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This study evaluates the 7-year outcome of lumbar disc surgery and the predictive value of pre- and perioperative risk factors.The 7-year follow-up rate of a sample of 122 patients was 93% ( n =114). Six per cent of the patients had undergone repeat surgery. Approximately 90% reported that they were satisfied with having undergone surgery. The clinical outcome was evaluated in 96 patients (54 men and 42 women) by means of patient-scores (VAS) of low back and leg pain, and a Clinical Overall Score (COS). In multivariate regression analyses, women were shown to have poorer outcome than men. Preoperative psychological distress and impaired fibrinolytic activity were predictors of poor 7-year outcome. Age, weight, smoking habits and physical fitness had no statistically significant prognostic value.Whether the patients were operated for one or two herniated discs, or whether surgery involved a full or partial laminectomy, did not influence the outcome significantly. [ABSTRACT FROM AUTHOR]

Treatment of columnar instability in children with conventional fusion procedures may preclude normal growth and cause dysfunction and pain due to malalignment or reduced mobility. To achieve normal growth, we have treated spinal instability in 7 children with posterior fusion, using bilateral rib transplants secured by horizontal laminar cerclages. Solid fusion was obtained and no serious complications occurred.

Sciatica in low back pain is usually caused by lumbar disc herniation, degenerative spinal disease or lumbar spinal stenosis. Important pathogenetic factors are mechanical compression of and inflammatory changes in nerve roots caused by nucleus pulposus tissue. Decompression of nerve roots and removal of nucleus pulposus tissue are the main surgical goals. Emphasis should be placed on clinical identification of the symptomatic nerve roots. Computerized tomography (CT) and magnetic resonance (MR) imaging are the most important diagnostic tools today. Plain X-ray may be required for correct identification of the lowest mobile segment. Functional myelography combined with CT may be required to diagnose lumbar spinal stenosis. A proper selection of patients for surgery seems to be more important for a successful outcome than whether macro- or microsurgery is used, or wether the operation comprises one or several nerve roots. The combination of clear nerve root affection, mechanically provoced pain, and corresponding pathological findings at imaging are the best predictors of successful outcome. Psychosocial stability is an additional positive predictive factor. Impaired fibrinolysis occurring in smokers and in sedentary and obese patients, may be a negative predictive factor.

Carotid endarterectomy has a documented stroke preventing effect in symptomatic high-grade carotid stenosis when the rate of serious complications is below 6%. In the period 1986-96, 160 procedures were performed on 150 patients at the Department of Neurosurgery, Ullevål Hospital. Oslo. The indication for surgery was hemispheric transient ischemic attack and/or amaurosis fugax in 137 patients and/or minor stroke in 49 in addition to a high-grade stenosis. Mean age was 61 years (42-74 years). One patient (0.6%) died four hours after surgery. Three patients (1.9%) suffered disabling postoperative stroke. The rate of serious complications was thus 2.5%. In addition, nine patients experienced minor and temporary paresis. Three patients were reoperated for haematoma and one for wound infection. Our surgical morbidity and mortality rate is comparable to larger series.

In a prospective cohort study 122 patients with herniated intervertebral lumbar disc and no previous low back surgery preoperatively were assessed regarding medical history, anthropometric and biological background variables. The outcome of surgery (traditional methods) was evaluated one year postoperatively, mainly using a composite Clinical Overall Score (COS), including pain intensity, physical signs, functional capacity and analgesics. Return to work was also assessed. In regression analyses, low body height, high values of weight and body mass index, as well as long duration of sickness absence were shown to be significantly related to a poor outcome, as evaluated by the COS. However, after controlling for modifying effects of previously determined predictive fibrinolytic and psychological variables, the background variables lost their significance. Female sex, low stature, long duration of sickness absence and physically strenuous work activities were statistically significantly related to lower frequencies of return to work.

Sciatica (a term used synonymously with lumbar radiculopathy) is usually caused by lumbar disc herniation or lumbar spinal stenosis. Mechanical compression of nerve roots is a predominant factor, and decompression the surgical goal. Emphasis should be placed on clinical identification of the nerve roots causing the complaint. Although computed tomography (CT) and magnetic resonance imaging (MRI) are the most important diagnostic tools used today, plain x-ray may be required for correct identification of the lowest mobile segment, and the functional myelography combined with CT may be required if lumbar spinal stenosis is suspected, or if the clinical findings are unclear--especially if the patient has already undergone surgery for sciatica. The proper selection for candidates for surgery seems to be a more important determinant of successful outcome than whether macro- or micro-surgery is used, or whether one or more segments are operated upon (12, 13). Clear clinical identification of the roots affected and corresponding pathological findings at imaging are the best predictors of successful surgical outcome, an additional factor of positive predictive value being psychosocial stability. Impaired fibrinolysis, occurring in smokers and in the sedentary and obese, may be a negative predictive factor (10, 11). Published findings suggest that, unlike the case with disc surgery (9), neither long duration of symptoms nor long preoperative sick leave is associated with poor outcome of surgery for spinal stenosis (14).

Study Design: Prospective cohort study., Objectives: To assess the amount of scar tissue by viewing magnetic resonance images, and to evaluate the correlation between the amount of scar tissue and clinical outcome, surgical technique, and fibrinolytic factors., Summary of Background Data: The influence of fibrinolytic factors on magnetic resonance images has not been investigated previously. The relation between clinical outcome and findings on magnetic resonance imaging remains uncertain., Methods: Magnetic resonance imaging at 0.5 Tesla was performed to produce sagittal and axial spin-echo T1-weighted images before and after contrast enhancement on 78 patients 7 years after traditional lumbar discectomy with partial or full laminectomy. Before surgery all patients had been tested for fibrinolytic factors., Results: The overall clinical success rate of the surgery was 73%. No evidence of scar formation was seen in 19 patients, a small amount was seen in 36 patients, a moderate amount in 17 patients, and a large amount was observed in 6 patients. Ten patients who had undergone surgery at two disc levels and 18 who had been treated with full laminectomy exhibited more scar tissue than those patients who had undergone surgery on a single level (P = 0.033) and those who had undergone a partial laminectomy, respectively (P = 0.017). The amount of scar formation also was associated with a poor outcome (P = 0.017) and with low preoperative values of tissue plasminogen activator antigen (P = 0.003) and tissue plasminogen activity (P = 0.048) in samples collected after venous occlusion. The intensity of contrast enhancement, however, was not influenced by these or any other parameters., Conclusion: The amount of scar formation after lumbar discectomy seems to be related to the clinical outcome, the size of the surgical exposure, and some fibrinolytic factors.

The incidence of methicillin-resistant Staphylococcus aureus in Norway is extremely low. Isolation of such strains is nearly always associated with import. From December 1993 to January 1997 at the Ullevål University Hospital Department of Medical Microbiology, methicillin-resistant Staphylococcus aureus was isolated from 22 persons in Oslo (17 patients and five healthy carriers). A cluster of ten infected persons was detected (five patients and five carriers (nurses)) who were infected with strains showing an unusual antibiotic resistance pattern. All of the cluster strains except for beta-lactams were resistant to fucidic acid and sensitive to other antistaphylococcal agents. The cluster was associated with two hospitals. The five patients were all admitted to the same intensive care unit during the period May to July 1995. Four of the five patients (one died) were referred to the same department in a long-term care hospital for rehabilitation and training. Problems concerning epidemiological investigation and control are discussed.

Previously, only three studies with representative samples of patients with ruptured intracranial aneurysms have provided detailed results of prospective, repeated, neuropsychological assessments after surgery. These studies apparently disagree with regard to occurrence of cognitive deficits and to degree of improvement between early and delayed follow-ups. The present paper attempts to analyze the conditions underlying these differences in results. As a first step in this analysis we present a comprehensive, prospective, neuropsychological investigation of a consecutive sample of 41 patients with rupture of a supratentorial aneurysm, assessed 4 and 12 months after surgery. It is concluded that a prorated course of improvement of a wide specter of psychological functions may be revealed, but that sensitive tests and large samples are needed to establish the range of deficits and improvements with time. Differences in patient selection with respect to severity of the acute clinical state and delayed deterioration apparently contribute importantly to the discrepance in previously reported outcome.

Treatment of cerebral aneurysms with Guglielmi Detachable Coils (GDC) was performed for the first time in Scandinavia in 1992. The experience at Ullevål University Clinic from 1994 to 1996 comprises 27 surgically inoperable aneurysms. Successful embolization was performed in 20 patients. No complications were seen during the procedure. However, renewed bleeding with fatal outcome occurred in one patient. In accordance with other colleagues we consider this treatment to be unsuitable for wide neck aneurysms (> 5 mm). For this reason seven patients were not treated. We conclude that GDC embolization seems to be an effective therapy for selected inoperable aneurysms. In the near future the method will probably be used to treat some of the surgically operable aneurysms as well.

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 patients were treated. The overall success rate after an average observation time of 21 months was 56%. The results were not influenced by whether a diffuse posterior bulge or a focal hernia had been treated or not (p = 0.449). Spinal stenosis (p = 0.043) and disk space narrowing exceeding 25% of the expected width (p = 0.017) were associated with a poor outcome. By excluding these categories and patients with symptoms from more than one disk level, the success rate rose to 70%. With this selection, the results were equally good in patients with predominantly low-back pain compared to those with predominantly sciatica (p = 0.490).

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 a total material of 130 patients, a primary good response to the treatment was observed in 81 (62%). However, owing to recurrencies the success rate had fallen to 52% at 12-39 months (mean 22 months) after nucleotomy. In selected patients with symptoms from one disk level only, and with no evidence of spinal stenosis, or of osteophyte formation or a narrowing of the disk space by more than 25%, the results were better. Here the success rate was 61% (70% in males and 50% in females).