[Diagnostics and minimally invasive therapy for chronic low back pain]. / Diagnostik und minimal-invasive Therapie bei chronischen Lumbalgien.

Chronic low back pain is one of the most frequent causes for seeking medical help in Germany. Many factors play a causal role in its pathogenesis. This is where the dilemma resides in narrowing down the diagnosis and deciding on subsequent therapeutic intervention. There is overall agreement on the concept of when it is expedient to initiate further diagnostic measures. With the exception of clear pathomorphological findings and the presence of cardinal symptoms or warning signs, so-called "red flags", primary back pain should not be subjected to any specific diagnostic tests and therapy during the first 3 months. We present well-established techniques for blockade, discography, and minimally invasive treatment options such as cryotherapy, procedures for thermal ablation, and intradiscal electrotherapy. Vertebroplasty, currently a frequently applied method, is also included in the discussion of minimally invasive treatment for chronic low back pain.

[Rachitic knock knees in children]. / Das rachitische X-Bein im Kindesalter. Pathogenese und Therapie aus historischer Sicht.

Knee malpositions, for example valgus or varus deformations or flexion contractures, were often cited in the historical literature. In earlier times, clinical pictures such as rickets were often the reason for this kind of deformity. A causal therapy did not exist until the twentieth century. In most cases of rickets, genu valgum was reported as the typical knee deformation. The differential diagnosis for genu valgum caused by rickets was genu valgum traumaticum, paralyticum, and inflammatorium. The most important reports on the pathogenesis of valgus deformation can be found in publications by Hueter and von Mikulicz. The causal therapy of rickets was introduced at the beginning of the twentieth century.Vitamin therapy and UV phototherapy were developed during this period. Using these therapies, rickets decreased dramatically. Kurt Huldschinsky, a pediatrician from Berlin,was one of the main inventors of UV phototherapy in Germany. At the end of the nineteenth century, the operative correction of knee deformities increased while conservative treatment continued to be applied. Plaster casts,orthoses, and osteoclast therapy were the main noninvasive therapeutic possibilities. Positive aspects of the conservative techniques were mostly the good results and easy, timesaving technique compared with the operative treatment. The operative therapy increased with the knowledge of antisepsis and asepsis as well as advances in anesthetic procedures. Operative treatment modalities, for example tibial and femoral osteotomies, were more precise, but connected with multiple complications and greater time expenditure. Sufficient vitamin prophylaxis rendered knee deformations caused by rickets a rarity.

[Pott triad and Schmorl nodules. A historical overview of kyphosis with special reference to tuberculous spondylitis and Scheuermann disease]. / Von Pott-Trias und Schmorl-Knoten. Ein geschichtlicher Uberblick zur Kyphose unter besonderer Berücksichtigung der tuberkulösen Spondylitis und des Morbus Scheuermann.

This report provides an overview of the history of the different types of kyphosis (arcuated and angulated forms). Especially tuberculous spondylitis and Scheuermann's disease are pointed out from among the large group of kyphotic diseases. Therefore, Beckhterew's disease, the combination of rickets and kyphosis as well as the dysraphic diseases and constitutional kyphosis caused by faulty posture are only mentioned. These two special types of kyphosis (Scheuermann's disease and tuberculous spondylitis) are presented from the first description with diagnostic findings, the ideas of pathogenesis and aspects of treatment through to the different periods of medical history. This article describes the way of thinking and discussing of opinion leaders at the beginning of the century and the influence of new techniques and developments (asepsis, antisepsis, anesthesia, bacteriology, X-ray, antibiotics) on the differential diagnosis and therapy. It is impossible to give a complete overview of all aspects during the centuries concerning tuberculous spondylitis or arcuated kyphosis. The authors of this article have focussed their studies on developments from the first descriptions until World War II, based mainly on literature from German journals and historical books from the library of the German Museum for Orthopedic History and Science.