[Current operative strategies for rotator cuff tears in German hospitals]. / Aktuelle operative Therapiestrategien der Rotatorenmanschettenruptur an deutschen Kliniken.

The surgical treatment of rotator cuff lesions is still a controversial subject. We therefore decided to perform a study designed to yield an overview of the treatment modalities currently applied in Germany. A nationwide questionnaire survey was sent to 470 orthopaedic and trauma departments to ask about their surgical treatment of rotator cuff lesions: frequency of operative treatment, methods used in diagnosis and types of operative treatment; particular attention was paid to the application of minimally invasive techniques and to postoperative rehabilitation. The response rate was 55%. In all, 30,462 arthroscopic treatments were recorded for the year 2004, 9,094 of which were open or mini-open techniques and 2,528 were endoscopic reconstructions of the rotator cuff. Overall, we found that arthroscopic rotator cuff repair was performed in only 111 of the 257 departments from which responses were received and that the majority of surgeons preferred to use sutured and nonresorbable anchors. The postoperative treatment varies widely, from the full range of motion allowed within the first postoperative week to substantially more restrictive regimens. We see that the arthroscopic repair is still not the standard treatment for rotator cuff lesions in Germany. Further research is clearly still needed especially in the area of postoperative treatment.

[Rare differential diagnosis of a radicular spine syndrome: herpes zoster radiculitis]. / Herpes-Zoster-Neuritis als seltene Differenzialdiagnose eines radikulären Wirbelsäulensyndromes.

We report on the case of a 66-year-old patient who was hospitalized because of intractable low back pain radiating into the right leg. Leg pain was accompanied by a numbness and muscle weakness which was clearly assigned to the L5 dermatome. Concerning the patient's medical history a nucleotomy L4/5 and a osteomyelofibrosis were known. MRI of the lumbar spine revealed a multisegmental stenosis which was pronounced on the level L4/5. One day after admission of the patient to the hospital a typical zoster exanthema involving the L5 dermatome appeared. Varicella-zoster virus (VZV) was detected in the fluid of the vesicular skin lesions by polymerase chain reaction. Intravenous administration of aciclovir lead to rapid decrease of pain and exanthema. A few months later the patient died because of an acute myeloid leukemia as a complication of the known osteomyelofibrosis. This case report shows that a herpes zoster infection can imitate a radicular spine syndrome usually caused by degenerative changes. Especially in immunocompromised patients, a zoster radiculitis should be included in the differential diagnosis of radiculopathy. VZV infection might also occur without skin lesions (zoster sine herpete) so that serological assays for the early detection of virus DNA can be useful.

[Frequency and utility of internet use by orthopaedic patients]. / Prävalenz und Stellenwert der Internetnutzung orthopädischer Patienten.

AIM: We assessed to what degree orthopaedic patients use the internet as an information platform and how these patients rate the information they obtain over the World Wide Web (WWW). METHODS: 450 consecutive patients consulting the out-patient department of our university clinic for the first time anonymously filled out a three-page questionnaire. Apart from clinical and sociodemographic data, the questionnaire addressed aspects such as the availability of computers and internet. Also, questions concerning the use and interpretation of medical information freely available on the WWW were asked. RESULTS: 402 questionnaires were evaluated. 54 % of the patients stated that they readily had access to the internet. Of the remaining patients without internet access, 19 % planned the installation in the near future. The prevalence of the use of the WWW of patients in the age group up to 40 years was 72 % and in patients over 40 years only 49 %. Compared with internet non-users, internet users were younger (p < 0.001), more frequently men (p < 0.05), and of a higher education level (p < 0.001). 68 % used the internet on a regular basis with regard to queries concerning their health and well being. More than every third patient (38 %) had consulted the internet about the specific orthopaedic ailment prior to seeking advice in our clinic. Almost half of the patients judged the previous treatment to be partially in accordance with the information obtained from the internet. 86 % considered the information obtained over the WWW as helpful or very helpful. 85 % would recommend other patients to use the internet for information concerning their orthopaedic complaint. 65 % of all patients objected to an orthopaedic on-line consultation via internet. CONCLUSION: The internet seems to be an important source of information for orthopaedic patients. The prevalence concerning the use of the WWW is particularly high in younger, well educated patients.

[Systemic spread of wear debris--an in-vivo study]. / In-vivo-Analyse zur systemischen Verteilung von metallischen Abriebpartikeln.

AIM: The aim of this study was to elucidate whether there is a systemic spread of wear debris from peripherally applied stainless steel and titanium particles into the blood and subsequently to parenchymatous organs. Furthermore, we report on histological findings at the implantation site. METHOD: In Syrian Gold hamsters we implanted 2 mm3 wear debris of stainless steel and titanium into the dorsal skin fold chamber. Over a period of 2 weeks we took blood samples and afterwards explanted the implant area, the heart, lung, liver and spleen. One half of the organs and the implant area were used for histological analysis. The other half of the organs and the blood samples were analysed by optical emission spectrometer with inductively coupled plasma and graphite furnace atomic absorption spectrophotometry for their contents of chromium, nickel and titanium. RESULTS: In the group with titanium particles, histological analysis of the implant site showed moderate phagocyted wear in granulocytes but no other pathological findings. Animals treated with stainless steel wear debris had a massive inflammatory reaction, in some cases leading to necrosis. The analysis of the blood and one half of the organs showed increased levels of chromium and, already 24 hours after implantation, raised values for nickel. The result of the hamsters treated with titanium showed significantly elevated levels of titanium ions in the organs, but not in the blood samples. Histology of the organs did not reveal pathological findings. CONCLUSION: In this study we could show a massive inflammatory reaction for stainless steel wear debris in contrast to titanium wear debris at the implantation site. The elevated blood levels of chromium and increased values of other metals in the organs suggest the haematogenic distribution of ions from the peripherally implanted wear debris.

Background noise cancellation of manatee vocalizations using an adaptive line enhancer.

The West Indian manatee (Trichechus manatus latirostris) has become an endangered species partly because of an increase in the number of collisions with boats. A device to alert boaters of the presence of manatees is desired. Previous research has shown that background noise limits the manatee vocalization detection range (which is critical for practical implementation). By improving the signal-to-noise ratio of the measured manatee vocalization signal, it is possible to extend the detection range. The finite impulse response (FIR) structure of the adaptive line enhancer (ALE) can detect and track narrow-band signals buried in broadband noise. In this paper, a constrained infinite impulse response (IIR) ALE, called a feedback ALE (FALE), is implemented to reduce the background noise. In addition, a bandpass filter is used as a baseline for comparison. A library consisting of 100 manatee calls spanning ten different signal categories is used to evaluate the performance of the bandpass filter, FIR-ALE, and FALE. The results show that the FALE is capable of reducing background noise by about 6.0 and 21.4 dB better than that of the FIR-ALE and bandpass filter, respectively, when the signal-to-noise ratio (SNR) of the original manatee call is -5 dB.

Theoretical detection ranges for acoustic based manatee avoidance technology.

The West Indian manatee (Trichechus manatus latirostris) has become endangered partly because of watercraft collisions in Florida's coastal waterways. To reduce the number of collisions, warning systems based upon detecting manatee vocalizations have been proposed. One aspect of the feasibility of an acoustically based warning system relies upon the distance at which a manatee vocalization is detectable. Assuming a mixed spreading model, this paper presents a theoretical analysis of the system detection capabilities operating within various background and watercraft noise conditions. This study combines measured source levels of manatee vocalizations with the modeled acoustic properties of manatee habitats to develop a method for determining the detection range and hydrophone spacing requirements for acoustic based manatee avoidance technologies. In quiet environments (background noise approximately 70 dB) it was estimated that manatee vocalizations are detectable at approximately 250 m, with a 6 dB detection threshold, In louder environments (background noise approximately 100dB) the detection range drops to 2.5 m. In a habitat with 90 dB of background noise, a passing boat with a maximum noise floor of 120 dB would be the limiting factor when it is within approximately 100 m of a hydrophone. The detection range was also found to be strongly dependent on the manatee vocalization source level.

Pathology and preliminary characterization of a parapoxvirus isolated from a California sea lion (Zalophus californianus).

Cutaneous pox-like lesions are a common complication in the rehabilitation of pinnipeds. However, the exact identity, taxonomy, and host range of pinniped parapoxviruses remain unknown. During a poxvirus outbreak in May 2003 in California sea lions (Zalophus californianus) at a marine mammal rehabilitation facility, multiple raised, firm, 1-3-cm skin nodules from the head, neck, and thorax of one sea lion weanling pup that spontaneously died were collected. Histologically, the nodules were characterized by inflammation and necrosis of the dermis and epidermis, acanthosis, and ballooning degeneration of the stratum spinosum. Large, coalescing eosinophilic cytoplasmic inclusions were observed in the ballooned cells. A parapoxvirus (sea lion poxvirus 1, SLPV-1) was isolated on early passage California sea lion kidney cells inoculated with a tissue homogenate of a skin nodule. The morphology of the virions on electron microscopy was consistent with that of parapoxviruses. Partial sequencing of the genomic region encoding the putative major virion envelope antigen p42K confirmed the assignment of the sea lion poxvirus to the genus Parapoxvirus. Although SLPV-1 is most closely related to the poxvirus of harbor seals of the European North Sea, it is significantly different from orf virus, bovine papular stomatitis virus, pseudocowpox virus and the parapoxvirus of New Zealand red deer.

[Quality analysis of internet information on epicondylitis radialis humeri]. / Analyse der Informationsqualität im Internet zur Epicondylitis radialis humeri.

AIM: By means of conventional internet search engines we assessed the World Wide Web for the topic "epicondylitis radialis humeri" and analysed the content of the listed pages for their quality and transparency. METHODS: Three of the most frequently used internet search engines were utilised to search the World Wide Web for the terms "tennis arm", "tennis elbow" and "epicondylitis". The first 50 listed internet addresses per search engine were scrutinised in respect to the authors' source, financier of the web page and whether commercial interests were evident. Furthermore, the medical content concerning radial epicondylitis was analysed using a 10-point score. RESULTS: After elimination of repetitive and not accessible internet pages, as well as web pages only giving links to further web-sites or chat-rooms, we were able to evaluate 137 internet sites. The average content-score of all pages was low with 2.91 +/- 3.27 SD. Web-pages, where authorship could not be identified or where commercial interests were clearly evident, had the lowest content-scores. Sites authored by or associated with orthopaedic surgeons had a significantly higher content-score (6.84 +/- 3.17 SD) in comparison to other initiators of web-pages (p < 0.0001). CONCLUSION: The facts derived from the World Wide Web when searching for information on epicondylitis radialis humeri are mostly of low professional quality and transparency. Orthopaedic surgeons need to point out this problem to patients who additionally inform themselves on the internet. If the desire for browsing the web for further information concerning musculoskeletal pathology exists, orthopaedic surgeons should tell their patients which web sites are suitable.

[Sacral fracture as a rare early complication of lumbosacral spondylodesis]. / Sakrumfraktur als seltene Frühkomplikation nach lumbosakraler Spondylodese.

A 57 year old patient with secondary cortisone induced osteoporosis war surgically treated by means of posterior lumbar interbody fusion with internal fixation from L4-S1 for symptomatic instability in the level L4/5 after previous dorsal stabilisation L5/S1. After an unapparent initial postoperative phase, the patient complained of severe pain in the low back and gluteal region 9 day after surgery. Radiographs as well as CT-scans showed a horizontal fracture of the sacrum. After a short period of immobilisation the patient was carefully remobilised with an orthesis and the pain gradually subsided. Conventional radiographs one year later showed complete consolidation of the fracture and a good clinical result. There are only two literature reports with together 3 cases of patients attaining an early sacral fracture after spondylodesis. The main cause seems to be the unphysiological biomechanical stress placed on the osteoporotic sacrum after moresegmental spondylodesis. Further risk factors seem to be adipositas, female gender and age. Despite the rarity of sacral fractures after lumbosacral fusion, this complication should at least be considered in the differential diagnosis in patients who complain of persisting or sudden-onset pain after surgery.

[Rare differential diagnosis of a degenerative cervical syndrome: an arteriovenous meningeal fistula of the sigmoid sinus]. / Seltene Differenzialdiagnose eines degenerativen HWS-Syndroms: Dura-AV-Fistel im Bereich des Sinus Sigmoideus.

A 65-year-old patient was referred to our clinic with persisting, severe tinnitus aurium. Due to the facts that prior otolaryngological as well as neurological assessment had been unremarkable and that the patient showed marked degenerative changes in the cervical spine the referring orthopaedic surgeon suggested the cause to be of vertebral origin. Case history showed that the tinnitus had spontaneously occurred and was pulse synchronous. Overall clinical evaluation of the cervical spine was inconspicuous. A brachialgia or other symptoms typically associated with a degenerative cervical syndrome could not be provoked. On the basis of this atypical clinical picture we performed a digital subtraction angiography (DSA) to exclude pathology in the vicinity of the cerebral vessels. This revealed an arteriovenous fistula of the sigmoid sinus which was then, under the auspices of our neurosurgeons, successfully closed by Gugliemo coil embolism. The patient reported that the tinnitus subsided almost immediately. This case demonstrates that despite the manifold pathology that is associated with degenerative cervical syndrome, pulse synchronous tinnitus aurium needs further clarification. Had the case history been taken more accurately and the quality of the tinnitus assessed earlier, the period between onset of symptoms and correct treatment could have been decreased significantly.

Background noise cancellation for improved acoustic detection of manatee vocalizations.

The West Indian manatee (Trichechus manatus latirostris) has become endangered partly because of an increase in the number of collisions with boats. A device to alert boaters of the presence of manatees, so that a collision can be avoided, is desired. A practical implementation of the technology is dependent on the hydrophone spacing and range of detection. These parameters are primarily dependent on the manatee vocalization strength, the decay of the signal's strength with distance, and the background noise levels. An efficient method to extend the detection range by using background noise cancellation is proposed in this paper. An adaptive line enhancer (ALE) that can detect and track narrow band signals buried in broadband noise is implemented to cancel the background noise. The results indicate that the ALE algorithm can efficiently extract the manatee calls from the background noise. The improved signal-to-noise ratio of the signal can be used to extend the range of detection of manatee vocalizations and reduce the false alarm and missing detection rate in their natural habitat.

[Residual stability of different interbody fusion techniques after pedicle screw loosening]. / Reststabilität differierender Spondylodesetechniken bei Pedikelschraubenlockerung.

INTRODUCTION: In spinal surgery, postoperative failure of pedicle screw instrumentation due to loosening of the implant at the bone-screw interface is a clinically relevant problem. While there are numerous biomechanical studies dealing with stability after internal fixation, little is known about the remaining segmental stability after pedicle screw loosening. We hypothesize that, in cases of implant loosening, the remaining stability is dependent on whether the segment received an isolated pedicle screw instrumentation or a 360 degrees instrumentation. METHODS: Motion analysis was performed under static, damage-free, sagittal strain (preload 100 N) on intact (controls) and posterior monosegmental L5/6 destabilized lumbar spines of sheep. Spine preparations underwent a flectional torque. Changes of spinal profile were radiographically documented, digitalized and then evaluated. Primary insertion of the conical pedicle screws was performed with a torque of 1.4 Nm. Pedicle screw loosening was simulated by turning the inserted screw back either 180 degrees or 540 degrees . Specimens instrumented with screws of differing diameters (5.5 mm and 6.7 mm) as well as non-instrumented pedicles were also compared. RESULTS: Independent of the type of instrumentation, we found that a loosening of pedicle screws increased remaining segmental motion. In maximal flexion (20 degrees ) and loosening of pedicle screws by 540 degrees, we found a statistically significant increase of remaining segmental motion with sole pedicle instrumentation (- 3.1 degrees ) in contrast to 360 degrees instrumentation (- 1.6 degrees ). For extension, a significant discrepancy between the two stabilization methods could not be shown. In cases where screws were firmly inserted, there was no advantage of using pedicle screws with an increased diameter of 6.7 mm. Independent of the type of fixation method, 5.5 mm screws that were inserted in widened pedicles showed a marked decrease of primary segmental stability. CONCLUSION: This study suggests that, concerning the remaining stability, 360 degrees instrumentation is superior in cases where pedicle screw loosening has occurred. The screw diameter plays an only subordinate role in primary segmental stability when the pedicle screws are inserted firmly.

[Invasive chondrosarcoma of the thoracic spine as a rare cause of acute paraplegia]. / Invasives Chondrosarkom der Brustwirbelsäule als seltene Ursache einer akuten Querschnittssymptomatik.

We report on the case of a invasive chondrosarcoma of the thoracic spine in a 65-year-old woman as a rare cause of acute paraplegia.

Coccygectomy for coccygodynia: does pathogenesis matter?

BACKGROUND: Severity of vertical impact to the coccyx can range from mere contusion to a dislocated fracture of the coccyx. With early conservative management, most patients have a good prognosis and heal within weeks to months after the initial trauma. Occasionally, persisting symptoms make a surgical intervention with coccygectomy necessary. METHODS: We report on the results of patients surgically managed for traumatically induced, persisting coccygodynia and compare these to patients operatively treated for idiopathic coccygodynia. Sixteen patients with an average follow-up of 7.3 years were evaluated. Of these, eight were surgically treated for traumatic and eight for idiopathic coccygodynia. The clinical results were assessed by means of the Hambly Score and the Oswestry Low Back Pain Disability questionnaire. Patient satisfaction with the postoperative result was assessed by a visual analog scale. RESULTS: Seven of eight (88%) patients treated for traumatically induced coccygodynia had a good or excellent postoperative result, in contrast to only three of eight (38%) patients with idiopathic coccygodynia. The former group had better results in terms of sitting tolerance and general pain intensity as represented by the Oswestry Low Back Pain Disability questionnaire. According to the significantly better clinical results, personal satisfaction was clearly higher in the traumatic group. CONCLUSION: These results suggest that, in patients where all conservative treatment methods work to no avail, particularly those with traumatically induced persisting coccygodynia benefit from surgical intervention with coccygectomy.

[Effectiveness of interscalene plexus block for open subacromion decompression]. / Effektivität der interskalenären Plexusblockade nach offener subakromialer Dekompression.

AIM: The aim of this study was to assess the influence of interscalene brachial plexus blocks on the functional outcome, subjective pain appraisal and patient satisfaction after open shoulder surgery. These results were compared with patients treated by conventional analgesic measures. METHOD: 23 patients with interscalene brachial plexus block (ISB) and 21 patients without ISB were evaluated preoperatively as well as 1, 7, 12 and 90 days after open surgery of the shoulder. By means of a visual analogue scale (VAS) subjective postoperative pain intensity was assessed. Using the Constant score preoperatively and 6 months after surgery the functional status of the treated shoulder was evaluated. At discharge from hospital patients were asked whether they were satisfied with the analgesic measures taken. RESULTS: The range of motion of the shoulder of patients treated with an ISB was significantly higher 1 and 7 days after surgery than those without ISB. 12 and 90 days postoperatively the range of motion in the ISB group was still higher, but no longer statistically significant. Assessment of the postoperative subjective pain status showed that patients with an ISB had significantly lower values and required less additional analgesia. In both groups the Constant score was significantly higher 6 months after surgery, compared to the preoperative condition. Compared to the control group, patients treated with ISB were clearly more satisfied with the postoperative pain management. CONCLUSION: By implementing ISB sufficient analgesia in the early postoperative period after open shoulder surgery is attained, allowing for early physiotherapy. This positively influences convalescence and the outcome of the surgical procedure. Furthermore, patients are visibly more satisfied with the postoperative pain management.

Determination of West Indian manatee vocalization levels and rate.

The West Indian manatee (Trichechus manatus latirostris) has become endangered partly because of a growing number of collisions with boats. A system to warn boaters of the presence of manatees, based upon the vocalizations of manatees, could potentially reduce these boat collisions. The feasibility of this warning system would depend mainly upon two factors: the rate at which manatees vocalize and the distance in which the manatees can be detected. The research presented in this paper verifies that the average vocalization rate of the West Indian manatee is approximately one to two times per 5-min period. Several different manatee vocalization recordings were broadcast to the manatees and their response was observed. It was found that during the broadcast periods, the vocalization rates for the manatees increased substantially when compared with the average vocalization rates during nonbroadcast periods. An array of four hydrophones was used while recording the manatees. This allowed for position estimation techniques to be used to determine the location of the vocalizing manatee. Knowing the position of the manatee, the source level was determined and it was found that the mean source level of the manatee vocalizations is approximately 112 dB (re 1 microPa) @ 1 m.

[Value of sonography after rotator cuff repair: a comparison with MRI and clinical results]. / Wertigkeit der Sonographie nach Rotatorenmanschettennaht: ein Vergleich mit MRT und klinischer Diagnostik.

AIM: How well do ultrasound- and MRI-results after rotator cuff reconstruction correlate with postoperative clinical findings? METHODS: Ultrasound- and MR-imaging of the afflicted shoulder on 40 patients who were surgically managed for isolated tear of the tendon of supraspinatus was performed at least 24 months after intervention. Patients were also clinically assessed. Based on the clinical result, sensitivity and specificity for the two imaging procedures was determined. RESULTS: Only 11 (27.5%) patients had a completely inconspicuous ultrasonography. By ignoring the sonographic parameter "echogenicity" this number was raised to 29 (72.5%) patients. Without the above mentioned parameter ultrasonography demonstrated a good specificity (90.3%) yet a poor sensitivity (33.3%). Incorporation of "echogenicity" markedly weakened both values. MR-imaging showed an intact cuff in 32 (80%) patients, 5 (12.5%) had signs for a partial tear and in 3 (7.5%) a recurrent tear was diagnosed. Based on the clinical result, MR-imaging showed sufficient specificity (87.1%), yet also a poor sensitivity (44.4%). CONCLUSION: After rotator cuff repair MRI- and ultrasound-findings frequently stand in distinct discrepancy to clinical results. Based on clinical findings, postoperative MR-imaging shows a slightly higher sensitivity than ultrasonography. Despite this, both radiographic methods do not allow deductions concerning the clinical outcome. The postoperative shoulder-scan and MRI should therefore be interpreted with utmost care. Symptoms and functional results are of high clinical relevance in the assessment of the postoperative shoulder.

[Foot injury as a rare cause of scendosporiosis with fetal outcome]. / Fussverletzung als seltene Ursache einer Scedosporiose mit letalem Ausgang.

After an attempted suicide with a fall from a height of 5 m, a 33 year old male suffered a subarachnoidal haemorrhage, an instable fracture of the second lumbar vertebra as well as a soft-tissue decollément in the vicinity of the right heel. Despite surgical management, the comatose patient showed slow wound-healing of the heel, making revision-surgery necessary 10 days after the first treatment. Fungi were histologically recognised, and subsequent culturing identified Scedosporium apiospermum. Systemic antimycotic therapy with itraconazol (800 mg/d) was immediately initiated. Despite this, S. apiospermum was repeatedly found in wound swabs over the following 2 weeks. After 4 weeks, a radiographically verified osteomyelitis of the calcaneus was diagnosed and local debridement was once again performed. After 5 days, an MRI of the cranium suggested an abscess in the posterior horn of the left lateral ventricle. Itraconazol was altered to voriconazol (4 mg/kg body weight). Neurosurgical opening of the abscess and subsequent culturing once again showed S. apiospermum. CT-scans performed over the following period showed an increase in lesions in the brain suggestive for numerous abscesses. At 78 days after the initial trauma, the still comatose patient died due to a massive cerebral haemorrhage. Microbiological assessment of the soil at the site of injury revealed S. apiospermum.

[Coccygectomy in the treatment of coccygodynia]. / Die Steissbeinresektion in der Behandlung der Kokzygodynie.

AIM: Excision of the coccyx for the treatment of therapy-resistant coccygodynia is a disputable management option. Due to the low morbidity only few studies concerning the long-term follow-up after coccygectomy exist. The aim of this study is a retrospective analysis of our patients surgically managed for coccygodynia and a critical review of the results obtained in comparison to the literature. METHOD: 12 patients with complete radiographic and clinical data were included in the study. The average age of patients at the time of surgery was 43.3 years (11 - 75 years). The average follow-up was 9.8 years (2 - 16 years). As suggested by Hambly (1989) the clinical result was assessed according to postoperative pain status and subjective patient satisfaction. RESULTS: 9 of 12 patients regarded the surgical intervention as a success and claimed that they would repeat the procedure (75 %). Three patients did not show marked improvement after coccygectomy. All patients (n = 6) surgically managed for traumatically induced coccygodynia had a positive result, while only 3/6 patients treated for idiopathic coccygodynia reported that symptoms were postoperatively reduced. CONCLUSION: According to our results and review of those documented in the literature, excision of the coccyx for the treatment of coccygodynia, after all conservative treatment options have been exhausted, seems a justifiable alternative. Patients with a history suggestive of traumatically induced coccygodynia are more likely to benefit from coccygectomy.

[Comparison of dorso-lateral and dorso-ventral stabilization procedures in the treatment of vertebral fractures]. / Vergleich von dorsolateralen mit dorsoventralen Stabilisierungsverfahren in der Behandlung von Wirbelsäulenfrakturen.

AIM: The radiological and clinical outcome of surgical treated thoracolumbal fractures were followed up after 6.7 years. METHOD: The study encompassed 97 patients. The degrees of the bony deformation and the local kyphosis were measured on the lateral view X-ray at 4 different time points: post trauma, after the operation, before implant removal and at the follow up examination. The clinical outcome was evaluated by the Oswestry score. RESULTS: 74 fractures were treated with a fixateur intern and a dorsal fusion by apposition of autologous bone postero-laterally. 23 fractures were fused in a combined dorso-ventral manner by intervertebral fusion with tricortical autologous bone. The lateral X-rays showed a loss of correction up to 48 % in the dorsal fused group and 10 % loss of correction in the combined group. The local kyphosis increased up to 84 % in the dorsal operated group due to degeneration of the injured disk. The clinical Oswestry score showed no significant difference in both groups. CONCLUSION: The additional ventral surgery should be evaluated carefully.