[The effect of propanidid in patients with an increased tendency to cerebral convulsions (author's transl)]. / Zur Wirkung von Propanidid bei Patienten mit erhöhter zerebraler Krampfbereitschaft

In view of the observation of tonic-clonic convulsions after the use of Propanidid in certan patients, a study was undertaken of the effects of this drug (7 mg/kg) on the EEG of 2 volunteers with a known history of epilepsy. Both subjects developed tonic-clonic convulsions and showed typical alterations of the EEG pattern even before the onset of hyperventilation. These EEG alterations were producible also during complete relaxation. The convulsions were easily stopped by the administration of short-acting barbiturates. Similar observations reported in the literature are briefly discussed. The conclusion is drawn that Propanidid should not be given to patients with a known history of epilepsy or any other convulsive disease.

[Ventral osteosynthesis for the treatment of metastatic tumours of the superior thoracic spine (author's transl)]. / Die ventrale Osteosynthese bei Metastasen der oberen Brustwirbelsäule.

In patients with carcinoma, resection of one or more adjacent destroyed vertebral bodies is indicated in selected cases to preserve or restore walking. Stabilization of the spine with bone cement and metal plating ensures early mobilization, which is desirable in patients with limited survival. In the upper thoracic spine the location and number of the destroyed vertebral bodies will dictate the operative approach. Anatomical studies in cadavers showed median sternotomy and high posterolateral thoracotomy to be equally unsuited as access for plating, if both the second and third thoracic vertebrae are destroyed.

[Dorsal inter- and extracorporal osteosynthesis for tumours of the thoracic vertebral bodies (author's transl)]. / Die dorsale inter- und extrakorporelle Osteosynthese bei thorakalen Wirbelkörpertumoren.

Various surgical alternatives for benign and malignant tumours of the thoracic vertebral bodies are compared. The objective of surgery, i.e. extirpation of the tumour and adequate stabilization of the spine by internal fixation, can be attained both by ventral intercorporeal osteosynthesis and by dorsal inter- and extracorporeal osteosynthesis. The relative merits and demerits of the two techniques are discussed. When using the dorsal approach, the surgical microscope will provide sufficient light and vision so that the tumour can be successfully resected even in the presence of extensive destruction of the vertebral bodies. The indications for, and technique of, inter- and extracorporeal osteosynthesis are reviewed on the basis of case reports.

[Anterior cervical intervertebral disk operation without secondary fusion. Clinical and experimental studies]. / Vordere Halsbandscheiben-Operation ohne zusätzliche Verblockung. Klinischen und experimentelle Untersuchungen

The problems of the spontaneous fusion after cervical discectomy were studied in 12 patients. An examination after the operation showed an improvement of the neurological-radicular symptoms, but 75% of the patients complained about severe pains in the area of neck and shoulders. The cause of these complaints was found by radiological examination to be an angular kyphosis of the cervical spine combined with the subluxation of the intervertebral joints in the operated segment. The mechanical results of the ventral fusion without using interponates are being experimentally reproduced and evaluated. By comparing both methods, the method using interponates showed better results. Therefore, the discectomy with fusion using interponates should be preferred.

Intradural variant of cervical nerve root fibres. Potential cause of misinterpreting the segmental location of cervical disc prolpases from clinical evidence.

In 40 postmortem specimens the cervical posterior roots were examined under the surgical microscope, and intradural communicating fibres between neighbouring segments were demonstrated. The implications of these frequent variants for the diagnosis of prolapsed cervical discs are discussed.

[Results of cervical chordotomy with and without rhizotomy in therapy-resistant pain in the shoulder and arm]. / Ergebnisse der zervikalen Chordotomie mit und ohne Rhizotomie bei konservativ therapieresistenten Schmerzen im Schulter-Arm-Bereich.

Herein we report on 39 patients, who were treated with the upper cervical cordotomy (C1/C2), because of intractable pain of the shoulder and arm region. 30 patients suffered from malignant tumors, 9 had a benign lesion. A simultaneous cordotomy and rhizotomy was performed in 9 tumor patients and in 2 patients with a benign lesion. The upper cervical cordotomy proofed successful in the treatment of pain of cancer bearing patients. However, our results demonstrated that the combination of cordotomy and rhizotomy did not provide further advantage than the cordotomy alone.

Microsurgical anterior decompression and internal fixation with iliac bone graft and titanium plates for treatment of cervical intervertebral disc herniation.

42 cervical interbody fusions with iliac bone graft and titanium plate fixation were performed between October 1991 and March 1994. The mean follow up period in this study was 10.7 months. In 32 cases fusion was done for 1 and in 10 cases for 2 segments. 2 different types of plates were used. In 25 cases micro-osteosynthesis plates and screws with 2.7 mm diameter were used, and in 17 cases cervical H-plates and screws with 3.5 mm diameter. A favourable outcome was achieved in 31 of 42 cases (74%). Satisfactory pain relief was achieved in 90%. For radicular motor deficit good results were obtained in 84% and for cervical myelopathy in 54%. The 2 different types of plates showed a remarkable difference in the clinical outcome. The results were regarded favourable in 15 of 25 microplate fusions (60%) and in 16 of 17 H-plate fusions (94%). Compression of the bone graft was seen in 5 patients of the micro plate group, however, radiological signs for fusion were present in all 42 cases at follow up. Major surgical complications, damage to neural structures or neurological deterioration did not occur in this study. Plate fixation in cervical interbody fusions seems to be a safe procedure and may reduce graft related complications at the fusion site if the plates and screws are sufficiently well proportioned. A favourable impact upon the results for cervical interbody fusion might be expected and should be further investigated in a long term follow up study.

[Psychic disturbances in patients with cervical intervertebral disk changes and cervical osteochondrosis]. / Psychische Störungen bei zervikalen Bandscheibenschäden und Osteochondrosen.

The paper is concerned with the investigation of 51 patients with alterations of cervical intervertebral disks and cervical osteochondrosis who have undergone surgical intervention. The examination included a psychiatric interview as well as the application of paper pencil tests. Seventeen patients indicated symptoms of an endogenous depression. The group of depressed patients offered a significantly slow onset of cervical symptoms and, in the period after the operation, complained more often than the group without depressive symptoms. The psychological test revealed an increased tendency of inhibition and anxiety of the depressed group. Lastly, methodical problems are discussed concerning the evaluation of the lapse of psychic conduction as tension over a long period.

[Experiences with ventral stabilization in vertebral metastases in the area of the thoracic and lumbar spine]. / Erfahrungen mit der ventralen Stabilisierung bei Wirbelkörpermetastasen im Brust- und Lendenwirbelsäulenbereich.

43 cases of tumor resection followed by ventral stabilisation are reported in 42 patients with metastases in the spine. Indications for surgery were beginning or incomplete transversal lesion of the spinal cord, bedrest for at least 3 weeks, unsusceible pain caused by instability, or unsuccessful conservative and radiotherapeutic treatment. 46.5% of the cases can be rated as good considering the time of survival and life quality, 18.5% can be judged as a partial success. 7 patients hat to be reoperated in the same level, most of them because of local recurrence. Complications occurred in 40% of the cases. These operations should be performed by a "term of specialists". Postoperative treatment with isotope-, hormone- or radiotherapy is decisive to obtain good results.