[Mid-term outcome after fusion due to isthmic spondylolysis]. / Mittelfristige Ergebnisse nach Fusionsoperationen bei isthmischer Spondylolisthese und deren Auswirkung auf die Arbeitsfähigkeit.

The isthmic spondylolisthesis, as a result of a spondylolysis, has an incidence of about 5%. It plays a major role in the cause of low back pain. If conservative treatment fails, surgery is indicated. The study examined the working disability after fusion operations due to isthmic spondylolisthesis. The results are very promising, as 2/3 of the patients could go back to the same work. 87% of the patients showed a good or very good outcome. This operation should thus be recommended if conservative treatment fails.

Prevention of epidural scarring after microdiscectomy: a randomized clinical trial comparing gel and expanded polytetrafluoroethylene membrane.

A randomized clinical trial compared two materials used to prevent epidural scarring after microdiscectomy. To determine whether ADCON-L Gel (ALG) or Preclude Spinal Membrane (PSM) was more effective in preventing scarring, reducing pain, and improving quality of life postoperatively. Postdiscectomy syndrome may result from epidural scarring. Various materials have been used in attempts to prevent this problem, but none have provided optimal results. Previous laboratory and clinical studies have found ALG and PSM to be effective, but none compared the two materials. Thirty-one patients undergoing primary microdiscectomy were randomly assigned to receive either ALG or PSM. Postoperatively, patients were evaluated by magnetic resonance imaging (MRI), with contrast, for volume and rostral-caudal extent of scar tissue and nerve root involvement. Back and leg pain and quality of life were assessed by neurologic examinations and standardized patient surveys. Findings at any reoperations were recorded. Results in the PSM (n = 18) and ALG (n = 13) groups were compared statistically. No operative or postoperative complications occurred. Two patients in each group required reoperation. MRI at 6 months showed no, mild or mild-moderate scarring in most patients, with no significant differences between the ALG and PSM groups in scar volume and extent or nerve root involvement. Neurologic examinations and patient surveys showed substantial reductions in pain over time in both groups but no significant differences between groups. PSM was easy to see and remove at reoperation. PSM and ALG are equally effective in preventing epidural scarring associated with postdiscectomy syndrome.

Direct stabilization of lumbar spondylolysis with a hook screw: mean 11-year follow-up period for 113 patients.

STUDY DESIGN: A retrospective study involving 113 patients with a spondylolysis who underwent direct repair with a hook screw was conducted. OBJECTIVES: Spondylolysis with instability can produce low back pain. In adults, fusion of the affected level is the gold standard of treatment. In the adolescent, direct repair of the lysis can save a functional segment. SUMMARY OF BACKGROUND DATA: It has been proved that direct repair of spondylolysis can accomplish restitutio ad integrum for a functional segment. So far, only short-term results are available in the literature. METHODS: This study involved 113 patients who underwent direct repair of spondylolysis with a hook screw according to Morscher. After an average follow-up period of 11 years, the patients were reviewed. The main issue was the question of fusion. For this purpose, plain radiographs were taken. For doubtful cases or for the patient experiencing pain, conventional tomography scans or computed tomography scans were taken. RESULTS: The pseudarthrosis rate was 13.3%. The fusion rate for patients younger than 14 years was higher than that for older patients, especially those older than 20 years. CONCLUSIONS: Direct repair of spondylolysis can be recommended for patients with a growing skeleton, a slight slip, an instability, or failure of conservative treatment. Thereby, a functional segment can be saved with a relatively small operation.

Orthotics and insoles for the forefoot: the European way.

Technical aids in the treatment of foot problems have been known for hundreds of years. In the German-speaking countries, especially, shoemakers, prosthetists, and orthotists are well respected. They have great skills and provide the orthopedic surgeon with alternatives to surgery. Also, the combination of surgery and technical aids is important because suboptimal surgical results can be improved by a good orthopedic device.