Competitive sports and the progression of spondylolisthesis.

To consider the effects of several years of competitive sports training on children and adolescents with spondylolisthesis, we carried out a retrospective radiologic and clinical study of 86 young athletes with spondylolysis or spondylolisthesis (24 girls and 62 boys between the ages of 6 and 20 years). The mean degree of displacement was 10.1% at the beginning of the observation. The radiologic tests showed an increase in displacement over time in 33 athletes. The average progression of spondylolisthesis in this group was 10.5%. For 36 athletes, spondylolisthesis did not progress during the period of athletic training. In seven athletes, a decrease in the displacement was observed, from 17.9 to 8.9% on average. For 10 athletes, the course of spondylolisthesis could not be determined, because only one lateral radiograph was available. In spite of intensive daily training, the athletes had no symptoms during the entire period of observation, which lasted an average of 4.8 years. In light of our experiments, there is no justification for generally advising children and adolescents with limited spondylolytic spondylolisthesis not to take part in competitive sports.

[Measurement data of the lateral lumbosacral region in healthy subjects during the growth period]. / Messwerte der seitlichen Lumbosakralregion bei Normalpersonen im Wachstumsalter.

The following measurement data were obtained to characterise the healthy lumbosacral profile, via lateral x-rays taken of 90 female and 90 male patients between 8 and 17 years of age: Degree of slip 0%, slip angle -21.3 degrees, sacral inclination 45.5 degrees, posterior lumbosacral angle 140.5 degrees. These measurement data are independent of age and sex. If an adolescent suffers from lumbosacral spondylolisthesis, they will quantify the process of slip that has taken place, more accurately than the conventional method after Meyerding. If the shape of the sacral vertebra is considered at the same time, these parameters will also enable to assess the risk of progression of spondylolisthesis to a degree that is satisfactorily accurate in clinical practice.

[Lumbar segmental spondylodesis--isolated ventral or combined dorsoventral? A comparison of results]. / Lumbale Segmentspondylodese--isoliert ventral oder kombiniert dorsoventral? Ein Ergebnisvergleich.

Indications for intercorporal fusion are progressive spondylolisthesis in children and adolescents, painful segmental instability in adults (spondylolisthesis, post-discectomy-syndrome, failed-back-syndrome). From 1980-86 152 isolated anterior intercorporal fusions had been realized, and in 1987/88 we carried out 79 combined anterior-posterior fusions. The rate of pseudarthrosis has been 25% with isolated anterior fusion and on the contrary 9% with combined fusion. With combined fusion the rate of complications did not increase, but the objective and subjective results became better. The postoperative period became more convenient, the stay in hospital and the consolidation of fusion were shorter. The reposition of spondylolisthesis was durable and the spine channel was accessible. We consider the instrumented fusion to be a complex reconstructive operation with high chances of success.

[Use of the halo-gravitation-extension in preoperative preparation in severe scoliosis]. / Die Anwendung der Halo-Schwerkraft-Extension zur Operationsvorbereitung bei schweren Skoliosen.

Severe and fixed scoliosis needs a preoperative extension treatment to attain a good result of correction by spondylodesis. Halo-up-extension is a very simple, comfortable and successful method to prepare patients with a severe scoliosis for operation. From January 1981 to July 1989 we carried out the preoperative halo-up-Extension treatment at 45 patients. 39 of them had a severe scoliosis with a cobb-angle of more than 70 degrees. The correction by halo-up-Extension runs on an average of 35% of the total correction.

[The status of discography in determining indications for therapy of intervertebral disk-induced diseases]. / Der Stellenwert der Diskografie bei der Indikationsstellung zur Therapie bandscheibenbedingter Erkrankungen.

During a 6-year period from 1983 to 1989 we performed lumbal discography in 403 disc levels on 144 patients. We used the discography to determine the therapeutic way in patients with chronic back pain. In the greater half it was possible to define the symptomatic level exactly. About 90% the discography was very helpful to get a diagnosis or to plan the therapy. The reproduction of pain with discography is helpful in the assessment of abnormal disc levels. Even today in view of CT and MRI.

[The value of spinal CT in the planning of spinal surgery]. / Zur Wertigkeit der spinalen CT bei der Planung von Wirbelsäulenoperationen.

The diagnostic information gained by spinal CT for the planning of surgery of spinal disease is discussed under clinical aspects. For discogenic disease CT has replaced myelography in significance and as primary investigation, except for unclear complaints, that cannot be attributed to a specific segment. Here myelography still is the prime investigation. With CT degenerative peripheral appendages turned out to be significant for secondary stenosis syndromes of the spinal canal. In future it seems advisable, to differentiate between the facultatively pathogenetic important dorsal spondylosis and ventro-lateral spondylosis, which is unimportant for the spinal complaints. If surgical correction of congenital spinal malformations is considered, apparent or silent dysraphia must be ruled out in order to prevent neurological complications. Here CT can improve diagnostic safety significantly. For the resection of tumourous or inflammatory destructions CT provides an excellent means for preoperative statements on the necessary resection area, the size of the graft and the strength of adjacent soft tissues for the graft, the required stabilisation instruments, possible effects on adjacent organs, lumen reduction of the spinal canal, and the appropriate surgical entrance. The exploration of traumatic conditions of the spinal column by CT is of value especially for a detailed preoperative investigation, since it facilitates a quantification of the destruction of the vertebral body and the arches, the condition of the posterior body surface and the stenosis of the spinal canal.

[Surgical treatment possibilities in tumors of the spine. Indications, technics, experiences]. / Operative Behandlungsmöglichkeiten bei Tumoren der Wirbelsäule. Indikation, Techniken, Erfahrungen.

Widely normal stability of the vertebral column with adequate load-bearing capacity should be achieved, following osseous reconstruction of a defect area from which benign tumours or tumour-like lesions had been removed by radical surgery. In malignant processes, surgical tumour removal may add to the effectiveness of chemotherapy or radiotherapy. Postoperative restoration of the vertebral column will also improve the psychic, physical, and social quality of survival.

[Experiences with external fixation of the cervical spine in the halo-yoke system]. / Erfahrungen mit der externen Fixation der Halswirbelsäule im Halo-Yoke-System.

The Halo-Yoke-System allows an external fixation, reposition and immobilisation of the cervical spine. Indications for application of application of Halo-Yoke exist in conservative or operative treatment of acute traumatic lesions and protection of results after surgical treatment in cases of instability of different etiology (tumour, spondylitis, rheumatoid arthritis, congenital deformities). The experience basing on 28 own cases is reported.