Affiliated to research
Paul Gerdhem became specialist in Orthopaedics 2000. He defended his thesis titled "Risc factors for falls and fractures in elderly women" 2004 and became associate professor 2005.
He is the head of the section for spinal disorders at the department of reconstructive orthopaedics at the Karolinska University Hospital since 2017.
His clinical work concerns spinal disorders with a special interest in spinal deformities.
He is the principal investigator of a multicenter study concerning scoliosis and genetics and another on conservative treatment for scoliosis. He is a member of the steering committees of the national quality registers Swespine and the Swedish Fracture Register.
He is the former President of the Swedish Society of Spinal Surgeons and the current President of the Nordic Spinal Deformities Society.
My research is focused on spinal disorders; genetic and biochemical studies of scoliosis, conservative treatment of scoliosis, and predictor and outcome studies in scoliosis and disc hernia.
Studies on scoliosis
Idiopathic scoliosis is the most common spinal deformity and affects around 3% of children and adolescents. About one tenth gets an aggressive variant leading to a severe deformity of the spine and thorax. Severe scoliosis leads to pulmonary dysfunction and pain.
Despite the frequent use of braces to prevent severe scoliosis, evidence for effectiveness of the brace is based on a few studies. No completely randomised controlled trials have been performed, and data is especially scarce for braces used only night time compared to full-time brace wear (>20 hours per day). The former have proposed advantages such as better compliance and patient comfort. Postural retraining have been proposed as treatment for scoliosis, but higher quality evidence is lacking.
Therefore, a randomised controlled trial will be performed to compare the result from night time brace treatment, postural retraining and observation in patients with idiopathic scoliosis, and currently 115 out of planned 135 patients have been included into the study.
The only effective treatment to reduce the scoliotic curve is surgery, leading to a fused, immobile spine. Idiopathic scoliosis is by far the most common reason for spinal surgery in children and adolescents.
The hereditary component of idiopathic scoliosis is well known, but the pathogenesis of scoliosis is poorly understood and it is difficult to early identify those at risk of severe scoliosis. Our aim is to increase understanding of the genetic background in idiopathic scoliosis and to find prognostic markers for scoliosis progression by genetic studies in families, and by examining RNA expression from tissue samples collected from idiopathic scoliosis patients and controls. Significant genes and genetic pathways will be tested in a large already available cohort of patients and controls.
New insights into the aetiology and treatment may in the long-term give rise to new and more personalised treatment options. This will be beneficial for all individuals suffering from this condition. The results from the treatment studies and genetic studies could also lead to trials on patients with other causes of scoliosis.
Studies on disc hernia
The Swedish spine register is useful to describe outcome after surgical procedures, to identify predictors of treatment and to identify suboptimal treatment methods.
Lumbar disc herniation is a common cause of low back and leg pain6. When non-surgical treatment fails, surgery gives relief from symptoms for the majority, but as much as one fourth are reporting an unsatisfactory result.
The incidence of surgery for lumbar disc hernia varies. Between the Nordic countries there is a 30-60% difference in surgical incidence. These differences may reflect a real difference in incidence of lumbar disc hernia, but with a similar socio-economic and ethnical background in these countries it is more likely that the differences are due to varying surgical indications.
Using data in three Nordic national spine registers we will study indications and patient reported outcome after surgery for lumbar disc herniation. This can provide important bench-marking information, including guidance in optimal indications for surgery, and relevant predictors for successful outcome.
Register based studies have advantages such as large sample sizes, reflecting real life, but they also have limitations such as lower follow-up rates than smaller research studies. We will therefore also compare register data with clinical observational and randomised controlled trials with high follow-up rates. During the last decade, publications have reported similar results from register observational studies, compared with results reported from clinical trials. In addition, we will also study outcome in subgroups where there is a shortage of data today, for example outcome from surgery for lumbar disc herniation in children and adolescents.
Paul Gerdhem is involved in the supervision of undergraduate students at medical school and PhD-students. He was Director/Co-director of PhD-studies at CLINTEC 2008-2017.
Orthopaedics, osteoporosis, spinal disorders.
Teaching includes supervision of students during theses projects (15-30 credits) and lectures. Paul Gerdhem is the course leader of courses in spinal disorders and basic orthopaedic skills for residents with about 2 courses per year.
Academic honours, awards and prizes
Awards ASBMR Young Investigator Award (first author of abstract) (American Society for Bone and Mineral Research), September, 2003, in Minneapolis, USA John Sevastik Award for best abstract in the category etiology and genetics at the ”International Research Society of Spinal Deformities” in Montreal, Canada, 1-3 juli, 2010 (Senior author of abstract) Best abstract / Highest ranked abstract among 800 submissions during Eurospine/Spineweek 2012 (Senior and presenting author). Nominated to best abstract, Nordic Spine Deformity Society, Oslo 26-28 Aug, 2014 (First and presenting author). Best podium presentation / Highest ranked abstract among more than 1000 submissions during Eurospine, Berlin, 5-7 Oct, 2016 (Senior author of abstract)
Positions of trust and honor (selected) Appointed member of the Doctoral Dissertation committee at the Karolinska Institutet (2010-2016). Elected Scientific Secretary of the Swedish Society of Spine Surgeons (2006-2008). Elected Vice President of the Swedish Society of Spine Surgeons (2010-2012). Elected President of the Swedish Society of Spine Surgeons (2012-2014) Member of the steering committee of the Swedish Spine Register (2014-ongoing) Member of the steering committee of the Swedish Fracture Register (2014-ongoing) Secretary of the Swedish Study Group on Early Onset Scoliosis (2014- ongoing) Appointed member of the committee for academic evaluation of physicians applying for a position at the Karolinska University Hospital (since 2007) President of the Nordic Spinal Deformities Society (2017-2019)