Introduction: Although decompressive surgery of spinal stenosis is a common procedure in spine surgery, there are no studies assessing patients’ perceived health related quality of life (HRQOL) by EQ-5D. An objective was to describe status overall and by analyzing pre- and one year postoperative health related quality of life (HRQOL) by the EQ-5D instrument in patients operated on for lumbar spinal stenosis. This cohort was compared to a Swedish population EQ-5D survey.

Methods: Data were obtained from the National Swed-ish Registry for lumbar spine operations 2001–2002. On 230 patients (mean age 66 years, 53% females) operated on for lumbar spinal stenosis the primary outcome measures were pre- and postoperative EQ-5D data. In addition, patient and disease characteristics (pain and walking ability) were reported. Analysis of variance (ANOVA) was performed and the relative differences pre-and postoperatively compared to a Swedish population survey were calculated.

Results: The majority of patients experienced an improved and their EQ-5D score increased from 0.36 to 0.64 one year after operation. However, they did not reach the level reported by an age- and gender matched population sample (mean difference 0.18). Woman had lower pre- and postoperatively EQ-5D scores than men. Preoperative severe pain was a significant predictor for a lower postoperative EQ-5D score. Four out of ten reported considerable improvement while a similar portion of patients (41%) with high preoperative scores were slightly improved. A third group (14%) were unchanged with low EQ-5D scores, and a few (4%) perceived a decline in their HRQOL. The mean VAS rating of leg- and back pain improved one year after operation by 28 and 29 %, respectively. The proportion of patients able to walk longer than 500 m increased from 25 % preoperatively to 65 % postoperatively.

Conclusions: Our national Swedish representatively cohort of disc herniation patients has a remarkable low EQ-5D scores preoperatively. However their HRQOL improved considerably in 80 % of the patients one year after surgery. The health related quality of life improves after surgery for lumbar spinal stenosis, approaching the population reference level. It is of most importance to further investigate the risk factors behind the less favourable outcomes in health related quality of live (EQ-5D score) in women.

Introduction: Spinal fractures are associated with pain, disability, neurological dysfunction and mortality. Osteoporosis and risky leisure time activities are increasing in the population. New treatment options have been introduced. However, only a few international studies have reported its descriptive epidemiology. There are no clear consensuses regarding the choice of operative interventions versus non-operative treatment in patients with thoracolumbar fractures. Treatment is often based on local traditions, skills and experiences. The aim of this nationwide study is to analyse the incidence, the characteristics of the patients, the subsequent development, surgical incidence and mortality rate among hospitalized patients with thoracolumbar fractures in Sweden.

Methods: All discharges between 1997 and 2000 with diagnoses of thoracic or lumbar vertebrae fracture according to ICD 10 classification were selected from the National Inpatient Register. Surgery in these patients was categorised by procedure codes indicating spine operations. In order to calculate the risk of patients dying, linkage was performed to the Swedish Death Register using the unique personal identification number.

Results: We identified 13, 496 admissions during the study period. This corresponds to an incidence rate of 30 per 100, 000 person-years and the occurrence was stable during 1997 and 2001 for patients younger than 50 years but decreased for patients above 50 years. The incidence of spine surgery among all patients was 1.9 per 100, 000 person-years, ranging from 1.6 per 100, 000 inhabitants per year to 2.6 per 100, 000 in the different region of Sweden. The most common causes of the fracture were falls (53 %) followed by vehicle accidents (37%). Almost two thirds of the patients operated on were men (63 %) and two thirds had lumbar vertebral fractures (66 %). The median age of the patients operated on was 42 years. The median length of stay was eight days. Among those who was operated the 30 days case fatality rate was 0.7 %. Median age for death was 64 years. Operations were less common in women (OR 0.79). The number of patients operated on during the last study year 2001 was significantly increased (OR 1.29). The probability of being operated on was highest in the more urban and densely populated regions of Stockholm and southern Sweden.

Discussion: This national study based study showed a stable cumulative incidence of thoracolumbar fractures over the year 1997–2000. However, the two last year of this study an increased incidence of operation was observed. A possible explanation of this finding could be the new percutaneus technique for verterbroplasty. We find it of most importance to further investigate the reasons behind the gender differences in surgical incidence in patients with vertebral fractures

We investigated the pre-operative and one-year post-operative health-related quality of life (HRQoL) outcome by using a Euroqol (EQ-5D) questionnaire in 230 patients who underwent surgery for lumbar spinal stenosis. Data were obtained from the National Swedish Registry for operations on the lumbar spine between 2001 and 2002. We analysed the pre- and postoperative quality of life data, age, gender, smoking habits, pain and walking ability. The relative differences were compared to a Swedish EQ-5D population survey.

The mean age of the patients was 66 years, and there were 123 females (53%). Before the operation 62 (27%) of the patients could walk more than 500 m. One year after the operation 150 (65%) were able to walk 500 m or more.

The mean EQ-5D score improved from 0.36 to 0.64, and the HRQoL improved in 184 (80%) of the patients. However, they did not reach the level reported by a matched population sample (mean difference 0.18). Women had lower pre- and post-operative EQ-5D scores than men. Severe low back pain was a predictor for a poor outcome.

We investigated the pre-operative and one-year post-operative health-related quality of life (HRQOL) outcome by using a Euroqol (EQ-5D) questionnaire in 263 patients who had undergone surgery for herniation of a lumbar disc. Data from the National Swedish Register for lumbar spinal surgery between 2001 and 2002 were used and, in addition, a comparison between our cohort and a Swedish EQ-5D population survey was performed. We analysed the pre- and post-operative quality of life data, age, gender, smoking habits, pain and walking capacity.

The mean age of the patients was 42 years (20 to 66); 155 (59%) were men and 69 (26%) smoked. Pre-operatively, 72 (17%) could walk at least 1 km compared with 200 (76%) postoperatively.

The mean EQ-5D score improved from 0.29 to 0.70, and the HRQOL improved in 195 (74%) of the patients. The pre-operative score did not influence the post-operative score. In most patients, all five EQ-5D dimensions improved, but did not reach the level reported by an age- and gender-matched population sample (mean difference 0.17). Predictors for poor outcome were smoking, a short pre-operative walking distance, and a long history of back pain.

The National Inpatient Register and the Swedish Death Register were linked to determine the incidence of surgical intervention, the trends and characteristics of the patients, the death rate and the pre- and post-operative admissions for herniation of a lumbar disc based on comprehensive national data between 1987 and 1999.

There were 27 576 operations which were followed cumulatively for 155 249 years, with a median of 6.0 years. The mean annual rate of operation was 24 per 100 000 inhabitants, the median age of the patients was 42 years. The 30-day death rate was 0.5 per 1000 operations. The rates of re-operation at one and ten years were 5% and 10%, respectively, decreasing significantly (40%) with time. The mean length of stay decreased from nine to five days. Patients who had been in hospital because of a previous spinal disorder had a significantly higher risk of readmission.

Aims: Surgical treatment of forefoot deformities is a common procedure. The vast majority comprising surgery for Hallux Valgus. The indication for surgical intervention varies from pain to cosmetic reasons and footwear problems. Evidence for the effectiveness of different surgical methods is limited. The aims of this study were to perform a cross sectional population based prevalence study of surgery for forefoot deformities in Sweden and to analyze the surgical methods in use. Methods: Data on forefoot surgery were collected from the National Swedish Patient Registry between 1997 and 2000. Both ambulatory surgery (2000) and in-patient surgery (1997–2000) were collected. The data were processed to quantify the frequency of different surgical methods. Results: In 2000, a total of 4409 procedures for forefoot deformities were reported in ambulatory surgery. 82% were female and 18% were male. During 1997–2000, a total of 2547 procedures were performed performed in hospitalised patients. The gender distribution in this group was similar; 84% were female and 16% were male. The frequency distribution between different forefoot deformities will be presented. Discussion: Forefoot surgery is a common procedure, Hallux Valgus being the most frequent deformity to be corrected. The choice of surgical methods will be discussed and a validation of the National Swedish Patient Registry against the Local Reimbursement Registry in the Stockholm area will be presented.