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Biomedical subjects

C Hamburger

Publications and source records attributed to C Hamburger.

At least 19 recordsLinked to original sources
PubMed2001

Ventral discectomy with pmma interbody fusion for cervical disc disease: long-term results in 249 patients.

STUDY DESIGN: Retrospective study of patients who underwent ventral discectomy and polymethyl-methacrylate (PMMA) interbody fusion for cervical radiculopathy. OBJECTIVES: To evaluate the long-term outcome after ventral discectomy and PMMA interbody fusion and to compare it with previous data from other surgical techniques for the treatment of cervical radiculopathy. SUMMARY OF BACKGROUND DATA: Because PMMA interbody fusion after ventral discectomy does not result in solid bony fusion in all cases, a good long-term outcome using this surgical technique has been questioned. METHODS: Long-term follow-up evaluation after surgery was performed in 249 patients (96 women and 153 men) with radicular signs only. The mean age was 46.0 +/- 8.7 years (range, 24-74 years), and the observation time ranged from 10-15 years (mean, 12.2 +/- 1.2 years). Clinical grading after surgery according to Odom's criteria was based on a questionnaire. The outcome was related to morphologic findings, lumbar symptoms, physical stress, duration of symptoms, age, sex, and cervical level involved. RESULTS: Complications related to surgery occurred in 13 (5.2%) patients, but only three (1.2%) had persistent problems. Of the 249 patients, 101 (40.6%) were without any symptoms (Odom I), 92 (36.9%) had a good outcome (Odom II), and 47 (18.9%) a fair outcome (Odom III). Only nine patients (3.6%) reported an unchanged or worse status than before surgery (Odom IV). Additional lumbar symptoms, high occupational physical stress, and discrepancy of preoperative findings were significantly correlated with a worse outcome. Short duration of symptoms and soft disc disease were favorable prognostic factors. CONCLUSIONS: PMMA interbody fusion after ventral discectomy in cervical disc surgery is a safe and reliable method with few complications and an outcome comparable with other ventral procedures.

Adult↗
PubMed1999

Cavernous haemangiomas of the spinal cord. A review of 117 cases.

Intramedullary spinal cord cavernous haemangiomas are rare lesions that can cause severe myelopathic symptoms. The purpose of the present study was to define the pattern of clinical presentation, part of natural history, prognostic factors and therapeutic strategies considering both our own experience and reports from the literature. The data of 48 studies (published between 1903 and 1996), presenting information of all together 107 patients (108 lesions) regarding pre-treatment clinical and radiological factors, treatment strategies, and the outcome, plus our own experience of nine patients were retrospectively re-analyzed. The prognostic influence of pretreatment factors was estimated with the chi-square statistics. Clinical evaluation before/after treatment was performed using the Frankel scale. The average bleeding rate was obtained from the ratio of percentage of first bleeding events in the population to the mean age of the population. There were 47 males and 69 females (aged from twelve to 88 years). Thirty nine percent of the lesions were found in the cervical, 54% in the thoracic (30% upper, 24% lower) and 7% in the lumbar cord. The peak age of presentation was in the fourth decade, the median duration of symptoms was 32 months. Clinical symptoms before treatment were progressive in all cases. Three patterns of clinical presentation could be identified: a) episodes of stepwise clinical deterioration (30%), b) slow progression of neurological decline (41%), c) acute onset with rapid or gradual decline over weeks or months (26%). 58% of the lesions showed clinical or radiological signs of haemorrhage. In 66% of surgical patients (91 efficiently documented cases), clinical improvement was achieved, 28% remained unchanged and 6% deteriorated. Whereas age, sex and lesion location had no influence on the results, duration of symptoms (< three years) correlated significantly to a better outcome (p < 0.02). Surgical management in symptomatic patients is recommended. Once clinical signs caused by the malformation have appeared, the patients tend to experience progressive neurological deterioration.

Adolescent↗
PubMed1998

Spinal epidural cavernous hemangiomas. Report of three cases and review of the literature.

Epidural cavernous hemangiomas are increasingly identified as a cause of acute or chronic progressive spinal cord syndrome and local back pain or radiculopathy. The authors present three cases of spinal epidural cavernous hemangiomas manifesting as spinal cord syndrome, thoracic radiculopathy, and lumbar radiculopathy. Based on the imaging characteristics of these three cases and a review of the literature, the clinical signs and symptoms and their implications, the role of preoperative neuroradiological diagnosis, and the need for complete surgical resection are discussed. Epidural cavernous hemangiomas display consistent magnetic resonance imaging properties: T1-weighted images most commonly show a homogeneous signal intensity similar to those of spinal cord and muscle, and contrast enhancement is homogeneous or slightly heterogeneous. On T2-weighted images the signal of the lesion is consistently high and slightly less intense than that of cerebrospinal fluid. Frequently, the lesion is characterized by its extension through the intervertebral foramen. Awareness of these characteristics facilitates diagnosis and treatment of the lesions. Despite the risk of bleeding, in all three cases complete surgical excision was achieved.

Adolescent↗
PubMed1997

The cross-sectional area of the cervical spinal canal in patients with cervical spondylotic myelopathy. Correlation of preoperative and postoperative area with clinical symptoms.

STUDY DESIGN: Retrospective analysis of routine computed tomography investigations. OBJECTIVE: To investigate whether the extent of clinical symptoms in patients undergoing surgery for cervical spinal myelopathy depends on the transsectional area of the cervical spinal canal. METHODS: Forty-five patients underwent surgery using different techniques to enlarge the width of the spinal canal. For clinical evaluation before and after surgery, a modified score of the Japanese Orthopedic Association was used (mean follow-up period, 19.6, 9.1 months). The cross-sectional area of the spinal canal in computed tomography scans (C4-C6) was quantified 1 day before and 1 week after surgery using pixel-dependent area calculation software for three different density ranges given in Hounsfield units. RESULTS: After surgery, a significant enlargement of the cervical spinal canal of 78.2 +/- 55.9% could be achieved. The Japanese Orthopedic Association score increased significantly by 3.7 +/- 2.2 points from a median preoperative score of 10 to a score of 14 after surgery. Patients with a preoperative Japanese Orthopedic Association score > or = 10 achieved a significantly better outcome after surgery. Conversely, no patient with a postoperative area larger than 1.6 cm2 achieved a score of less than 12 Japanese Orthopedic Association-points. No significant linear correlation, however, was found between the postoperative transsectional area and the postoperative Japanese Orthopedic Association score of all patients. CONCLUSION: The preoperative clinical presentation of the patient was found to be the only prognostic hint for improvement after surgery. Preoperative area measurements of the spinal canal cannot be used as a prognostic tool for surgical outcome. Further, the postoperative measurements do not correlate with the clinical outcome. These data, however, which refer to C4 to C6, provide evidence that every surgical procedure to enlarge the cervical spinal canal should result in an area of 1.6 cm or more.

Cervical Vertebrae↗
PubMed1997

Spinal cord compression caused by the rod of a Harrington instrumentation device: a late complication in scoliosis surgery.

We report a unique complication caused by the rod of a Harrington instrumentation device, which resulted in spinal stenosis and myelopathy. A literature review revealed no previous causes of direct spinal cord impingement caused by the rod of a Harrington device. In this case, years after the initial operation, the rod penetrated the lamina at the junction between a thoracic and a lumbar curve, causing spinal stenosis and myelopathy. We conclude that regular control of the position of the device and awareness of possible late neurological complications are necessary to identify such complications as early as possible.

Female↗
PubMed1997

Imaging findings in patients with ventral dural defects and herniation of neural tissue.

The aim of this paper is to describe clinical and imaging findings in three patients with ventral dural defects and herniation of the spinal cord or cauda equina. The literature is reviewed and the clinical, radiological and operative findings are compared. Three patients with ventral dural defects of different etiologies are presented. One patient gave a longstanding history of ankylosing spondylitis, the second patient presents 37 years after spinal trauma, and the third patient presents with spontaneous spinal cord herniation. All patients had typically slowly progressive neurological symptoms with multiple hospitalizations until diagnosis was made. Characteristic findings in postmyelographic CT included a ventral or ventrolateral displacement with deformation of the spinal cord or the cauda equina. Sagittal MRI showed this abrupt and localized anterior deviation of the spinal cord or the cauda equina to the posterior portions of a vertebral body with or without a bony vertebral defect optimally. Additionally, due to the ventral displacement of the spinal cord, the dorsal subarachnoid space was relatively enlarged without evidence of an arachnoid cyst, in all patients. Magnetic resonance imaging and postmyelographic CT can diagnose ventral dural defects with spinal cord herniation or nerve root entrapment. Dural defects must be considered in the presence of neurological symptoms in cases of longstanding ankylosing spondylitis, late sequelae of fractures of vertebral bodies, and without history of spinal trauma or surgery.

Aged↗
PubMed1997

Ganglioglioma of the spinal cord: report of two rare cases and review of the literature.

OBJECTIVE AND IMPORTANCE: The goal of this article is to present the clinical and histopathological features of two rare cases of ganglioglioma occurring in the cervicothoracic and thoracolumbar spinal cord. CLINICAL PRESENTATION: A 4-year-old female patient presented with tetraparesis, whereas a 54-year-old woman showed paraparesis of both feet. INTERVENTION: Both tumors could be removed totally by microsurgical techniques. Light microscopically, the tumors in both cases showed basically identical histological features and were diagnosed as benign gangliogliomas. Postoperatively, the two patients did not show improvement. Tumor recurrence was not noted at follow-up examinations within 11 and 24 months after surgery, respectively. CONCLUSION: Ganglioglioma must be considered in the differential diagnosis of tumors affecting the spinal cord. In cases of suspected spinal ganglioglioma showing no sharp delineation from the surrounding tissue, a subtotal tumor removal should be considered to prevent severe neurological deficits.

Child, Preschool↗
PubMed1995

T-laminoplasty--a surgical approach for cervical spondylotic myelopathy. Technical note.

The T-laminoplasty allows for a generous decompression of the cervical canal. At the same time, it avoids the risk of late instability. The T-laminoplasty is an improvement over various other methods of laminoplasty for several reasons: 1. A bone graft from donor site is not needed. 2. The implanted bone graft is firmly secured, avoiding dislocation and compression of the spinal cord. 3. A fusion of two segments becomes unnecessary. 4. Implants (metal or bone) are not needed.

Cervical Vertebrae↗
PubMed1995

Modification of costotransversectomy to approach ventrally located intraspinal lesions. Preliminary report.

To minimize tissue trauma and to reduce pulmonary complications a modification of costotransversectomy is presented. This procedure has been carried out in 6 patients with ventrally located space occupying lesions in the spinal canal. The results are good, complications did not occur. We consider this technique to be less traumatic than conventional costotransversectomy while giving the same results. Whether the complication rate is lower has yet to be proved in a larger series.

Adolescent↗
PubMed1994

The treatment of spondylotic cervical myelopathy by ventral discectomy. Long term results on 121 patients.

The pathophysiology of spondylotic cervical myelopathy is still a matter of discussion. This paper presents a series of 126 patients operated on using a ventral approach. In 47% of the patients only a spondylotic narrowing of the spinal canal was present and in 35% an additional disc herniation was found. In 13% of the cases however a soft disc without spondylotic spures was found and in 5% a dislocation of vertebral bodies. We found a marked male preponderance of 77%, mean age was 51.6 years, ranging from 25-50 years. Most patients were operated on at the levels of C4/5 and C5/6. Observation time covered a period of 3-10 years. The outcome was rated relatively to the preoperative degree of disablement using a questionnaire for the patients and their family doctors. We found a marked difference in the answers, especially in rating deterioration, which was stated by patients in 34%, by physicians only in 12%. Another finding was the time-related outcome. We found best results with 75% improvement and 5% deterioration between 3-6 months postoperatively, with increasing time the results decreased to 33% improvement, 33% identical statys and in 33% a deterioration related to the preoperative status must be noted.

Adult↗
PubMed1993

Surgical treatment and results in patients suffering from lumbar spinal stenoses.

Stenosis of the lumbar spinal canal is contributing to 3-5% of all patients operated on a lumbar nerve root compression syndrome. Morphologically, a reduction of the midsagittal diameter of the spinal canal to less than 12 mm or stenoses of the lateral recessus or foramen intervertebrale have been described. In our department 37 patients with a lumbar spinal stenosis have been surgically treated between 1982 and 1987. Spinal stenosis is a disease of aged patients mostly suffering for a long history. The main symptoms are lumbar and sciatic pains, neurological deficits and a claudicatio intermittens spinalis. Neuroradiologically, the diagnosis can be confirmed by CT, myelography or MRI. These studies were demonstrating the stenosis in 69% at the level of L4/5, multiple stenoses have been found in 22% of all cases. An additional disc herniation existed in 35% of the patients. Concerning the specific complaints of the patients and their neuroradiological findings, the extent of the surgical decompression was decided on individually in each patient. We performed 22 laminectomies, 11 hemilaminectomies, in 3 cases an extended flavectomy and in one case an implantation of a dorsal column stimulation device. The postoperative follow-up period, ranging from 3 months to 3 years, demonstrated a complete recovery in 53%, a marked reduction of complaints in 44% of all cases. One patient did not respond to surgical treatment, but in the remaining cases surgical treatment led to satisfactory results.

Aged↗
PubMed1993

Motor recovery following capsular stroke. Role of descending pathways from multiple motor areas.

The functional anatomy of motor recovery was studied by assessing motor function quantitatively in 23 patients following capsular or striatocapsular stroke. While selective basal ganglia lesions (caudate and/or putamen exclusively) did not affect voluntary movements of the extremities, lesions of the anterior (plus caudate/putamen) or posterior limb of the internal capsule led to an initially severe motor impairment followed by excellent recovery, hand function included. In contrast, lesions of the posterior limb of the internal capsule in combination with damage to lateral thalamus compromised motor outcome. In experimental tracing of the topography of the internal capsule in macaque monkeys, we found axons of primary motor cortex passing through the middle third of the posterior limb of the internal capsule. Axons of premotor cortex (dorsolateral and post-arcuate area 6) passed through the capsular genu, and those of supplementary motor area (mesial area 6) through the anterior limb. Small capsular lesion can therefore disrupt the output of functionally and anatomically distinct motor areas selectively. The clinically similar motor deficits with a similar course of functional restitution following disruption of these different descending motor pathways indicate a parallel operation of cortical motor areas. They may have the further capability of substituting each other functionally in the process of recovery from hemiparesis.

Adult↗
PubMed1992

Surgical observations in extremely lateral lumbar disc herniation.

About 10% of lumbar disc herniations are localized in an extreme lateral position referred to as "extracanalicular". The clinical syndrome is a typical one with compression signs of the lateral, extra-foraminal nerve root and minimal lumbar pain. A reliable diagnosis can be made only since high resolution spinal computed tomography has become available. Surgical treatment will be rendered difficult by the "hidden" localisation of the disc fragments. A total number of 15 patients has been operated on in our department during the last year. In 10 patients, we used the lateral microsurgical approach proposed by REULEN, in five cases a combined procedure with lateral sequestrotomy and medial nucleotomy. In the first group, re-sequestration occurred in three cases and further surgery including medial nucleotomy was performed then. A good result with remission could be achieved in 13 cases, whereas in two cases with additional spondylolisthesis, lumbar back pain continued, but the radicular symptoms were reduced.

Follow-Up Studies↗
PubMed1992

Management and prognosis of intracranial giant aneurysms. A report on 58 cases.

Between 1975 and 1989, 58 patients, 32 females and 26 males, mean age 50 years, with intracranial giant aneurysms with a diameter more than 2.5 cm were treated at our clinic. 48% of the patients presented with subarachnoidal hemorrhage. The most of the other 30 patients presented with cranial nerve dysfunctions. The most common site of the aneurysm was the internal carotid artery (25 cases, 43%), followed by the anterior cerebral artery (14%), and the vertebro-basilar region (11 cases, 19%). In 14 patients direct surgery was not performed because of the poor general condition of the patient, the high risks, or non-consent. In seven patients (12%) the aneurysm had been misdiagnosed as meningeoma, pituitary-adenoma, craniopharyngeoma or glioblastoma. 47% of all patients were discharged as "independent" and 19% died. Patients without SAH had better chance of survival: 7% of patients without SAH died and 29% of patients with hemorrhage. 50% of patients without hemorrhage were discharged as "independent" but only 18% of patients with SAH. Because of the high incidence of hemorrhage and the better prognosis for patients without hemorrhage, we recommend routine surgical treatment of patients with giant aneurysms.

Adult↗
PubMed1992

[The proton MR spectroscopy of intracranial tumors. The differential diagnostic aspects for gliomas, metastases and meningiomas].

Twenty-two patients with intracranial tumours were examined by MR images and in vivo proton-MR-spectroscopy. The changes of relative concentrations of NAA, PCr/Cr, Cho, and Ins were measured spectroscopically and the amount of these metabolites were related to different tumour groups. Analysis of the results has shown that the spectra from all the tumours differed from normal spectra. All cerebral tumours showed marked reduction of the Pcr/Cho quotient and the NAA/Cho quotient was also reduced. The Ins/Cho quotient for meningiomas and metastases was also lower than in normals; in gliomas of low malignancy the quotient was slightly raised and in gliomas of greater malignancy it was significantly higher than normal. The spectra of cerebral metastases showed unusual high lipid signals of 0.9 ppm and 1.25 ppm. The only common feature for meningiomas was marked reduction of NAA concentration. In summary, localised in vivo proton-MR-spectroscopy can be used clinically to obtain valuable information for the differential diagnosis of gliomas and intracerebral metastases.

Brain Neoplasms↗
PubMed1992

The development of policy on denizens in Denmark.

"This article offers an analysis of Danish migration policy from 1960-90. The framework employed is the Swedish sociologist Thomas Hammar's concentric 'gate' model and his concept of 'denizens'. Non-Danish citizens' access to Danish society is regulated by 'gates' and security and rights increase in proportion with the number of 'gates' passed, culminating in naturalisation and full social, legal and political rights. After an initial profile of the various groups of foreigners living in Denmark, I discuss the development of policy measures regulating immigration with particular reference to the 'Law for Foreigners'. Finally I turn to the critical issue of policy on denizens."

Demography↗
PubMed1990

Neurosurgical management of cerebellar hemorrhage.

Controversy remains concerning the management of patients with cerebellar hemorrhage. In this study the records of 42 patients were reviewed. In 60% of them the signs of brainstem compression and upward transtentorial herniation were found. The level of consciousness was found to be consistent with the radiologic finding of the ambient cistern on the CT scan. Complete compression of the ambient cistern was always associated with coma, a partially compressed ambient cistern with stupor or drowsiness, while a normally shaped ambient cistern was associated with a normal level of consciousness. Immediate surgical decompression of the posterior fossa was life-saving for patients with brainstem compression and upward transtentorial herniation. Mortality was 57% for comatose patients and 9% for drowsy or stuporous patients. Ventriculostomy alone is the treatment of choice in cases with only hydrocephalus without brainstem compression or transtentorial herniation.

Adolescent↗