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Epidemiology of traumatic spinal cord injuries in Iceland from 1975 to 2009
(2012-02) Knútsdóttir, S.; Thórisdóttir, H.; Sigvaldason, K.; Jónsson, H.; Björnsson, A.; Ingvarsson, P.; Department of Engineering
Study design:Retrospective population-based epidemiological study. Objectives: To assess the nationwide, population-based incidence, causes, age, gender, extent and prevalence of spinal cord injuries (SCIs) in Iceland from 1975 to 2009. Setting: Landspitali University Hospital in Iceland, the single referral center for SCIs in Iceland. Methods: A retrospective review of hospital records on all admissions due to SCIs. Analysis of incidence, causes, age, gender, extent of injury and prevalence. Results: A total of 207 patients with traumatic spinal cord injury (TSCI) were admitted: males 72%, females 28%. The percentage of females with TSCI increased to 37% in 2000-2004. Mean age at injury was 38 years. Average incidence per million population per year was 30 in 1975-1979, 12.5 in 1995-1999 and 33.5 in 2005-2009. Thirty-day mortality was 6.3%. Causes of injury were road traffic accidents (RTA) in 42.5% of the cases; the majority did not use seatbelts. Falls amounted to 30.9%, with an increase of low falls among the elderly causing incomplete cervical lesions. Sport/leisure activities were the cause in 18.8%, of which 54% occurred after 2000. The main single cause of TSCI in sport/leisure were horse-riding accidents, followed by winter sport accidents, especially among women. Other causes constituted 7.7%. The injury was complete in 39%; cervical lesions were 57% and thoracic/lumbar lesions were 43%. In December 2009, the crude prevalence rate was 526 per million population.Conclusions:The findings showed a significant increase of TSCI in 2005-2009, especially in sport/leisure accidents and incomplete cervical lesions due to falls among elderly. Prevention strategies need to focus on these risk groups and on seatbelt use.
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Altered scapular orientation during arm elevation in patients with insidious onset neck pain and whiplash-associated disorder
(2010-12) Helgadottir, Harpa; Kristjansson, Eythor; Mottram, Sarah; Karduna, Andrew; Jonsson, Halldor; Department of Engineering
OBJECTIVES: To investigate whether there is a pattern of altered scapular orientation during arm elevation in patients with insidious onset neck pain (I0NP) and whiplash-associated disorder (WAD) compared to asymptomatic people. BACKGROUND: Altered activity in the axioscapular muscles and impairments in scapular orientation are considered to be important features in patients with cervical disorders. Scapular orientation has until now not been investigated in these patients. METHODS: A 3-dimensional tracking device measured scapular orientation during arm elevation in patients with I0NP (n = 21) and WAD (n = 23). An asymptomatic group was selected for comparison (n = 20). RESULTS: The groups demonstrated a significantly reduced clavicle retraction on the dominant side compared to the nondominant side. The WAD group demonstrated an increased elevation of the clavicle compared to the asymptomatic group and the I0NP group, and reduced scapular posterior tilt on the nondominant side compared to the I0NP group. CONCLUSION: Altered dynamic stability of the scapula may be present in patients with cervical disorders, which may be an important mechanism for maintenance of recurrence or exacerbation of symptoms in these patients. Patients with cervical disorders may demonstrate a difference in impairments, based on their diagnosis of IONP or WAD.
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Inflammatory cytokines in relation to adrenal response following total hip replacement
(2007-01) Bjornsson, G. L.; Thorsteinsson, L.; Gudmundsson, K. O.; Jonsson, H.; Gudmundsson, S.; Gudbjornsson, B.; Department of Engineering; Department of Business and Economics
Our objective was to investigate the initiation and course of pro- and anti-inflammatory cytokines in early inflammatory response and to elucidate the cytokine system in relation to the adrenal response caused by stress. Seven blood samples were collected, pre- and postoperatively (0-72 h) after total hip replacement (THR) due to osteoarthritis. The following cytokines were measured using Cytometric Bead Array: interleukin-1β (IL-1β), IL-6, tumour necrosis factor-α, IL-8, IL-12 and IL-10 (B&D). Thirteen patients took part in the study (67 ± 9 years). C-reactive protein increased from <6 to over 200 mg/l on the second post-op day. The concentration of IL-6 increased 10-fold just 3 h post-op (4-47 pg/ml) and reached its maximum value 6 h post-op (77 pg/ml; Wilcoxon test P < 0.01) Repeated measurements were also significant (Friedman P < 0.05). The concentration of IL-8 doubled the day of surgery but did not reach a significant level (Friedman test =0.069). None of the other cytokines showed any significant changes. The diurnal cortisol rhythm was interrupted after the surgery and there was a significant correlation between the cortisol secretion and IL-6 response. This study demonstrates an isolated elevation in IL-6 levels with only a minor elevation in IL-8 following THR. This pro-inflammatory response seemed to decline without activation of anti-inflammatory cytokines (IL-10), but cortisol seemed to play a complicated role in halting the acute inflammatory response.
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Short hospital stay augmented with education and home-based rehabilitation improves function and quality of life after hip replacement : Randomized study of 50 patients with 6 months of follow-up
(2005-08) Siggeirsdottir, Kristin; Olafsson, Örn; Jonsson, Halldor; Iwarsson, Susanne; Gudnason, Vilmundur; Jonsson, Brynjolfur Y.; Department of Engineering
Background: Because of current cost restrictions, we studied the effect of a shorter hospital stay on function, pain and quality of life (QOL) after total hip replacement (THR). Patients and methods: 50 patients from two hospitals were randomized into a study group (SG) of 27 patients receiving preoperative and postoperative education programs, as well as home visits from an outpatient team, and a control group (CG) of 23 patients receiving "conventional" rehabilitation often augmented by a stay at a rehabilitation center. Results: Mean hospital stay was shorter for the SG than for the CG (6.4 days and 10 days, respectively; p < 0.001). During the 6-month study period, there were 9 non-fatal complications in the SG and 12 in the CG (p = 0.3). The difference in Oxford Hip Score between the groups was not statistically significant before the operation, but was better for the SG at 2 months (p = 0.03) and this difference remained more or less constant throughout the study. The overall score from the Nottingham Health Profile indicated a better QOL in the SG. Interpretation: Our preoperative education program, followed by postoperative home-based rehabilitation, appears to be safer and more effective in improving function and QOL after THR than conventional treatment. Copyright
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Is the sagittal configuration of the cervical spine changed in women with chronic whiplash syndrome? A comparative computer-assisted radiographic assessment
(2002) Kristjansson, E.; Jónsson, H.; Department of Engineering
Objective: To reveal whether women with chronic whiplash-associated disorder (WAD) symptoms, grade I-II, demonstrate regional and/or segmental radiographic signs of altered cervical lordosis. Design: Case-control study. Setting: Radiography department at a university hospital. Participants: Three age-balanced groups comprising 120 women. The case group included women with chronic whiplash syndrome (n = 41), and the control group included women with chronic insidious onset neck pain (n = 39) and an asymptomatic group (n = 40), who were given baseline data. The sample was referred from informed doctors and physiotherapists. Intervention. The women sat in a standardized sitting position and radiographs were taken in a lateral position with fluoroscopic control for alignment. Outcome Measures: Two distinct measurements were taken; 1 of the angles of the upper and lower cervical curvatures, respectively, and 1 of the angles between the inferior borders of each pair of vertebrae in the lower cervical spine. The 3 groups were compared on the ratio of the lower to upper cervical spine angles and on the mean angular values for each segment in the cervical spine. Results: The whiplash group showed a decreased ratio between the lower versus upper cervical spine but comparisons between groups were not statistically significant. The whiplash group was in a significantly more flexed position at the C4-C5 level compared with the asymptomatic group (P = .007). The reliability measures have to be strengthened to render these results definitely conclusive. Conclusion: The whiplash group exhibited a different configuration of cervical lordosis. This is clinically important and needs to be studied more closely.

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