Can we predict favourable quality of life after surgically treated vertebral osteomyelitis? Analysis of a prospective study.

PURPOSE: Vertebral osteomyelitis (VO) is a severe clinical entity associated with significant morbidity and mortality. Several studies have showed that successful treatment of VO patients leads to significantly improved quality of life (QoL). Nevertheless, QoL levels of these patients remained below those of the general population. There are rarely studies focusing on predicting factors for favourable QoL after surgically treated VO. The aim of this study was to identify factors influencing positively the QoL of patients undergoing surgery for VO. METHODS: We conducted a prospective monocentric study including surgically treated VO patients from 2008 to 2016. Data were collected before (T0) and 1 year (T1) after surgery. Primary outcome was favourable QoL defined as back pain with disability restricting normal life activity with a cutoff value ≥ 12 on Oswestry Disability Index (ODI). ETHICS: Ethical approval was given by the Faculty of Medicine at the University of Cologne (09-182). RESULTS: A total of 119 patients surviving 1 year after surgically treated VO were analysed. Favourable QoL was achieved in 35/119 patients. On multivariate analysis, younger age (hazard ratio = HR: 0.95; 95% CI 0.91-0.99; p = 0.022), lower albumin (HR: 0.9; 0.83-0.98; p = 0.019) an ASA score ≤ 2 (HR:4.24; 95%CI 1.42-12.68; p = 0.010), and a lower preoperative leg pain on the VAS (HR: 0.86; 95% CI 0.76-0.97; p = 0.018) were identified as independent risk factors for favourable QoL. Interestingly, the absence of neurological deficits was not predictive for a favourable outcome by means of QoL. CONCLUSION: One-third of surgically treated VO patients (29%) in our cohort achieved favourable QoL by means of ODI. Our findings can facilitate an estimation of the prognosis when informing the patient before surgery, and underscore that spine disability questionnaires, such as ODI, measuring QoL, are mandatory to evaluate comprehensively the outcome of this entity.

Home-based vibration assisted exercise as a new treatment option for scoliosis - A randomised controlled trial.

OBJECTIVES: The aim of this study was to evaluate the effect of scoliosis specific exercises (SSE) on a side-alternating whole body vibration platform (sWBV) as a home-training program in girls with adolescent idiopathic scoliosis (AIS). METHODS: 40 female AIS patients (10-17 years) wearing a brace were randomly assigned to two groups. The intervention was a six months, home-based, SSE program on a sWBV platform five times per week. Exercises included standing, sitting and kneeling. The control group received regular SSE (treatment as usual). The Cobb angle was measured at start and after six months. Onset of menarche was documented for sub-group analysis. RESULTS: The major curve in the sWBV group decreased significantly by -2.3° (SD±3.8) (95% CI -4.1 to -0.5; P=0.014) compared to the difference in the control group of 0.3° (SD±3.7) (95% CI -1.5 to 2.2; P=0.682) (P=0.035). In the sWBV group 20% (n=4) improved, 75% (n=15) stabilized and 5% (n=1) deteriorated by ≥5°. In the control group 0% (n=0) improved, 89% (n=16) stabilized and 11% (n=2) deteriorated. The clinically largest change was observed in the 'before-menarche' sub-group. CONCLUSIONS: Home-based SSE combined with sWBV for six months counteracts the progression of scoliosis in girls with AIS; the results were more obvious before the onset of the menarche.

Pathoanatomic Risk Factors for Instability and Adjacent Segment Disease in Lumbar Spine: How to Use Topping Off?

PURPOSE: The goal of this review is to identify criteria indicating implantation of hybrid system into lumbar spine and to evaluate general benefits of use. METHODS: A systematic review of literature was performed using current randomized clinical trials, reviews, and meta-analyses. Data sources included relevant literature of human studies identified through searches of Medline Library until May 2015. RESULTS: Predisposing factors for Adjacent Segment Disease (ASDi) are discussed in literature: laminar horizontalization, insufficiency of fascia thoracolumbalis, facet tropism, and facet sagittalization. Currently there is no evidence for topping off. There are only 12 studies and these have no consistent statements about use of a hybrid system for avoidance of ASDi. CONCLUSION: Hybrid instrumentation of lumbar spine, either with pedicle-based technique or additional spacer, might possibly prevent ASDi from developing in previously damaged segment adjacent to a fusion. Good clinical data proving effectiveness of this new implant technique is as yet unavailable. Thus, currently one must speak of an unevaluated procedure. Various radiological classifications can assist in making a reliable decision as to whether hybrid instrumentation is an appropriate choice of therapy. Pathoanatomical conditions of facet joints and laminae as well as preservation of sagittal balance must also be considered.

Fracture risk of vertebral bodies after cryosurgery using a miniature cryoprobe: A biomechanical in-vitro analysis on human bones.

INTRODUCTION: Due to spinal instability and compressive neurologic deficits surgical management is sometimes necessary in patients with metastatic spinal lesions. However, in some cases open surgery is not possible and minimally invasive procedures, like cryoablation, are needed. The aim of the current study was to investigate whether a miniature cryoprobe provides adequate tissue cooling in vertebrae and to evaluate the direct impact of cryosurgery on vertebral body stability. MATERIALS AND METHODS: Twelve thoracic vertebral bodies were harvested from fresh cadavers. After documenting bone density cryoablation was performed in six vertebral bodies according to a standardized procedure. Afterwards temperature inside the vertebral body and maximum breaking force were measured in the control and experimental groups. RESULTS: Required temperature of -50° was reached in all areas. There was a significant correlation between maximum breaking force and measured bone density (p= 0.001). Mean breaking force within the experimental group was 5047 N (SD = 2955 N) compared to 4458 N (SD = 2554 N) in the control group. There were no observable differences in maximum breaking force between both groups. CONCLUSION: Miniature cryoprobe can deliver adequate tissue cooling to -50°C in vertebral bodies. The procedure does not seem to influence breaking force of the treated bones in-vitro. Therefore, using miniature probes cryosurgery may provide a valuable alternative to conventional surgical resection of neoplastic diseases as well as of benign locally aggressive bone tumors.

[Injuries during Equestrian Vaulting]. / Sportverletzungen beim Voltigieren.

Background: Vaulting is the least studied equestrian sports regarding the occurrence of injuries. As its sequences of motion do not compare to riding, vaulting must be assessed separately. Material and Methods: This retrospective, questionnaire-aided survey was aimed to gain insight into the overall frequency of injuries among equestrian vaulters. The second part of the study looked into the knee injuries that occurred. Survey forms were sent to 60 vaulting and equestrian clubs all over Germany, making for a response rate of 63 %. Results: 95 % of 624 responding athletes were female. The pool of participants consisted of both amateur and professional level vaulters with a mean age of 15 years. The survey showed a mean number of 4.1 injuries sustained during the observation period, i. e. the entire time an athlete had been active in the sport up to the data collection. The lower extremities were the most commonly injured area with a total proportion of 45 %, followed by injuries to the spine and the head with 30 %, and the upper extremities with 25 %. Contusions accounted for the highest number of reported injuries. Other frequently reported injuries included muscle strain to the head and spine, fractures to the upper extremity and ligament damage to the lower extremity. 14 % of the participants experienced at least one knee injury. The medial collateral ligament (27 %) was found to be most prone to lesions, followed by the anterior cruciate ligament (23 %) and the medial meniscus (22 %). Half of all knee injuries occurred during dismounts, especially when swing-offs or flanks led to faulty landings. Conclusions: The results show that the lower extremity is the most commonly affected area. The ligamentous injuries affecting the lower extremity mainly result from dismounts. A specific training aimed at improving landing techniques might therefore prove beneficial in preventing injuries. The frequency of contusions and fractures to the upper extremity suggests that these injuries are related to falls.

Influence of spinopelvic parameters on non-operative treatment of lumbar spinal stenosis.

BACKGROUND: Non-operative treatment is widely accepted for early stages of lumbar spinal stenosis. In general, a trial of conservative treatment is recommended prior to surgery. OBJECTIVE: The influence of sagittal alignment on treatment outcomes remains unclear. METHODS: Twenty-five patients were included in this prospective study. All patients received repeated epidural injections and facet joint injections as well as physiotherapy during a one week hospitalization. Patient characteristics, VAS scores, COMI scores, ODI scores and SF-36 were assessed prior to and immediately after treatment as well as after six, twelve, and 26 weeks. Spinopelvic parameter measurements were performed. Outcome parameters were correlated to spinopelvic parameters. RESULTS: ODI and PCSS scores improved significantly up to three months follow-up. COMI score improved significantly over the entire follow-up. Back pain improvement at six weeks and three months follow-up correlated inversely with pelvic incidence. Sacral slope correlated significantly with ODI improvement immediately after therapy. Low lumbar lordosis also correlated significantly with ODI improvement at three months follow-up. CONCLUSIONS: Subjects with higher pelvic incidence reported significantly greater back pain improvements at three months follow-up. ODI improvements were higher for patients with high sacral slope immediately after treatment and for patients with a higher lumbar lordosis after three months. No influence of sagittal alignment was observed on leg pain or quality of life.

The accuracy of 3D fluoroscopy-navigated screw insertion in the upper and subaxial cervical spine.

PURPOSE: Due to better primary stability and repositioning options, pedicle screws are increasingly used during posterior stabilization of the cervical spine. However, the serious risks generally associated with the insertion of screws in the cervical spine remain. The purpose of this study is to examine the accuracy of pedicle screw insertion with the use of 3D fluoroscopy navigation systems, also accounting for various spine levels. METHODS: Data of 64 patients were collected during and after screw implantation (axial and subaxial) in the cervical spine. 207 screws were implanted from C1 to C7 and analyzed for placement accuracy according to postoperative CT scans and following the modified Gertzbein and Robbins classification. RESULTS: The accuracy of most of the inserted screws was assessed as grade 2 according to the modified Gertzbein and Robbins classification. 93.9% of the screws implanted at C1 or C2, and 78.51% of the screws implanted at levels C3-C7 showed placement accuracy grade 2 or better, indicating pedicle wall perforation of <2 mm. Overall, seven complications were observed. In three cases, the vertebral artery was affected, leading to one fatality. Surgical revision was necessary once because of Magerl screw misplacement and three times due to impaired wound healing. No radicular symptoms resulted from screw malposition. CONCLUSION: Axial and subaxial screws can be inserted with a high grade of accuracy using 3D fluoroscopy-based navigation systems. Nevertheless, while this useful innovation helps to minimize the risks of misplacement, the surgery is still a challenge, as arising complications remain severe.

Ultrasound-guided diagnosis of fractures of the distal forearm in children.

PURPOSE: Distal radius and forearm fractures are injuries that are frequently seen in trauma surgery outpatient clinics. Usually, the wrist is X-rayed in 2 planes as standard diagnostic procedure. In contrast, we evaluate in our study the accuracy of ultrasonography (US) in diagnosing these fractures. METHODS: This prospective study includes the patients who presented at two trauma surgery clinics with a presumptive diagnosis of distal radius or forearm fracture between January and December 2012. After a clinical examination, US imaging of the distal forearm was first carried out on 6 standardized planes followed by radiographs of the wrist made in two planes. The age limit was set at the end of 11 years. RESULTS: In total, 201 patients between 4 and 11 years of age were recruited with an average age of 9.5 years at the time of the trauma. There were 104 (51.7%) fractures distributed as follows: 89 (85.9%) injuries of the distal radius, 9 (8.7%) injuries of the distal ulna, and 6 (5.8%) combined injuries (radius and ulna). Sixty-five greenstick fractures were detected. Surgery was necessary in 34 cases. Specificity and sensitivity of ultrasound diagnosis were 99.5%. CONCLUSION: Ultrasound imaging is suitable to demonstrate fractures of the distal forearm. It is a highly sensitive procedure in detecting distal forearm fractures. In our opinion, a negative result in ultrasound may reduce the need for further radiographs in children with distal forearm lesions. But in any doubtful situation the need for conventional radiographs remains.

Peripartum pubic symphysis separation--Current strategies in diagnosis and therapy and presentation of two cases.

BACKGROUND: During spontaneous vaginal delivery, pubic symphyseal widening is normal. Common changes are reversible after complication-free birth. However, cases of peripartum symphysis separation are rare. There is no consensus in the literature on how to treat pregnancy-related pubic symphysis separation. METHODS: This review used a literature-based search (PubMed, 1900-2013) and analysis of 2 own case reports. Studies with conclusions regarding management were particularly considered. RESULTS: Characteristic symptoms, suprapubic pain and tenderness radiating to the posterior pelvic girdle or lower back, may be noted 48 h after delivery. Pain on movement, especially walking or climbing stairs, is often present. Conservative treatments, such as a pelvic brace with physiotherapy and local interventions such as infiltration, are successful in most cases. Symptom reduction within 6 weeks is the most common outcome, but can take up to 6 months in some cases. Surgical intervention is needed in cases of persistent separation. Anterior plate fixation is offered as a well-known and safe procedure. Minimally invasive SI joint screw fixation is required in cases of combined posterior pelvic girdle lesions. SUMMARY: Postpartum symphyseal rupture can be indicated with the rare occurrence of pelvic pain post-delivery, with sciatica or lumbago and decreased mobility. The diagnosis is made on clinical findings, as well as radiographs of the pelvic girdle. Conservative treatment with a pelvic brace is the gold standard in pre- and postpartum cases of symphysis dysfunction.

Injuries in competitive boxing. A prospective study.

Boxing remains a subject of controversy and is often classified as dangerous. But the discussion is based mostly on retrospective studies. This survey was conducted as a prospective study. From October 2012 to September 2013, 44 competitive boxers were asked to report their injuries once a month. The questionnaire collected general information (training, competition) and recorded the number of bouts fought, injuries and resulting lost days. A total of 192 injuries were recorded, 133 of which resulted in interruption of training or competition. Each boxer sustained 3 injuries per year on average. The injury rate was 12.8 injuries per 1 000 h of training. Boxers fighting more than 3 bouts per year sustain more injuries (p=0.0075). The injury rate does is not a function of age (age≤19 vs. > 19a, p=0.53). Injuries to the head and the upper limbs occur most frequently. The most common injuries are soft tissue lacerations and contusions. Head injuries with neurological symptoms rarely occur (4.2%). Boxing has a high injury rate that is comparable with other contact sports, but most injuries are minor. Injury frequency is not a function of whether the boxer competes in the junior or adult category. Athletes fighting many bouts per year have a greater risk of injury.

[Influencing factors on the length of stay in lumbar spine surgery : analysis of the German spine registry]. / Einflussfaktoren auf die Verweildauer in der Wirbelsäulenchirurgie : Eine Datenanalyse des Deutschen Wirbelsäulenregisters.

INTRODUCTION: Spinal disc herniation, lumbar spinal stenosis and spondylolisthesis are known to be leading causes of lumbar back pain. The cost of low back pain management and related operations are continuously increasing in the healthcare sector. There are many studies regarding complications after spine surgery but little is known about the factors predicting the length of stay in hospital. The purpose of this study was to identify these factors in lumbar spine surgery in order to adapt the postoperative treatment. MATERIAL AND METHODS: The current study was carried out as a post hoc analysis on the basis of the German spine registry. Patients who underwent lumbar spine surgery by posterior surgical access and with posterior fusion and/or rigid stabilization, whereby procedures with dynamic stabilization were excluded. Patient characteristics were tested for association with length of stay (LOS) using bivariate and multivariate analyses. RESULTS: A total of 356 patients met the inclusion criteria. The average age of all patients was 64.6 years and the mean LOS was 11.9 ± 6.0 days with a range of 2-44 days. Independent factors that were influencing LOS were increased age at the time of surgery, higher body mass index, male gender, blood transfusion of 1-2 erythrocyte concentrates and the presence of surgical complications. CONCLUSION: Identification of predictive factors for prolonged LOS may allow for estimation of patient hospitalization time and for optimization of postoperative care. In individual cases this may result of a reduction in the LOS.

Anterior spinal artery syndrome: reversible paraplegia after minimally invasive spine surgery.

Background Context. Percutaneous balloon kyphoplasty is an established minimally invasive technique to treat painful vertebral compression fractures, especially in the context of osteoporosis with a minor complication rate. Purpose. To describe the heparin anticoagulation treatment of paraplegia following balloon kyphoplasty. Study Design. We report the first case of an anterior spinal artery syndrome with a postoperative reversible paraplegia following a minimally invasive spine surgery (balloon kyphoplasty) without cement leakage. Methods. A 75-year-old female patient underwent balloon kyphoplasty for a fresh fracture of the first vertebra. Results. Postoperatively, the patient developed an acute anterior spinal artery syndrome with motor paraplegia of the lower extremities as well as loss of pain and temperature sensation with retained proprioception and vibratory sensation. Complete recovery occurred six hours after bolus therapy with 15.000 IU low-molecular heparin. Conclusion. Spine surgeons should consider vascular complications in patients with incomplete spinal cord syndromes after balloon kyphoplasty, not only after more invasive spine surgery. High-dose low-molecular heparin might help to reperfuse the Adamkiewicz artery.

[Special prosthesis implant with partial femoral replacement. Operation after periprosthetic femoral fracture and ipsilateral long-stem knee prosthesis and fixed-angle osteosynthesis]. / Implantation eines Femurteilersatzes nach periprothetischer Femurfraktur. Operation bei einliegender Knietotalendoprothese und winkelstabiler Plattenosteosynthese.

The development of modular prostheses is becoming increasingly important in revision surgery due to the rising need of arthroplasty in knee and hip joints. The demand for suitable prostheses is high because of the desire for a higher mobility and a good postoperative functionality, whereby preliminary experience with megaprostheses using modular implant systems in orthopedic oncology have already been obtained. Considering the clinical outcome of our 58-year-old patient (obesity III, BMI 58) and the third revision operation after two periprosthetic fractures, a megaprosthesis was implanted (Mega C-system, co. Link, Hamburg). We aimed both at good clinical functionality and good stability of the knee joint. After the implant, a good functional result was observed at the beginning; however, there were some indices for prosthesis loosening. During the fourth revision we implanted a total femoral replacement. Postoperatively, a good clinical outcome after intensive physiotherapy was observed. Nevertheless, the use of megaprostheses has to be judged cautiously because of a lack of long-term results. In addition, it should not be used as a standard implant in periprosthetic joint surgery because of the risk of aseptic loosening during its course.

Injuries and overuse syndromes in competitive and elite bodybuilding.

Competitive bodybuilding is a weightlifting sport similar to powerlifting, strongman competition and Olympic weightlifting, which aims to increase muscle mass, symmetry, and body definition. Although data regarding rates of injury, overuse syndromes and pain during routine training is available for these other disciplines, it is rare for competitive bodybuilding. The aim of this study was to investigate rates of injury, pain during workouts and/or overuse syndromes, as well as the influence of particular intrinsic and external factors. Data was collected using questionnaires from 71 competitive and elite bodybuilders. The information included training routines and prior injuries. Participants were recruited from bodybuilding clubs in Germany. 45.1% of athletes reported symptoms while training. The overall injury rate was computed to be 0.12 injuries per bodybuilder per year (0.24 injuries per 1 000 h of bodybuilding). Athletes over 40 exhibited higher rates of injury (p=0.029). Other investigated parameters showed no effects. Most injuries occurred in the shoulder, elbow, lumbar spine and knee regions. A large proportion of bodybuilders complained of pain not resulting in interruptions of training/competition. The injury rate is low compared to other weightlifting disciplines such as powerlifting, Olympic weightlifting or strongman competition. In comparison to team or contact sports the injury rate is minimal.

Correlation of reduction and clinical outcome in patients with degenerative spondylolisthesis.

STUDY DESIGN: Prospective cohort study. INTRODUCTION: Operative treatment is increasingly implemented for the treatment of degenerative lumbar listhesis, with lumbar fusion the most common intervention. Prediction of clinical outcomes after such procedures is of ongoing relevance, and the correlation of radiologic parameters with clinical outcome remains controversial. In particular, clinical studies have not determined conclusively whether reduction of slipped vertebrae is beneficial. METHODS: We performed a monocenter prospective analysis of a comprehensive set of quality of life scores (QLS) (Core Outcome Measure Index, Oswestry Low Back Pain Disability Index, SF-36) of 40 patients, who underwent a standardized PLIF procedure for symptomatic, Spondylolisthesis. Follow-up was 24 months. The correlations between the radiologic parameters (degree of slippage, sagittal rotation) and the clinical scores before surgery as well as 12 and 24 months post-operatively were examined. RESULTS: All QLS showed a statistically significant improvement after 12 and 24 months post-operatively (p < 0.05). The mean amount of the anterior slippage was 34.2 ± 14.7 % (minimum 12 %, maximum 78 %). After 12 months, there was an average 19.1 % decrease to 15.1 ± 8.3 % (minimum 2 %, maximum 38 %, p < 0.000) and after 24 months it was decreased by 18.0-16.2 ± 9.0 % (minimum 2.9 %, maximum 40 %, p < 0.000). Average sagittal rotation measured 67.3° ± 16.6° initially (minimum 35°, maximum 118) and decreased by 4.3° to an average of 63.0° ± 15.2° at 12 months post-surgery (minimum 15°, maximum 101°, p = 0.065,), and by 5.7° to an average of 61.6° ± 13.0° at 24 months (minimum 15°, maximum 90°, p = 0.044). The data show positive correlations between the amount of reduction of the slipped vertebra as well as the amount of correction of the sagittal rotation and the improvement of the clinical outcomes(r = 0.31-0.54, p < 0.05). CONCLUSION: The current study indicates a modest advantage for the best possible reposition in respect of the clinical outcome.

Biomechanical evaluation of the primary stability of pedicle screws after augmentation with an innovative bone stabilizing system.

INTRODUCTION: In today's aging population, diminished bone quality often affects the outcome of surgical treatment. This occurs especially when surgical implants must be fixed to bone, as it occurs when lumbar fusion is performed with pedicle screws. Besides Polymethylmethacrylate (PMMA) injection, several techniques have been developed to augment pedicle screws. The aim of the current study was to evaluate the primary stability of an innovative system (IlluminOss™) for the augmentation of pedicle screws in an experimental cadaveric setup. IlluminOss™ is an innovative technology featuring cement with similar biochemical characteristics to aluminum-free glass-polyalkenoate cement (GPC). MATERIALS AND METHODS: IlluminOss™ was inserted transpedicularly via a balloon/catheter system in 40 human cadaveric lumbar vertebrae. For comparability, each vertebra was treated bilaterally with pedicle screws, augmented and non-augmented. The maximum failure load during pull out test was documented by a universal material testing machine. RESULTS: The results showed significantly higher failure loads for the augmented pedicle screws (Median 555.0 ± 261.0 N, Min. 220.0 N, Max. 1,500.0 N), compared to the native screws (Median 325.0 ± 312.1 N, Min. 29.0 N, Max. 1,400.0 N). CONCLUSIONS: Based on these data, we conclude the IlluminOss™ system can be used to augment primary screw stability regarding axial traction, compared to native screws. The IlluminOss™ monomer offers ease of control for use in biological tissues. In contrast to PMMA, no relevant heat is generated during the hardening process and there is no risk of embolism. Further studies are necessary to evaluate the usefulness of the IlluminOss™ system in the in vivo augmentation of pedicle screws in the future.

[Complication analysis of spinal interventions in adult central movement disorders and scoliosis]. / Komplikationsanalyse von spinalen Eingriffen bei adulten zentralen Bewegungsstörungen und Skoliosen.

BACKGROUND: Adult central movement disorders, malpostures, and scolioses can have their cause in various neurological underlying diseases such as Morbus Parkinson, Pisa syndrome, or segmental dystonia. Important clinical characteristics are marked postural distortions such as camptocormia (bent spine) or laterocollis. In cases of these adult scolioses, surgical spine treatment puts high demands on the surgeon. Surgery in Parkinson's disease, for example, is associated with serious surgery-specific as well as general complications. The more rarely occurring Pisa syndrome is an entity primarily requiring medical therapy. PATIENTS AND METHODS: A series of ten case reports of patients with Morbus Parkinson and Pisa syndrome who underwent spinal surgery is presented and discussed. From these reports, treatment recommendations have been derived and complemented by references from the literature. An extensive MEDLINE search was performed for this purpose. RESULTS AND CONCLUSION: In patients suffering from Parkinson's disease, even minor surgical interventions can lead to instability of whole spine segments or even the entire spine. Implant loosening, adjacent segment instability, general perioperative complications, and progressive malposture due to disease progress can bring forth disastrous treatment courses. Spinal fixation should be performed long-segmented in combination with ventral stabilisation. Due to osteoporosis, pedicle screw cement augmentation is recommended in this collective. If the diagnosis of Pisa syndrome is established, an optimised preoperative preparation should be initiated in close cooperation with neurologists. In many cases medical therapy is sufficient and surgical interventions can be avoided.

Percutaneous interspinous spacer versus open decompression: a 2-year follow-up of clinical outcome and quality of life.

PURPOSE: Percutaneous interspinous stand-alone spacers offer a simple and effective technique to treat lumbar spinal stenosis with neurogenic claudication. Nonetheless, open decompressive surgery remains the standard of care. This study compares the effectiveness of both techniques and the validity of percutaneous interspinous spacer use. METHODS: Forty-five patients were included in this open prospective non-randomized study, and treated either with percutaneous interspinous stand-alone spacers (Aperius(®)) or bilateral open microsurgical decompression at L3/4 or L4/5. Patient data, operative data, COMI, SF-36, PCS and MCS, ODI, and walking distance were collected 6 weeks, 3, 6, 9, 12, and 24 months post-surgery. RESULTS: Group 1 (n = 12) underwent spacer implantation, group 2 (n = 33) open decompression. Five patients from group 1 required implant removal and open decompression during follow-up (FU); one patient was lost to FU. From group 2, seven patients were lost to FU. Remaining patients were assessed as above. After 2 years, back pain, leg pain, ODI, and quality of life improved significantly for group 2. Remaining group 1 patients (n = 6) reported worse results. Walking distance improved for both groups. CONCLUSION: Decompression proved superior to percutaneous stand-alone spacer implantation in our two observational cohorts. Therapeutic failure was too high for interspinous spacers.

Measuring procedures to determine the Cobb angle in idiopathic scoliosis: a systematic review.

BACKGROUND: Scoliosis of the vertebral column can be assessed with the Cobb angle (Cobb 1948). This examination is performed manually by measuring the angle on radiographs and is considered the gold standard. However, studies evaluating the reproducibility of this procedure have shown high variability in intra- and inter-observer agreement. Because of technical advancements, interests in new procedures to determine the Cobb angle has been renewed. This review aims to systematically investigate the reproducibility of various new techniques to determine the Cobb angle in idiopathic scoliosis and to assess whether new technical procedures are reasonable alternatives when compared to manual measurement of the Cobb angle. METHOD: Systematic review. Studies examining procedures used to determine the Cobb angle were selected. Two review authors independently selected studies for inclusion, extracted data and assessed risk of bias. Statistical results of reliability and agreement were summarised and described. RESULTS: Eleven studies of new measuring procedures were included, all reporting the reproducibility. The new procedures can be divided into computer-assisted procedures, automatic procedures and smartphone apps. CONCLUSIONS: All investigated measuring procedures showed high degrees of reliability. In general, digital procedures tend to be slightly better than manual ones. For all other measurement procedures (automatic or smartphone), results varied. Studies implementing vertebral pre-selection and observer training achieved better agreement.

[Pyogenic spondylodiscitis: therapy algorithm and a new classification for therapeutic decision-making]. / Pyogene Spondylodiszitis : Therapiealgorithmus und neue Klassifikation zur therapeutischen Entscheidungsfindung.

The incidence of pyogenic spondylodiscitis is low but has been steadily increasing in recent years. To date there has been no consensus concerning selection of the appropriate treatment, management and strategies and the recommendations for an operative strategy are still a highly controversial issue. In the literature a few statements have been published concerning therapeutic decision-making in pyogenic spondylodiscitis. The classification given in this article is based on clinical experience and retrospective data analysis considering the degree of segmental bony destruction, grade of kyphosis and instability, epidural involvement of the disease and neurological deficits, which are pivotal for therapeutic decision-making. The therapeutic procedure can be defined based on this classification.