[Surgical management of acute traumatic spinal cord injury : Stability vs. functionality]. / Chirurgische Therapie der akuten traumatischen Querschnittsverletzung : Stabilität vs. Funktionalität.

BACKGROUND: Traumatic spinal cord injuries represent a devastating condition in the lives of those affected, with physical, emotional, and economic burdens for the patients themselves, their social environment, and society as a whole. OBJECTIVE: Surgical approach and techniques in traumatic spinal cord injuries. RESULTS: Traumatic spinal cord injuries should be surgically treated as soon as possible, but at least within 24 h of injury. If accompanying dural injuries occur, suturing or applying a patch is the primary method of choice. Early surgical decompression is essential, particularly in cervical spinal cord injuries. Stabilization in terms of instrumentation or fusion is inevitable and should be carried out over short segments to maintain the functionality of the cervical spine. Long-distance dorsal instrumentation with prior reduction in thoracolumbar spinal cord injuries provides high stability and preserved functionality in patients. Injuries to the thoracolumbar junction often require a two-stage anterior treatment. CONCLUSION: Early surgical decompression, reduction, and stabilization of traumatic spinal cord injuries within 24 h are recommended. While short-segment stabilization is recommended in the cervical spine in addition to decompression, instrumentation should be over long segments in the thoracolumbar spine to provide the necessary stability while maintaining functionality.

[Infiltration anesthesia]. / Infiltrationsanästhesie.

OBJECTIVE: Complete anesthesia of any skin and soft tissue area by intradermal, subcutaneous, or intramuscular injections. INDICATIONS: Small injuries or incisions in limbs or trunk, minor surgery on the face/jaw (e.g., on the teeth), or postoperative analgesia (local infiltration anesthesia, LIA). CONTRAINDICATIONS: Local infections at the injection site. SURGICAL TECHNIQUE: By means of intradermal, subcutaneous or intramuscular administration, a grandeur arises, here the local anesthetic blocks nerve transmission. If anesthetized distal to end arteries, vasoconstrictors (e.g., epinephrine) should be avoided. Proximal to end arteries, localized ischemia may facilitate operative care. POSTOPERATIVE MANAGEMENT: The effect of local anesthesia is self-limiting. RESULTS: By means of infiltration anesthesia or "field block", larger areas of skin are easily accessible for surgical treatment. The amount to be applied has to be adapted to the extent of the operation and the maximal dose. Postoperatively, after knee or hip arthroplasty, analgesia consumption can be reduced, and early mobilization promoted using LIA.

[Oberst's block anesthesia]. / Leitungsanästhesie nach Oberst.

OBJECTIVE: Complete anesthesia of the phalanges of the fingers and toes. INDICATIONS: All lesions distal to the metacarpophalangeal/metatarsophalangeal joint. CONTRAINDICATIONS: Local infections at the injection site. Lesions proximal to the metacarpophalangeal/metatarsophalangeal joint. TECHNIQUE: A subcutaneous deposit of a 0.5-2% local anesthetic is administered dorsoradially and dorsoulnarly at the base of the metacarpophalangeal/metatarsophalangeal joint. With the cannula advanced to palmar, an additional 0.5-1.5 ml is then administered to achieve complete anesthesia. POSTOPERATIVE MANAGEMENT: The effect of the local anesthesia is self-limiting. RESULTS: The Oberst block results in reliable anesthesia of the finger and toe. All surgical procedures distal to the metacarpophalangeal/metatarsophalangeal joint can be performed without pain.

Of Cestodes and Men: Surgical Treatment of a Spinal Hydatid Cyst.

BACKGROUND: The cestode Echinococcus granulosus causes hydatid disease. In addition to manifestations in the liver and lung, it can lead to cystic lesions in the spine. CASE DESCRIPTION: We report a 42-year-old male patient with primary hydatid disease in the eighth thoracic vertebra. The only clinical symptom was chronic back pain. Although laboratory findings were normal, imaging displayed lytic destruction that raised the suspicion of a metastatic disease. Diagnostics of the thoraces and abdomen did not reveal other pathologic abnormalities. Follow-up magnetic resonance imaging (MRI) depicted a progressive compression of the spinal cord and inhomogeneous structure in the fat-suppressed sequences. Because the Jamshidi biopsy was inconclusive, the tumor board recommended surgery. Dorsal decompression, spondylodesis of T6-T10, and vertebral column resection of T8 with complete cyst removal were performed. The resected vertebrae showed a mucous-like lesion with white granular tissue interfusing the whole vertebral body. A pathologic examination and enzyme-linked immunosorbent assay confirmed E. granulosus. Thus chemotherapy with albendazole was initiated. A follow-up MRI of the whole spine confirmed complete remission and found no additional resettlements. The patient's back pain was resolved without neurologic deficits. CONCLUSIONS: For lytic manifestations of the vertebral column, hydatid cysts should be considered a differential diagnosis in addition to malignant metastasis, tuberculosis, and osteomyelitis. Thorough surgical resection and strict follow-up are necessary.