Biomedical subjects

C Carstens

Publications and source records attributed to C Carstens.

At least 55 records · Page 3Linked to original sources

PubMedDate not supplied

[Controlled distraction as a therapeutic option in moderate degeneration of the intervertebral disc -- an in vivo study in the rabbit-spine model].

AIM: The aim of this study was to investigate the effects of temporary distraction on a degenerated intervertebral disc to characterize regenerative changes associated with disc distraction. METHOD: New Zealand white rabbits (n = 32) were used for this experimental animal study. The rabbits were randomly assigned to one of five groups. 6 animals were loaded for 28 days using a custom-made external loading device to stimulate disc degeneration (G2). In 6 animals the discs were first loaded for 28 days and after 28 days loading time the discs in six animals were treated as dynamic distraction with an external distraction device (G1). In six animals the discs were distracted for 28 days without previous loading (G5) and in six animals the discs were loaded for 28 days and afterwards the loading device was removed for 28 days for recovery without distraction (G3). Six animals were sham operated (G4) without application of axial load. After 28 to 56 days loading and distraction time, the animals were sacrificed and the lumbar spine was harvested for histological and radiographic analysis. Histology was performed according to a degeneration score and disc height was calculated radiographically. For the cell viability examination, the number of apoptotic cells was determined. RESULTS: After 28 days of loading (G2), the discs showed a significant decrease in disc space of the treated segment. Histologically, a disorganization of the architecture of the annulus occurred. The number of dead cells increased significantly in the annulus and cartilage endplate. These changes were reversible after 28 days of distraction (G1). The disc thickness increased significantly to physiological levels as compared to the specimens from the 28 days loading group without distraction. Histologically, the discs showed signs of tissue regeneration after 28 days of distraction (G1). The number of apoptotic cells decreased significantly in comparison to the loaded discs without distraction (G2). CONCLUSION: The results of this study suggest that disc regeneration can be induced by axial dynamic distraction in the moderately degenerated rabbit intervertebral disc. The decompressed rabbit intervertebral discs showed signs of tissue recovery at the cellular and histological levels after temporary disc distraction.

Animals↗

PubMedDate not supplied

[Experience in operations for scoliosis in patients with cerebral palsy].

AIM: Experiences in operation of scoliosis in cerebral palsy are very different. Therefore a therapeutic regiment does not exist. In this study we want to report our experiences. METHODS: This retrospective-clinical study (1986-2003) includes 46 patients with cerebral palsy who had been operated for scoliosis. The data focus in particular on the therapeutic strategies and its success and complications. Publications from 1946 to 2003 were reviewed and served for comparison. RESULTS: 28 female and 18 men during one period by median 3.4 years were after-observed. The post office-operationally reached correction of the curvature of all operation procedures was appropriate for median between 51 and 68 % depending upon localization of the curvature. In the last re-examination median a correction loss of 3-25 % existed. A fusion to S1 corrected a thoraco-lumbale or lumbale scoliosis significantly better than a fusion to L5. The posterior and the combined posterior-anterior operation procedure showed comparable correction results. The total complication rate was with 35 %. CONCLUSIONS: Due to good correction successes and smaller complication rate we favor a posterior-anterior operation procedure. A fusion to S1 is indicated with thoraco-lumbale and lumbale fusion. Altogether complication rate was reduced in patients with scoliosis and cerebral palsy after operation at the spinal column in the last years.

Cerebral Palsy↗

PubMedDate not supplied

[Health-economic considerations for the use of BMP-2 for spinal surgery in Germany].

INTRODUCTION: BMP-2 can replace autogenous bone grafting in lumbar one-level anterior lumbar interbody fusions (ALIF). The current G-DRG system does not reimburse the upfront price of 2,970 euro per BMP-2 application for hospitals in Germany. The purpose of the current study was to create a health economic model to evaluate the financial savings for health care providers (hospitals) and health care payers (health care insurance) that can be achieved by the use of BMP-2 in spine surgery. METHODS: A previously published pooled data analysis was used in which BMP-2 showed significant improvements in the treatment after ALIF surgery compared to autogenous bone grafting, including earlier return to work time and reduced revision rates. These medical findings were transformed into economic data based on the regulations of the German health system of 2005. RESULTS: The significantly shorter return to work time under BMP-2 treatment generates important financial savings for health care insurances offsetting the upfront prize of 2,970 euro for BMP-2. Savings for hospitals are mainly related to shorter surgery time due to the absence of the bone grafting procedure and faster discharge of the patient. CONCLUSIONS: The combination of improved medical outcome by BMP-2 treatment for the patient and net savings for the entire health care system in Germany represents a "dominant" strategy from a health economic perspective. This implicates that BMP-2 in ALIF procedures is to be recommended from a health economic point of view for the German health care system.

Bone Morphogenetic Protein 2↗

PubMedDate not supplied

[Orthotic treatment and walking ability of patients with myelomeningocele--analysis of influencing factors].

In 106 patients with myelomeningocele, which were fitted with orthotic devices, we analyzed the influence of level of neurologic deficit, scoliosis and contractures of the lower extremities on different walking parameters, e.g. orthotic wearing time, duration of walking and velocity, step length and mobility status. The most important factor is the level of neurologic deficit. From a functional point of view a bilateral hip dislocation can be neglected. Whereas impairment of walking ability is strongly correlated with scoliosis of more than 50 degrees and unilateral hip dislocation; therefore both conditions should be treated operatively.

Adult↗

PubMedDate not supplied

[Development of paralytic scoliosis in myelomeningocele].

Among other things the probability of developing a scoliosis in myelomeningocele depends on the patients age, the neurological level of lesion and the localisation of the vertebral arch defect. This study tries to analyse the influence of these factors in 465 patients with MMC and paralytic scoliosis. The results show, that the patients age and the neurological level of lesion are the most important factors for the development of paralytic scoliosis. The statistical evaluation based on the data found permits the determination of regression lines, which allow an estimation of further progression of paralytic scoliosis with respect to the neurological level of lesion and the patients age. At levels of paralysis between Th 3 and Th 12 an average progression of 3.5 degrees per year can be expected. Between L 1 and L 3 the progression rate can be estimated to be 2.5 degrees per year. At levels of paralysis distal to L 3 one can expect to find no significant development of scoliosis. In cases, which exceed the prediction interval, additional intraspinal anomalies, i.e. syringomyelia, must be considered and further examinations including MRI are required.

Adolescent↗

PubMedDate not supplied

[The effect of halo-gravity traction in the preoperative treatment of neuromuscular scoliosis].

The purpose of this study is to evaluate the influence of halo-gravity-traction on paralytic scoliosis in various neurologic diseases. Between 1980 and 1993 preoperative halo-gravity-traction was applied in 32 patients with paralytic scoliosis (23 patients with myelomeningocele, 6 patients with poliomyelitis, 3 patients with cerebral palsy). In the myelomeningocele group the average curvature before treatment was 97.8 degrees, after surgery 45.1 degrees; which is an improvement of 53.9%. Halo-gravity-traction accounted for 12.8% improvement. In the poliomyelitis group the average curvature before treatment was 104.3 degrees, after surgery 58.0 degrees; which is an improvement of 44.4%. Halo-gravity-traction accounted for 16.9% improvement. In the cerebral palsy group the average curvature before treatment was 75.0 degrees, after surgery 39.0 degrees; which is an improvement of 48.0%. Halo-gravity-traction accounted for -2.7% improvement. If there is an effect the question remains, whether this will have consequences for the surgical outcome. The comparison between good and bad responders with the surgical result shows, that this result is independent of the halo-gravity-traction. From this results we draw the conclusion, that preoperative halo-gravity-traction can not be recommended in paralytic scoliosis.

Adolescent↗

PubMedDate not supplied

[Surgical treatment of hip dislocation in patients with infantile cerebral palsy].

The results of 63 operations on 52 patients with cerebral palsy, which were performed between 1978 and 1988 to correct a subluxation or dislocation of the hip, were reviewed. The innominate pelvic osteotomy was preferably combined with intertrochanteric femoral osteotomy and soft tissue release. The average age at time of surgery was 7 years/2 months. Surgical intervention was indicated irrespective of the severity of neurologic involvement. The mean follow-up period is 3 years/4 months. The results show, that by a combinations of these surgical procedures a permanent stability of the hip joint can be achieved. Retrospectively the 5 cases of reluxation can be explained by insufficient surgical technique. The postoperative development of the CE-angle and the acetabular index reveal, that after adequate reduction of the femoral head the acetabulum is able to remodel its dysplasia. From a functional point of view actually patients with diplegia gained the most benefit from a stable hip joint, because they showed the most progress in motor activity. In tetraplegic patients the long-term success of these surgical procedures must be seen in the prevention of a painful hip in adult life, the maintenance of sitting-stability and the improvement of perineal care condition.

Adolescent↗

PubMedDate not supplied

[Surgical correction of clubfoot in patients with myelomeningocele].

Between 1974 and 1991, 100 equinovarus deformities in 65 patients with myelomeningocele have been primary operated at the authors clinic. Aim of our treatment was a plantigrade position of the foot, to give the possibility of an orthetic supply. 75% of our patients reached this result after the first operation, 25% had to be operated once more. The incision was done in the way of Cincinnati. According to the level and type of paralysis the operative treatment had to be adapted. We could reach good results of treatment in group 1 (thoracal to L2) with 64% of plantigrade feed as well as in group 3 (L5 to sacral) with 61%. Group 2 (L4 to L5) was worse with 32%. Within all types of paralysis there was a better result while doing a tenotomy. Paralysed muscles should be cut, innervated muscles should be extended to keep the function. Important is the reconstruction of a balance of the muscles. While you have a forefoot varus, a plentiful medial release is necessary. After the operation a cast was given for 8 to 12 weeks, followed by special shoes and nightly storage in stales. Corresponding to the treatment of idiopathic equinovarus deformity the beginning of therapy should be started after birth and should be completed while the child begins to verticalize.

Adolescent↗

PubMedDate not supplied

[Aortographic findings in children with myelomeningocele and lumbar kyphosis].

The findings in abdominal aortography performed preoperatively in 21 children with myelomeningocele (MMC), which underwent kyphectomy due to congenital kyphosis of the lumbar spine, are reported. In no case did the aorta follow the kyphotic radius of curvature. It rather seemed to be strung over the kyphosis like a tendon over a bow. An intraoperative lesion of the aorta seems rather unlikely, and this is why we believe, that a routinely performed preoperative abdominal aortography is not necessary. We found a remarkable number of anomalies of the intercostal and segmental arteries, which were only in part associated with deformities of the vertebral bodies. The kidneys seemed to be imbedded in the kyphotic concavity, partially with the inferior pole, partially in whole. In these cases the risk of intraoperative lesion seems higher. We found a number of cases with unilateral agenesis of the kidneys in the patients examined by us. Therefore we suggest the use of noninvasive methods prior to surgery in order to evaluate the presence of malpositions or malformations of the kidneys.

Abnormalities, Multiple↗

PubMedDate not supplied

[Malformations of the human tail bud or: caudal agenesis syndrome. A review].

This study presents radiological and clinical findings in 70 patients with aplasia of caudal spinal segments and associated anomalies of the lower extremities and the inner organs. From a functional point of view 5 different types can be classified--unilateral hemi-aplasia, bilateral aplasia with or without sacral plateau, complex malformations of the caudal spine and medial spinal aplasia. Foot deformities and anomalies of the inner organs are common findings regardless to the extent of spinal aplasia, whereas popliteal webbing is only seen in cases with involvement of the lumbar spine. The lack of osseous junction between the spine and the pelvis leeds to a lumbopelvic kyphosis. Additionally the iliac wings are rotated in the frontal plane with the result of a narrow pelvic outlet and a change in the geometry of the hip joints. Embryologically all types of caudal spinal aplasia can be referred to a damage of the human tail bud. However, the term "Syndrome of Caudal Regression" is misleading; with respect to the presented results it is proposed to call this type of spinal malformation "Syndrome of Caudal Aplasia".

Abnormalities, Multiple↗

PubMedDate not supplied

[Fractures and epiphyseal injuries in children with myelomeningocele].

Between February 1971 and February 1988, 947 children with myelomeningocele were treated at the Model Center of Heidelberg University Orthopedic Clinic. In 82 of these children, a total of 224 osseous lesions were seen. Metaphyseal and diaphyseal fractures were far more common than epiphyseal lesions, among which epiphysiolysis dominated. Diagnostically important symptoms included swelling, local hyperthermia, and high temperature. Owing to the paralysis, pain is of no value in diagnosing fractures. Protruding periosteal detachments are a common feature of lesions, and if this special form of healing of such fractures is unknown they may cause problems in differential diagnosis. Fractures in children with spina bifida should be treated conservatively, except for fractures of the femoral neck and epiphyseal lesions, which are treated with transcutaneous Kirschner wiring. Immobilization in plaster, postoperatively and during treatment of the injury, is the most common cause of osseous lesions in spina bifida children. Immobilization in plaster should therefore be minimized.

Adolescent↗

PubMedDate not supplied

[Intraspinal anomalies in myelomeningocele].

This study reports the results of MRI analysis of the spinal cord in 83 patients with myelomeningocele. 63 patients had a "tethered cord" or a "suspected tethered cord". In 14 cases we found a "hydro-/syringomyelia". In only 2 cases there were no pathological findings. The influence especially of the "tethered cord" and the "hydro-/syringomyelia" on the development of deformities of the locomotor apparatus is discussed. Concerning this problem the experience reported in the literature is not sufficient enough to make final statements. However, in cases of deterioration of the neurological status in patients with myelomeningocele the influence of intraspinal anomalies should be considered giving rise to further diagnostic examinations.

Adolescent↗

PubMedDate not supplied

[Hip joint problems in patients with Down's syndrome].

10 patients with Down's syndrome and hip disorders have been examined. Hip instability was present in 5 patients: habitual dislocations occurred in 2 patients, persistent subluxation was found in 2 patients and 1 patient had bilateral fixed hip dislocation. Hip instability usually occurs after the begin of walking and we suggest to perform regularly radiographic examinations on hip instability. Other hip disorders as slipped femoral capital epiphysis may be complicated by hip instability. Legg-Calvé-Perthes disease was found in 2 patients and slipped femoral capital epiphysis in 3 patients. 7 of the 10 patients underwent operative treatment. Subsequently a second or third operation was necessary in 2 patients because of an unexpected instability of the hip following the primary surgery. This was caused by the ligamentous laxity which is often found in Down's syndrome. An increased rate of infections is known in trisomy 21 and wound infections occurred in 2 of the 7 operated patients. Therefore we recommend to consider ligamentous laxity and susceptibility to infection in the treatment of hip disorders in Down's syndrome.

Adolescent↗

PubMedDate not supplied

[Results of surgical therapy of knee flexion contractures in patients with myelomeningocele].

This study reports the results of 98 operations for correcting knee-flexion-contractures, which were performed between 1972 and 1989 in 60 patients with myelomeningocele. 13 knees had hamstring lengthening and 85 knees had radical flexor release. In 4 patients, who had flexion-contractures of more than 50 degrees, the soft tissue release was combined with supracondylar extension osteotomy. 58 patients had additional hip-flexion-contractures and 39 patients had feet deformities. The average age at time of surgery was 8 years, 3 months. The average follow-up-period was 65 months with a minimum of 1 year and a maximum of 13 years. In 92 knees a permanent extension ability could be achieved. In 6 knees a recurrence of flexion-contracture occurred making a second surgery necessary. The main problem in the postoperative period were 13 skin necroses, which were seen mainly after an s-shaped incision. As a conclusion a perpendicular midline incision is recommended. After surgery 11 patients could be provided for the first time with an orthoses. In the remaining the upright body position or the erection of the orthoses could be improved.

Adolescent↗

PubMedDate not supplied

[Spinal surgery on patients with myelomeningocele. Results 1971-1990].

Between 1971 and 1990 33 kyphectomies were performed at the Orthopaedic Hospital, University of Heidelberg. The average age at time of surgery was 5 years/5 months; the follow-up period was 5 years. The best results were obtained in the group with congenital rigid kyphosis. A marked postoperative deterioration was considered in patients with a flexible paralytic kyphosis, probably due to a too short area of fusion. In 19 patients the correction of the kyphotic deformity was the prerequisite for being provided with orthotic devices. The most serious complication was the intraoperative death of 3 patients. It can be presumed, that after transection of the spinal cord a non-functioning CSF-shunt lead to an acute elevation of the intracranial pressure. Therefore an adequately functioning shunt must be secured preoperatively.

Adolescent↗

PubMedDate not supplied

[How idiopathic is idiopathic scoliosis? Results of neurological studies with somatosensory evoked potentials (SSEP) in children and adolescents].

UNLABELLED: About 90% of all the scolioses are called "idiopathic". Various neurological diseases (for example poliomyelitis, etc.) are frequently accompanied by deformities of the spine. The so-called somatosensory evoked potentials are at our disposal being a very sensitive and a non-problematic neurological diagnostic tool. Formation of the question: Are there clinically non-detectable neurological changes demonstrable by use of evoked potentials in children with so-called idiopathic scoliosis? 45 non-operated patients suffering from scoliosis and 21 healthy children were examined clinically, neurologically, and by use of evoked potentials. RESULTS: 26/45 children with idiopathis scoliosis showed pathological evoked potentials (right-left-side-difference concerning latency and amplitudes of the potentials and generally delayed transmission from peripheral nerves to the somatosensory cortex), mostly concerning the lower extremities. 19/45 children showed normal evoked potentials (EP). There was no correlation between EP and direction respectively degree of the scoliosis. Neurological affections mostly located caudally of the cervical spine are to be discussed (for example protrusion of the intervertebral disc, dysrhaphic processes etc.).

Adolescent↗

PubMedDate not supplied

[Experiences with surgical therapy of scoliosis in patients with myelomeningocele].

This study reports about the experiences in surgical correction of scoliosis, which were performed between 1984 and 1989 in 32 children with myelomeningocele. The average age at time of surgery was 14 years, 1 month; the average degree of scoliosis was 96 degrees preoperatively. 6 different types of surgical techniques were used. In comparison the best results were obtained by a combination of ventral osteodiscectomy with or without instrumentation and dorsal CD-instrumentation; an improvement of 56% was found. Furthermore we sent questionnaires to all patients, who were operated more then one year ago. The majority of them judges the improved sitting stability of the trunk to be the greatest advantage. There is a high rate of postoperative complications. Beside one death, which occurred intraoperatively, especially pseudarthroses of the lumbosacral junction must be mentioned. These pseudarthroses and a to short selected area of fusion are the main reasons for the loss of correction, which was noticed after a mean follow-up period of 24.6 months. The necessity of postoperative bracing was not reduced by using CD-instrumentation.

Adolescent↗

PubMedDate not supplied

[Proton spin tomography in children and adolescents with so-called idiopathic scoliosis].

Somato-sensory evoked potentials (SSEP) were found to be pathological mostly in the lower extremities in 26 out of 45 children suffering from so called idiopathic scoliosis. We examined the vertebral spine and the spinal cord of 8 of them (with controlled SSEP-findings) by use of conventional MR-imaging and (where necessary) 3-dimensional-data-set following the Fournier-procedure. 6 of the 8 children showed alterations as follows: 1. A lipoma spreading partly extra-, partly intraspinally. 2. Subligamentous protrusions of the intervertebral disc (2 patients). 3. Dysraphic processes (2 patients). 4. An abnormally cranial ending myelon surrounded by a widened spinal channel. The findings are demonstrated and discussed concerning the questions whether the pathological SSEP and, furthermore, the deformity of the vertebral spine could be explained thereby. We are at least able to prove that some of the children with so called idiopathic scoliosis show pathological evoked potentials and MRI-findings.

Adolescent↗