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Purpose Questionnaire survey among the members of the German Spine Society (Deutsche Wirbelsaulen-Gesellschaft, DWG) to objectify oncological infrastructure and current standard of care in spinal tumor treatment in Germany. Methods All DWG-members were contacted via the society's e-mail and asked to respond in anonymized form to a related questionnaire. Questions were asked regarding surgical specialty, type of institution involved, numbers of spinal procedures, as well as questions on treatment for primary tumors, whether the respondent belonged to a tumor center, decision-making procedures for surgery, and the type of procedure. Results 84 centers providing surgical treatment for spinal tumors in their departments were identified. 52.6% were carrying out more than 500 spinal procedures per year. There was a significant association (P ≤ 0.05) between the numbers of spinal surgeries, the number of treated tumor patients per year, the organisation in a tumor center and the treatment of primary tumors. 76% are part of a local tumor center for interdisciplinary decision making (i.e.surgical treatment and adjuvant therapy). 74% of the institutions stated that conventional postoperative radiotherapy is standardly administered in the case of secondary lesions, with 24% of them referring patients to external services for radiotherapy. Conclusion In spite of often large numbers of spinal operations, the centers perform relatively small numbers of tumor operations, particularly for primary tumors. A nearly three-quarter majority of the departments are integrated into interdisciplinary tumor care. However, there is a marked number that do not belong to an interdisciplinary organisation. Further advances in multidisciplinarity and oncology training are a continuous issue to increase treatment quality in spinal tumor patients.

In patients with adult spinal deformity, it was previously shown that 16 of the non-management items of the SRS-instrument showed a better fit to the theoretical four-factor model (pain, function, self-image, mental health) than did all 20 items. Whether the same phenomenon is observed in data from younger ( 20y) patients, for whom the questionnaire was originally designed, is not currently known.Confirmatory factor analysis was used to evaluate the factor structure of the 20 non-management items of the SRS-instrument completed by 3618 young patients with spinal deformity (75.5% female; mean age, 15.0 ± 2.0 years) and of its equivalence across language versions (2713 English-speaking, 270 Spanish, 264 German, 223 Italian, and 148 French). The root mean square error of approximation (RMSEA) and comparative fit index (CFI) indicated model fit.Compared with the 20-item version, the 16-item solution significantly increased the fit (p 0.001) across all language versions, to achieve good model fit (CFI = 0.96, RMSEA = 0.06). For both 16-item and 20-item models, equivalence across languages was not reached, with some items showing weaker item-loading for some languages, in particular German and French.In patients with adolescent idiopathic scoliosis, the shorter 16-item version showed a better fit to the intended 4-factor structure of the SRS-instrument. The wording of some of the items, and/or their equivalence across language versions, may need to be addressed. Questionnaire completion can be a burden for patients; if a shorter, more structurally valid version is available, its use should be encouraged.

Background The recently developed Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0) was proven a valid and reliable instrument measuring health-related quality of life (HRQOL) for patients with spinal malignancies. A German version was not available. Objective A cross-cultural adaptation of the SOSGOQ2.0 to the German language and its multicenter evaluation. Methods In a multistep process, a cross-cultural adaptation of the SOSGOQ2.0 was conducted. Subsequently, a multicenter, prospective observational cohort study was initiated to assess the reliability and validity of the German adaptation. To assess external construct validity of the cross-cultural adapted questionnaire, a comparison to the established questionnaire QLQ-C30 from the European Organisation for Research and Treatment of Cancer was conducted. Mean-difference plots were used to measure the agreement between the questionnaires in total score and by domain (deviation from mean up to 10% allowed). Further reliability and validity tests were carried out. Change to baseline was analysed 3–16 weeks later after different interventions occurred. Clinically relevant thresholds in comparison to the EORTC QLQ-C30 questionnaire were evaluated by ROC curve analysis. Results We could enroll 113 patients from four different university hospitals (58 females, 55 males). Mean age was 64.11 years (sd 11.9). 80 patients had an ECOG performance status of 2 or higher at baseline. External construct validity in comparison to the EORTC QLQ-C30 questionnaire in total score and by domain was confirmed (range of deviation 4.4 to 9.0%). Good responsiveness for the domains Physical Functioning (P

BackgroundStaphylococcus aureus surgical-site infections (SSIs) are a major cause of poor health outcomes, including mortality, across surgical specialties. Despite current advances as a result of preventive interventions, the disease burden of S. aureus SSI remains high, and increasing antibiotic resistance continues to be a concern. Prophylactic S. aureus vaccines may represent an opportunity to prevent SSI.MethodsA review of SSI pathophysiology was undertaken in the context of evaluating new approaches to developing a prophylactic vaccine to prevent S. aureus SSI.ResultsA prophylactic vaccine ideally would provide protective immunity at the time of the surgical incision to prevent initiation and progression of infection. Although the pathogenicity of S. aureus is attributed to many virulence factors, previous attempts to develop S. aureus vaccines targeted only a single virulence mechanism. The field has now moved towards multiple-antigen vaccine strategies, and promising results have been observed in early-phase clinical studies that supported the recent initiation of an efficacy trial to prevent SSI.ConclusionThere is an unmet medical need for novel S. aureus SSI prevention measures. Advances in understanding of S. aureus SSI pathophysiology could lead to the development of effective and safe prophylactic multiple-antigen vaccines to prevent S. aureus SSI.

Cement augmentation of pedicle screws biomechanically increases screw purchase in the bone. However, clinical complications may occur. The pros and cons of the technique are discussed from different clinical perspectives.

Die degenerative lumbale Spinalkanalstenose stellt eine verschleisbedingte Einengung des Wirbelkanals infolge einer Verdickung der Ligg. flava und der Bandscheiben sowie einer Hypertrophie der Wirbelgelenke dar. Die Spinalkanalstenose ist eine Alterskrankheit und gehort zu den am haufigsten behandlungspflichtigen Wirbelsaulenerkrankungen des alteren Patienten.

Cement augmentation of pedicle screws biomechanically increases screw purchase in the bone. However, clinical complications may occur. The pros and cons of the technique are discussed from different clinical perspectives.

Primare Wirbelsaulentumoren sind im Gegensatz zu den Wirbelsaulenmetastasen insgesamt selten. Die Dignitat der Lasion und ihre Klassifizierung bestimmen dabei die Behandlungsstrategie. Da charakteristische bildmorphologische Veranderungen haufig fehlen, ist die histopathologische Begutachtung fur die Diagnosesicherung entscheidend. Die Biopsietechnik der Wahl ist die perkutane Stanzbiopsie uber die tumorbefallene Seite des Wirbels, auch die Weichteilkomponente eines Tumors kann dabei perkutan in der Schneid-Biopsietechnik biopsiert werden. Ist eine offene Biopsie nicht zu umgehen, muss eine Eroffnung und somit Kontamination des Spinalkanals, wenn moglich, vermieden werden. Bei den benignen Tumoren ist eine intralasionale Tumorausraumung (Kurettage) in den meisten Fallen ausreichend. Die Defektrekonstruktion ist aufgrund der haufig geringeren Defektgrose vergleichsweise einfach, wobei in fast allen Fallen eine additive dorsale Stabilisierung mit Spondylodese erforderlich ist. Maligne Lasionen mussen extralasional en bloc mit tumorfreien Randern ohne Rucksicht auf einen moglichen Funktionsverlust reseziert werden. Patienten mit primar malignen Tumoren sollten stets multidisziplinar vom Onkologen, Strahlentherapeuten und Wirbelsaulenchirurgen betreut werden. Neben der eigentlichen Tumorentfernung ist die Rekonstruktion der Wirbelsaule mit Sicherstellung einer langfristigen biomechanischen Belastbarkeit bei den haufig noch jugendlichen Patienten von groser Bedeutung. Bei Patienten mit Sarkomen sind gutes Ansprechen auf die neoadjuvante Chemotherapie und tumorfreie Resektionsrander fur die Prognose entscheidend.

Die schwergradige Osteoporose stellt in der instrumentierenden Wirbelsaulenchirurgie ein groses Problem dar. Neben Anschlusskyphosierungen und -frakturen sind Schraubenlockerungen und Implantatausrisse ein alltagliches Problem bei der osteoporotischen Wirbelsaule. Es ist hinreichend bekannt, dass die Knochendichte neben Schraubendicke und -lange den grosten Einfluss auf die Stabilitat einer Schraube hat. Bei einer schweren Osteoporose kann durch die Zementaugmentierung die Ausrissfestigkeit einer Pedikelschraube um 96–278% verbessert werden. Bis heute haben sich zwei verschiedene Vorgehensweisen etabliert: Zementierung des Wirbelkorpers vor Einbringen der Schraube in den noch weichen Zement oder Zementaugmentierung nach Einbringung einer perforierten Schraube. Das groste Problem der Augmentierung ist das Auftreten von Leckagen. Zementleckagen konnen bei beiden Techniken auftreten. Bei der Augmentation uber die perforierte Schraube scheint aber das Problem eine geringere Rolle zu spielen, da die Zementierung bei einer beginnenden Leckage sofort beendet werden kann. Die Revision der zementierten Schrauben stellt nach aktuellen biomechanischen Erkenntnissen kein groseres klinisches Problem dar. Auch die initial zementierten Schrauben konnen im Revisionsfall 1 mm dicker gewahlt werden und ebenfalls erneut zementiert werden.

Progrediente Skoliosen ab einem Krummungswinkel von etwa 40–50° sollten durch eine Instrumentationsspondylodese korrigiert und stabilisiert werden. Dabei ist in der Regel die Fusion der strukturellen Krummung (Primarkrummung) ausreichend. Die nichtstrukturellen Krummungen (Sekundarkrummungen) sind flexibel und richten sich nach Korrektur der Primarkrummung spontan auf. Die Identifikation der Primarkrummung und ihre Abgrenzung von den Sekundarkrummungen sind dabei fur die Operationsplanung und fur den Erfolg der Operation entscheidend. Laut Lenke-Klassifikation sind alle Krummungen einer Skoliose, die auf der reversen Bending-Aufnahme eine Restkrummung von ≥25° oder eine pathologische Kyphosierung aufweisen, als strukturell einzustufen und sollten fusioniert werden. Eigene Erfahrungen und auch Berichte in der Literatur haben jedoch gezeigt, dass daruber hinaus klinische Parameter wie Schulterstand und Rippenbuckel bzw. Lendenwulst und auch andere radiometrische Grosen wie u. a. die Rotation eine entscheidende Rolle in der Festlegung der Fusionsstrecke spielen. Somit ist die Lenke-Klassifikation eine wichtige Entscheidungshilfe in der Operationsplanung, wobei in der individuellen Betrachtungsweise auch stets weitere wichtige Parameter berucksichtigt werden mussen.

We report on 48 patients with a mean postoperative follow-up of 7.7 years. 9 patients underwent simple anterior derotation spondylodesis (VDS), 31 patients were additionally fused with posterior Harrington spondylodesis. In 7 of 8 patients the Dwyer compression spondylodesis (DCS) was completed with the Harrington instrumentation. 2 of 3 scoliosis were idiopathic, the residual cases were mainly neuromuscular. The primary curve (preoperative mean: 69.9 degrees) was initially corrected by 62.8% and sustained a loss of correction of 7.6 degrees resp. 10.9% during long-term follow-up. The long-term loss of correction was maximal after DCS showing 10.4 degrees (14.4%), on the average, and minimal after combined VDS and Harrington spondylodesis showing 6.9 degrees (9.3%). After simple VDS the long-term progression of the curve was 7.0 degrees (12.9%). In this group the initial correction was above-average high showing 76.4%. The main loss of correction occurred during the first 2 years after surgery. The long-term correction stability did not show significant differences between simple VDS and combined antero-posterior instrumentation. After anterior instrumentation of the primary curve the secondary cranial nerve spontaneously straightened up by 30%, on the average, and remained stable in the long-term. The anterior instrumentation of the spine lead to a mean loss of lordosis of 13.6 degrees which in the long-term additionally increased by 6.4 degrees due to the anterior epiphyseodesis effect. In 17 patients (42.5%) 24 fractures of the 3 mm-threaded VDS-compression rod occurred. In case of single rod fractures no higher loss of correction or differences in incidence of pain were observed in comparison to intact implants.

In der operativen Therapie der idiopathischen Skoliose stehen sowohl dorsale als auch ventrale Korrektur- und Stabilisierungstechniken zur Verfugung. Ziel der vorliegenden Arbeit war die Analyse der Ergebnisse der ventralen Derotationsspondylodese unter Verwendung eines neueren Doppelstabsystems. Es erfolgt eine prospektive Analyse radiometrischer und klinischer Parameter von 93 Patienten, die zwischen 1996 und 2004 mit dem Munsteraner Anterioren Doppelstabsystem operativ behandelt worden sind. Bei einer kurzen Fusionstrecke von in der Regel End-zu-End-Wirbel gelang eine durchschnittliche Krummungskorrektur von 65% bei einem Ausgangswinkel von 59°. Der postoperative Korrekturverlust nach durchschnittlich 36 Monaten war mit 1,5° minimal. Die Derotation betrug thorakal 45% und lumbal 53%, wodurch sich der Rippenbuckel um 66% und der Lendenwulst um 81% korrigieren lies. Revisionsbedurftige oder neurologische Komplikationen traten nicht auf. Die ventrale Korrektur und Instrumentationsspondylodese in Doppelstabtechnik ermoglicht eine sehr gute und sichere dreidimensionale Krummungskorrektur strukturell einbogiger Skoliosen.

The idiopathic scoliosis is a three dimensional spinal deformity mostly occurring in female adolescents. Untreated it can progress and result in back pain, impaired lung capacity and psychosocial disorders due to the cosmetic appearance of the deformed trunk. The treatment depends on the severity of the curve and ranges from physiotherapy and observation, brace treatment to surgical treatment with partial correction and fusion of the primary curve. Patients with an idiopathic scoliosis should be encouraged to actively take part in sports activities. Positive influences on the general fitness including the lung function, on the trunk muscles and on the psyche can be expected. There are no scientific data indicating that any kind of sport activities alter the natural history of idiopathic scoliosis.

Lumbar interbody fusion used to be the most common surgical treatment for painful lumbar disc degeneration. With the technical development of total disc prostheses, replacement of the degenerated disc by a motion preserving implant has become a widely discussed alternative. The advantages of such replacement appear to include the prevention of adjacent segment disease as well as less perioperative morbidity. Three types of total disc prostheses are currently in common use. Although numerous studies have been made, a review of the literature reveals only two multicenter randomized studies comparing the outcome of disc prostheses with a control group of fusion patients. After 2 years, the available results show similar improvement after both types of surgery without significant differences. However, there is a trend towards faster recovery and improvement in disc arthroplasty patients. The long-term results of current and future randomized studies, including studies comparing results after disc arthroplasty, with results of standardized conservative therapies will determine the fate of lumbar disc prostheses.

Aim of study A low-dose radiotherapy with 5 Gy on the lumbar spine in patients with chronic low back pain was investigated. Method 31 patients with non-radicular low back pain since three years at the age of at least 50 years (64.3 years on average) were treated. A psychosomatic etiology of pain was excluded. 5 Gy or 0.5 Gy (placebo dose) were applied in five fractions to the lumbar spine including the facet joints. The pain was evaluated by means of the Oswestry-Disability-Score before, six weeks after therapy, and every three months during the follow-up (22.4 months on average). Drug therapy, physiotherapy, and physical treatment were continued. Results According to the randomised distribution, 18 patients were treated with 5 Gy and 13 patients with 0.5 Gy. The Friedman-Test did not reveal any significant difference (p > 0.05) of the Oswestry-Disability-Index before and after therapy for both single questions and the sum of questions in both groups. Conclusion No significant decrease of the Disability Index after radiotherapy on the lumbar spine with 5 Gy could be demonstrated in the verum and placebo group. The authors do not recommend radiotherapy in cases of chronic low back pain. Individual successes have to be attributed to conservative treatment or placebo effects.

The radiographic fusion rates, graft behaviour and clinical outcome of 41 patient with simultaneous combined anterior lumbar interbody fusion and posterior arthrodesis with translaminar screws were reviewed independently. In all patients a femoral cortical allograft (FCA) ring filled with autologous iliac crest cancellous bone was used anteriorly to replace the disc and achieve interbody fusion. The follow-up averaged 30.6 months, with a minimum follow-up of 24 months. All patients had disabling low-back pain with different degrees of radiating leg pain and either discogenic pain (n = 24) or a postdiscectomy syndrome (n = 15) respectively postfusion syndrome (n = 2). The overall fusion rate was 95.2% (59 of 62 segments). Time to radiographic fusion averaged 8.7 months (range 2-34 months), and in 66.1% radiographic fusion occurred without significant subsidence. In 18.6% fusion with subsidence resulted from resorption of the FCA and in 15.3% the FCA had protruded into the vertebral body. The posterior intervertebral disc height (PIVDH) increased postoperatively by 2 mm on average. However, loss of PIVDH was the rule, and occurred within the first 12 postoperative months, resulting in a negligible final gain in height of 0.3 mm on average. The segmental lordosis was increased by 3 degrees; however, loss of lordosis during the first 6 postoperative months led to a final gain in lordosis of 1.3 degrees on average. Graft incorporation occurred in 16 of 62 segments (25.8%) and was observed at an average of 21.9 months postoperatively. Subjectively, 82.4% of the patients were satisfied or highly satisfied with the clinical result of the fusion operation. In conclusion, the described technique has proven to be highly effective in achieving a high fusion rate with a good patient outcome.

Diagnostic radiology and magnetic resonance imaging (MRI) are the most important imaging tools in the evaluation of benign bone tumors. Computed tomography (CT) is an additional tool for bony lesions, such as in cases of confirmation of the diagnosis of osteoid osteomas. For benign bony lesions three-stage skeletal scintigraphy is an optional additional diagnostic tool. The identification of benign or semimalignant bone tumors is not always clear; therefore percutaneous biopsy is necessary in most cases. In benign spinal tumors an intralesional curettage with reconstruction and stabilization is sufficient. In cases of semimalignant tumors, e.g. giant cell tumors localized in the spine, an en bloc resection is necessary because of the high recurrence rate.

Zwischen 1987 und 1992 wurden an unserer Klinik 30 instabile Wirbelsaulenverletzungen operativ mit dem AO-Fixateur interne und der transpedikularen Spongiosaplastik versorgt. Es handelte sich dabei um 26 Flexions-Kompressions-Frakturen und je zwei Rotations- und Flexions-Distraktions-Verletzungen. Wir berichten uber mittel- bis langfristige Ergebnisse einer klinisch-radiologischen Nachuntersuchung, in deren Rahmen Nachbeobachtungszeitraume zwischen zwei und funf Jahren erzielt werden konnten. An radiologischen Parametern wurden neben der vertebralen Kyphose (Keilwirbelbildung) und dem Beckschen Index die segmentale Kyphose zwischen frakturiertem und dem kranial benachbarten Wirbelkorper und die lokale Kyphose zwischen jeweils oben und unten angrenzenden Wirbelkorpern bestimmt. Uber subjektiven Beschwerdegrad des Patienten sowie Funktionalitat und Arbeitsfahigkeit gab ein standardisierter Fragebogen Aufschlus. Eine praoperative vertebrale Kyphose von durchschnittlich +17° konnte auf +7° korrigiert werden, wobei sich der Becksche Index von 0,59 auf 0,86 verbesserte. Die segmentale bzw. lokale Kyphose wurde von praoperativ +15° bzw. +8° auf +5° bzw. −3° reduziert. Dabei blieb der reponierte und mit Spongiosa aufgefullte Wirbelkorper korrekturstabil. Im oberen Zwischenwirbelraum kam es zu einem Korrekturverlust von durchschnittlich 4° durch Sinterung der mitverletzten Bandscheibe. Der untere Bandscheibenraum unterlag einer leichten operativen Uberkorrektur mit lordotischer Einstellung, der sich im Rahmen einer postoperativen Reaquilibrierung von bis zu 3° jedoch wieder neutral ausrichtete. Die Rekyphosierung ereignete sich dabei sowohl vor als auch nach der Metallentfernung. Abgesehen von den beiden Flexions-Distraktions-Verletzungen, deren pathologisches Profil physiologisch eingestellt werden konnte, anderte sich das sagittale Profil insgesamt nur wenig. Von acht Patiente mit neurologischen Ausfallen konnten sich funf um mindestens eine Frankel-Stufe verbessern. In keinem Fall trat eine neurologische Verschlechterung auf. Die Patientenbefragung ergab in 70% ein gutes bis sehr gutes Ergebnis. Auf der visuellen Analogskala zum Schmerzstatus wurde zum Zeitpunkt der Nachuntersuchung ein durchschnittlicher Wert von 3 (mit 10 als unertragliche Schmerzen) angegeben.

Patients suffering from ankylosing spondylitis are prone to injuries of the cervical spine even with minor trauma. Although the fractures are markedly unstable, nonsurgical treatment using a halo-thoracic plaster or jacket is a common approach.We present three patients with cervicothoracic fractures of the ankylosed spine to describe problems and complications inherent in this type of treatment. In two, pin track infections and pin protrusion through the skull occurred, leading in one case to an intracerebral hemorrhage. In the third patient, the halo had to be removed after 8 months, just early enough to prevent the pins from cutting through.One patient required craniotomy. The second one could be resolved by local revision. In the third case, the fracture eventually united after using a stiff collar for 2 years.Halo treatment for cervical spine fracture in patients with ankylosing spondylitis is a challenging task for orthopedic surgeons and neurosurgeons.

Indications for surgical treatment of idiopathic scoliosis are progressive curves greater than 40-50 degrees. In most cases, fusion of only the primary (structural) curve(s) is sufficient due to the flexibility and spontaneous correction of the secondary curves. Therefore, it is crucial to identify both primary and secondary curves. According to the Lenke classification, all curves with a residual curve of more than 25 degrees on the bending films and those with a pathological kyphosis are regarded as structural and should be fused, whereas the nonstructural curves can be left unfused. However, according to reports in the literature and to the author's experience, clinical parameters such as shoulder level and rib or lumbar hump as well as radiometric criteria such as rotation are relevant as well. In summary, the Lenke classification is an important and helpful tool for analysing idiopathic curves and determining fusion length, even though each scoliosis case needs to be evaluated individually, especially taking clinical parameters into account.

In spinal fusion procedures, the local bone that is resected serves as the base bone graft for attaining biological fusion. The local bone is frequently not sufficient and requires supplementary grafting. Autologous bone transplantation is still regarded as the gold standard but might cause additional complications; also, autograft resources are limited. Alternatively, allografts and a wide variety of different bone substitutes are available.The bone substitutes currently used in scoliosis surgery are presented, and their clinical significance is elucidated by a review of the literature. Furthermore, our own experiences and clinical practice are compared with those in the literature and are critically discussed. The recently growing number of scientific publications reporting on bone substitutes reflects the immense interest and relevance of this issue. In scoliosis surgery, calcium phosphate ceramics together with bone marrow aspirate are increasingly applied.Although harvesting of autologous bone continues to be the accepted standard to extend the local autograft in scoliosis surgery, there is a clear trend toward the use of bone substitutes.

Posterior correction and fusion of scoliosis with multisegmental instrumentation systems was developed by Cotrel-Dubousset in the 1980s. Initially correction and instrumentation was performed using hooks only. Later pedicle screws were implemented first for the lumbar and then for the thoracic spine. Nowadays instrumentation based on pedicle screws only is well established for posterior scoliosis surgery. Biomechanical studies demonstrated higher pull-out forces for pedicle than for hook constructs.In clinical studies several authors reported better Cobb angle correction of the primary and the secondary curves and less loss of correction in pedicle screw versus hook instrumentations. Furthermore, pedicle screw instrumentation allows fewer segments to be fused, especially caudally, and thus saving mobile segments. In most of these publications there were no differences in operation time, blood loss and complication rates. In summary, there is better curve correction without an increased risk using multisegmental pedicle screw instrumentation in modern posterior scoliosis surgery.

In primary tumors of the spine and, with limitations, solitary metastasis, the surgical approach should aim for curative treatment of the disease. Because the prognosis of malignant bone tumors is extremely limited, if an intralesional approach is performed, an extralesional en bloc resection is the treatment of choice. Therefore, it is mandatory to use an appropriate staging system. For the spine, the WBB staging system has been approved, which transfers the principles of the Enneking classification for treating primary malignant tumors of the limb to the spine. After en bloc spondylectomy, rigid and primary stable instrumented dorsoventral reconstruction must be performed - posteriorly with a dual-rod system using pedicle screws, and anteriorly in the ideal case by means of a vertebral body replacement cage. The possibility of extralesional (wide or marginal) resection of spinal tumors depends on tumor size and location. Extralesional resection and, if indicated, other neoadjuvant, adjuvant, or local therapeutic modalities have a strong positive influence on long-term survival rates. A good prognosis for primary tumors is associated with a good response to chemotherapy and extralesional resection. Solitary metastases have a much worse quod vitam prognosis. Therefore, local control of the disease in en bloc resections of solitary metastasis is a second relevant goal, although curative treatment is the primary aim.

In the surgical treatment of idiopathic scoliosis both anterior and posterior correction and instrumentation techniques are available. The aim of the present study was to analyse the results of a new anterior dual rod instrumentation.Prospective analysis of radiometric and clinical parameters of 93 patients operated on between 1996 and 2004 using the Münster Anterior Dual Rod System.The average curve correction was 65% (fusion length usually Cobb levels) with a preoperative Cobb angle of 59 degrees. Postoperative loss of correction amounted to 1.5 degrees (average follow-up of 36 months). Apical vertebral derotation averaged 45% in the thoracic and 53% in the lumbar spine with a subsequent correction of the rib hump of 66% and the lumbar hump of 81%. There were no revisions or neurological complications.Anterior dual rod instrumentation enables an effective and safe three-dimensional curve correction in single structural curves with only minimal loss of correction.

Die Durchfuhrung wirbelsaulennaher Injektionen sowohl zu diagnostischen als auch zu therapeutischen Zwecken gehort zur orthopadischen Routine in Klinik und Praxis. Zu unterscheiden sind tiefe paravertebrale Injektionen (TPV), Facettengelenkinfiltrationen, Iliosakralgelenks-(ISG-) Infiltrationen, Nervenwurzelblockaden, dorsale epidurale Injektionen, epidural-perineurale Injektionen, Diskographien und Triggerpunkt-Injektionen. Komplikationen sind grundsatzlich abhangig vom Typ der Injektion, insbesondere von der Positionierung der Nadelspitze vom verwendeten Medikament von den Umgebungsbedingungen und von individuellen medizinischen Faktoren des Patienten.

The idiopathic scoliosis is a three dimensional spinal deformity mostly occurring in female adolescents. Untreated it can progress and result in back pain, impaired lung capacity and psychosocial disorders due to the cosmetic appearance of the deformed trunk. The treatment depends on the severity of the curve and ranges from physiotherapy and observation, brace treatment to surgical treatment with partial correction and fusion of the primary curve. Patients with an idiopathic scoliosis should be encouraged to actively take part in sports activities. Positive influences on the general fitness including the lung function, on the trunk muscles and on the psyche can be expected. There are no scientific data indicating that any kind of sport activities alter the natural history of idiopathic scoliosis.

Lumbar interbody fusion used to be the most common surgical treatment for painful lumbar disc degeneration. With the technical development of total disc prostheses, replacement of the degenerated disc by a motion preserving implant has become a widely discussed alternative. The advantages of such replacement appear to include the prevention of adjacent segment disease as well as less perioperative morbidity. Three types of total disc prostheses are currently in common use. Although numerous studies have been made, a review of the literature reveals only two multicenter randomized studies comparing the outcome of disc prostheses with a control group of fusion patients. After 2 years, the available results show similar improvement after both types of surgery without significant differences. However, there is a trend towards faster recovery and improvement in disc arthroplasty patients. The long-term results of current and future randomized studies, including studies comparing results after disc arthroplasty, with results of standardized conservative therapies will determine the fate of lumbar disc prostheses.

The aim of this paper was to analyse the vertebral morphometry in idiopathic scoliosis with respect to pedicle screw instrumentation by means of computed tomography scans. The pedicle morphometry between T5 and L4 was analysed by computed tomography scans in 29 surgically treated patients with idiopathic right thoracic scoliosis. Measurements included chord length, endosteal transverse pedicle diameter and transverse pedicle angle. The endosteal transverse pedicle diameter was significantly smaller (P0.05) on the concavity in the apical region of the thoracic spine. The chord length was the shortest at the fifth thoracic vertebra with significantly larger dimensions on the concavity of the apical region in the thoracic spine (P0.05). The transverse pedicle angle varied between 6 degrees in the lower thoracic spine and 12 degrees at the upper thoracic and lower lumbar spine. The morphometry in scoliotic vertebrae is substantially different from those in normal spines with an asymmetrical intra-vertebral deformity. Pedicle screw instrumentation in the middle thoracic spine appears critical due to the small endosteal pedicle diameter, especially on the concave side.

To prospectively evaluate the results of brace treatment in idiopathic scoliosis and to define risk factors of treatment failure.Fifty-two patients with a Cobb angle of between 25 and 40 degrees were included in the study. Prior to initiation of brace treatment with the Chêneau-Toulouse-Muenster orthesis, skeletal age and flexibility of the curve (bending films) were evaluated. The average follow-up after weaning of the brace was 42 months (36-78 months).An average initial Cobb angle of 31 degrees was corrected to 18 degrees (43 %) under brace treatment with a flexibility to 6 degrees Cobb angle on bending films. Three years after weaning there was an overall increase of the Cobb angle to 37 degrees on average. The apical vertebral rotation was corrected from 16 degrees to 11 degrees (31 %) and increased to 20 degrees during follow-up. Thoracic kyphosis changed from 24 degrees to 18 degrees during treatment. At the latest follow-up kyphosis had returned to the pre-treatment angle again. Twenty-two patients had a curve progression during or after brace treatment of more than 5 degrees. In 14 patients surgical correction and fusion have been indicated. There was a positive correlation between flexibility and Cobb angle correction during brace treatment and a negative correlation between Cobb angle correction during brace treatment and curve progression (p0.05).Curve progression was prevented in 58 %. Prognostic risk factors are a young age at initiation of brace treatment, a thoracic curve, unsatisfactory curve correction in the brace and a male gender.

Radiometric curve analysis of instrumented primary and spontaneous secondary curve correction after anterior correction and fusion of idiopathic thoracic scoliosis.Sixty-four patients with idiopathic thoracic scoliosis were prospectively evaluated. All patients were operated either with the Zielke-VDS or with a primary stable double rod instrumentation with selective fusion of the thoracic curve from end-to end-vertebra. Follow-up averaged 29 months (24 - 52 months).The Cobb angle of the primary curve averaged 63.2 degrees preoperatively and was corrected to 21.4 degrees postoperatively with an average loss of correction of 5.3 degrees (58 % final curve correction). Apical thoracic vertebral rotation was corrected by 48 %. The secondary lumbar curve measured 38.2 degrees preoperatively (72 % correction on the bending films) and was spontaneously corrected by 57 % to 16.4 degrees without significant loss of correction in the final follow-up. Apical vertebral rotation averaged 11.3 degrees in the lumbar curve and was corrected spontaneously by 24 % to 8.6 degrees without significant loss of correction. Lumbar apex vertebra deviation showed no significant reduction. There was no case of lumbar curve decompensation in either frontal or sagittal plane. Implant related complications were observed in 7 patients (rod breakage), but no pseudarthrosis occurred. There were no neurological complications noted.Selective anterior correction and fusion in idiopathic thoracic scoliosis enables a satisfactory correction of both primary and lumbar secondary curves. The advantage of selective anterior correction and fusion of thoracic scoliosis is the short fusion length, better derotation and satisfactory correction of the secondary lumbar curve. The disadvantages of single threaded rod techniques in terms of lack of primary stability and a kyphogenic effect have been eliminated by the development of a primary stable, small size double rod instrumentation.

The expert evidence of operated patients with idiopathic scoliosis is determined by functional and pulmonary restriction. The degree of deformity and the extent of fusion is crucial for grading disability. In a retrospective study on the quality of life (SF-36) and low back pain (Roland-Morris Score) of 82 patients (22 - 40 years) with idiopathic scoliosis treated with Harrington instrumentation the grading was registered.An average of 16.7 years after the surgery, these data were correlated with the type and size of curve and to the extension of fusion.Compared to the age-matched healthy population, there was no significant difference in the physical SF-36 scale (P = 0.98). Surgically treated patients showed significantly lower scores than at baseline in the psychological SF-36 scale (P = 0.005). Sixty-five (79.3 %) of the eighty-two patients reported no or occasional back pain in the Roland Index. Five patients (6.1 %) complained of chronic back pain. 33 patients (40 %) were legally defined in their rate of disability as severely handicapped patients. The grading disability was associated with the physical SF-36 scale (P0.001) and the low back pain (P = 0.02). A significant correlation between the grading disability and the extent of fusion (P = 0.53) or the size of curve (p = 0.4) could not be proven.Despite good long-term outcomes, 40 % of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons. The additional measurements of quality of life and low-back pain can improve legal assessment in orthopaedics.

Aim of this study was to compare the results of the surgical repair of full-thickness rotator cuff tears with and without resection of the lateral clavicle.102 patients were retrospectively observed by an independent observer for a mean follow-up of 21 months (12 - 42). 93 patients had medium to large sized tears (1 - 5 cm) and 9 had massive tears (5 cm). Additional resection of the lateral end of the clavicle was performed in 20 patients. The mean age of the 68 men and 34 woman was 57.3 years (28 - 80). For the evaluation the Constant score, the ASES score and the visual analogue scales for postoperative satisfaction, function, strength, pain and ADL were used.The subjective results were good to excellent in 79 patients (76 %), fair in 14 patients (13.7 %) and poor in 9 patients (8.9 %), too. After surgery the Constant score was 87 % of the contralateral side for all patients, 89 % for group I and 84 % for group II and the mean ASES score was 86 %, 87 % and 82 % of the contralateral side. Comparing the pre- and post-operative values on the visual analogue scale pain and disability in ADL were decreased highly significantly in all patients (p0.001).We conclude that in patients with a full-thickness rotator cuff tear the patient's satisfaction and function will improve after acromioplasty and rotator cuff repair. The results are not significantly influenced by an additional resection of the lateral clavicle.

The posterior extension osteotomy leads to a lengthening of the anterior column, which is associated with neurological complications and the risk of injuring retroperitoneal structures. Especially in high-grade syndesmophytosis the results are dissatisfactory. In this study we report on the results of an alternative procedure named the transpedicular subtraction osteotomy.After resection of the posterior elements of the vertebra at the level of the osteotomy, a wedge of the vertebral body including the pedicles with posterior basis is resected followed by an instrumented closing wedge, which leads to relordosation. 12 patients were treated with this method and reexamined with a minimum follow-up of 2 years (2 - 6 years). The level of osteotomy ranged from T12 to L3.The mean segmental correction averaged 30.1 degrees (25 - 36 degrees ). The overall relordosation averaged 35.9 degrees and was related to additional correction in the adjacent segments. With this dissatisfactory a sufficient correction of spinal balance and visual axis was obtained. All patients were satisfied with the result of the operation and would undergo surgery again from a retrospective point of view.With the transpedicular subtraction osteotomy fixed kyphotic deformities of the spine in patients with ankylosing spondylitis can be corrected produce safely. The level of osteotomy is discussed and should depend upon the apex of kyphosis.

Radiographic analysis of long-term results following CDI.Retrospective analysis of radiographs of 43 patients with idiopathic right thoracic scoliosis with an average follow-up of 82 months. Extensive radiographic analysis with special regard to curve correction in the frontal and sagittal planes.The average Cobb-angle of the preoperative primary curve was 61.6 degrees (min.: 40 degrees, max.: 84 degrees ), the correction postoperatively was 51.1 % representing 29.9 degrees. Due to the loss of correction of 7.1 degrees, the overall outcome was 39.9 % by the time of follow-up. More than 90 % of the loss of correction occurred within the first 2 years. The lumbar secondary curve correction was 47.2 % (preop.: 37.5 degrees; postop.: 19.8 degrees ). Average fusion length was 11 segments, fusion usually ended two vertebrae below the end vertebra. Translation of the apex was corrected by 38.8 % (preop.: 4.9 cm; postop.: 3.0 cm), tilt of the last instrumented vertebra by 44.2 % (preop.: 18.2 degrees; postop.: 10.16 degrees ). The amount of derotation was negligible (preop.: 24.1 degrees; postop.: 22.6 degrees ). The readjustment of a preoperative pathologic sagittal profile, meaning a thoracic hypokyphosis, was successful in 12 out of 15 cases. Blood loss, duration of operation and complications were documented.CD-Instrumentation in scoliosis surgery offers a long-lasting suffcient correction of the fronal and a good correction of the sagittal plane. Stability of correction is achieved 2 years after operation.

Die Kenntnis der Biomechanik der Wirbelsaule ist wichtig, um die Pathogenese von Wirbelsaulenverletzungen und ihre Stabilitat beurteilen zu konnen. Das Zweisaulenkonzept nach Holdsworth unterteilt die thorakolumbale Wirbelsaule in eine vordere und hintere Saule (Holdsworth 1970). Die vordere Saule umfasst die Wirbelkorper, die Bandscheiben und das vordere und hintere Langsband. Die hintere Saule wird von den dorsalen Wirbelstrukturen wie Wirbelgelenke und Wirbelbogen sowie den supraund interspinosen Bandern und dem Lig. flavum gebildet (Abb. 3.1). Biomechanischen Untersuchungen zufolge werden etwa 80% der axial auf die Wirbelsaule einwirkenden Krafte uber die vordere Saule und nur etwa 20% uber die hintere Saule fortgeleitet (Bergmark 1989). Demnach werden Wirbelkorper und Bandscheiben uberwiegend auf Kompression und die hintere Saule auf Zug belastet.

A low-dose radiotherapy with 5 Gy on the lumbar spine in patients with chronic low back pain was investigated.31 patients with non-radicular low back pain since three years at the age of at least 50 years (64.3 years on average) were treated. A psychosomatic etiology of pain was excluded. 5 Gy or 0.5 Gy (placebo dose) were applied in five fractions to the lumbar spine including the facet joints. The pain was evaluated by means of the Oswestry-Disability-Score before, six weeks after therapy, and every three months during the follow-up (22.4 months on average). Drug therapy, physiotherapy, and physical treatment were continued.According to the randomised distribution, 18 patients were treated with 5 Gy and 13 patients with 0.5 Gy. The Friedman-Test did not reveal any significant difference (p0.05) of the Oswestry-Disability-Index before and after therapy for both single questions and the sum of questions in both groups.No significant decrease of the Disability Index after radiotherapy on the lumbar spine with 5 Gy could be demonstrated in the verum and placebo group. The authors do not recommend radiotherapy in cases of chronic low back pain. Individual successes have to be attributed to conservative treatment or placebo effects.

While the biomechanical properties of pedicle screws have proven to be superior in the lumbar spine, little is known concerning pullout strength of pedicle screws in comparison to hooks in the thoracic spine. In vitro biomechanical pullout testing was performed to evaluate the axial pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine with regard to surgical correction techniques in scoliosis. Nine human cadaveric thoracic spines were harvested and disarticulated. To simulate a typical posterior segmental scoliosis instrumentation, standard pedicle hooks were used between T4 and T8 and supralaminar hooks between T9 and T12 and tested against pedicle screws. The pedicle screws were loaded strictly longitudinal to their axis; the hooks were loaded perpendicular to the intended rod direction. In total, 90 pullout tests were performed. Average pullout strength of the pedicle screws was significantly higher than in the hook group (T4-T8: 531 N versus 321 N, T9-T12: 807 N versus 600 N, p0.05). Both screw diameter and the bone mineral density (BMD) had significant influence on the pullout strength in the screw group. For scoliosis correction, pedicle screws might be beneficial, especially for rigid thoracic curves, since they are significantly more resistant to axial pullout than both pedicle and laminar hooks.

In order to evaluate the outcome of the operative treatment of neuromuscular scoliosis 45 patients were studied prospectively.27 Patients were operated by posterior correction and fusion using the Münster Posterior Doublerod-System (MPDS) (GI). 18 Patients were treated with one-stage ventro-dorsal procedure in combination of VDS with MPDS (GII). For all patients, medical and radiographic records were available, with a minimum follow-up of 2 years. Postoperative management, bloodloss and complications will be discussed.In group I the main curve (76.3 degrees), by an average flexibility of 36.1%, were corrected by 53.5% and 52.3% at follow up. The mean pelvic obliquity (7.7 degrees) averaged 53.8%. The mean major scoliosis of group II (107.1 degrees), by an average flexibility of 25%, gets improved by 61%. At most recent follow-up, the mean correction was 61.5%. The mean pelvic obliquity (23.1 degrees) averaged 73.2% and 70.6% respectively. The mean bloodloss in group I was 1840 ml and in group II 2180 ml.The data in the current study support the benefit of the operative treatment of patients with severe neuromuscular scoliosis. The quality of life gets improved by stability in seating and standing by correction of pelvic obliquity and trunk instability.

So far only radiometric and clinical methods have been available for the evaluation of results after anterior scoliosis surgery. Rasterstereography has proved to be a reliable method for three-dimensional surface measurement of conservatively treated idiopathic scoliosis patients. Therefore, patients treated operatively with anterior instrumentation were examined using rasterstereography to determine the three-dimensional correction of the spinal deformity. The aim was to measure back shape deformity, in particular derotation, and thus cosmetic improvements.31 patients with idiopathic thoracic, thoracolumbar and lumbar scoliosis (Cobb angle 57.2 degrees) were examined with raster stereography preoperatively, postoperatively and after follow-up (25.2 months) in a standardized standing posture. Standing radiographs were compared with raster stereography.The mean Cobb angle was reduced from 57.2 degrees to 17.2 degrees, the rasterstereographic maximal surface rotation from 16.5 degrees to 10.8 degrees, and the vertebral rotation according to Perdriolle from 29.2 degrees to 16.7 degrees. During follow-up the Cobb angle increased to 20.8 degrees, and surface rotation to 11.3 degrees. Vertebral rotation remained constant. Lordosis and kyphosis angles changed only slightly.Rasterstereography is a suitable tool for analyzing the three-dimensional correction of spinal deformities after anterior scoliosis surgery. In particular, the cosmetic improvement is clearly demonstrated. The measurement of surface rotation allows objective quantification of the obtained derotation.

Halm-Zielke Instrumentation (HZI) was developed to eliminate the disadvantage of ventral derotation spondylodesis (VDS)-Zielke in terms of lack of primary stability and in order to simplify sagittal plane control. Within a prospective clinical trial started in 1993, we have studied whether HZI fulfills these demands. HZI is an anterior double-rod system with a two screw per vertebral body fixation. The longitudinal components consist of a threaded VDS rod and a solid rod, which are attached to a hinge-conducted lid plate. Twenty-nine consecutive patients with idiopathic scoliosis and curves ranging from 36 degrees to 92 degrees were treated with HZI. The follow-up period ranged from 1 to 4 years. Correction of the frontal plane within the instrumented levels averaged 71.6% and 70.5% postoperatively and at follow-up, respectively. Derotation averaged 53.7% and mean correction of the tilt of the lowest instrumented vertebra was 69.5% at final follow-up. Thoracolumbar kyphosis was present in eight patients and was always completely corrected from +18.8 degrees to 3.3 degrees on average. One implant-related complication involved a screw breakage 18 months postoperatively without adverse effects. There was no case of pseudoarthrosis. All patients were mobilized without any additional external immobilization in terms of a brace or cast, and were allowed to go swimming for physiotherapeutical purposes immediately after wound healing. This study proves that HZI is a primary stable implant to perform VDS. Implant-related disadvantages typical of VDS are eliminated. Thereby, the period of rehabilitation is shortened by many months due to avoidance of cast and brace treatment.

Halm-Zielke Instrumentation (HZI) was developed to eliminate the disadvantage of VDS-Zielke in terms of lack of primary stability and in order to simplify sagittal plane control. Since 1993 we study within a prospective clinical trial, whether HZI fulfills these demands.HZI is an anterior double-rod system with a two screw per vertebral body fixation. The longitudinal components consist of a threaded VDS-rod and a solid rod, which are attached to a hinge-conducted lid plate. 25 consecutive patients with idiopathic scoliosis and curves ranging from 36 degrees to 92 degrees were treated with HZI. The follow-up period ranges from 2 to 4 years.Correction of the frontal plane within the instrumented levels averaged 71.4% and 70.4% postoperatively and at follow-up, respectively. Derotation averaged 51.7% and mean correction of the tilt of the lowest instrumented vertebra was 69.5% at final follow-up. Thoracolumbar kyphosis was present in 7 patients and always completely corrected. One implant related complication, a screw breakage 12 months postoperatively without adverse effects was noted. There was no case of pseudarthrosis. All patients were mobilized without any additional external immobilization in terms of a brace or cast and were allowed to go swimming for physio-therapeutical purposes immediately after wound healing.This study proves that HZI is a primary stable implant to perform the Ventral Derotation Spondylodesis. The VDS-typical implant related disadvantages are eliminated. With this the period of rehabilitation is shortened by many months due to avoidance of cast and brace treatment.

We prospectively studied 9 patients with deformities of the thoracic spine who underwent thoracoscopic surgery to critically evaluate the benefits and limitations of thoracoscopy.Seven patients with deformities of the thoracic spine (5 scoliosis, 2 kyphosis) underwent a thoracoscopic release and posterior correction and fusion in a single stage. In one case of a crankshaft-phenomenon a thoracoscopic epiphyseodesis und in another case of a posttraumatic kyphosis a thoracoscopic instrumentation and fusion were performed. The average age was 21 years, the follow-up was 18 months with a minimum of 12 months. The perioperative data including complications were collected and a radiographic analysis concerning curve correction was carried out.The scoliotic curves measured preoperatively 84 degrees on average with a Cobb angle of 62 degrees on the traction films and were corrected by 57% to averagely 36 degrees at follow-up. In the two cases of Scheuermann kyphosis a preoperative kyphosis of 94 degrees respectively 82 degrees was corrected to 52 degrees respectively 58 degrees. Between 4 and 5 discs were excised with an average operative time of 160 min and a blood loss of 380 ml. A conversion to open thoracotomy was not necessary in any case. There were no intraoperative neurovascular complications.Thoracoscopic procedures in deformities of the thoracic spine are technically demanding; however, it is a minimally invasive procedure with a reduced approach-related morbidity compared to open thoracotomy. The indications for a thoracoscopic release are rigid kyphosis and scoliosis with rigid curves between 80 and 90 degrees Cobb angle in which an anterior correction and instrumentation alone is not considered.

The muscles of the pectoral girdle attach the upper limb to the trunk. Of relevance concerning the endoscopic approaches to the thoracic spine are the serratus anterior, the pectoralis major and the latissimus dorsi muscles, the latter forming the muscular boundary of the anterior and the posterior axillary line (Fig. 14.1).

In order to evaluate the results of posterior correction and fusion using the Münster Posterior Doublerod-System (MPDS) 48 patients with idiopathic scoliosis were studied prospectively.All patients underwent clinical examination and radiological analysis of the frontal and sagittal plane preoperatively, postoperatively and at follow-up (2-4 years). Pedicle screws were used at the lumbar and thoracolumbar spine exclusively.The preoperative average Cobb angle was 61.4 degrees with an average flexibility of 36.8% to 38.8 degrees. The average postoperative Cobb angle was 24.8 degrees (59.6%) with an average loss of correction of 2.6 degrees Cobb angle (3.6%). Due to the use of thoracolumbar and lumbar pedicle screws instrumented fusion could be stopped at the lower endvertebra in 71%. Patients in whom only pedicle screws had been used improved correction of frontal plane could be shown compared to combined instrumentations with hooks and screws.The posterior instrumentation guarantees primary stability with good results of correction and allows brace free treatment postoperatively. The postoperative correction compared to the results at follow-up proves the stability of the instrumentation largely. The results of mainly pedicle screw based instrumentations verify that an improved correction can be achieved. In most cases fusion levels end at the lower end vertebra and therefore are shorter compared to instrumentation's based on hooks only.

While scoliosis and kyphosis are the most common spinal deformities in patients with myelomeningocele, single lordotic deformitics are rare. There are only few reports about the operative treatment of a primary thoracic lordosis of -135 degrees Cobb angle. By means of a dorso-ventral-dorsal procedure correction and stabilisation of the lordotic deformity was performed. A correction of -26 degrees Cobb angle was achieved without loss of correction during follow up of 18 months. The case report shows that in individual cases even severe lordotic deformities can be treated with surgery successfully. An anterior-posterior procedure should be considered. The case is discussed with the rare national and international literature.

To evaluate the midterm radiographic behaviour of femorocortical allograftrings (FCA) in lumbosacral fusions in patients with disabling low back pain.The radiographs of 41 patients with a minimum follow-up of 2 years were analysed by an independent orthopedic radiologist. The fusion rate was determined on lateral tomograms routinely obtained at 3 months intervals. On lateral radiographs the posterior intervertebral disc height as well as the segmental lordosis were measured. Changes of the allografting such as mottling, resorption and incorporation were registered.The fusion rate was 95.2%. Time to radiographic fusion averaged 8.7 months (2-34 months) and in 66.1% radiographic fusion occurred without significant subsidence. In 18.6% fusion with subsidence resulted from resorption of the FCA and in 15.3% the FCA had protruded into the vertebral body. The posterior intervertebral disc height increased postoperatively by 1.9 millimeters on average. However, postoperative height loss was the rule and occurred within the first 12 postoperative months, resulting in a negligible final gain in height of 0.3 millimeters on average. The final gain in segmental lordosis was 1.3 degrees on average. Complete graft incorporation occurred in 16 of 62 segments (25.8%).The described technique has proven to be highly effective in achieving a high fusion rate with a stable midterm graft behaviour.