0000000000082760
AUTHOR
P. Eysel
Vergleich radiologischer Verfahren zur präoperativen Beurteilung der Verankerungsfestigkeit von Wirbelsäulenimplantaten
PURPOSE To compare three techniques with regards to their ability to estimate pull out strength of spinal fusion hardware. MATERIAL AND METHODS VDS-screw fixation strength in 50 human cadaveric vertebral bodies was approximated by means of pull out force measurement. Bone quality was assessed by Dual X-ray Absorptiometry (DXA). Quantitative Computed Tomography (QCT) and T2*-relaxation time. For each of these techniques, correlation with axial pull out force strength was investigated. RESULTS Highest correlation was found for cancellous bone density measured by QCT (r = 0.72; p < 0.001). Immediately followed by DXA (r = 0.70; p < 0.001), which involves all bone components. Inverted T2*-relax…
Metastatic spinal cord compression--options for surgical treatment.
Fourty-three cases with metastatic spinal cord compression were reviewed post-operatively to clarify the usefulness of the procedures concerning restoration of neurological function, and pain relief. Only patients with pathological spinal instability and neurological sequelae were included. Posterior decompression and stabilization was performed in all but six patients. All but four patients (91%) reported decrease of pain symptoms. Amelioration of neurological function was achieved in 58%. Re-establishment of walking ability was obtained in 57%. Post-surgery life expectancy averaged 11 months. In patients with widespread metastatic disease and/or multi-level instability of the spine restri…
Sagittal static imbalance in myelomeningocele patients: improvement in sitting ability by partial and total gibbus resection
The progression of kyphosis in myelomeningocele is independent of skeletal growth and requires early operative correction and stabilization to prevent a loss of sitting ability. In severe cases, only vertebrectomy makes it possible to achieve correction, stability and skin-closure without tension. In 14 patients with myelomeningocele gibbus, kyphectomy was performed, removing two vertebral bodies on average. The average kyphosis angle decreased from 128 degrees to 81 degrees, enabling most of the patients to participate again in social life by restoring wheelchair mobility. Nevertheless, a significantly higher complication rate was found compared to other correctional operations, lengthenin…
Operative Treatment of Scoliosis With Cotrel-Dubousset-Hopf Instrumentation
Study design This study analyzes the effects of a new anterior spinal instrumentation system and the results of use in 50 patients with scoliosis. Objectives Anterior spine systems are reviewed. The principles of a new anterior spinal instrumentation system allowing for postoperative care without external support are discussed. Summary of background data Numerous different implants have been presented in the literature for anterior spinal surgery. Nevertheless a primary stable anterior instrumentation was not available for multisegmental procedures until now, and the restoration of lordosis in the lumbar spine was very difficult with the common devices. The development of more stable device…
Sonographische Verlaufskontrolle von experimentellen Muskelverletzungen
Experimental muscle lesions were produced in 28 rabbits by stab incision, thus creating a lesion of known extent and site. The changes in the course of healing were followed up and documented at short intervals for a period of two months via sonography. The changes take place in regular course and can be explained by fine tissue changes, taking into consideration the fundamentals of theoretical ultrasound physics. Sonography renders both valuable assistance in diagnosing muscular lesions and in following up the healing process--the latter, however, with some reservations due to the clinical terminology defining the extent of muscular lesions.
Bestimmung der Knochenqualität vor Wirbelsäuleninstrumentation - Stellenwert verschiedener in vivo-Methoden
OBJECTIVE: The present investigation should elucidate which assessment technique for bone quality is most appropriate to estimate preoperatively fixation strength of instrumental spine fusions. METHODS: VDS-screw fixation strength in 50 human cadaveric vertebral bodies was approximated by means of pullout force assessment. Bone quality was assessed by Dual Energy X-ray Absorptiometry (DEXA), Quantitative Computed Tomography (QCT), MRT and histomorphometry. For each of these techniques, correlation with axial pull out force strength was investigated. RESULTS: Highest correlation was found for cancellous bone density (QCT) (r = 0.72; p < 0.001) and DEXA (r = 0.70; p < 0.001). MRT, cortical bo…
Development of scoliosis in myelomeningocele. Differences in the history caused by idiopathic pattern.
The natural history of scoliosis in the literature concerning the idiopathic and neuromuscular scoliosis in myelomeningocele patients (MMC) are compared to our own results in 12 patients with MMC and 89 patients operated because of an idiopathic scoliosis. According to known experiences the natural history of scoliosis in MMC is progression even after the end of growth. The chance of developing a scoliosis increases with the patients, age and the level of the lesion. The higher the level of paralysis the more common is a spinal deformity. In literature the progression rate of MMC scoliosis is 2.5-3.5 degrees per year, with the idiopathic pattern 0.5-0.65 degrees per year after end of growth…
Stellenwert bildgebender Verfahren in der Diagnostik des lumbalen Bandscheibenvorfalles
As a seeming law of nature the possibility of making use of various multiplanar sectional imaging techniques is accompanied by diagnostic exaggeration. Simple and cost effective procedures with low radiation dosage such as plain x-rays of the spine are being thrust into the background. Not seldom are patients referred to the spine surgeon with MRI or Cat scan at hand but lacking standard radiographs. As far as the assessment of intervertebral disc disease is concerned the combination of plain X-rays of the spine and computed tomography of the level in question turned out to be sufficient for indication of the operation in more than 90% of 450 patients after nucleotomie at the Orthopedic Uni…
Chronische Insertions- tendopathie am lateralen Epicondylus humeri
Fragestellung: Seit Beginn der 90er Jahre wurde in der Orthopadischen Universitatsklinik Mainz uberpruft, bei welchen Krankheitsbildern die niederenergetische extrakorporale Stoswellentherapie sinnvoll eingesetzt werden kann. Methode: In einer prospektiv-randomierten Studie wurde die Wirksamkeit der 3maligen Applikation von 1000 vs. 10 Impulsen niedriger Energieflusdichte bei chronischer Epicondylopathia humeri radialis uberpruft. Ergebnisse: Sehr gute oder gute Ergebnisse lagen nach einem Follow-up von 12 Monaten bei 26 von 50 Patienten der Behandlungsgruppe vor, aber lediglich bei 3 der Kontrollgruppe. Schlusfolgerungen: Zusammenfassend last sich sagen, das die Methode bei entsprechender …
Metastatic instability at the proximal end of the femur
A retrospective study was performed of the surgical treatment of metastatic lesions of the proximal femur in 50 patients. In 25 consecutive cases a megaprosthesis was implanted; compound plate osteosynthesis was performed in another 25 consecutive patients. Indications for surgical treatment were pathological fractures or, for prophylactic treatment, lesions of the femoral cortex exceeding 2.5 cm in diameter or affecting half the diameter of the bone or more. In all patients capable of walking preoperatively mobility was regained. Immediate full weight-bearing stability was obtained in all patients. Group analysis showed that the functional rating of the hip joint was unchanged, i.e., good …
Decompression/Stabilization of the Metastatic Spine: Cotrel-Dubousset-Lnstrumentation in 50 Patients Jan
50 patients with metastatic disease of the spine underwent dorsal decompression and stabilization with the Cotrel-Dubousset-Instrumentation from 1987 to 1991. Indications for surgical treatment were neurologic deficit, spinal instability, and/or pain resistant to medical or radiation treatment. No external orthotics were used postoperatively. Pain was relieved dramatically in 45 patients. Among 25 patients suffering from neurologic deficit preoperatively, 13 improved, 15 remained unchanged, whereas 2 developed an incomplete, transient paraplegia. 15 (7) patients were alive after 1 (2) years. Postoperative complications were frequent, but there were only 2 failures of the stabilization devic…
Outcome after palliative posterior surgery for metastatic disease of the spine - evaluation of 106 consecutive patients after decompression and stabilisation with the Cotrel-Dubousset instrumentation
From 1987 to 1996, 106 consecutive patients with metastatic disease of the spine who underwent palliative decompression from a dorsal approach and subsequent stabilisation with Cotrel-Dubousset instrumentation (CDI) were followed prospectively, and independent of the surgeons. Parameters evaluated were neurological function, perioperative complications, survival and rehabilitation. Following the Frankel system for the assessment of neurological disorder, 33 patients had a major deficit (grade A, B or C), 23 a minor deficit (grade D) and 50 no deficit. If there was no neurological dysfunction, the only patients who underwent operation were those graded as class IV according to Harrington. Ou…
Shoulder function after extracorporal shock wave therapy for calcific tendinitis.
We report a controlled, prospective study that explored the effect of extracorporal shock waves of low- versus high-energy density in patients with chronic shoulder pain and calcific tendinitis. We assigned at random 100 patients who had had calcific tendinitis for more than 12 months to 2 groups to receive shock wave therapy either of a low- or high-energy density. Group 1 received 1500 impulses of 0.06 mJ/mm2, whereas group 2 received 1500 impulses of 0.28 mJ/mm2. Unlike group 1, in which the shock wave application could be performed without local anesthesia, all patients in group 2 required brachial plexus anesthesia. The patients were reviewed at 6 and 24 weeks. Partial or complete disi…
Gait analysis in idiopathic scoliosis before and after surgery: a comparison of the pre- and postoperative muscle activation pattern
In a prospective experimental study the level gait activity scores of the iliocostalis lumborum, glutaeus medius, tensor fasciae latae, vastus lateralis and peronaeus longus muscles of both body sides were examined by computerized electromyography in 23 patients with idiopathic scoliosis before and after CD instrumentation. The pre- and postoperative findings were examined as to asymmetric patterns in muscle requisition during gait and the respective changes induced by the spinal correction. These results were compared with the corresponding results obtained in healthy subjects in two independent sessions with identical experimental conditions. A muscle activity asymmetry coefficient was de…
Epithelioides Hämangioendotheliom der Wirbelsäule
Hintergrund: Epithelioide Hamangioendotheliome sind seltene vaskulare Tumoren, die bevorzugt im Bindegewebe, in der Lunge oder in der Leber auftreten. Falldarstellung: Wir prasentieren den Fall einer 58-jahrigen Patientin, die mit oberer Einflussstauung, Horner-Syndrom und segmentalen Sensibilitatsstorungen in den Fingern der rechten Hand aufgenommen wurde. Die daraufhin durchgefuhrten Computertomographie- und Magnetresonanztomographieuntersuchungen der Wirbelsaule zeigten eine tumorose Raumforderung vom siebten Halswirbelkorper bis zum vierten Brustwirbelkorper. Wegen rascher Tumorprogression mit progredienter oberer Einflussstauung und neurologischen Ausfallen musste die Patientin wiederh…