Sporadic desmoid fibromatosis of the neck after dorsal spondylodesis of the cervical spine.

BACKGROUND: Rare soft-tissue tumors, termed desmoid fibromatosis (DF), are comprised proliferated spindle cell fibroblasts and myofibroblasts embedded in a prominent collagenous stroma. They can occur either sporadically, due to prior trauma or surgery, or may have a genetic component. Clinically, DF has a high infiltrative growth/ local recurrence rate, but does not metastasize. CASE DESCRIPTION: A 58-year-old male underwent a C5-C7 laminectomy/instrumented fusion. Two years later, he presented with a large gross swelling on the right side of the neck. The lesion was removed and proved to histologically consist of DF. Within the first postoperative 12 months, tumor did not recur. CONCLUSION: Sporadic DF may follow trauma or prior surgery. Symptomatic tumors are treated by surgical en bloc resection (preferably R0). If lesions are inoperable, partially resected, or recur, different hormonal/ chemotherapeutic systematic treatment options are available (e.g., tamoxifen or tyrosine kinase inhibitors). In the future, better molecular understanding of DF likely offers additional therapeutic approaches (e.g., immune checkpoint inhibitors).

Rupture of the Superior Sagittal Sinus in Penetrating Head Injury-Management of a Rare Trauma Mechanism.

Civilian penetrating head injury caused by foreign objects is rare in Germany (Europe), but can result in complex neurovascular damage. We report on a patient who in suicidal intent inflicted on himself a penetrating brain injury near the vertex with a captive bolt gun. A laceration at the junction of the middle to the posterior third of the superior sinus occurred by bolt and bone fragments leading to critical stenosis and subsequent thrombosis. Upon surgery, the proximal and distal sinus openings were completely thrombosed. The sinus laceration was closed by suture and the intraparenchymal bone fragments were retrieved. Postoperative angiography disclosed persistent occlusion of the superior sagittal sinus. The patient did not develop any symptoms due to venous congestion (edema, hemorrhage), suggesting sufficient collateral venous outflow. The patient completely recovered despite the complexity of the lesion.

[Guideline-conform treatment of injuries to the subaxial cervical spine]. / Leitliniengerechte Therapie von Verletzungen der subaxialen Halswirbelsäule.

Injuries to the subaxial cervical spine are increasing and have an increased neurological risk compared to the thoracic and lumbar spines. The current treatment recommendations according to the therapeutic recommendations of the Spine Section of the German Society for Orthopedics and Trauma Surgery (DGOU) as well as the S1 guidelines of the German Trauma Society (DGU) are presented. This second part of the article describes the correct indications and treatment planning for injuries to the cervical spine. Based on the AOSpine classification for subaxial cervical spine injuries, decisions can be made about conservative or surgical treatment as well as individual details of the treatment. The underlying principles of treatment are relief of neurological structures, restoration of stability and reconstruction/preservation of the physiological alignment.

[Guideline-conform diagnostics for injuries of the subaxial cervical spine]. / Leitliniengerechte Diagnostik bei Verletzungen der subaxialen Halswirbelsäule.

Injuries to the subaxial cervical spine are increasing and have a high risk for neurological injury in comparison to the thoracic and lumbar spine. The current treatment recommendations according to the recommendations of the section spine of the German Society for Orthopaedics and Trauma (DGOU) and the S1 guidelines of the German Society for Trauma Surgery are summarized in this article. High-energy as well as low-energy trauma can cause a significant injury to the cervical spine. If there is a suspicion of a cervical spine injury, a tomographic imaging modality (CT/MRI) is the procedure of choice. Injuries should be classified according to the AOSpine classification for subaxial injuries. Based on this classification, a decision on a conservative or operative treatment regimen as well as individual details of the treatment can be made.

Staged surgical treatment for infection of total disc arthroplasty: three cases and a narrative review of the literature.

Although total disc arthroplasty (TDA) is a common procedure for selected cases of degenerative disc disease, until today there are only two cases of TDA infections reported in the literature. We report three cases of postoperative TDA infections, two developed cutaneous fistulas. To eradicate the infectious site, a staged removal of the device, resolute debridement, and stabilization plus fusion is proposed. Surgeons are challenged by (1) major retroperitoneal vessels adherent to the device, (2) surrounding scar tissue, (3) accompanying retroperitoneal abscess, and (4) technical issues when removing and replacing the implant. A staged multidisciplinary team approach involving vascular and plastic surgery as well as spine specialists is mandatory to achieve good results.

[Conservative Treatment of Thoracic and Lumbar Vertebral Fractures - what's it all about?] / Konservative Behandlung von Wirbelfrakturen in BWS und LWS ­ was geht wie?

The basis for assessing thoracolumbar vertebral body fractures are two established classification systems. Important, especially in terms of further treatment, is the distinction between osteoporotic and healthy bones. The AO Spine classification offers a comprehensive tool for healthy bones to reliably specify the morphological criterias (alignment, integrity of the intervertebral disc, fragment separation, stenosis of the spinal canal). In addition to the fracture morphology, the OF classification for osteoporotic fractures includes patient-specific characteristics to initiate adequate therapy. In general an adequate pain therapy is required for early rehabilitation. While in the bone healthy population, physiotherapy reduces the risk of muscle deconditioning, in the osteoporotic population it additionally serves to prevent subsequent fractures. Unlike osteoporotic patients, bone healthy patients with vertebral fractures should not undergo a corset/orthosis treatment.

Transoral Spine Surgery - an Update. / Die transorale Wirbelsäulenchirurgie ­ ein Update.

Even though in recent years the number of transoral spinal interventions has decreased in Europe and North America - mainly because of the progress in the drug therapy of rheumatism, there are still pathologies that can only be addressed by a transoral approach. The classical transoral approach can be expanded in collaboration with oral-maxillofacial surgery and ear, nose and throat surgery, but this is rarely necessary. The transoral approach is now mainly used for resection of pathological tissue. Additional stabilisation is often necessary and is performed in Europe and North America via a posterior approach, due to the lack of availability of anterior plate systems. Anterior plate systems are still used in India and China. In these countries, the numbers of transoral operations are generally still increasing. Today the indications for transoral spinal surgery consist mainly of infections and tumours, and more rarely of trauma and congenital malformations of the craniocervical junction. The numbers of surgical interventions for these indications has remained constant in recent years. The most recent advancement is the use of endoscopes and transnasal access. With these techniques, additional alternatives and supplements are available for further reducing the morbidity of transoral surgery. Despite the low number of cases, surgical therapy of the corresponding pathologies can be offered to patients with a calculable risk.

Erratum to: Transthoracic mini-open approach for anterior monosegmental stabilization and fusion.

Unfortunately, the title of the above mentioned article was incorrectly published on the original version. The complete correct title should read as follows: "Transthoracic mini-open approach for anterior monosegmental stabilization and fusion".

Endothelial adhesion of synchronized gastric tumor cells changes during cell cycle transit and correlates with the expression level of CD44 splice variants.

AIM: To study adhesion capacity and CD44 expression of human gastric adenocarcinoma MKN45 cells at different stages of a first cell cycle. METHODS: MKN45 cells were synchronized by aphidicolin and assayed for adhesion to an endothelial cell (HUVEC) monolayer. Surface expression of CD44 and CD44 splice variants on MKN45 cells was evaluated by flow cytometry. Functional relevance of CD44 adhesion receptors was investigated by blocking studies using anti CD44 monoclonal antibodies or by hyaluronan digestion. RESULTS: Adhesion of MKN45 to HUVEC was increased during G2/M transit, after which adhesion returned to baseline levels with cell cycle completion. In parallel, CD44 splice variants CD44v4, CD44v5, and CD44v7 were all up-regulated on MKN45 during cell cycle progression with a maximum effect in G2/M. The function of CD44 surface receptors was assessed with specific receptor blocking monoclonal antibodies or removal of hyaluronan by digestion with hyaluronidase. Both strategies inhibited tumor cell adhesion to HUVEC by nearly 50%, which indicates that MKN45-HUVEC-interaction is CD44 dependent. CONCLUSION: CD44 expression level is linked to the cell cycle in gastrointestinal tumor cells, which in turn leads to cell cycle dependent alterations of their adhesion behaviour to endothelium.