Tom Amundsen's research while affiliated with Oslo University Hospital and other places
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Publications (16)
Fifty patients with lumbago-sciatica due to a proven herniated intervertebral lumbar disc were randomised between two treatment groups: manual traction and careful isometric exercises. Treatment was given daily over a period of 5-7 days. A blind overall assessment subsequent to treatment showed that in both groups approximately 40% of the patients...
samenvatting Lumbar spinal stenosis: Conservative or surgical management? A prospective 10-year study [Spine 2000;25(11):1424-36]
Our objectives were to study a/ the clinical results of microsurgical decompression without laminectomy compared to those reported from standard decompression laminectomy in patients with central lumbar spinal stenosis, and b/ if the microsurgical technique could prevent post-operative instability and concomitant symptoms. Twenty-one patients were...
A cohort of 100 patients with symptomatic lumbar spinal stenosis, characterized in a previous article, were given surgical or conservative treatment and followed for 10 years.
To identify the short- and long-term results after surgical and conservative treatment, and to determine whether clinical or radiologic predictors for the treatment result ca...
Study Design. A cohort of 100 patients with symptomatic lumbar spinal stenosis, characterized in a previous article, were given surgical or conservative treatment and followed for 10 years. Objectives. To identify the short- and long-term results after surgical and conservative treatment, and to determine whether clinical or radiologic predictors f...
This prospective study was performed to assess whether CT-diskography (CT-D), diskomanometry (DMM) including recording of the pain response, or the MR signal intensity of the disks are reliable predictors of the outcome of nucleotomy.
Ninety-one patients, 44 females and 47 males aged 18-68 years (mean 37.4) treated at 99 disk levels were included....
This study was carried out in order to assess the clinical results after percutaneous automated nucleotomy with regard to predictive factors for the outcome. Selection criteria included patients with predominance of low-back pain, diffuse posterior disk bulges and concomitant spinal stenosis who are not normally accepted for nucleotomy. In all, 142...
This study was carried out in order to assess the clinical results after percutaneous automated nucleotomy with regard to predictive factors for the outcome. Selection criteria included patients with predominance of low-back pain, diffuse posterior disk bulges and concomitant spinal stenosis who are not normally accepted for nucleotomy. In all, 142...
This prospective study was performed to assess whether CT-diskography (CT-D), diskomanometry (DMM) including recording of the pain response, or the MR signal intensity of the disks are reliable predictors of the outcome of nucleotomy. Ninety-one patients, 44 females and 47 males aged 18–68 years (mean 37.4) treated at 99 disk levels were included....
A prospective, randomized study of patients with symptomatic lumbar spinal stenosis.
Evaluation of clinical and radiologic characteristics and relationship.
The diagnosis of lumbar spinal stenosis is frequently used and represents a wide variety of patients with more or less well-defined spinal disorders.
One hundred patients who met inclusion crit...
Percutaneous nucleotomy is designed to treat small and medium-sized contained disk hernias. It is offered to patients who have not responded to conservative treatment for three months or more. The nucleotomy procedure is well tolerated by a majority of patients and the rate of complications is low. The patients can be treated as out-patients. Among...
In order to assess changes occurring in disk hernias and disk spaces following percutaneous nucleotomy a follow-up CT was carried out an average of 6 months after treatment of 69 disks in 60 patients. Forty-three of the disks were also reexamined at an average of 11 months after the first follow-up. Twenty-seven percent of the hernias were reduced...
In order to assess changes occurring in disk hernias and disk spaces following percutaneous nucleotomy a follow-up CT was carried out an average of 6 months after treatment of 69 disks in 60 patients. Forty-three of the disks were also reexamined at an average of 11 months after the first follow-up. Twenty-seven percent of the hernias were reduced...
The purpose of this study was to evaluate 2 years' experience with percutaneous automated nucleotomy. Adult patients with small to medium sized disk hernias corresponding to clinical symptoms, and without evidence of free fragments or stenosis were treated on an outpatient basis. All patients had sciatica and conservative treatment had failed for a...
Citations
... There are several causes of pain after scarring, including tethering of the nerve root, preventing its free movement in the spinal canal and foramen; entrapment of the nerve or of a vein which in turn entraps the nerve, leading to swelling of the nerve with attendant pain, either in the back or legs; sequestration of the nerve, so that medications applied to the nerve cannot reach it (43,44). While some have questioned whether scarring does lead to radicular pain (45,46), others claim the association of radicular pain with scarring (1,44,(47)(48)(49). Bosscher and Heavner (28) found that concordant pain was found in 84% of patients with post lumbar surgery syndrome and concluded that epidural fibrosis is the underlying pathology in most of these patients. ...
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... We believe that post-operative physical therapy after lumbar spine surgery is important to strengthen the affected muscles, improve balance, and facilitate return to ADL. Spinal surgery mainly includes decompression and fusion, with good post-operative results regardless of the surgical technique, and in recent years, multi-level fusion has become increasingly common [64,103]. In a comparison of surgical techniques, fixation as compared to decompression has more blood loss, operative time, and length of hospital stay [104,105]. ...
... As seen in Fig. 1, 122 studies were included in the revised network meta-analyses [5, (one publication included two studies [119]), 86 were RCTs [5,48,49,51,52,54,[56][57][58][59][60][61][62]64,66,67,[69][70][71][73][74][75][76][78][79][80][81][82][83]85,[87][88][89][90]93,[95][96][97][99][100][101]103,[105][106][107]110,111,[114][115][116][117][118][119][120][121][122][123][124][126][127][128]130,[132][133][134][135][136][137][138][139][140][141][143][144][145][149][150][151][152][153][154][155]158,160,163] and four quasi-RCTs (Q-RCTs) [46,91,104,109]. The network metaanalysis of global effect included 95 studies (68 RCTs/ Q-RCTs) and pain intensity 53 studies (46 RCTs/Q-RCTs). ...
... Based on the location of the stenotic pathology, lumbar spinal stenosis can be anatomically classified into three types: central stenosis, lateral recess stenosis, and foraminal stenosis (4). Degenerative lateral recess stenosis is usually caused by hyperplasia of the articular facets, osteophyte formation, hypertrophied ligamentum flavum, or disc herniation (5). A hypertrophied ligamentum flavum and hyperplasia of the articular facet on the dorsal side are the main causes of spinal canal and nerve root compression (6). ...
... This suggests that PAN may not be truly effective, the successful outcomes being due in many cases to spontaneous resolution of the symptoms. Studies using serial CT showed that after a mean period of six months the size of the herniation was not modified or had increased in some 75% of patients submitted to PAN. 38 The indications for this form of treatment are so limited, however, that only a small proportion of patients with disc herniation are good candidates for it and in these patients conservative management has a good chance of relieving the symptoms. Little is known concerning the mechanism of this technique and the few available studies suggest that PAN may increase rather than reduce the bulging of the disc in the spinal canal. ...
Reference: MANAGEMENT OF HERNIATION OF THE LUMBAR DISC
... Afterwards, either 2 or 4 mm pituitary rongeurs were used to remove 1.71±0.38 g of nuclear material, which is approximately 50% of NP volume (Castro et al., 1992;Dullerud et al., 1993). Amount of NP removed was not correlated with sample degeneration (r = 0.19, p = 0.5). ...
... The group under study did not include all eligible patients undergoing decompression within our spine unit, but instead comprised patients who had offered their voluntary participation in a RCT [25]. Nonetheless, adequate external validity of the findings was suggested by the fact that the medical history, clinical status and treatment outcomes of the study patients were broadly comparable to those of the typical patient undergoing decompression surgery described in the literature [10,31] and of consecutive patients from our own centre [23], documented systematically in connection with the Spine Tango Spine Registry of the Spine Society of Europe [34]. The only exception to this was that the study attracted a predominance of male volunteers, with slightly lower baseline symptoms than the ''typical patient''. ...
... Patients typically have leg pain, back pain, and a reduced walking distance. Surgical decompression is considered more successful than conservative treatment, [1][2][3][4] and LSS has become the most common indication for spinal surgery. [5][6][7] Degenerative spondylolisthesis (DS), defined as slippage of a vertebral body over the vertebral body below, may be present at the level of stenosis. ...
... Additionally, a few reports on less invasive procedures indicated that these procedures also caused instability despite the minimal tissue damage and bone removal (34,35) . However, most studies on bilateral laminectomy and unilateral or bilateral decompression have not described any instability (16,(36)(37)(38)(39)(40)(41) . Weiner et al. (16) suggested bilateral microdecompression using a unilateral route to successfully treat lower back pain by causing minimal tissue damage. ...
