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PURPOSE OF THE STUDY There s a known relation between the chronical back-pain-syndrome and psychical problems. We suppose a direct causality between acute stress and onset of the backpain syndrome. MATERIAL AND METHODS A prospective cohort-study (IV/2014 - VIII/2014) of patients who came to our emergency department with acute backpain-syndrome, with no relevant previous history - such as operations or chronic pain. We questioned together 39 patients (19 female and 20 male). The patients filled in two charts: FW7, and also a modified HADS-D. In the later one the patients were questioned in two extra points regarding contingent excessive emotional or existential problems in their brief history. The Pain-Severity-Score was assessed as well. RESULTS Combined together, relevant score-results and / or anamnesis of excessive emotional or existential problem was found in 79.5% (SD 0.4%) of the whole cohort. CONCLUSIONS This could have implications for guidelines, introducing the psychotherapy-first into the concepts. Key words:stress; well-being; depression; back-pain-syndrome.

Complex regional pain syndrome (CRPS) is an extremely painful and partially disabling disease. It often occurs secondary to trauma, but also spontaneously. The emergence of CRPS has been reported following nerve root compression and/or spinal surgery, but its incidence is unknown. In this article, the present knowledge about the incidence of CRPS in the context of nerve root compression and spine surgery is reviewed and therapeutic and diagnostic consequences are discussed.

Purpose. Anderson type III odontoid fractures have traditionally been considered stable and treated conservatively. However, unstable cases with unfavorable results following conservative treatment have been reported. Methods. We present the cases of two patients who sustained minimally displaced Anderson type III fractures with a characteristic fracture pattern that we refer to as "oblique type axis body fracture." Results. The female patients aged 90 and 72 years, respectively, were both diagnosed with minimally displaced Anderson type III fractures. Both fractures had a characteristic "oblique type" fracture pattern. The first patient was treated conservatively with cervical spine immobilization in a semirigid collar. However, gross displacement was noted at the 6-week follow-up visit. The second patient was therefore treated operatively by C1-C3/4 posterior fusion and the course was uneventful. Conclusions. Oblique type axis body fractures resemble a highly unstable subtype of Anderson type III fractures with the potential of severe secondary deformity following conservative treatment, irrespective of initial grade of displacement. The authors therefore warrant a high index of suspicion for this injury and suggest early operative stabilization.

Spinal canal stenosis is a dynamic phenomenon that becomes apparent during spinal loading. Current diagnostic procedures have considerable short comings in diagnosing the disease to full extend, as they are performed in supine situation. Upright MRI imaging might overcome this diagnostic gap.This study investigated the lumbar neuroforamenal diameter, spinal canal diameter, vertebral body translation, and vertebral body angles in 3 different body positions using upright MRI imaging.Fifteen subjects were enrolled in this study. A dynamic MRI in 3 different body positions (at 0° supine, 80° upright, and 80° upright + hyperlordosis posture) was taken using a 0.25 T open-configuration scanner equipped with a rotatable examination bed allowing a true standing MRI.The mean diameter of the neuroforamen at L5/S1 in 0° position was 8.4 mm on the right and 8.8 mm on the left, in 80° position 7.3 mm on the right and 7.2 mm on the left, and in 80° position with hyperlordosis 6.6 mm (P < 0.05) on the right and 6.1 mm on the left (P < 0.001).The mean area of the neuroforamen at L5/S1 in 0° position was 103.5 mm on the right and 105.0 mm on the left, in 80° position 92.5 mm on the right and 94.8 mm on the left, and in 80° position with hyperlordosis 81.9 mm on the right and 90.2 mm on the left.The mean volume of the spinal canal at the L5/S1 level in 0° position was 9770 mm, in 80° position 10600 mm, and in 80° position with hyperlordosis 9414 mm.The mean intervertebral translation at level L5/S1 was 8.3 mm in 0° position, 9.9 mm in 80° position, and 10.1 mm in the 80° position with hyperlordosis.The lordosis angle at level L5/S1 was 49.4° in 0° position, 55.8° in 80° position, and 64.7 mm in the 80° position with hyperlordosis.Spinal canal stenosis is subject to a dynamic process, that can be displayed in upright MRI imaging. The range of anomalies is clinically relevant and dynamic positioning of the patient during MRI can provide essential diagnostic information which are not attainable with other methods.

Background: Complex regional pain syndrome (CRPS) has been reported following spinal surgery, but its frequency after spinal surgery is unknown. The aim of this study was to determine the frequency of spinal surgery preceding CRPS and to examine these patients regarding the course of the disease and prognostic factors., Methods: We examined 35 CRPS patients regarding the symptoms and signs of CRPS, the type of CRPS (I or II), the origin and grade of the disease, the type of surgeries prior to CRPS onset, the course of the disease, and the therapies following diagnosis of CRPS., Results: In 6 patients, CRPS began during the postoperative course (lumbar spine surgery, n = 5; cervical spine surgery, n = 1). Four of these patients suffered from CRPS II. The course of the disease in the 6 patients was not different from that of patients with CRPS of other origins. First symptoms of CRPS could be observed 1-14 days after surgery., Conclusions: CRPS is a rare complication after spinal surgery, but spinal surgery precedes the onset of CRPS of the lower limb in almost one-third of the cases. The first typical symptoms of CRPS emerge within 2 weeks after spinal surgery., (Copyright © 2012 S. Karger AG, Basel.)

Chondrosarcoma is the third most frequent primary malignant tumor of bone, constituting up to 16% of the malignant osseous neoplasms. Up to date several genetic alterations and markers were described concerning the pathogenesis and the progression of the chondrosarcoma, which represents actually a heterogeneous group of different types including conventional intramedullary, clear cell, myxoid, mesenchymal, and dedifferentiated chondrosarcoma. The pathologic appearance varies, however, in general they grow with a lobulated pattern. Histologically the hyaline cartilage demonstrates high water content and typically enchondral ossification is apparent. Imaging reflect this while radiographic findings suggest the diagnosis when the typical "ring-and-arc" chondroid matrix mineralization, endosteal scalloping and soft-tissue extension were apparent. The CT is used for detecting the mineralization of the matrix, especially when it is subtle or when the lesion is located in complex areas. MRT is the method of choice to detect the high water content of these lesions with a high signal intensity with T2-weighting and its bone marrow extend. Surgical resection is the primary and preferred treatment modality for most individuals with localized disease. In selected cases of the Grad I conventional chondrosarcoma curettage should be discussed. Systemic chemotherapy may be considered in variant forms such as mesenchymal or dedifferentiated chondrosarcomas. In knowledge of the "many faces" of the primary chondrosarcoma individualized patient assessment and optimal clinical management is possible.

Study Design: The risk of transmission of human immunodeficiency virus (HIV), hepatitis B and C viruses as well as the development of costs has changed the use of homologous blood cell products., Methods: The present investigation shows the state of the art of blood salvage in orthopedic and elective trauma surgery., Results: In this investigation the established methods such as controlled hypotension (spine surgery), arrest of blood supply (extremity surgery) and the following methods of autotransfusion have been examined: acute normovolemic hemodilution (ANH), intra- (Cell-Saver, Haemonetics Corp.) and postoperative autotransfusion, autologous donor plasmapheresis and autologous predeposit., Conclusions: Using this method it is possible to reduce homologous blood transfusions particularly in elective procedures such as orthopedic surgery and elective trauma surgery to a minimum.

The surgical treatment of burst fracture, tumour or spondylitis remains a challenge with regard to the surgical approach to the anterior aspect of the cervicothoracic junction. Many vital structures including osseus, articular, vascular and nervous ones hinder the exposure. Fortunately, indications for surgery in this region are rare. However, when it becomes necessary for the surgeon to expose this region, it is useful to be prepared to approach it carefully. In this investigation the anatomy and exposure of the cervicothoracic junction by means of a sternotomy are described. An illustrated review of the sternotomy approach to the cervicothoracic junction with a description of 'tricks and pitfalls' is provided.

Purpose: According to literature there is a pseudarthrosis rate of about 1% up to 64% depending on the treatment of the dens fracture (16). Generally the treatment of dens pseudarthrosis consists of the fusion of the joint C1/C2 with or without dens resection. Now, a method is presented whereby, on the one hand the pseudarthrosis is treated, while on the other hand the anatomical structures and physiological function of the joint C1/ C2 are restored., Method: The operation consists of a gradual outboring of the base of the dens and the dens axis and filling with autologous cancellous bone. Then follows a lateral, temporary transarticular screw fixation of C1/C2 which guarantees an immobilisation of the filled out dens. A halo-body-jacket is then applied. The removal of the screws of the temporary fixation follows three months post operatively after X-ray control. Then physiotherapy of the cervical spine follows., Results: During 7/93 and 7/97 this operation was carried out on 11 patients. In 9 cases compression screw osteosynthesis was primarily conducted and in 2 cases conservative therapy had preceded. The X-ray follow ups showed on an average of 14 month a stable bony fusion in 10 patients, the clinical follow up examinations on an average of 14 month a normal function., Conclusion: The operation presented is indicated in case of dens pseudarthrosis because this accomplished a definite bony fusion without disturbance of the function of the joint C1/C2 in patients not older than 60 years. Disadvantages are to be found in the intraoperatively high X-ray radiation and the 3 month immobilisation.

Herniated thoracic discs are uncommon entities that are difficult to diagnose. They may be associated with a myriad of symptoms, which often delays diagnosis. In general dorsal pain that radiats around the chest or abdomen are found. In case of spinal cord compression signs of thoracal myelopathy are common. This paper describes a patient with a complete paralysis of the left foot as the first symptom of a herniated thoracic disc. After frustrated diagnostic of the lumbar spine, the exact neurological examination showed a sensible cut at the level of D6/7, the MR tomography diagnosed a herniated thoracic disc at the same level. Four months later he was presented again with a plegia of the left foot and a sensible cut at the level D5/6. The MR tomography showed a herniated disc at the level above the spondylodesis. The immediately performed transthoracic disc excision and fusion of D6/7 was followed by complete remission of the plegia and the sensible cut. Four months later we performed a rethoracotomy, disc excision and decompression with a spondylodesis D5/6. The procedure was again followed by complete remission. In case of paralysis of the lower extremities one has to consider a herniated thoracic disc.