Neurogene Wirbelsäulendeformitäten

Sitting is a dynamic process regulated by motor reactions due to endogenic and exogenic influences. Patients with neuromuscular disorders may not continuously adapt their sitting posture but seating devices may improve their quality of life. Prerequisites for the indication of high quality and cost effective seating devices are guidelines for planning and fitting which consider both pathomorphologic mechanisms and the patient's personality. In order to avoid functional problems and pain caused by an insufficient seating device it is necessary to pay attention to the exact indication, time, and combination of technical options. Planning within a seating clinic needs teamwork. First the goal of treatment is defined; it depends on the functional deficit, on the daily living activities of the patient, and on the social environmental factors. Second fitting of the devices follows defined treatment guidelines. By examination of the sensoric and statomotoric system it is possible to classify the patient's sitting or seating ability for simplifying indication: three groups of active sitters who are able to change position of trunk and pelvis actively are differentiated from three groups of passive sitters who have to be seated.     

Oesophagusverengungen bei Wirbelsäulendeformitäten

Zusammenfassung Verengerungen des Oesophagus durch Deformierungen der Wirbels?ule sind selten; am ehesten kommen sie noch im Halsteil der Speiser?hre vor. H?ufigste Ursachen sind, neben Tumoren und Exostosen der Halswirbel, kompensatorische Lordosen der Halswirbels?ule bei schweren Kyphoskoliosen der Brust und Lendenwirbels?ulen. Selten sind posttraumatische Knickungen der Halswirbels?ule die Ursache dauernder Schluckbeschwerden, wobei jedenfalls eine Verminderung der Elastizit?t der Speiser?hrenwand durch Ver?nderungen im Gefolge der Verletzung eine gewisse Rolle spielt. 3 einschl?gige F?lle werden mitgeteilt.      

Wirbelsäulendeformitäten bei Parkinson

Spinal deformities in Parkinson’s disease are difficult to treat but with good indications, spinal surgery is a better treatment option taking into account all factors that accompany Parkinson’s disease. Despite greater operational time and cost expenditure with a long rehabilitation period, long stretch segmental fusion is preferable to short stretch segment fusion due to the lower revision rate. An adequate postoperative rehabilitation and good patient care is essential for success. This case illustrates successful treatment of a patient with Parkinson’s disease and camptocormia by long stretch segmental fusion.     

Wirbelsäulenverletzungen

Trauma und Berufskrankheit - Die Diskussion über die Behandlung von Wirbelkörperfrakturen im Alter wird nicht zuletzt durch die Entwicklung immer neuer Behandlungsmethoden...     

Tabische Wirbelsäulenarthropathie

Zusammenfassung Um die Häufigkeit der tabischen Arthropathie der Wirbelsäule festzustellen, haben die Verfasser Röntgenaufnahmen von 235 Tabikern untersucht.5 von den 12 Patienten, die an Arthropathie litten, zeigten grobe Läsionen der Wirbelsäule. Dies bestätigt die Annahme der Häufigkeit dieser Arthropathie. Nach kurzen Betrachtungen über die Pathogenese von Knochen- und Gelenkläsionen der Tabiker, beschreiben die Verfasser die Röntgenbefunde der von ihnen untersuchten Kranken.Mit 5 Textabbildungen (9 Einzelbilder)     

Beckenringinstabilitäten

Trauma und Berufskrankheit - Beckenringverletzungen treten einerseits bei 20- bis 30-jährigen Patienten als Hochenergietraumata und andererseits bei Patienten älter als 65 Jahre...     

Kleinzehendeformitäten

Zusammenfassung Stellten in der Vergangenheit — in Analogie zur Behandlung des Hallux valgus — resezierende Operationsverfahren die Methode der Wahl auch zur Korrektur von Kleinzehendeformitätem dar, stehen heutzutage auch bei Fehlstellungen der Kleinzehen rekonstruktive, gelenkerhaltende Operationen im Vordergrund des Therapiespektrums.Aufbauend auf einer differenzierten Analyse der Pathobiomechanik der Fehlstellung unter dem Gesichtspunkt einer kontrakten oder flexiblen Deformität kann mittels Sehnentranspositionen oder Korrekturosteotomien eine Funktionseinschränkung häufig vermieden werden. Eine Resektionsarthroplastik sollte in der Anwendung auf kontrakte Fehlstellungen beschränkt bleiben, der Verlust des Metatarsaleköpfchens bei der Therapie degenerativer Deformitäten gänzlich vermieden werden.     

Beckenringinstabilitäten

Background

Pelvic ring injuries occur in patients aged 20–30 years old after high energy trauma and also in patients over the age of 65 years predominantly after low energy trauma. The latter have greatly increased. The necessity for treatment depends on the degree of instability and on the accompanying injuries and comorbidities.

Emergency treatment

Despite following effective treatment algorithms, pelvic ring injuries caused by high energy force still have a high mortality rate. The differentiation between pelvic ring fractures with or without life-threatening bleeding is extremely important in the initial phase of treatment of these patients. The emergency treatment of life-threatening pelvic ring fractures should be embedded in a standardized protocol for the treatment of severely injured patients. Among the first measures are external stabilization, such as pelvic ferrules and external fixators as well as surgical hemostasis of the lesser pelvis. The final osteosynthesis should be performed in the secondary phase when the patient shows stable vital signs.

Elective treatment

A pelvic ring fracture without relevant circulatory instability can be electively treated after completion of clinical diagnostics. Type A injuries are predominantly conservatively treated. In type B injuries stabilization of the anterior pelvic ring via osteosynthesis of the symphysis or external fixator is sufficient. The restoration of stability of the dorsal pelvic ring is the main task in type C injuries. Sacral fractures are a special feature. In cases of neurological disorders these fractures need immediate osteosynthesis after decompression of the neural structures. Highly unstable injuries require spinopelvic stabilization.

Results

The outcome of patients depends on the extent of the injuries suffered and on the quality of repositioning and stabilization. The results of radiological investigations were better than the functional outcome.

     

Wirbelsäulenverletzungen und Unfallfolgezustände

The aim of computer-assisted navigation procedures is to increase the anatomical orientation intraoperatively, to improve the accuracy, to minimize the invasiveness and to reduce the emission of radiation. In the field of orthopedic surgery navigation has been used for over 15 years and these techniques are particularly widely used in spinal surgery. There are three major applications of navigation: CT-based (computed tomography) navigation which needs a preoperative CT scan, 2D navigation which is based on standard X-ray images of a C-arm during surgery and 3D navigation which requires an intraoperatively performed C-arm based 3D scan. Higher accuracy has been proven for instrumentation of the lumbar and cervical spine and reduced emission of radiation could be demonstrated. Higher accuracy for pedicle screw insertions of the thoracic spine is still not proven in prospective studies with sufficient numbers of pedicle screws. Navigation systems provide additional information for better anatomical orientation in spinal surgery and can reduce intraoperative fluoroscopy time. Intraoperative 3D scan technology with automatic registration is the perfect tool in spinal surgery today. Knowledge of the classical techniques remains crucial for the safety of patients.     

Wirbelsäulenmetastasen urologischer Tumoren

The high incidence of bone metastases of urologic neoplasms and their morbidity, especially of vertebral metastases, requires exact diagnosis and consequent therapy. Conventional radiography plays an important role in the diagnosis of symptomatic bone lesions. Computed tomography can evaluate the stability of metastatic lesions and is indispensable for therapy planning. MRI and PET-CT have the highest diagnostic accuracy for the detection of bone metastases and MRI can evaluate their intra- and extraosseus components. PET-CT, PET-MRI, or SPECT-CT in combination with specific tracers – due to their high specificity and sensitivity – have the potential to replace conventional methods in the future. Conservative treatment basically consists of analgesic therapy, the administration of calcium and vitamin D3 and bisphosphonates or inhibitors of RANKL (denosumab). Moreover radium-223-dichloride can improve overall survival and the time to the first symptomatic skeletal event in castration-resistant prostate cancer patients with bone metastases.     

Wirbelsäulenverletzungen im Wachstumsalter

Spine injuries during growth are rare, but in comparison to adults they are more often associated with neurologic impairment. They also may occur without visible injuries in X-rays. The problems of conventional radiologic diagnostics include before all the differential diagnosis between synchondrosis, apophysis and fracture lines. MRI is indicated in case of neurologic deficits without radiologic abnormalities. In principle the fracture types correspond to those seen in adults. In addition growth specific injuries of the end-plates (growth plates) or ring apophysis may occur. Stable compression fractures are treated conservatively. The spontaneous remodelling capacity for posttraumatic deformities decreases with age: in children below the age of ten years the remodelling capacity for posttraumatic kyphosis is excellent whereas deformities in the frontal plane show no or only incomplete remodelling. Unstable fractures and injuries with associated compression of neural structures should be treated conservatively.     

Beckenring und Wirbelsäule

Ohne ZusammenfassungMit 18 Textabbildungen (32 Einzelbilder)Nach einem Vortrag auf einem Kursus der FAC am 13. 11. 1957 in Hamm i. W.Es werden hier nur die Diapositive des Vortrages als Abbildungen gezeigt, die noch nicht in derselben oder ähnlichen Art in früheren Veröffentlichungen erschienen sind.     

Infektionen der Wirbelsäule

Spinal infections are relatively rare entities but the incidence is significantly increasing due to the rapidly growing numbers of interventions on the spine. Primary infections of intervertebral discs (spondylodiscitis) and vertebral bodies (spondylitis) are distinguished from secondary postinterventional infections. Treatment relies primarily on either conservative or surgical management. In the absence of indications for surgery, a conservative approach is indicated when the patient is neurologically intact and the bony destruction is minimal. Conservative therapeutic options are based on the microbiological diagnosis and use of antibiotics, immobilization, analgesics and orthotics. Indications for a surgical intervention are the presence of neurological deficits, intraspinal abscesses, extensive osseous destruction and failure of conservative management. Surgical therapy focusses on the decompression of neural structures, debridement and eradication of the focus of infection, pathogen identification, correction of the deformity and restoration of a physiological spinal profile. Following a postoperative infection a timely diagnosis including assessment of the extent of infection is crucial. In the case of a purely superficial infection, antibiotic prophylaxis and close monitoring is indicated. If findings are pronounced surgical revision, debridement together with antibiotic therapy and if necessary vacuum-assisted closure as well as revision ranging from exchange of implants to complete removal of osteosynthetic material are required. Spinal infections are severe conditions frequently with residual long-term sequelae, whether the patients are managed conservatively or surgically.     

Oberschenkelamputation und Wirbelsäulenveränderungen

Ohne Zusammenfassung     

Begutachtung von Wirbelsäulenverletzungen

Appraisals and expert opinions of clearly identified injuries of the spine, ranging from fractures and dislocations to intervertebral disc ruptures and haemorrhage into soft tissue are generally unproblematic. The residual functional deficit is commensurate with the extent of damage. However, differences between the patient’s symptoms and objective findings can be unrelated to the injury, and are often explained by the actual compensation process or other psychological/psychosocial factors. The current article discusses a basis for providing expert medical opinions, as well as a number of practical tips on the German medical insurance system. Particular attention is paid to expert opinions on causality. The article also includes information on the evaluation of structural injuries to the spine on the basis of assessment criteria that have proven to be reliable and authoritative in recent decades.