seconds; P = 0.006). The density at L3-L4 decreased in the lumbar fusion group but remained unchanged in the exercise group. The mean difference was 5.3 HU (95% confidence interval, 1.1-9.5 HU; P = 0.01). The cross-sectional area was unchanged in both groups. Conclusions Patients with chronic low back pain who followed Cognitive Intervention and exercise programs improved significantly in muscle strength compared with patients who underwent lumbar fusion. In the lumbar fusion group, density decreased significantly at L3-L4 compared with the exercise group.

  • randomized clinical trial of lumbar instrumented fusion and Cognitive Intervention and exercises in patients with chronic low back pain and disc degeneration
    Spine, 2003
    Co-Authors: Jens Ivar Brox, Roger Sorensen, Astrid Friis, Oystein P Nygaard, Aage Indahl, Anne Keller, Tor Ingebrigtsen, Hege R Eriksen, Inger Holm, Anne Kathrine Koller
    Abstract:

    Study design Single blind randomized study. Objectives To compare the effectiveness of lumbar instrumented fusion with Cognitive Intervention and exercises in patients with chronic low back pain and disc degeneration. Summary of background data To the authors' best knowledge, only one randomized study has evaluated the effectiveness of lumbar fusion. The Swedish Lumbar Spine Study reported that lumbar fusion was better than continuing physiotherapy and care by the family physician. Patients and methods Sixty-four patients aged 25-60 years with low back pain lasting longer than 1 year and evidence of disc degeneration at L4-L5 and/or L5-S1 at radiographic examination were randomized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy, or Cognitive Intervention and exercises. The Cognitive Intervention consisted of a lecture to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The main outcome measure was the Oswestry Disability Index. Results At the 1-year follow-up visit, 97% of the patients, including 6 patients who had either not attended treatment or changed groups, were examined. The Oswestry Disability Index was significantly reduced from 41 to 26 after surgery, compared with 42 to 30 after Cognitive Intervention and exercises. The mean difference between groups was 2.3 (-6.7 to 11.4) (P = 0.33). Improvements inback pain, use of analgesics, emotional distress, life satisfaction, and return to work were not different. Fear-avoidance beliefs and fingertip-floor distance were reduced more after nonoperative treatment, and lower limb pain was reduced more after surgery. The success rate according to an independent observer was 70% after surgery and 76% after Cognitive Intervention and exercises. The early complication rate in the surgical group was 18%. Conclusion The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration randomized to Cognitive Intervention and exercises, or lumbar fusion.

Ragnhild Gunderson - One of the best experts on this subject based on the ideXlab platform.

  • no difference in long term trunk muscle strength cross sectional area and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus Cognitive Intervention and exercises
    The Spine Journal, 2011
    Co-Authors: Anne Froholdt, Anne Keller, Inger Holm, Ragnhild Gunderson, Olav Reikeraas, Jens Ivar Brox
    Abstract:

    BACKGROUND CONTEXT: Reduced muscle strength and density observed at 1 year after lumbar fusion may deteriorate more in the long term. PURPOSE: To compare the long-term effect of lumbar fusion and Cognitive Intervention and exercises on muscle strength, cross-sectional area, density, and self-rated function in patients with chronic low back pain (CLBP) and disc degeneration. STUDY DESIGN: Randomized controlled study with a follow-up examination at 8.5 years (range, 7–11 years). PATIENTS AND METHODS: Patients with CLBP and disc degeneration randomized to either instrumented posterolateral fusion of one or both of the two lower lumbar levels or a 3-week Cognitive Intervention and exercise program were included. Isokinetic muscle strength was measured by a Cybex 6000 (Cybex-Lumex, Inc., Ronkonkoma, NY, USA). All patients had previous experience withthetestprocedure.Thebackextension(E)flexion(F)musclesweretested,andtheE/Fratioswere calculated.Cross-sectionalareaanddensityofthebackmusclesweremeasuredattheL3–L4segment by computed tomography. Patients rated their function by the General Function Score. OUTCOME MEASURES: Trunk muscle strength, cross-sectional area, density, and self-rated function. RESULTS: Fifty-five patients (90%) were included at long-term follow-up. There were no significant differences in cross-sectional area, density, muscle strength, or self-rated function between the two groups. The Cognitive Intervention and exercise group increased trunk muscle extension significantly (p!.05), and both groups performed significantly better on trunk muscle flexion tests (p!.01) at long-term follow-up. On average, self-rated function improved by 56%, crosssectional area was reduced by 8.5%, and muscle density was reduced by 27%. CONCLUSION: Although this study did not assess the morphology of muscles likely damaged by surgery, trunk muscle strength and cross-sectional area above the surgical levels are not different between those who had lumbar fusion or Cognitive Intervention and exercises at 7- to 11-year follow-up. 2011 Elsevier Inc. All rights reserved.

  • trunk muscle strength cross sectional area and density in patients with chronic low back pain randomized to lumbar fusion or Cognitive Intervention and exercises
    Spine, 2004
    Co-Authors: Anne Keller, Jens Ivar Brox, Astrid Friis, Inger Holm, Ragnhild Gunderson, Olav Reikeras
    Abstract:

    Study design A randomized study. Objectives To compare muscle strength, cross-sectional area, and density of the back muscles in two categories of patients with chronic low back pain, randomized to either lumbar fusion or Cognitive Intervention and exercises. Summary of background data In two clinical trials, patients with chronic low back pain plus disc degeneration and postlaminectomy syndrome, respectively, were randomized to either lumbar fusion or Cognitive Intervention and exercises. We have previously reported that results for the primary outcome were similar at the 1-year follow-up examination. Methods As the treatment alternatives and test procedures were identical, the two trials were merged into one. A total of 124 patients 25 to 60 years of age were included. Muscle strength, measured by isokinetic test device and by the Biering-Sorensen Test, was measured in 112 patients, and the cross-sectional area and density of the back muscles were measured in 61 patients at the inclusion and at the 1-year follow-up examination. Results The exercise group performed significantly better in muscle strength than did the lumbar fusion group, with the mean difference at 184 Nm (95% confidence interval, 64-303 Nm; P = 0.003) and for the Biering-Sorensen Test 21 seconds (95% confidence interval, 6-36 seconds; P = 0.006). The density at L3-L4 decreased in the lumbar fusion group but remained unchanged in the exercise group. The mean difference was 5.3 HU (95% confidence interval, 1.1-9.5 HU; P = 0.01). The cross-sectional area was unchanged in both groups. Conclusions Patients with chronic low back pain who followed Cognitive Intervention and exercise programs improved significantly in muscle strength compared with patients who underwent lumbar fusion. In the lumbar fusion group, density decreased significantly at L3-L4 compared with the exercise group.