[Are There Segmental Differences of Lumbar Spondylodesis? - Comparison of the Segments L IV/V and L V/S I in Patients with Transforaminal Lumbar Intercorporal Fusion (TLIF)]. / Gibt es segmentabhängige Unterschiede bei lumbalen Spondylodesen? - Vergleich der Segmente L IV/V und L V/S I bei der transforaminalen lumbalen interkorporellen Fusion (TLIF).

BACKGROUND: The aim of this study was to report surgical results with open TLIF (transforaminal lumbar intervertebral fusion) of segment L V/S I, in comparison with TLIF of segment L IV/V. PATIENTS AND METHODS: 60 patients with degenerative spine disease were operated with TLIF spondylodesis and followed up in a clinical and radiological study. 30 patients were operated in segment L IV/V (group 1) and another 30 in segment L V/S I (group 2). These patients were followed up 2 weeks and 12 months after surgery, by means of a clinical examination and questionnaires on pain (visual analogue scale) and quality of life (Oswestry score). RESULTS: The rate of intra- and postoperative complications was 5 % in all 60 patients; the fusion rate was 100 %. In all patients, a 70 % improvement in back pain, leg pain and quality of life was achieved after 12 months. For leg pain and quality of life, a significantly better result was seen in group 1 than in group 2 two weeks after the operation. This may be explained by reversible dysaesthesias in 3 patients in group 2. In 2 patients in group 2, it was necessary to convert from TLIF to ALIF (anterior lumbar interbody fusion). Directly after the operation, the mean intervertebral height was 8.2 mm in group 1 and 7.3 mm in group 2, in comparison with 7.7 mm and 6.8 mm after one year, respectively. CONCLUSION: In patients with contraction osteochondrosis in segment L V/S I, spondylodesis in segment L V/S I is - for anatomical reasons - more likely to be linked to reversible nerve irritations than with segment L IV/V. In some cases, conversion from TLIF on ALIF is necessary. In patients with degenerative spine disease, TLIF in segments L IV/V and L V/S I is absolutely accepted as a safe and up-to-date procedure.

Imaging and interpretation of axial spondylarthritis: the radiologist's perspective--consensus of the Arthritis Subcommittee of the ESSR.

This article reflects the radiologist's perspective on the imaging and interpretation of axial spondylarthritis (SpA). The arthritis subcommittee of the European Society of Skeletal Radiology provides a consensus for the following questions: When and how should we image? How should we analyze the images? How should we interpret the imaging findings? To answer these questions, we address the indications in imaging axial SpA and the different imaging techniques, with a special focus on magnetic resonance imaging protocols. The value of different imaging modalities is discussed. For adequate image analysis, knowledge of the anatomy and the pathologic changes in chronic and acute inflammation of the sacroiliac joints and the spine is mandatory. Differential diagnoses of inflammatory lesions of the sacroiliac joints and the spine are addressed due to their importance in image interpretation.

[Hip dysplasia and spinal osteochondritis (Scheuermann's disease) in a girl with type II manifesting collagenopathy]. / Hüftdysplasie und Morbus Scheuermann bei einem Mädchen mit Typ-II-Kollagenopathie.

OBJECTIVES: This paper describes the natural course of irritable hip pain associated with spinal rigidity and pain in the thoracic region with subsequent development of mild kyphosis in a girl with a mutation in the collagen 2 alpha 1 gene (type II collagenopathy). METHODS: Phenotypic and genotypic characterization was carried out in a 14-year-old girl to identify the underlying pathology of severe irritable hip pain associated with thoracic spinal rigidity and pain. Detailed clinical examination, skeletal survey and genetic testing were performed accordingly. Bernese periacetabular osteotomy was used to alleviate pain and to improve the anatomical correlation of the acetabular and femoral heads. RESULTS: Short stature associated with acetabulo-femoral dysplasia, spinal osteochondritis (Scheuermann's disease) and mild thoracic kyphosis were the most prominent abnormalities. Genetic analysis showed a heterozygous mutation in the collagen type II gene (COL2A1-c.1636G>A, p. G546S). A Bernese periacetabular osteotomy was performed to improve the clinical status of the patient. There was significant improvement in the extrusion index, the acetabular index and the lateral center-edge angle. CONCLUSIONS: Hip dysplasia and Scheuermann's osteochondritis have never been reported in connection with a mutation in COL2A1 (collagenopathy type II). Awareness is needed for careful phenotypic and genotypic characterization in patients with irritable hip pain and spinal stiffness.

[Degenerative alterations of the spinal column: rational imaging]. / Degenerative Veränderungen der Wirbelsäule: Rationale Bildgebung.

Unspecific back pain is a common phenomenon. Imaging often shows no clear cause for the genesis of back pain and generally has no impact on the therapeutic procedure. In contrast specific back pain, where a morphological cause is present is more infrequent. In these cases imaging and especially magnetic resonance imaging (MRI) is indicated. The indications for imaging should be geared to the so-called red flags which suggest serious morphological changes of the spine. The article deals with often encountered degenerative changes of the spine and describes spondylodiscitis as an important differential diagnosis to erosive osteochondritis.

Biotechnical measurement and software system for the prediction and diagnosis of osteochondrosis of the lumbar region with the use of fuzzy logic rules.

We propose a biotech measurement scheme and software based on new features for the diagnosis of backbone osteochondrosis. Together with the traditional methods of diagnosis, the energy characteristics of biologically active points (acupuncture points, or APs) are used. This new software is based on mathematical models of the internal and biologically active points of meridian structures' interaction. The information from the APs is used in the solving rules based on fuzzy logic for decision-making, together with the factors of confidence of Shortliffe, the membership functions of Zadeh, and Kullback's informativeness measures. In terms of prognostic decision rules, clinical test shows that the quality of prediction using only the energy characteristics of APs is high, with high coefficient of confidence for the control sample as well. A check on control samples allows us to recommend the obtained results for use in medical practice as a part of corresponding systems of support for decision-making.

[Using vibration training for the treatment of neurological manifestations of osteochondrosis in the lumbar spine region].

The physical rehabilitation of the patients presenting with neurological manifestations of osteochondrosis in the lumbar spine region remains a challenging problem due not only to the high prevalence of this condition but also to its substantial financial burden. Vibration training provides be a promising tool to address this problem. We studied 50 patients with neurological manifestations of osteochondrosis in the lumbar spine region recommended vibration training as a rehabilitative treatment. The objective assessment of its outcome was made based on the results of biokinematic videoanalysis of the movements and the scales for the evaluation of pain syndrome intensity. This approach allowed the clinical efficacy of vibration training following the recommended schedule to be verified.

[Degenerative diseases of the spine]. / Degenerative Erkrankungen der Wirbelsäule.

Degenerative alterations of the spine are among the most common causes of complaints of the musculoskeletal system. Imaging procedures are an established component of diagnostics and differential diagnoses. A reduction in height of the intervertebral space and sclerotization of the basal and covering plates are part of the first radiological alterations and in the further course can be accompanied by formation of spondylophytes, arthrosis of the intervertebral joints and degenerative vertebral surface gliding. However, early changes of the mobile segments can often not be visualized in x-ray images. Computed tomography (CT) and magnetic resonance imaging (MRI) substantially improve the diagnostic options. Using MRI the spinal column and the surrounding soft tissues can be visualized in 3-D and a differential diagnostic differentiation between inflammatory, traumatized or neoplastic processes is possible. A lack of correlation between the imaging findings and clinical symptoms remains problematic. A meaningful interpretation of x-ray images and MRI can only be made with the appropriate knowledge of the symptoms and possible diseases.

[Infrared laser puncture and manual therapy in the treatment of cervical and thoracic osteochondrosis and neurological manifestations of this disease].

The effect of two methods of the treatment (traditional and in combination with lascropuncture infrared radiation and manual therapy) on clinical symptoms of vertebral refractory pain syndroms was studied in 120 patients with neck-pectoral osteochondrosis. The empirical knowledge confirmed the necessity of expediency of these methods in the treatment of this pathology.

[Spondylogenic visceropathies].

A group of 830 patients with spondylogenic visceropathies was divided into three with clinical symptoms of bronchial (n = 80), cardiac (n = 530), and abdominal (n = 220) vertebral syndromes. Their clinical features, differential diagnosis and methods of treatment are described.

[Minimally invasive surgery of degenerative diseases of the spine].

Results of minimally invasive surgical treatment were studied in 978 patients with degenerative diseases of the spine. Paracentetic interventions were made on different structures of the spinal-motor segment after complex clinico-radial examinations. Catamnestic investigations during 3 years allowed detection of sufficiently stable positive effect of fenestration and decompression of the intervertebral disk (71%), dereception of different structures (64.1%), high-frequency electrodestruction (67.1%) and laser influence on them (78.4%).

[Use of a diode laser in surgery of intervertebral disks in osteochondrosis of the vertebral column].

The results of surgical treatment of 185 patients with osteochondrosis of the vertebral column were studied during 12 months who, after complex clinico-radial examination, were treated by puncture laser nucleoplasty of intervertebral disks using a diode laser. Stable positive effect was obtained in 84.3% of cases using minimally invasive manipulations.

[Osteogenic factor in pathogenesis of vertebrogenic cardialgia].

A total of 136 patients with clinical symptoms of thoracic osteochondrosis and reflex vertebrocardiac disorders were examined. 100 of them presented with vertebrogenic cardialgia and CHD, 36 had no CHD. 56 patients with clinical symptoms of thoracic osteochondrosis and CHD received traditional therapy and a course of intraosseous blockade (IOB). 56 patients with clinical symptoms of thoracic osteochondrosis and CHD received traditional therapy and a course of paravertebral blockade (PVB). 36 patients with clinical symptoms of thoracic osteochondrosis without CHD received a course of IOB. Efficiency of therapy was assessed from dynamics of pain syndrome parameters, data of the visual analog scale, McGill and body diagram questionnaires, changes of cardiac function and heart rhythm recorded by 24-hr Holter monitoring. Therapeutic efficiency of IOB in patients with vertebrogenic cardialgia with and without CHD was higher than that of PVB in patients with clinical symptoms of thoracic osteochondrosis and CHD. It is concluded that osteogenic factor plays a key role in the mechanism of development of vertebrogenic cardialgia.

[Rehabilitative treatment of spine osteochondropathies in children and adolescents].

Vertebral osteochondropathies are socially significant conditions. The use of neurorehabilitation techniques may improve their clinical and vital prognosis. These methods include postural correction, traction therapy, breathing exercises, sculptural gymnastics, hypoxic barotherapy, and proprioreceptive neuromuscular facilitation.

[Express-diagnostic of clinical tendency of low-back pains in elderly patients].

Diagnostics of diseases of the lumbar part of spine in elderly and senile people is difficult due to their polyethiologics, similarity of clinical currents accompanied by both pathological and age changes in an organism essentially deforming a clinical picture of a disease. Having used the experience of treatment of 2102 patients with low-back pain, the authors worked out the schemes of differential, thopical and X-ray diagnosis. All that will enable the practice doctors to diagnose the diseases in proper time and to determine the proper way of inquiry and treatment.