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Schmerzreduktion und Verbesserung der Lebensqualitat durch ISG-Fusion. Chronische Iliosakralgelenk-assoziierte Schmerzen. Positive ISG-Testinfiltration mit Lokalanasthetikum. Positive ISG-Provokationstests. Erfolglose konservative Therapie uber 6 Monate. Nicht ISG-assoziierte Beschwerden. Tumor/Infektion/instabile Fraktur im Implantationsareal. Fehlbildungen, Tumor oder Osteolyse des Sakrum- oder Iliumknochens. Aktive Infektion an der Behandlungsstelle. Allergie gegen Metallkomponenten. Sekundarer Krankheitsgewinn, Rentenbegehren. Unzureichend behandelte Osteoporose. Uber einen lateralen minimal-invasiven Zugang bildwandlergesteuertes Einbringen von Kirschner-Drahten transartikular durch das ISG in das Sakrum. Aufmeiseln des Implantatlagers uber die Kirschner-Drahte und Einbringen von insgesamt 3 triangularen Titanimplantaten zur ISG-Arthrodese. Thromboseprophylaxe. Drei Wochen Teilbelastung und anschliesend schrittweise Aufbelastung. Rontgenkontrollen in definierten Intervallen. Physiotherapie. Es wurden 26 konsekutive Patienten nach 48 Monaten untersucht. Die evaluierten Endpunkte waren tieflumbale Schmerzen entsprechend der visuellen Analogskala (VAS 0–10), Funktionseinschrankungen entsprechend Oswestry Disability Index (ODI) und Lebensqualitat entsprechend EuroQOL-5D (EQ-5D). Nach 4 Jahren zeigte sich der Ruckenschmerz im Vergleich zu praoperativ deutlich verbessert (VAS praoperativ 8,4, VAS 4 Jahre postoperativ 4,6). Die Funktionseinschrankungen zeigten sich rucklaufig (ODI praoperativ 58,1, ODI 4 Jahre postoperativ 32,1), und ein Anstieg der Gesundheitsbewertung im EQ-5D war zu verzeichnen (praoperativ 0,5, nach 4 Jahren 0,7). Die Rate an Patienten, welche Opiate zur Schmerztherapie einnahmen, konnte deutlich gesenkt werden (praoperativ 82 %, postoperativ 39 %). Es zeigte sich keine Implantatlockerung im untersuchten Zeitraum.

Durch die Spinal-Cord-Stimulation (SCS) werden Strukturen der Hinterstrange und Hinterhorner des Ruckenmarks mittels elektrischer Impulse stimuliert und dadurch wird die Schmerzwahrnehmung moduliert. Ziel ist es, bei chronischen Schmerzpatienten, z. B. bei Failed-Back-Surgery-Syndrom (FBSS), das Schmerzniveau zu reduzieren und betroffenen Patienten eine verbesserte Lebensqualitat zu ermoglichen. Failed-Back-Surgery-Syndrom, komplex regionales Schmerzsyndrom (CRPS) Typ I und II, therapierefraktarer Ischamieschmerz, neuropathische Schmerzsyndrome (z. B. Phantomschmerz). Chirurgisch sanierbare Schmerzursache, nicht behandelte psychische Erkrankung. Zweizeitige Implantationstechnik. Beginn mit der Testphase nach perkutaner Implantation von epiduralen Elektroden und Stimulation durch externen Pulsgenerator. Bei Schmerzreduktion Implantation eines subkutanen internen Pulsgenerators zur Dauerstimulation. Fruhfunktionelle Mobilisation und ggf. Anpassung der Stimulationsparameter. Es wurden 19 konsekutive Patienten mit FBSS mittels Hochfrequenz-SCS (HF-SCS) behandelt und in eine prospektiv prognostische Studie eingeschlossen. Bei 18 Patienten wurde ein implantierbarer Pulsgenerator (IPG) zur HF-SCS permanent implantiert. Der Therapieerfolg wurde mittels Oswestry Disability Index (ODI), visueller Analogschmerzskala (VAS) und painDetect-Fragebogen erfasst. Bei den Patienten dominierten neuropathische Schmerzen der Beine gegenuber dem Rucken (Mittelwerte: VAS Bein 71 mm, VAS Rucken 69 mm) bei praoperativem mittlerem ODI von 63 %. Unter der HF-SCS zeigte sich eine deutliche Schmerzreduktion und persistierte auch im Follow-up nach 6 Monaten (VAS Bein 18 mm, VAS Rucken 24 mm). Im ODI zeigte sich eine Verbesserung auf einen Mittelwert von 24 % nach 6 Monaten.

BACKGROUND AND OBJECTIVE: Musculature affected during spondylodesis surgery may benefit and recover faster if supported by spine orthosis postoperatively. METHODS: This prospective study included 50 consecutive patients undergoing one- or two-level spondylodesis. The intervention group received a lumbar spine orthosis (n= 23), while the control group remained without orthosis (n= 27). Patients were assessed for pain (Visual Analogue Scale, VAS), Oswestry Disability index (ODI) as well as the use of analgesics. RESULTS: Patients wearing an orthosis postoperatively reported a higher degree of subjective stability. However, both intervention as well as control group did not show any significant differences for each of the follow-up points regarding VAS, ODI or the use of analgesics. CONCLUSION: Wearing an orthosis has neither impact on subjective pain, the need for analgesics nor for postoperative functionality. However, patients reported that they profited from wearing the orthosis by feeling more stable, thereby nicely improving their postoperative mobility. Thus, novel patient reported outcome measures have to be developed to assess these features in future studies.

Spinal cord stimulation (SCS) is an evidence-based, reversible but invasive procedure for the treatment of chronic pain syndromes: for example, in patients with failed-back-surgery syndrome or complex regional pain syndrome. A more recent, similar technique uses high-frequency stimulation for SCS and follows a different mechanism of action that does not result in paresthesia. This Technical Note and video present surgical instructions of a “2-way cut-down” technique for a high-frequency SCS trial period and permanent implantation of an implantable pulse generator.

Pain reduction and improvement in quality of life with sacroiliac joint (SIJ) fusion.Chronic SIJ-associated pain; positive response to SIJ injection with local anesthetic; positive SIJ provocation tests; failed conservative therapy over 6 months.Non-SIJ-associated pain; tumor/infection/unstable fracture in the implantation area; malformations; tumor or osteolysis of the sacrum or ilium bone; active infection at the implantation site; allergy to metal components; secondary gain from illness, request for a pension; inadequately treated osteoporosis.Transarticular placement of Kirschner's wires through the SI joint via minimally invasive lateral approach. Guided preparation of implant site over Kirschner's wires and implantation of 3 triangular, transarticular titanium implants for SIJ fusion.Deep vein thrombosis prophylaxis. 3 weeks partial weight-bearing and then moving on to full weight-bearing. X‑ray controls at defined intervals. Physiotherapy.We enrolled 26 patients who were followed up over the period of 4 years. The evaluated endpoints were low back pain on the visual analog scale (VAS 0-10), grade of disability with the Oswestry Disability Index (ODI) and quality of life with the EuroQOL-5D. At 4 years, mean low back pain improved compared to preoperative (VAS preoperative 8.4, VAS 4 years postoperative 4.6). Mean improvements in ODI (ODI preoperative 58.1, ODI 4 years postoperative 32.1) and EQ-5D (preoperative 0.5, after 4 years 0.7) could be evaluated over the long-term period of 4 years. Satisfaction rates were high and the proportion of subjects taking opioids decreased at the 4‑year follow-up (preoperative 82%, postoperative 39%). Implant loosening could not be detected on plain radiograph.OPERATIONSZIEL: Schmerzreduktion und Verbesserung der Lebensqualität durch ISG-Fusion.Chronische Iliosakralgelenk-assoziierte Schmerzen. Positive ISG-Testinfiltration mit Lokalanästhetikum. Positive ISG-Provokationstests. Erfolglose konservative Therapie über 6 Monate.Nicht ISG-assoziierte Beschwerden. Tumor/Infektion/instabile Fraktur im Implantationsareal. Fehlbildungen, Tumor oder Osteolyse des Sakrum- oder Iliumknochens. Aktive Infektion an der Behandlungsstelle. Allergie gegen Metallkomponenten. Sekundärer Krankheitsgewinn, Rentenbegehren. Unzureichend behandelte Osteoporose.Über einen lateralen minimal-invasiven Zugang bildwandlergesteuertes Einbringen von Kirschner-Drähten transartikulär durch das ISG in das Sakrum. Aufmeißeln des Implantatlagers über die Kirschner-Drähte und Einbringen von insgesamt 3 triangulären Titanimplantaten zur ISG-Arthrodese.Thromboseprophylaxe. Drei Wochen Teilbelastung und anschließend schrittweise Aufbelastung. Röntgenkontrollen in definierten Intervallen. Physiotherapie.Es wurden 26 konsekutive Patienten nach 48 Monaten untersucht. Die evaluierten Endpunkte waren tieflumbale Schmerzen entsprechend der visuellen Analogskala (VAS 0–10), Funktionseinschränkungen entsprechend Oswestry Disability Index (ODI) und Lebensqualität entsprechend EuroQOL-5D (EQ-5D). Nach 4 Jahren zeigte sich der Rückenschmerz im Vergleich zu präoperativ deutlich verbessert (VAS präoperativ 8,4, VAS 4 Jahre postoperativ 4,6). Die Funktionseinschränkungen zeigten sich rückläufig (ODI präoperativ 58,1, ODI 4 Jahre postoperativ 32,1), und ein Anstieg der Gesundheitsbewertung im EQ-5D war zu verzeichnen (präoperativ 0,5, nach 4 Jahren 0,7). Die Rate an Patienten, welche Opiate zur Schmerztherapie einnahmen, konnte deutlich gesenkt werden (präoperativ 82 %, postoperativ 39 %). Es zeigte sich keine Implantatlockerung im untersuchten Zeitraum.

Background Vertebral compression fractures (VCF) change the natural spinal alignment and inevitably lead to a decreased quality of life. Objective The aim of the study was to evaluate changes in pulmonary function after VCF were treated by radiofrequency kyphoplasty (RF-TVA). Methods Twenty-five patients were treated with RF-TVA and analyzed in 3 subgroups taking into account the spinal location of the VCF. Pain as measured by visual analogue scale (VAS), Oswestry-Disability-Index (ODI), vertebral height, forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF) were assessed before, directly after and 30 days after RF-TVA. Results The mean vertebral height was improved in all subgroups, with a minor reduction from one to 30 days postoperatively. The mean VAS and ODI significantly decreased in the main and upper diaphragm groups from baseline to the follow-up after 30 days. Patients treated below the main diaphragm region showed a significant improvement of ODI and a clear trend to significant improvements of VAS. PEF and FEV1 were significantly improved in the main diaphragm group. FEV1 also increased significantly in the upper diaphragm group with a clear trend to significance in the lower diaphragm group. Conclusions Results indicate that RF-TVA may improve pulmonary function especially in cases where fractures are located in the main spinal region of the diaphragm.

BACKGROUND Kyphoplasty is a proven minimally invasive procedure for the treatment of patients with osteoporotic fractures. By augmentation of fractured vertebral body, however, a very large portion of the intervertebral structures will be destroyed. With the help of a new device (Vertect Jack Device), the erection of the vertebral body will be carried out more gentle. OBJECTIVE In the present study, the new method should be clinically tested for efficacy and safety for the first time. As a comparison results of previous treatments with kyphoplasty were used. METHODS For Vertect Jack Device study patients with painful vertebral fractures were selected in which conservative treatment had not yielded sufficient results. For comparison random data from the records of patients who had been treated with kyphoplasty were selected. The Vertect Jack Device was placed under the central fractures and then erected. After having restorted the vertebral height the device was removed and cement injected. Clinical and radiological examinations were carried out before and after 1,3, and 6 months. RESULTS In the Vertect Jack Device Group the data of 40 patients were evaluated. For group 2 (kyphoplasty) 50 patients were selected. There was a significant difference in the duration of the surgery (Group 1: 27.4, Group 2: 45.9 minutes). A significant difference of 20 mm with regard to the reduction of VAS scores (0-100 mm pain intensity) was detected. Under the application of the Vertect Jack Device an average increase of 3.1 mm of vertebral height was achieved. In group 2, the erection averaged 0.4 mm. A correlation between the postoperative change of vertebral body height and VAS scores could not be detected in both groups. CONCLUSIONS The comparative analysis of this study shows that promising results can be achieved with the augmentation of vertebral fractures with the Vertect Jack Device. When compared with kyphoplasty, advantages show in terms of targeted and thus more gentle application possibility and better pain relief over a period of 6 months after surgery. Further study results should help to demonstrate the efficacy and tolerability of the new method.

Background 30% of myeloma patients suffer from vertebral compression fractures (VCF). Consequently, augmentation often becomes inevitable to prevent further problems. This study evaluated the interaction of radiation therapy (RT) and radiofrequency kyphoplasty (RFK) in the treatment of myeloma associated VCF. Methods Eighty-six myeloma patients with VCF were treated with RFK followed by radiation therapy (RFK group) or vice versa (RT group). Visual analgoue scale (VAS), Oswestry-Disability-Index (ODI), vertebral height and kyphosis angle were assessed preoperatively, 3-4 days, 3 and 6 months postoperatively. Adverse events like cement leakage or additional fractures were documented. Results Both groups achieved comparable outcomes, but the course of VAS and kyphosis angle differed. Early postoperative kyphosis angles improved significantly in the RFK group, but significantly worsened afterwards. The RT group showed a trend towards significantly improvement postoperatively and minor worsening afterwards. VAS remained constant in the RT group and worsened in the RFK group after 6 months. More cement leakages and additional fractures were noted in the RT group. Conclusions RFK is an effective method for treating VCF in myeloma patients independent of treatment order with regard to radiation therapy. However, RT should be conducted after RFK to minimize risks of cement extrusion and additional fractures.

ZusammenfassungPathologische Veränderungen an den Iliosakralgelenken (ISG) müssen in bis zu 25% als Ursache einer schweren Schmerzsymptomatik im unteren Rückenbereich angesehen werden. Es wird eine sorgfältige differenzialdiagnostische Abklärung benötigt, um eine Fehlinterpretation der von den Patienten geäußerten Beschwerden zu vermeiden bzw. eine Arthropathie im Iliosakralgelenk zu identifizieren. Neben einer umfassenden Aufnahme der Anamnese bilden positive Resultate unterschiedlicher Provokationstests wichtige Anhaltspunkte für die richtige Diagnosestellung. Als vorrangiger Beleg für die definitive Diagnose und damit auch für eine Operationsempfehlung wird jedoch die Schmerzlinderung nach wiederholter intraartikulärer Injektion eines Lokalanästhetikums angesehen. Mithilfe konservativer Behandlungsmaßnahmen (Analgetika/Neuroleptika) und physikalischer Maßnahmen kann symptomatisch eine meist mäßige Besserung erreicht werden. Bei den operativen Maßnahmen zeigt sich eine deutliche Überlegenheit der minimalinvasiven Eingriffe gegenüber offenen, invasiveren operativen Verfahren. Besonders gut dokumentiert sind die Resultate der minimalinvasiven Operationen mit dem iFuse Implant System®, dessen 3-eckiges Implantatprofil mit Titanplasmaspraybeschichtung eine unmittelbare und langanhaltende Stabilisierung garantiert. Patienten, bei denen sich die Symptomatik infolge einer Dysfunktion im ISG, einer degenerativen Sakroiliitis oder einer pathologischen Veränderung am ISG ausgebildet hat und bei denen konservative Behandlungen unzureichend gewirkt haben, zeigen nach Versorgung mit iFUSE klinisch bedeutsame Verbesserungen hinsichtlich Schmerzsymptomatik, Funktionsfähigkeit und Lebensqualität. Das Verfahren zeichnet sich auch durch einen geringen intraoperativen Blutverlust, kurze Operationszeiten und Aufenthaltsdauer in der Klinik aus.

BACKGROUND Sacroiliac joint (SIJ) syndrome can cause various symptoms and may also be one reason for persistent low back pain, especially in patients with prior spinal fusions. If conservative treatments fail to improve symptoms, arthrodesis surgery can be considered. Minimally invasive approaches have emerged recently providing a good alternative to conventional methods. A novel triangular implant system (iFuse) can achieve an arthrodesis of the SIJ without the use of additional screws or bone material. OBJECTIVE Aim of the present study was an evaluation of short-term safety and efficacy of the implant system. METHODS Twenty-four patients were included in the study and treated with the iFuse system. In addition to demographic data, pain intensity (visual analogue scale) and functional impairment (Oswestry-disability index) were assessed prior to surgery and 1 month, 3 months, 6 months, 12 months and 24 months thereafter. During surgery and the follow up period all adverse events were documented and the correct implant position was controlled via plain radiographs. RESULTS VAS scores and ODI improved significantly directly after surgery from 84.3 ± 9.2 mm to 40.7 ± 9.2 mm and from 76.8 ± 9.2% to 40.7 ± 9.2 % (p < 0.001). The ODI improved further to 31 ± 5.4% after 24 months whereas the VAS improved until the 3 months examination and ten stayed constant between 27.7 mm and 26.5 mm to 27 ± 6.6 mm at 24 months. No adverse events, intraoperative complications, implant malpositioning or loosening could be recorded at any time. CONCLUSIONS The iFuse system is an effective and safe treatment for minimally invasive surgical arthrodesis of the SIJ. Pain and functional impairment can be significantly improved. However, in addition to this case series, further controlled studies are necessary, particularly in terms of a previous spinal fusion history.

Since the first vertebral body replacement operations over 50 years ago until now, there were developed numerous methods and implants. Vertebral body replacement after corpectomy nowadays is a standard procedure in spinal surgery. At the beginning mainly bone grafts were used. Due to continuous development, PMMA and titanium implants were developed. Nowadays various expandable and non-expandable implants are available. Numerous implants can still be justified. The question arises which methods and systems are on the market and which ones have proven themselves? This article describes and compares the advantages and disadvantages of each implant type.Von den ersten Wirbelkörperersatzoperationen vor ca. 50 Jahren bis heute wurden zahlreiche Methoden und Implantate entwickelt. Der operative Wirbelkörperersatz nach Korporektomie ist heute ein etabliertes Verfahren in der Wirbelsäulenchirurgie. Lange Zeit wurden hauptsächlich Knochentransplantate verwendet. Im Verlauf einer kontinuierlichen Entwicklung wurden Implantate aus PMMA und Titan entwickelt und verwendet. Heute stehen diverse expandierbare und nicht expandierbare Implantate zur Verfügung. Zahlreiche Implantate haben weiterhin ihre Berechtigung. Es stellt sich die Frage, welche Methoden und Systeme auf dem Markt sind und welche sich bewährt haben. Dieser Artikel beschreibt und vergleicht die Vorteile und Nachteile der einzelnen Implantatarten.

Spinal cord stimulation (SCS) targets structures of the dorsal column and dorsal horn of the spinal cord with electrical impulses, thereby, modulating pain perception. For chronic pain patients, e.g., in failed back surgery syndrome (FBSS), the aim is to achieve pain relief and enable patients to improve their quality of life.Failed back surgery syndrome, complex regional pain syndrome (CRPS) type I and II, therapy-refractory ischemic pain, neuropathic pain syndromes (e.g., phantom limb pain).Identification of degenerative alterations as the cause of pain; untreated mental illness.A two-stage implantation technique is performed. Initially, after percutaneous implantation of epidural leads a trial period with stimulation by an external pulse generator is evaluated. Following verification of pain relief, a subcutaneous internal pulse generator is implanted.Early mobilization and adjustment of stimulation parameters.In all, 19 consecutive patients with FBSS were treated by high frequency SCS (HF-SCS) and included in a prospective prognostic study. In 18 patients, an internal pulse generator (IPG) for HF-SCS was permanently implanted. Therapy success was assessed using the Oswestry Disability Index (ODI), visual analogue pain scale (VAS) and painDetect questionnaire. Neuropathic pain of the legs versus the back (median values: VAS leg 71 mm, VAS back 69 mm) was dominant in the patients at a preoperative mean ODI of 63%. With HF-SCS therapy, a pronounced pain reduction was seen and persisted in the follow-up after 6 months (VAS leg 18 mm, VAS back 24 mm). The ODI showed an improvement to a mean of 24% after 6 months.OPERATIONSZIEL: Durch die Spinal-Cord-Stimulation (SCS) werden Strukturen der Hinterstränge und Hinterhörner des Rückenmarks mittels elektrischer Impulse stimuliert und dadurch wird die Schmerzwahrnehmung moduliert. Ziel ist es, bei chronischen Schmerzpatienten, z. B. bei Failed-Back-Surgery-Syndrom (FBSS), das Schmerzniveau zu reduzieren und betroffenen Patienten eine verbesserte Lebensqualität zu ermöglichen.Failed-Back-Surgery-Syndrom, komplex regionales Schmerzsyndrom (CRPS) Typ I und II, therapierefraktärer Ischämieschmerz, neuropathische Schmerzsyndrome (z. B. Phantomschmerz).Chirurgisch sanierbare Schmerzursache, nicht behandelte psychische Erkrankung.Zweizeitige Implantationstechnik. Beginn mit der Testphase nach perkutaner Implantation von epiduralen Elektroden und Stimulation durch externen Pulsgenerator. Bei Schmerzreduktion Implantation eines subkutanen internen Pulsgenerators zur Dauerstimulation.Frühfunktionelle Mobilisation und ggf. Anpassung der Stimulationsparameter.Es wurden 19 konsekutive Patienten mit FBSS mittels Hochfrequenz-SCS (HF-SCS) behandelt und in eine prospektiv prognostische Studie eingeschlossen. Bei 18 Patienten wurde ein implantierbarer Pulsgenerator (IPG) zur HF-SCS permanent implantiert. Der Therapieerfolg wurde mittels Oswestry Disability Index (ODI), visueller Analogschmerzskala (VAS) und painDetect-Fragebogen erfasst. Bei den Patienten dominierten neuropathische Schmerzen der Beine gegenüber dem Rücken (Mittelwerte: VAS Bein 71 mm, VAS Rücken 69 mm) bei präoperativem mittlerem ODI von 63 %. Unter der HF-SCS zeigte sich eine deutliche Schmerzreduktion und persistierte auch im Follow-up nach 6 Monaten (VAS Bein 18 mm, VAS Rücken 24 mm). Im ODI zeigte sich eine Verbesserung auf einen Mittelwert von 24 % nach 6 Monaten.

BACKGROUND Several studies showed encouraging results after total disc replacement (TDR) in patients with cervical-brachial syndrome (CBS). OBJECTIVE The aim of this study was to supplement the existing documentation of results after total disc replacement and to underline the importance of the correct indication. METHODS The clinical and radiological outcome of 34 patients was evaluated in a 2-year follow-up by several parameters as the Visual Analogue Scale (VAS) for pain, the Neck Disability Index (NDI) and the Kellgren and Lawrence Score. RESULTS The median values for NDI changed from 65% (20-90) before surgery to 20% (0-86) 2 years after surgery (p< 0.0001). Pain intensity had an average rate of reduction from 8.4 ± 2 cm (VAS scale 0-10 cm) to 2.9 ± 2 cm (p< 0.0001). A median of 1 (0-3) was calculated for the Kellgren and Lawrence Score in the affected segment preoperatively. Due to loosening in five cases the TDR was removed and changed into anterior cervical decompression and fusion (ACDF). In all of these five cases a preoperative Kellgren and Lawrence Score of 2 or 3 was calculated and five of five patients (100%) were smokers. CONCLUSION The use of TDR in nonsmoking patients with a low preoperative Kellgren and Lawrence Score of 0-1 lead to a clinically and radiologically successful outcome.

Introduction Besides the target joints (elbow, knee and ankle), the hip is one of the commonly affected joints in haemophilic arthropathy. Hip arthroplasty is the therapy of choice after failure of conservative treatment. There are only limited data on long-term results after primary total hip arthroplasty (THA). Aim The aim of this retrospective study was to analyse clinical outcome and complication rate after total hip replacement in patients with severe haemophilic arthropathy. Methods Forty-three patients with haemophilia (PWH), one patient with von Willebrand disease and one patient with a Factor-VII-deficiency undergoing 49 total hip arthroplasties, were evaluated in a retrospective study. Harris hip score (HHS), range of motion (ROM), pain status (visual analogue scale, VAS) complication rate and patient satisfaction were assessed at a mean follow-up of 11.5 years (range: 3–32). Results HSS, ROM and VAS improved significantly combined with high patient satisfaction. In total, three (6.1%) periprosthetic infections and five (10.2%) aseptic implant loosenings occurred after THA leading to revision arthroplasty. In two (4.1%) cases, a pseudotumour and one (2.0%) periarticular ossification had to be resected after THA. Conclusion Total hip replacement in PWH leads to a significant increase of function, reduction of pain and a high satisfaction. Due to the relatively high complication rate (infections and aseptic loosening) compared to patients without haemophilia, an individual assessment of the risk–benefit ratio from surgical and haemostaseological point of view is needed.

Background: Painful vertebral compression fractures (VCF) caused by osteoporosis are a common health problem in the elderly population. If conservative treatments are unsuccessful, surgical treatments like vertebroplasty or kyphoplasty are recommended. But the use of Polymethylmethacrylat (PMMA) bone cement for augmentation surgery is associated with risks. Objectives: Evaluation of the effectiveness and safety of a newly developed silicon polymer (VK100) that can be used instead of PMMA bone cement for kyphoplasty treatments. Study Design: A retrospective study of 30 patients comparing the outcomes of kyphoplasty treatments conducted with PMMA and VK100. Setting: Clinic for Orthopedics and Trauma Surgery Bonn, Germany. Methods: Thirty patients with one to 3 VCF were treated either with balloon kyphoplasty using VK100 or balloon kyphoplasty using PMMA bone cement. Data from both groups was compared by a matched pair analysis. The medial vertebral height was measured at each examination radiologically. The patients stated their pain intensity using the Visual Analogue Scale (VAS) and the patient’s functional impairment was evaluated with the Oswestry-Disability-Index (ODI). All data were assessed before surgery, and 3 days, 3 months, 6 months, and 12 months after surgery. Intraoperative and postoperative adverse events were documented. Results: The patients’ functional impairment and pain improved significantly after surgery. The course of ODI and VAS was comparable in both treatment groups, but the improvement in the VK group was significantly ongoing until the 12 month follow-up. Vertebral height improvement was significant in both groups, but the PMMA group achieved a better absolute restoration. The vertebral height stayed constant during the follow-up in the VK group and worsened significantly in the PMMA group. There was no significant difference between groups concerning the occurrence of additional fractures; and no other types of complications or surgery-related adverse events were observed in either the PMMA group or in the VK group. Limitations: The study is only a matched pair analysis of 15 patients for each procedure and the amount of injected filling material was not recorded. Conclusion(s): The study results demonstrate that the clinical outcome of VAS and ODI of using the silicon polymer VK100 is comparable or slightly better than using PMMA. VK 100 shows a trend to minor additional fractures during the follow-up. However, height restoration is not satisfactory in comparison to PMMA, although vertebral height stayed more or less constant in the VK group. To address the augmentation success further, it would be necessary to study a larger patient group over a longer study period and to assess additional parameters such as bone density and injected amount of filling material. Key words: Vertebral compression fracture, kyphoplasty, augmentation, osteoporosis, back pain, VK 100, elastoplasty

Compared to older patients undergoing total hip arthroplasty (THA) younger patients are considered to be more active, thereby exposing the implant to significantly higher loads over a much longer period of time. Additionally, cases of secondary osteoarthritis caused by hip dysplasia, femoral head necrosis or rheumatic diseases are much more frequent than among the average patient population. Therefore, durable implant fixation and low wear rates are extremely important to achieve good long-term implant survival in this group of patients. The aim of this retrospective study was to evaluate the mid- to long-term survival of a cementless femoral stem (Zweymuller® SL stem) and a threaded cup (Bicon SL®) in patients younger than 50 years of age. Therefore, a consecutive series of 100 patients (111 hips) aged 50 years or younger (range: 30 to 50 years) was analysed at a mean follow up of 13.5 years. Follow-up assessment included physical examination and radiographic workup. Hip disability osteoarthritis and outcome score (HOOS) and Harris hip score (HHS) were used to evaluate the pre- and post-operative functional outcome, respectively. Patient satisfaction with the surgical result was assessed by standardized questionnaires. The overall survival rate with any revision as endpoint was 96.8 % (95 % CI: 90.5 % to 98.9 %) at ten years. Gender, operation time and the occurence of osteolyses had no influence on joint function or patient satisfaction. We recorded an overall failure rate of 7.4 % (six cases). In four cases (5 %) the prosthesis had to be revised due to aseptic loosening of the cup after 12 years, eight years, 12 years and 11 years, in one case (1.2 %) recurrent luxation led to a revision operation (acetabular cup and head) after three years of primary implantation. In one case an implant failure was recorded (acetabular cup breakage after eight years of implantation). We recorded the occurence of asymptomatic radiolucent lines of the cup in 21 % and of the stem in 35 % in our series. The HOOS was influenced by the presence or abscence of radiolucent lines of the stem. Patients with radiolucent lines of the stem had a median HOOS score of (74 points) compared to those without radiolucent lines (89 points). Other factors, such as “diagnosis led to operation” and “previous operations” had no influence on the HHS and HOOS. Our study demonstrates excellent long-term survival of cementless femoral stem in combination with a threaded cup in young patients undergoing total hip arthroplasty.

Objectives Percutaneous radiofrequency is an established method for treatment of chronic low back pain of intervertebral facet etiology. Endoscopic techniques have the advantage of visualization of the facet joint and the dorsal medial ramus and thus allow for more accurate denervation. It was thus hypothesized that pain reduction is vaster and longer enduring. Patients and Methods A total of 98 consecutive patients that underwent endoscopic facet joint denervation (EFJD) were included in this study. Prior to intervention and for follow-up, patients were asked to complete VASpain, ODI, COMI and EQ5D questionnaires. Results VASpain was reduced significantly (EFJD: p Conclusion EFJD is a promising technique for the treatment of facet joint syndrome caused CLBP as it contributes to sustaining significant pain reduction and improvement of subjective quality of life parameters.

Spondylodiscitis is an infection of the intervertebral disc with subsequent infection of the adjacent vertebral bodies. The main causes are 3 pathogen groups: bacteria, particularly tuberculosis pathogens, fungi and parasites. In pyogenic spondylodiscitis, infections with Staphylococcus aureus are the most common, with an incidence of up to 80%. Mortality is around 2 - 3%. Infections with tuberculosis are often associated with psoas and paravertebral abscesses. Neurological deficits are registered in up to 50% of patients. For microbiological diagnostic testing, blood cultures are used for aerobic and anaerobic bacteria. However, histological examination leads significantly more frequently to positive pathogen detection. In tissue samples, results with 16S rRNA PCR results are clearly superior to results from microbiological examination. The MRI exhibits high sensitivity and specificity and is therefore superior to other radiological methods. Elimination of the infection, pain reduction and stabilisation of the spine are the main objectives of any treatment. A standardised antibiotic therapy for spondylodiscitis has not been clearly defined. Pathogen detection is important, with focused antibiotic therapy. Antibiotic therapy should initially be administered intravenously for 2 - 4 weeks. This should be followed by oral administration for 6 - 12 weeks. In the case of antibiotic-resistant infections with neurological deficiencies, it is recommended to perform a surgical procedure, with careful debridement and instrumentation as well as i. v. administered antibiotics for 3 weeks followed by three month oral antibiotic treatment. Surgical procedures are indicated with neurological deficits, progressive increase in spinal deformities, failure of conservative therapy with insufficient pain relief and unreliable pathogen identification. The selection of the surgical procedure should mainly be based on the extent and localisation of bone destruction and the individual circumstances of the patients. The prognosis is good if there is a clear reduction in CRP and ESR in the first few weeks.Die Spondylodiszitis ist eine Infektion der Bandscheiben mit einer nachfolgenden Infektion der benachbarten Wirbelkörper. Hauptursache sind 3 Erregergruppen: Bakterien (pyogene Infektion), Tuberkuloseerreger und Pilze (granulomatöse Infektion) und Parasiten. Bei der pyogenen Spondylodiszitis dominieren meist Monoinfektionen mit Staphylococcus aureus bei einer Häufigkeit bis zu 80%. Die Letalität liegt bei der Spondylodiszitis bei 2 – 3%. Tuberkulöse Infektionen sind häufig mit Psoas- und paravertebralen Abszessen assoziiert. In bis zu 50% der Patienten werden neurologische Ausfälle registriert. Zur mikrobiologischen Diagnostik werden Blutkulturen für aerobe und anaerobe Keime eingesetzt. Die histologische Untersuchung führt jedoch signifikant häufiger zu einem positiven Erregernachweis. Hinsichtlich Genauigkeit ergibt sich eine deutliche Überlegenheit der 16S-rRNA-PCR im Vergleich zur mikrobiologischen Untersuchung von Gewebeproben. Das MRT zeigt eine hohe Sensitivität und Spezifität und ist daher den anderen radiologischen Methoden überlegen. Die Beseitigung der Infektion, die Verminderung der schmerzhaften Beschwerden sowie die Wiederherstellung und Bewahrung von Struktur bzw. Funktion der Wirbelsäule gelten als Hauptziele jeder Behandlungsmaßnahme. Eine standardisierte Antibiotikatherapie der Spondylodiszitis ist bisher nicht eindeutig definiert. Entscheidend sind der Erregernachweis und eine entsprechende gezielte Antibiotikatherapie. Die antibiotische Therapie sollte zunächst 2 – 4 Wochen intravenös verabreicht werden. Anschließend ist eine Umstellung auf eine orale Gabe für 6 – 12 Wochen vorzusehen. Beim Nachweis antibiotikaresistenter Infektionen mit neurologischen Ausfällen wird empfohlen, ein chirurgisches Vorgehen mit sorgfältigem Débridement und Instrumentation vorzunehmen sowie eine Nachbehandlung mit intravenös verabreichten Antibiotika über 3 Wochen mit anschließend 3-monatiger oraler Antibiotikabehandlung zu verordnen. Chirurgische Eingriffe sind indiziert bei neurologischen Defiziten, progressiver Zunahme spinaler Deformierungen, Versagen der konservativen Therapie mit unzureichender Schmerzlinderung und unsicherer Keimidentifizierung. Die Auswahl des Operationsverfahrens sollte hauptsächlich nach dem Ausmaß der Knochendestruktion, der Lokalisation und den individuellen Gegebenheiten bei den Patienten richten. Eine gute Prognose kann gestellt werden, wenn CRP und BSG in den ersten Wochen deutlich abfallen.

Hintergrund: Nachdem der Morbus Parkinson bereits fur allgemein- und unfallchirurgische Patienten als relevanter Faktor der perioperativen Morbiditat identifiziert werden konnte, soll hier erstmals der Einfluss des Morbus Parkinson auf den perioperativen Verlauf von Patienten nach elektiver lumbaler Spondylodese untersucht werden. Patienten und Methoden: Es wurde eine retrospektive Matched-Pairs-Analyse mit jeweils 17 Patienten nach elektiver lumbaler Spondylodese bei konservativ austherapierten degenerativen Erkrankungen der LWS durchgefuhrt. Untersucht wurde der perioperative Verlauf von Parkinsonpatienten (MP) im Vergleich zu Patienten ohne Parkinsonerkrankung (kein MP) hinsichtlich der stationaren Verweildauer, Dauer der intensivmedizinischen Behandlung, Dauer bis zur Mobilisation, Notwendigkeit stationarer Anschlussheilbehandlungen und Auftreten von perioperativen Komplikationen. Ergebnisse: Die durchschnittliche stationare Verweildauer (MP 18,4 ± 11,6 d; kein MP 14,7 ± 5,4 d), Dauer der Intensivbehandlung (MP 1,7 ± 4,2 d; kein MP 1,0 ± 1,9 d) und die Dauer bis zur erfolgreichen Mobilisation (MP 8,8 ± 12,46 d; kein MP 5,0 ± 4,2 d) war bei Patienten mit MP tendenziell, jedoch nicht statistisch signifikant, langer. Eine stationare Anschlussheilbehandlung war bei Patienten mit MP haufiger (MP n = 4; kein MP n = 2). Peri- und intraoperative Komplikationen traten in keiner der beiden Gruppen gehauft auf. Schlussfolgerung: Signifikante Unterschiede in Bezug auf einen langeren stationaren Aufenthalt, haufigere Sturze und eine haufigere Verlegung in eine stationare Anschlussheilbehandlung, wie sie in fruheren Untersuchungen fur ein allgemein- und unfallchirurgisches Kollektiv gezeigt wurden, konnten fur Patienten mit elektiver lumbaler Spondylodese nur tendenziell bestatigt werden. Hierbei besteht eine Limitation der Studie hinsichtlich der Anzahl der eingeschlossenen Patienten. Auch wenn in der vorliegenden Studie keine gehauften Komplikationen auftraten, sollten typische Risikofaktoren bei Patienten mit MP, wie das erhohte Risiko fur Atemwegskomplikationen, Harnwegsinfekte und ein erhohtes Sturzrisiko, beachtet werden.

BACKGROUND Infiltration procedures are a common treatment of lumbar radiculopathy. There is a wide variety of infiltration techniques without an established gold standard. Therefore, we compared the effectiveness of CT-guided transforaminal infiltrations versus anatomical landmark-guided transforaminal infiltrations at the lower lumbar spine in case of acute sciatica at L3-L5. METHODS A retrospective chart review was conducted of 107 outpatients treated between 2009 and 2011. All patients were diagnosed with lumbar radiculopathic pain secondary to disc herniation in L3-L5. A total of 52 patients received CT-guided transforaminal infiltrations; 55 patients received non-imaging-guided nerve root infiltrations. The therapeutic success was evaluated regarding number of physician contacts, duration of treatment, type of analgesics used and loss of work days. Defined endpoint was surgery at the lower lumbar spine. RESULTS In the CT group, patients needed significantly less oral analgesics (p < 0.001). Overall treatment duration and physician contacts were significantly lower in the CT group (p < 0.001 and 0.002) either. In the CT group, patients lost significant fewer work days due to incapacity (p < 0.001). Surgery had to be performed in 18.2 % of the non-imaging group patients (CT group: 1.9 %; p = 0.008). CONCLUSION This study shows that CT-guided periradicular infiltration in lumbosciatica caused by intervertebral disc herniation is significantly superior to non-imaging, anatomical landmark-guided infiltration, regarding the parameters investigated. The high number of treatment failures in the non-imaging group underlines the inferiority of this treatment concept.

Background Spinal fusion surgery has become one of the most common spinal procedures during the recent years. Searching for an optimum structural stability of the vertebral interspace, surgical implants which can be inserted via a posterior lumbar interbody fusion (PLIF) approach have been enhanced recently. Objective Evaluation of safety and efficacy of a novel PLIF polyetheretherketone (PEEK) interbody cage (TWIST) with an impactionless insertion technique. Methods Surgical outcome in 15 patients treated with the new system were observed preoperatively, one and three years after surgery using the Oswestry Disability Index (ODI), a Visual Analogue Scale (VAS) for pain and radiological outcome analysis of fusion success. Results Fifteen patients (7 female, 8 male) were included in the test series. After three years ODI and VAS were significantly improved. The pain intensity was reduced by more than 75% after one year and after 3 years, pain intensity was about 60% below the initial situation. The Oswestry values (ODI) improved significantly in all patients after 3 years. The fusion evaluation showed a fusion success in 87% of the patients. Conclusion The clinical and radiological results of this first series give a positive standing and important information on the efficacy and safety over 3 years. The follow-up checks with imaging techniques showed that the fusions were very successful and functional outcome as well as pain reduction were increased.

Pain coming from the sacroiliac (SI) joints can explain up to 25% of all chronic low back pain. A careful differential diagnosis is required to avoid misdiagnosis of low back pain. In addition to historical findings, positive findings on physical examination maneuvers that stress the SI joint are a key component diagnosis. The SI joint is confirmed as a pain generator when intraarticular injection of local anaesthetics provides acute back pain relief. Minimally invasive SI joint fusion is clearly superior to invasive open surgical procedures, with decreased blood loss and tissue disruption, shorter procedure times and shorter hospital stays. Especially well documented are the results of minimally invasive SI joint fusion using iFuse Implant SystemPathologische Veränderungen an den Iliosakralgelenken (ISG) müssen in bis zu 25% als Ursache einer schweren Schmerzsymptomatik im unteren Rückenbereich angesehen werden. Es wird eine sorgfältige differenzialdiagnostische Abklärung benötigt, um eine Fehlinterpretation der von den Patienten geäußerten Beschwerden zu vermeiden bzw. eine Arthropathie im Iliosakralgelenk zu identifizieren. Neben einer umfassenden Aufnahme der Anamnese bilden positive Resultate unterschiedlicher Provokationstests wichtige Anhaltspunkte für die richtige Diagnosestellung. Als vorrangiger Beleg für die definitive Diagnose und damit auch für eine Operationsempfehlung wird jedoch die Schmerzlinderung nach wiederholter intraartikulärer Injektion eines Lokalanästhetikums angesehen. Mithilfe konservativer Behandlungsmaßnahmen (Analgetika/Neuroleptika) und physikalischer Maßnahmen kann symptomatisch eine meist mäßige Besserung erreicht werden. Bei den operativen Maßnahmen zeigt sich eine deutliche Überlegenheit der minimalinvasiven Eingriffe gegenüber offenen, invasiveren operativen Verfahren. Besonders gut dokumentiert sind die Resultate der minimalinvasiven Operationen mit dem iFuse Implant System

Wir berichten in unserer Fallstudie von einem Patienten, der nach Implantation einer Hufttotalendoprothese (Huft-TEP) bei zuvor bestehender Hyperurikamie eine generalisierte, fulminante Gicht mit nachfolgender Superinfektion mehrerer Gelenke und Gichttophi entwickelt hatte. Multiple Operationen waren notwendig, um das Krankheitsbild zu beherrschen und letztendlich die Ausheilung der Infektionen zu erreichen. Dieser Fall stellt die praoperative Hyperurikamie als ernstzunehmende Erkrankung und die positive Anamnese fur eine Gicht als Risikofaktor fur postoperatives Ausfallen von Harnsaure dar. Wir mochten den Operateur fur die postoperativen Symptome der Gicht sensibilisieren, damit eine adaquate Versorgung der Patienten gewahrleistet ist.

BACKGROUND: Radiofrequency ablation (RFA) temperatures reaching 45 ◦ C in adjacent tissues are cytotoxic to the spinal cord, nerves and surrounding tissues. OBJECTIVE: This study compares different RFA electrodes with regard to the temperature distribution during ablation of spinal metastases. METHODS: In vitro experimental study in isolated lumbar vertebrae of a human cadaveric spine. The temperature distribution of RFA electrodes was measured during ablation in human cadaveric lumbar vertebrae containing a simulated vertebral body lesion. The analysis compared a novel bipolar RFA electrode with two conventional monopolar RFA electrodes. A vertebral metastasis model was prepared in eight lumbar vertebrae for each electrode. Differences between the electrodes were evaluated with a one-way ANOVA. RESULTS: The lowest temperature at the thermocouples adjacent to the simulated lesion was achieved when using the bipolar RFA electrode (46.4 ± 3.3 ◦ C), but temperature difference to the monopolar RFA electrodes was not significant. In the neural foramen and epidural space of lumbar vertebrae the maximal temperature measured when using the bipolar RFA electrode was 37.0 ± 0 ◦ C and 37.3 ± 0.7 ◦ C, which was significantly lower than during ablation via either of the monopolar RFA electrodes (p 0.001). CONCLUSIONS: Temperatures in areas of adjacent tissue during RFA using a specific for spinal ablation designed electrode with integrated thermocouples were significantly lower compared to other electrodes, potentially reducing temperature related risks during ablation.

Background Smoking is a risk factor in the process of bone healing after lumbar spondylodesis, often associated with complications that occur intraoperatively or during follow-up periods. Objective To assess if smokers yield worse results concerning lumbar interbody fusion than non-smokers in a clinical comparative setting. Methods Spondylodesis outcomes in 50 patients, 34 non-smokers (mean 58 years; (range 29-81) and 16 smokers (mean 47 years; range 29-75) were compared preoperatively and one year after spondylodesis surgery using Oswestry-Disability-Index (ODI), visual analogue scale (VAS) and radiological outcome analysis of fusion-success. Results Smokers showed a comparable ODI-improvement (p = 0.9343) and pain reduction to non-smokers (p = 0.5451). The intake of opioids was only reduced in non-smokers one year after surgery. Fusion success was significantly better in non-smokers (p = 0.01). Conclusions The results indicate that smoking adversely effects spinal fusion. Particularly re-operations caused by pseudarthrosis occur at a higher rate in smokers than in non-smokers.

BACKGROUND Patients with lumbar degenerative disk disease (DDD) often require an interbody fusion. Several spacer systems have been developed to achieve an adequate fusion. The newly developed flexible interbody spacer system (Luna®, Benvenue Medical Inc.) expands to the disk space and is adjustable to the patient's anatomy. OBJECTIVE Prospective monocentric evaluation of interbody fusions performed with the new system in patients with DDD to assess the device's efficacy and safety. METHODS The study includes patients with DDD of one or two contiguous lumbar levels. All patients were treated with the new flexible cage system. To evaluate the clinical outcome, examinations were conducted preoperatively, 6 weeks, 6 months and 12 months postoperatively. At each study visit possible implant loosening was assessed by plain radiography and any adverse events were documented. Furthermore, back pain was evaluated using the visual analogue scale (VAS), functional impairment using the Oswestry-Disability-Index (ODI) and quality of life using the SF36. RESULTS A total of 30 patients (age: 52.8 ± 11 years, gender: 53% male) were included. None of the patients showed signs of implant loosening and the total number of adverse events was low (3%). The VAS improved significantly from 81.2 ± 9.5 mm at baseline to 28 ± 26.2 mm after 12-months (p ≤ 0.0001). The ODI also improved significantly from 57.9 ± 9.6% at baseline to 20 ± 15.6% after 12-months (p ≤ 0.0001). The physical component score (PCS) of the SF36 improved significantly ongoing from 29.2 ± 9.3 at baseline to 56.1 ± 14.9 after 12-months (p = 0.0079) and the mental component score (MCS) improved significantly from 49.2 ± 20.7 at baseline to 62.8 ± 18.9 after 12 months (p = 0.013). CONCLUSIONS Minimal-invasive lumbar interbody fusion with the new flexible system is a safe and effective treatment method for patients with DDD. Complication rates are low and treatment leads to an improvement of pain, functional impairment and quality of life.

Osteoarthritis is a common and progressive joint disorder. Despite its widespread, in clinical practice only late phases of osteoarthritis that are characterized by severe joint damage are routinely detected. Since osteoarthritis cannot be cured but relatively well managed, an early diagnosis and thereby early onset of disease management would lower the burden of osteoarthritis. Here we evaluated if biophysical parameters of small synovial fluid samples extracted by single molecule microscopy can be linked to joint damage. In healthy synovial fluid (ICRS-score 2/s, N = 5) than in samples from patients with joint damage (ICRS-score > 2) (4.5 μm2/s, N = 16). More strikingly, the diffusion coefficient of hyaluronan in healthy synovial fluid was on average 30% slower than expected by sample viscosity. This effect was diminished or missing in samples from patients with joint damage. Since single molecule microscopy needs only microliters of synovial fluid to extract the viscosity and the specific diffusion coefficient of hyaluronan this method could be of use as diagnostic tool for osteoarthritis.