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Background: Overview of the literature: Idiopathic scoliosis (IS) is most commonly developed during adolescence and affects 2%–3% of the population. The overall complication rate for corrective surgeries in adolescent IS patients is described as 6.3%. Perioperative complications include intraoperative blood loss, neurological deficit, and infection, with excessive blood loss being one of the most common. The aim of the study is to evaluate the prevalence of major and minor complications following posterior or anterior fusion for IS. Methods: Retrospective multicenter study of data from the DWG-Register of patients who underwent operative treatment for IS from January 2017 to September 2022. Inclusion criteria: IS, age between 10 and 30 years. Results: In total, 825 IS patients undergoing fusion were identified in the registry; n = 801 (Group 1) did not have operative complications and n = 24 had a complication related to surgical procedure (Group 2); therefore, the complications rate was 2.9%. A 1.3% rate of major complications and 1.6% rate of minor complications were recorded as follows: spinal cord damage n = 2 (8.4%), subfaszial hematoma n = 2 (8.4%), motor dysfunction n = 1 (4.2%), cerebrospinal fluid (CSF)-leakage n = 7 (29.2%), sensory dysfunction n = 6 (25%), bowel/bladder dysfunction n = 1 (4.2%), superficial site infection n = 2 (8.4%), and pulmonary lung atelectasis n = 3 (12.5%). According to the logistic regression model, an odds ratio for pedicel screws versus laminar hooks for hyperkyphosis correction of 3.73 and for Ponte-osteotomy of 11.5 was found. Conclusions: In IS patients treated operatively, the prevalence of nonneurologic postoperative complications following corrective surgery was 1.80% with CSF leak being the leading risk of complication at 0.84.%. These findings should guide surgeons in their intraoperative Dural tear repair particularly osteotomies. Alternate level pedicle-screw placement with laminar hooks leads to higher operation time and more extensive fusion with consequent slightly prevalence in perioperative complications. [ABSTRACT FROM AUTHOR]

Background: Intramedullary tumors represent only 10% of the spectrum of spinal tumors. Their management is not an easy task and depends essentially on the surgical resection which can be very challenging. The main aim of our study was to analyze the complication rate in intramedullary tumors as well as postoperative outcome after intramedullary tumor resection. Methods: This was a retrospective analysis of data from the "DWG-Register" of patients who have undergone operative treatment for primary intramedullary tumors in 170 departments from January 2017 to May 2021. Since 2017, pre-, intra-, and postoperative data until demission from the hospital have been continually collected in the "DWG-Register" (a total of 179,955 in a period of 4 years in 170 departments). Results: In total, 307 primary intramedullary tumors in the spine were identified; n = 248 (Group 1) had nonoperative complications and n = 59 had a complication related to the surgical procedure (Group 2); taking this in to account, die complication rate was 19.2%. The incidence of complications was: epidural hematoma n = 5 (8.4%), paresis n = 23 (38.9%), bowel/bladder dysfunction n = 15 (25.4%), wound infection n = 5 (8.4%), medullary injury n = 2 (3.4%), cerebrospinal fluid (CSF) leakage n = 15 (25.4%), and reintervention with hematoma, abscess, or surgical CSF leakage management in n = 22 (37.2%). The risk of permanent morbidity increased with a thoracic level, masculine gender, a long clinical history, presence of epidural hemorrhage, blood transfusion, and surgery on a recurrent tumor. Conclusion: Medullary tumors are a rare entity with a relative high complication rate (20%). Improvement of symptoms postoperative depends on several factors such as operated level, masculine gender, a long clinical history, presence of epidural hemorrhage, blood transfusion, and surgery on a recurrent tumor. In rare pathologies such as intramedullary tumors, the data from the DWG Register can be used to describe spinal surgery care in "real life." [ABSTRACT FROM AUTHOR]

Study Design: A prospective experimental study. Purpose: This biomechanical in vitro study aimed to examine the extent to which the use of a rod persuader (RP) leads to additional mechanical stress on the screw–rod system and determine its influence on the bony anchoring of primary pedicle screws. Overview of Literature: Degenerative spine diseases and deformities are the most common indications for the stabilization and fusion of spinal segments. The pedicle screw–rod system is considered the gold standard for dorsal stabilization, and an RP is also increasingly being considered to fit the spondylodesis material. Methods: Ten lumbar spines from body donors were examined. Bisegmental dorsal spinal lumbar interbody fusion of the L3–L5 segments was performed using a pedicle screw–rod system (ROCCIA Multi-LIF Cage; Silony Medical, Germany). In group 1, the titanium rod was inserted without tension, whereas in group 2, the rod was attached to the pedicle screws at the L4 and L5 levels, creating a 5-mm gap. To attach the rod, the RP was used to press the rod into the pedicle screw. The rod was left in place for 30 minutes and then removed. Results: The rod reduction technique significantly increased the mechanical load on the overall construct measured by strain gauges (p<0.05) and resulted in outright implant failure with pedicle screw pullout in 88.9%. Conclusions: In cases where the spondylodesis material is not fully attached within the pedicle screw, an RP can be used with extreme caution, particularly in osteoporotic bones, to avoid pedicle screw avulsion and screw anchor failure. [ABSTRACT FROM AUTHOR]

OBJECTIVES To date, there are no standardized treatment algorithms or recommendations for patients with infective endocarditis (IE) and concomitant spondylodiscitis (SD). Therefore, our aim was to analyse whether the sequence of surgical treatment of IE and SD has an impact on postoperative outcome and to identify risk factors for survival and postoperative recurrence. METHODS Patients with IE underwent surgery in 4 German university hospitals between 1994 and 2022. Univariable and multivariable analyses were performed to identify possible predictors of 30-day/1-year mortality and recurrence of IE and/or SD. RESULTS From the total IE cohort (n  = 3991), 150 patients (4.4%) had concomitant SD. Primary surgery for IE was performed in 76.6%, and primary surgery for SD in 23.3%. The median age was 70.0 (64.0–75.6) years and patients were mostly male (79.5%). The most common pathogens detected were enterococci and Staphylococcus aureus followed by streptococci , and coagulase-negative Staphylococci. If SD was operated on first, 30-day mortality was significantly higher than if IE was operated on 1st (25.7% vs 11.4%; P  = 0.037) and we observed a tendency for a higher 1-year mortality. If IE was treated 1st, we observed a higher recurrence rate within 1 year (12.2% vs 0%; P  = 0.023). Multivariable analysis showed that primary surgery for SD was an independent predictor of 30-day mortality. CONCLUSIONS Primary surgical treatment for SD was an independent risk factor for 30-day mortality. When IE was treated surgically 1st, the recurrence rate of IE and/or SD was higher. [ABSTRACT FROM AUTHOR]

Background: Overview of the literature - Fractures of the C1 constitute 3%-13% of all cervical spine injuries in adults. Most isolated C1 fractures are stable and can be treated nonoperatively with external immobilization. Traditional surgical options for C1 fracture treatment are occiput-to-C2 fusion or C1 with lateral mass screws (LMSs). Purpose - The aim is to assess the management and perioperative complications of C1 fractures undergoing LMS fusion between fluoroscopy and computed tomography (CT)-guided navigation. Methods: This was a retrospective multicenter study of data from the DWG-Register of patients who underwent operative treatment for C1 traumatic fracture with LMSs from January 2017 to September 2022. Inclusion criteria - traumatic injury and age > 18 years old. Results: In total, 202 patients with traumatic C1 fracture requiring spinal surgery were identified in the registry; n = 175 (Group 1) were treated conventionally without CT-guided navigation and n = 27 were treated with CT-guided navigation (Group 2). C1-LMS was principally performed by spine surgeons n = 90 (53.4%) and n = 72 (18.5%) by neurosurgeons in both the groups. Intraoperative adverse events were as follows: dural tear in group 1 n = 0 and in group 2 n = 1, vascular injury, with one case in group 1 and no cases in group 2. General complications were: cardiovasculars in group 1 n = 6 (3.4%) and Group 2 n = 4 (14.8%) (P = 0.03), pulmonary complications in group1 n = 2 (1.1%) and n = 9 in group 2 (33.3%) (P < 0.001), stroke n = 1 (0.57%) in group1 and n = 4 in group 2 (14.8%) (P < 0.001), gastrointestinal bleeding n = 1 (0.57%) in group1 and no cases in group 2, renal insufficiency n = 2 (1.1%) in group 1 and n = 3 (11.1%) in group 2 (P = 0.01). One death was recorded in group 2 (3.7%). Conclusion: This series of 404 screws placed in 202 patients over 5 years who underwent two types of C1 fracture fixation had a considerably lower incidence of screw malposition and vertebral artery injury than has previously been reported in the literature. C1 screws can be safely placed with a low risk of vertebral artery and neurologic injury with and without CT-guided navigation support. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to evaluate the outcomes after prosthetic arthroplasty of the proximal interphalangeal joint. Of 73 prostheses, 67 were available for follow-up at a median of 35 months (range 10–78 months). The median brief Michigan Hand Questionnaire score was 88/100 (interquartile range [IQR] 69–98), quickDASH 11 (IQR 1–29), pain on the visual analogue scale during activity 0 (IQR 0–2) and at rest 0 (IQR 0). Median range of motion improved from 50° (IQR 40°–70°) to 70° (IQR 53°–88°; p < 0.001). Preoperatively, there was axial deviation of >15° in 15 (23%) joints, with none postoperatively. There were no signs of loosening or migration of the prostheses. Two cases required revision with the implant staying in situ. In two cases, the prosthesis was removed and the joint was fused. Prosthetic arthroplasty of the proximal interphalangeal joint using a modular surface gliding implant is a good option for patients with primary osteoarthritis achieving acceptable pain relief, range of motion and axial stability. : Level of evidence: IV [ABSTRACT FROM AUTHOR]

(215 words): Introduction: Ehlers-Danlos syndromes (EDS) represent a group of heritable connective tissue disorders characterised by skin hyperelasticity, joint hypermobility and generalized tissue fragility. Many patients remain undiagnosed years after initial symptoms and an accurate diagnosis is difficult despite all efforts. Currently, Germany lacks a patient registry and a specialised EDS centre., Methods: In early 2020, a dermatological-orthopaedic EDS outpatient service was established at the University Hospital of Cologne. Medical records of all patients presenting in 2020 were retrospectively analysed., Results: 43 adults were examined. 15 patients were diagnosed with EDS (different types), 13 with hypermobility spectrum disorder (HSD) and one with likely Loeys-Dietz syndrome (LDS) based on patient history and a suspicious variant in the gene TGFBR1 and. Excluding hypermobile EDS (6 patients), molecular confirmation was achieved in a total of 4 of 9 patient. The combination of symptomatic generalised hypermobility and skin manifestations was diagnostic in more than two-thirds of the EDS patients. Arterial involvement (aneurysms, dissection and rupture) and distinctive cutaneous signs (thin translucent skin with haematomas) indicated vascular EDS and LDS in altogether three patients., Conclusion: With the present analysis, we discuss our diagnostic approach in patients with a suspected diagnosis of EDS in order to raise awareness for this rare group of genodermatoses and review recent developments in EDS nosology., (S. Karger AG, Basel.)

The aim of this retrospective study was to evaluate the long-term outcome of ulnar shortening osteotomy. A total of 66 patients treated with an ulnar shortening osteotomy for a primary or post-traumatic ulnar impaction syndrome were included, with a median follow-up time of 75 months.There was a positive correlation between the sigmoid notch angle and the final QuickDASH score, but no correlation with final range of motion, grip strength or pain level. Radiological signs of osteoarthritis of the distal radioulnar joint were seen in 20% of patients, yet there was no correlation between the development of distal radioulnar joint osteoarthritis and the sigmoid notch angle. No symptomatic distal radioulnar joint osteoarthritis was observed.Ulnar shortening osteotomy is a good option to treat patients with ulnar impaction syndrome regardless of the distal radioulnar joint angle. Level of evidence: IV., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Level of evidence: IV., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.