[Spondylosclerosis hemispherica: a rare radiological syndrome of the spine]. / Spondylosclerosis hemispherica: Ein seltenes bildmorphologisches Syndrom der Wirbelsäule.

BACKGROUND: Spondylosclerosis hemispherica is a rare syndrome of the spine and was described first by Dihlmann. The typical radiographic appearance is a hemispherical sclerosis of the vertebral body, which is accompanied by pain in the affected region. Usually it appears at the lower lumbar spine. The etiology varies and includes degenerative disk diseases, scoliosis, bacterial infections, ankylosing spondylitis, osteoid osteoma, and malignant diseases.The radiological findings of 2 patients with spondylosclerosis hemispherica are presented and the current literature discussed. MATERIAL AND METHODS: Two women (33 and 60 years old) with spondylosclerosis hemispherica of the lower spine suffered from low back pain and fulfilled all criteria of Dihlmann's description. Malignant disease was excluded in both cases with a broad diagnostic workup (lab values, x-ray, CT scan, MRI) and in one case a biopsy from the affected vertebra was taken. RESULTS: In both cases all radiological findings demonstrated the typical changes of spondylosclerosis hemispherica with sclerosis of the vertebra body and erosions at the upper and inferior end plates. Malignant disease was excluded in one case with a biopsy and in the other case with noninvasive diagnostic procedures. Both patients were treated nonsurgically. During clinical follow-up, the patients were in a good condition with decreasing regional low back pain and no ongoing radiological changes in the affected vertebral bodies. CONCLUSION: Spondylosclerosis hemispherica is a syndrome with a typical radiographic appearance. The etiology of spondylosclerosis hemispherica is manifold; however, malignancy must be excluded. In most cases, noninvasive diagnostics are sufficient to rule out malignant growth even in cases with concomitant degenerative changes of the affected segment. Thus, there is no need for a biopsy except in cases with ambiguous results. Subsequently, close clinical and radiological follow-up of the patients with spondylosclerosis hemispherica is necessary.

[Prognosis scores for spinal metastases]. / Prognostische Scores bei Wirbelsäulenmetastasen.

Advances in early detection and therapy of spinal metastasis have improved life expectancy of patients with various tumor entities. However, this and the demographic development have led to an increased risk for developing spinal metastases. Numerous prognostic factors have been determined to allow an assessment of outcome and survival time of patients with metastatic spinal tumors. The implementation of these factors into different scoring systems has been encouraging in the decision making process of spinal surgery. This overview highlights some of the most important prognostic factors and scores which may facilitate surgical considerations.

[Results-adapted operative treatment options for spinal metastases]. / Befundadaptierte operative Versorgungsmöglichkeiten bei Wirbelsäulenmetastasen.

The current operative approaches and technical possibilities in the operative treatment of spinal metastases are manifold which enables an individual operative strategy adapted to the patient's condition. Maintaining quality of life is the primary goal in the treatment of these patients. The therapeutic goals, such as pain control, avoidance of neurological deficits and the achievement of spinal stability have to be attained with as little morbidity as possible. From this perspective the available operative techniques ranging from minimally invasive approaches to complex reconstructive surgery will be addressed and discussed in this article.

The short stem GHEs in total hip replacement - experience after 380 implantations.

INTRODUCTION: Standard straight stems have been recognized as a gold standard implant in the field of hip replacement surgery. However, lately uncemented bone-preserving short stems started to gain more and more popularity. This was reflected in the increasing variety of available models. Up till now, short and mid-term results are available. PATIENTS AND METHODS: In 2002, the cementless short stemmed GHEs was introduced. 380 patients were included in our study between 2002 and 2008. Only GHEs short stems were implanted. The clinical and radiological evaluations were performed in the Orthopaedic Department, Leipzig University Hospitals, on the average of 24 months (3 to 60 months) postoperatively. RESULTS: 365 primary implantations and 15 revision implantations were carried out. Average age 60 years. Favourable clinical and radiological outcome was seen in 361/380 patients (95%). Postoperative complications were seen in 19/380 patients (5%): 8 fissures/fractures (2.1%), 5 infections (1.3%), 4 aseptic loosenings (1.1%), 2 dislocations (0.5%). CONCLUSIONS: Short stem implants, including our own experience with GHEs model, are satisfying and promising. They represent a valuable supplementation of the treatment modalities in hip replacement surgery. However, long term results are still awaited.

[Short-stemmed endoprostheses in total hip arthroplasty]. / Kurzschäfte in der Hüftendoprothetik.

Short-stemmed endoprostheses in total hip arthroplasty are anchored exclusively in the metaphysis and the proximal part of the diaphysis. Therefore, they are much shorter than the classic standard stems. These implants are specially favourable in terms of eventual revision surgery, and also due to the fact that with close diaphyseal bone marrow spaces a sufficient proximal size dimensioning is possible. In this study, the best known short-stemmed systems in clinical use are introduced. Positive long-term results are so far available only with the Pipino and Mayo stems, short and partially medium-term experience with the remaining short stems (C.F.P.(R), Metha, PROXIMA, ESKA) are--with the available learning curve--encouraging. Despite the call for sufficient experience and scientific evaluation, short-stemmed endoprostheses already represent a valuable alternative in endoprosthetics for younger patients.