[Therapeutic efficiency in multisegmental fusions of the lumbar spine]. / Therapeutische Effizienz langstreckiger Fusionen im Bereich der LWS.

AIM: The aim of this study was to evaluate of the efficiency of an internal fixateur used since 1998 in multisegmental spondylodesis of the lumbar spine. METHOD: The prospective study included 105 patients with degenerative changes or instabilities of the lumbar spine, who underwent an anterior and posterior stabilisation of more than two segments. The minimum period of follow-up was more than 6 months. There were several objective scores used for the evaluation of the efficiency (Oswestry score/visual analogue scale [VAS]). In addition, the quality of the new internal implant was assessed concerning the rate of loosening and failure of the implant. This new internal fixateur, produced as a titanium alloy, consists of pedicle screws and longitudinal rods with 5 mm diameter and connection elements. Upon pulling the nut a square stabilised situation is created. Altogether the three-segmental stabilisations predominated (n=77), 23 patients received a four-segmental, four patients a five-segmental stabilisation and one received a stabilisation of six levels, mainly involving the segments L3/4 to L5/S1. Because of severe deformities in 14 cases the pedicle screws were applied by computer-assisted navigation (Navitrak). RESULTS: In 12 patients (11.4%) radiological signs of loosening of the inserted pedicle screws in the vertebra were diagnosed. The radiological analysis resulted in pseudarthrosis of 4 (1.2%) of the 349 amalgamated segments. There were no cases of material failure. The average value of the pain score preoperatively (VAS) was 7.7 (5-10, SA 1.3) and postoperatively 4.6 (1-10, SA 1.8). With regard to the Oswestry disability index the preoperative average value amounted to 51.9% (30-91, SA 11.8) and postoperatively 35% (12-74, SA 11.8). In all 98 (93.3%) patients were satisfied, 7 (6.7%) patients reported a decline of the subjective outcome. CONCLUSION: This system achieved a high degree of patient satisfaction and showed a low rate of pseudarthrosis. Furthermore, it can be inserted for short and long fusions, as well in deformities.

Relation between peri-operative antithrombin activity and deep vein thrombosis after elective hip replacement surgery.

BACKGROUND: The purpose of the study was to evaluate whether the postoperative depletion or the preoperative antithrombin (AT) activity is related to the occurrence of deep vein thrombosis (DVT) in patients receiving low-molecular-weight heparin for DVT prevention after elective hip replacement surgery. PATIENTS AND METHODS: In 93 patients AT-activity and standard laboratory parameter were determined on the preoperative day and daily for one week after operation. Furthermore, a color-coded compression sonography was performed before and 8-10 days after surgery. The amount of blood loss and blood transfusions was evaluated. Patients were divided into two groups in respect to the occurrence of a postoperative DVT. RESULTS: The overall incidence of DVT was 8.6% (n = 8). Patients with DVT had a significantly lower preoperative AT-activity (80.6 +/- 3.31%) compared to those without DVT (98.1 +/- 1.12%, p < 0.001), however, without being predictive for DVT (positive predictive value 0.71). There was no association between postoperative fall of AT, the lowest postoperative AT activity, blood loss or blood substitution and DVT. CONCLUSIONS: It has to be expected that a small fraction of patients for elective hip surgery present with AT-activity levels possibly being insufficient for a therapeutic effect of low-molecular-weight heparin even preoperatively. Those patients are subject to a significant higher risk of DVT postoperatively.

[Cement-free ACA hip total endoprosthesis--5 years results]. / Die zementfreie ACA-Hüfttotalendoprothese--5-Jahres-Ergebnisse.

AIM: Since 1994 the cementlesss AlloClasssicAdditional (ACA) total hip replacement system is used in the 1st Orthopedic Department of the Hesssing-Stiftung, Augsburg/Germany. Oblique steps on the medial and lateral side of the stem turn negative retrotorsional forces into axial forces and increase rotational stability. The new shape of the self-cutting metric thread of the dual-radius designed acetabular component provides excellent primary fixation without secondary takeover of the force transmission. We checked the medium-term results. METHODS: The titanium prosthesis (distributed by Sulzer Orthopedics/Switzerland) was used for primary total hip replacement as a complete system in 1320 cases, as a hybrid system in 96 patients. In revision arthroplasty 156 components have been implanted up to now. All patients are included in a prospective study with radiological and clinical examinations. 176 of 242 primary implanted total hip systems with a minimum follow-up of 5 years had been reviewed. RESULTS: For the minimum 5 years implanted complete systems, the Harris Hip Score rose from 42 to 91 points. 94% of the patients were mostly or completely satisfied. Thigh pain was reported in 4%. Two aseptic loosenings of the acetabular component and one aseptic loosening of the stem occurred. CONCLUSION: A high degree of osseo-integration and complications below 2% proves encouraging outcomes but final acceptance must await long-term follow-up.

[Ventral interligamental-intercorporal spondylodesis in spondylolisthesis]. / Die ventrale interligamentäre-interkorporelle Spondylodese bei der Spondylolisthesis.

From November 1982 to March 1986 ventral interligamental intercorporal spondylodesis was accomplished at 69 patients with spondylolisthesis staging from MEYERDING I-IV in the vertebral segments L 4-5 and L 5-S 1. By the spondylodesis we succeeded in 90% of cases in attaining a firm osseous fusion of the vertebral moving segment. In 85% we gained a good clinical result. The period of follow-up is on average of 26 months. The average age of the patients is 38.8 years.

[Results of the surgical therapy of scoliosis]. / Ergebnisse der operativen Skoliosetherapie.

In the years 1981 to 1985 84 patients with scoliosis were mainly treated by the proceeding of Harrington respectively Harrington-Luque. By using the combination Harrington-Luque-wires its getting an evident better result in correction (63%) as by only using the Harrington-instruments (55%).

[Autologous transfusion in scoliosis operations: preoperative autologous blood donations and intraoperative mechanical autotransfusion]. / Autologe Transfusion bei Skolioseoperationen: Präoperative Eigenblutspende und intraoperative maschinelle Autotransfusion.

Autologous transfusion was used to reduce the high demand for blood accompanied with scoliosis surgery. Half of the blood loss could be saved by intraoperative autotransfusion (35 patients). This resulted in a corresponding reduction in homologous transfusion. An elimination of the need for homologous blood could be achieved only by the combination of preoperative blood donation and intraoperative autotransfusion (37 patients). With freezing the predeposit blood was independent of storage time and autologous plasma was available. Thus, the risks of transfusion can be avoided.

[Bone density determination using 125I-densitometry in idiopathic scoliosis]. / Knochendichtebestimmung mit der 125J-Densitometrie bei der idiopathischen Skoliose.

The aim of the present study was to find out whether idiopathic scoliosis is associated with a general reduction of the calcium salt content of the bones. The study was conducted in a scoliosis patient group of 48 individuals, using 125I densitometry.

[New possibilities of radiologic diagnostic methods for diseases of the spinal column using spinal computer tomography]. / Neuorientierung des radiologisch-diagnostischen Vorgehens bei Erkrankungen im Bereich der Wirbelsäule durch die spinale Computertomographie.

During the last there years (from May 1981 to March 1984) we performed 1368 CT examinations of the spine, 447 of the cervical, 264 of the thoracic and 657 of the lumbar vertebral column. 30% of the CT examination of the lumbar spine revealed a prolapse of an intervertebral disk. In 38% of the cases involving the thoracic spine metastases were seen. We diagnosed fractures in 10% of the cervical spine and 11% of the thoracic spine examinations. Posttraumatic or postoperative intravertebral haemorrhage was hardly ever diagnosed in our patients (1.9% of the cases). Spinal trauma: The anterior-posterior and lateral plain films continue to be the mainstay of radiographic screening in spinal injury. Nevertheless, the degree of injury is underestimated in a significant number of patients with spinal trauma if conventional radiography is the only diagnostic approach. For further clarification CT proved to be the fastest and best method to recognise the causes and extent of compression of the vertebral canal. CT has attained a high degree of accuracy in the diagnosis of prolapse of intervertebral disks, replacing myelography if the findings are unequivocally established. CT should also be preferred to myelography in suspected recurrent prolapse. Localisation, shape and density are criteria for differentiating between scarification and prolapse via CT. The results show that CT has opened up new possibilities in the diagnosis of spinal diseases and has resulted in a reorientation of the diagnostic approach.

[Treatment of osteomyelitis with PVP-iodine solution using lavage-suction drainage]. / Behandlung der Osteomyelitis mit PVP-Jod-Lösung in Spül-Saug-Drainagen.

PVP-iodine was applied in this pilot study as irrigation solution containing 0.2% active ingredient for irrigation-suction drainage. It was well tolerated. The degree of iodine absorption remained within a lower region encountered with commonly available iodine-containing medications. Increased iodine levels returned to normal ranges soon after termination of treatment. Changes in thyroxine values were without clinical symptoms. No hypothyreosis was encountered. In spite of this it is recommended to control thyroid function before, during and after irrigation treatment with PVP-I in patients with a possible disposition for iodine-induction of thyroid function. Pregnancy (after the third month) and the presence of autonomous adenomas of the thyroid are contraindications because of the iodine load encountered. Palpable evidence for a thyroid enlargement is also a contraindication, except when the patient had not responded with thyroidal side reactions after prior exposure to iodine-containing contrast agents. During the irrigation treatment with PVP-I wounds became free of microorganisms. Local irritations due to the application of PVP-I were rare. The patient acceptance was excellent or good.

[Determination of minerals and trace elements in idiopathic scoliosis]. / Mineral- und Spuren- elementbestimmungen bei der idiopathischen Skoliose.

In a preliminary study the spinal processes of the curve and the parietal bone in idiopathic scoliosis were analyzed in 10 patients by atom absorption spectrophotometry during dorsal fusion operations using the Harrington instrumentarium. In addition to calcium and magnesium, the trace elements iron, copper, manganese and zinc were determined. For comparison, bone samples were taken from the pelvic ridges of the patients, as well as control biopsies from the pelvic ridges of 21 healthy patients in the clinic who were of the same age. The bone samples had been taken from the latter during surgery for pseudarthrosis. The statistical analysis of the mineral and trace elements showed that there is no local disturbance of mineral and trace element metabolism in idiopathic scoliosis; a comparison of the bone samples from the scoliosis patients with the normal values also largely ruled out a generalized disturbance of mineral and trace element metabolism in bone tissue in idiopathic scoliosis.

[Somatosensory evoked potentials in surgery of the spine]. / Somatosensorisch evozierte Potentiale bei Eingriffen an der Wirbelsäule.

The authors report on their experience using cortical somatosensorially evoked potentials in 23 studies on 21 patients. The method is used intraoperatively when the spinal cord is at risk, for early identification of functional damage to the cord. The potentials found are classified according type of manifestation and compared with the results obtained by other authors.

[Results of surgical scoliosis treatment at the Munich Orthopedic Clinic (a study of the years 1973-1977)]. / Ergebnisse der operativen Skoliosebehandlung an der Orthopädischen Klinik München (Eine Studie der Jahre (1973-1977).

We report about a collective of 73 patients which were operated according to Harrington. The patients were followed up for at least two years. In addition we compared two groups of patients each of which had received different bone material. We present our data in comparison to other studies and we discuss advantages and complications of the method applied.

[Results of conservative treatment of scoliosis using the Milwaukee corset]. / Ergebnisse der konservativen Skoliose-Behandlung mit dem Milwaukee-Korsett.

The conservative treatment of scoliosis with Milwaukeebrace has been studied in 165 patients over a period of seven years. We have shown that good results were obtained as long as the initial did not exceed angle of 40 degrees according to COBB. When the curvature exceeds 50 degrees the progression of the scoliosis was not stopped by the MILWAUKEE-brace. In our experience the latter patients should undergo an operation. An improvement of the corrections with the conservative treatment using the MILWAUKEE-brace can only be expected when the treatment was initiated in an early state. To achieve this good propose a number of screening methods to evaluate the progressive character of the scoliosis in particular during puberty; an intensive physio-therapy and careful control of the brace are required for the success of the therapy.

[Functional scintigraphy of pulmonary ventilation with 133Xe in juvenile scoliosis (author's transl)]. / Die Funktionsszintigraphie der Lungenventilation mit 133Xe bei juveniler Skoliose.

Twenty children with severe scoliosis underwent spirometry, chest X-ray and 133Xe ventilation studies before surgical correction by the Harrington operation. By means of functional scintigraphy the relative distribution of the functional residual capacity (FRC) and the wash-out curves (3-min-retention without background correction, mean time constant, effectivity index after background correction) were analysed quantitatively. The chest X-ray and the single-breath-phase of the ventilation study remained mostly unchanged, whereas the shifting of the FRC distribution towards the lung of the concave side indicated in all cases a regional ventilation restriction of the convex side. In addition the analysis of the wash-out curves showed a regional impairment of the alveolar ventilation of the convex side which exceeded the shifting of FRC distribution. Even in the cases with normal spirometric values all scintigraphic parameters were slightly pathological, probably due to the decreased lung function caused by the scoliosis. The effectivity index taking into account the respiration frequency, the tidal volume, the FRC and the dead space, was found to be the most accurate and sensitive parameter for the evaluation of regional ventilation impairment.

[Defective type I collagen in a woman patient with juvenile idiopathic scoliosis (author's transl)]. / Defekt des Typ-I-Kollagens bei einer Patientin mit juveniler idiopathischer Skoliose.

The molecular causes of idiopathic scoliosis have not yet been clarified to any appreciable extent and are probably heterogeneous. The occurrence of scolioses in congenital diseases of the connective tissue points to changes in connective tissue metabolism. Collagen is the most essential structural connective tissue component of bone. It was the aim of our investigations to examine the synthesis of collagen of Types I and II in order to identify a possible molecular defect. In the woman patient examined by the authors, a pathologically changed alpha-chain of the collagen of Type I was found as the probable cause of this particular case of idiopathic scoliosis.

[Observations on the ability to work surgically treated scoliosis patients during 1946-1966 (author's transl)]. / Beobachtungen zur Erwerbsfähigkeit an operativ behandelten Skoliosepatienten der Jahre 1946-1966.

Basing on follow-up observation of a group of 113 scoliosis patients who had undergone surgery during 1946 to 1966, the connection between scoliosis and ability to work is subjected to close scrutiny. The study shows that there is a connection between reduction in the ability to work and the scoliosis angle, the extent of stiffness and cardiopulmonary performance of the patients. We may well expect that improved results of surgery, as they are now obtained with the modern methods (Harrington), will result in improved physical ability and a less pronounced reduction in the patients' capacity for gainful employment.

[Reduplication of femur - course observation and treatment (author's transl)]. / Femurgabelung-Verlaufsbeobachtung und Therapie.

The paper reports on the further growth of the leg in the case of a 7- year-old boy with congenital reduplication of the femur, tibial aplasia and dysplasia of the foot, who was treated conservatively until now. The possibilities of conservative and operative treatment to reconstruct the limb and to improve the function were discussed and finally the operative treatment carried out is explained. The case report is an example of the variety of problems in the reconstruction of dysplastic limbs in childhood.

[A contribution to the recording and study of the disease pattern of osteogenesis imperfecta tarda (author's transl)]. / Ein kasuistischer Beitrag zum Krankheitsbild der Osteogenesis imperfecta tarda.

This study aims at investigating in a group of thirty-five patients whether osteogenesis imperfecta tarda presents a uniform disease pattern in respect of clinical and roentgenological criteria, or whether it can be subdivided into clinical groups. Depending on the severity of the disease, it was possible to subdivide this into two groups: a severe form of osteogenesis imperfecta tarda, and a bland form. This subdivision was effected according to the most conspicuous symptom of frequency of the fracture. The other symptoms do not allow any subdivision into groups since their occurrence is independent of the severity of the disease pattern.