[Correction of post-traumatic and congenital kyphosis: indications, techniques, results]. / Korrektur posttraumatischer und kongenitaler Kyphosen: Indikation/Technik/Ergebnisse.

Post-traumatic kyphosis necessitates surgical correction mostly because of pain and also secondary neurological complications. In the majority of cases the cause is iatrogenic due to incorrect or non-indicated conservative or erroneous surgical treatment, because the severity of the injury was incorrectly estimated and the pathomechanical situation was ignored. The basic biofunctional principles of spinal reconstruction (load distribution and dorsal tension banding system) as well as structural rebalancing must be respected even during secondary correction interventions. A variety of open or closed wedge osteotomy procedures are available which can be adapted to the individual pathologic situation and carried out in combination or as a purely dorsal operation technique. The results are good with elimination of pain in 80% and normalization of the spinal function. The interventions are very demanding. Because a misalignment without serious instability will often remain undetected for 5-20 years due to compensatory mechanisms of the spinal column, the traumatologist must be conscious of and accept the necessity for the primary operation to be anatomically justified and correctly carried out. Congenital kyphosis with rapid progression develops mostly due to dorsal formation of hemivertebrae. It is highly likely that dorsal formation of hemivertebrae will lead to neurological deficits, therefore, early diagnosis and surgery is necessary as soon as progression of kyphosis becomes evident. Resection of the apical vertebral body and/or the apical spinal section has proven to be of value. Presently, the majority of surgical interventions are performed using a dorsal approach and should include bilateral costotransversectomy. Modern pedicle instrumentation has created completely new surgical possibilities not only for adult patients but also for infants. These types of surgical interventions require a much higher level of skill of the surgeon and are also associated with significant neurological complications. Therefore, they should only be performed in specialized spine centres. Intraoperative SEP and MEP monitoring are indispensable and under difficult anatomical situations especially in infants intraoperative Iso-C-3D navigation can be very useful.

[Correction of posttraumatic deformities. Principles and methods]. / Korrekturen posttraumatischer Fehlstellungen. Prinzipien und Techniken.

The reason for inadequate results after the treatment of spinal lesions may be due to the misinterpretation of the type of lesion thus leading to incorrect therapy. Frequently the bio-functional construction principles of the spine are ignored and biomechanically based reconstruction of the spine is not done. Unsuitable approaches and fusion techniques may result in insufficient stabilisation with predictable failure. In both the first surgery and the salvage procedure, the principles of the load-sharing system as well as the posterior tension band principle must be respected. These principles and the surgery techniques are demonstrated in individual examples. Special attention is drawn to the impact of segmental deformities on the general statics of the spine. Frequently, residual deformities with the typical clinical picture lead to decompensation and the reduction of efficiency only after ten to fifteen years.

Correction of traumatic deformities. Principles and techniques.

The reason for inadequate results after the treatment of spinal lesions may be due to the misinterpretation of the type of lesion thus leading to incorrect therapy. Frequently the biofunctional construction principles of the spine are ignored and biomechanically based reconstruction of the spine is not done. Unsuitable approaches and fusion techniques may result in insufficient stabilisation with predictable failure. In both the first surgery and the salvage procedure, the principles of the load-sharing system as well as the posterior tension band principle must be respected. These principles and the surgery techniques are demonstrated in individual examples. Special attention is drawn to the impact of segmental deformities on the general statics of the spine. Frequently, residual deformities with the typical clinical picture lead to decompensation and the reduction of efficiency only after ten to fifteen years.

[The radiotherapy of heterotopic ossifications in paraplegics. The preliminary results]. / Strahlentherapie heterotoper Ossifikationen bei Querschnittsgelähmten. Präliminäre Ergebnisse.

BACKGROUND/AIM: Mobilisation of patients with paraplegia is frequently associated with acute inflammatory processes of soft tissues and muscles in the neighbourhood of joints, where subsequently heterotopic bone formation develops. Rehabilitation is then seriously compromised. For this clinical situation, no local therapeutic options exist so far except extensive resection. To evaluate if radiotherapy early in the course of the disease prevents heterotopic bone formation or if--in case of already manifest ossification and consecutive resection--recurrence can be avoided. PATIENTS AND METHODS: In 20 patients with paralysis, 25 regions were irradiated with (mostly) 10 Gy in single fractions of 2 to 2.5 Gy using 8 MV photons. In 15 patients radiotherapy was performed as a primary treatment in the status of myositis; 7 patients were treated after (subtotal) resection of already manifest ossifications (2 patients were treated twice, primarily and postoperatively). RESULTS: In a minimum follow-up of 12 weeks, none of the 20 irradiated patients showed any progression of the developing or already manifest ossification; thus mobilisation and rehabilitation could be carried out as desired. No side effects occurred. CONCLUSION: The preliminary results of the present study suggest that radiotherapy is an effective local treatment with minimal side effects for the prevention of heterotopic bone formation in patients with paraplegia. Treatment should be started early in the course of the disease. Further evaluation in a prospective study seems desirable.

[High-grade transverse syndrome caused by echinococcus cysts]. / Hochgradiges Querschnittsyndrom durch Echinokokkuszysten.

In this report we present the case of a 16-year-old patient, born in Macedonia, who complained of abdominal and back pain and developed paraparesis. On admission to hospital, he showed a paraplegic syndrome, the level of sensation being T7, together with high-grade paraparesis of the lower extremities and spasticity and urinary incontinence. The protein content of the CSF was raised to 183 mg/dl. CT and MRI of the thoracic spine showed cystic lesions at the level of the 6th and 7th thoracic vertebrae, in the paravertebral area and in the 7th rib on both sides. The antibody titer of Echinococcus in the serum was positive. To treat this problem, corporectomy of the 6th to 8th thoracic vertebrae was performed, the area being bridged by a corticospongoid pelvic bone graft and with instrumental support of the 5th to 9th thoracic vertebrae. Histological examination revealed multilocular Echinococcus lesions. Under long-term treatment with mebendazole, the neurological deficits decreased in the postoperative phase.

The indications and principles of correction of post-traumatic deformities.

Post-traumatic malposition of the spine usually results in inadequate conservative treatment or incorrect surgical therapy. The main indication for secondary reconstructive measures in pain. Besides the predominant vertebragenic causes, neuropathic forms may be combined in spinal cord damage. Secondary neurological damage or progressive neurological deficits are combined with persistent spinal compression or increasing (mostly kyphotic) malpositions. The objective of the surgical treatment is to correct the malposition with reprofiling the spine and restoration of the stability of the axis organ. Attention must be paid to primary or secondary spinal lesions, since additional neurological lesions can be provoked when the strategy is wrong, and concomitant or prior neurosurgical interventions may become necessary. Almost exclusively, the objective of our reconstructive measures with reprofiling of the injured spine avoiding damage to healthy movement segments can be achieved only by a combined ventral and dorsal operation. The crucial shortcomings result from the first treatment. Acceptable treatment results can only be expected in both first and secondary treatment of spinal cord injuries when the following factors are taken into consideration: (1) pretherapeutic definition of the injury pattern; (2) the functional anatomy of the spine (load sharing and tension band principle); (3) mastery of all approaches (dorsal, dorsolateral, ventral) and the instrumentation.

[Pain in the knee as a first symptom of retroperitoneal space-occupying processes (author's transl)]. / Der Knieschmerz als Erstsymptom bei retroperitonealen Raumforderungen.

Knee complaints may be the first symptom of retroperitoneal space-occupying processes, as a result of compression of the femoral or obturator nerve. This differential diagnostic possibility is pointed out with reference to four case histories. The importance of CT examination as a part of the diagnostic procedure is emphasised.

[Computer tomography for rare soft tissue tumours of the extremities (author's transl)]. / Computertomographie bie seltenen Weichteiltumoren der Extremitäten.

Five patients with undiagnosed soft tissue masses in the extremities were examined and in two a pathological diagnosis could be made. One was an extensive, invasive fibroma (desmoid) 22 cm long which could be followed from the thigh almost into the pelvis. It was sharply demarkated form the surrounding muscles and of higher density. The second case was a 12 cm long cavernous haemangioma in the semi-membranosus muscle. This was originally hypo-dense, but showed marked increase in its density after the administration of contrast.