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Biomedical subjects

D Schlenzka

Publications and source records attributed to D Schlenzka.

At least 37 records · Page 2Linked to original sources
PubMed1993

Operative treatment of adolescent idiopathic thoracic scoliosis. Harrington-DTT versus Cotrel-Dubousset instrumentation.

Radiographic outcome and complications of Harrington-DTT (H) and Cotrel-Dubousset (CD) instrumentation of idiopathic adolescent thoracic scoliosis were compared retrospectively. The patient material consists of 55 consecutive patients in the H group and 52 consecutive patients in the CD group. The mean age at operation was 15 +/- 2 years (range, 11-19 years) in both groups. The follow-up interval was 43 +/- 18 months (range, 17-91 months) in the H group and 28 +/- 11 months (range, ten to 53 months) in the CD group (p = 0.0001). The preoperative radiographic measurements (Cobb angle of primary and secondary curve, apical rotation, thoracic kyphosis, lumbar lordosis) were fully comparable in both groups. The mean correction of the primary curve at the follow-up evaluation was 47% in both groups. Apical rotation of the primary curve remained almost unchanged in both groups. Rotation of the secondary curve increased significantly in the CD group. Thoracic kyphosis was unchanged in the CD group but decreased in the H group. Spinal balance worsened in 29% of the H cases and in 44% of the CD cases. There were no neurologic complications in either of the groups. Intraoperative lamina fractures (four cases) and postoperative hook dislodgement (five cases) occurred only in the CD group. One distraction rod breakage occurred in the H group. Three reoperations were performed in the H group, nine in the CD group.

Adolescent↗
PubMed1993

Isthmic spondylolisthesis in symptomatic and asymptomatic subjects, epidemiology, and natural history with special reference to disk abnormality and mode of treatment.

Observations during the past 35 years on operative and conservative treatment of adult and young patients with isthmic spondylolisthesis, demonstrate the main indications of fusion are pain and risk of further progression of the slip. At one time, posterior fusion was recommended. Posterolateral fusion in situ was adopted in 1975, and during the past ten years anterior fusion combined with reduction and transpedicular fixation has been performed in severe slips. Surgery was mainly indicated to alleviate pain or to prevent further progression of the slip. It seems possible to alter the natural course of the disease by operation, but it is difficult to prove the connection between the radiographic findings and the pain. The epidemiologic study shows that the prevalence of spondylolisthesis in Finland is 6%, but there are no significant differences between these subjects and controls without spondylolisthesis. Symptomatic patients may have pain, however, even after a long observation time. Prevention of the slip is difficult because, statistically, 90% of the slip has already occurred when the patient is first seen. Posterolateral fusion in situ is the method of choice, especially for most young patients. Anterior fusion is indicated if the slip is greater than 40%-50%. Reduction of the slip is indicated in exceptional cases only.

Adolescent↗
PubMed1991

Intervertebral disc changes in adolescents with isthmic spondylolisthesis.

The lower lumbar discs in adolescent patients with isthmic L5 spondylolisthesis requiring operative treatment were evaluated by means of plain radiography, discography, and magnetic resonance imaging (MRI). There were 14 girls and 13 boys, mean age on admission 14.4 (range, 11-18) years. The mean slip in girls was 45 +/- 23% and in boys 27 +/- 17% (p less than 0.05). Discography was performed in 23 patients (42 discs) and MRI in 16. In 12 patients, both examinations were made. In plain radiographs, normal presacral disc height was seen in 11 patients with mean 14.5% slip, narrowing of the disc height less than 50% in four patients with mean 24% slip, and greater than 50% in 12 patients with mean 52.6% slip. In discograms and MRIs, the presacral disc was pathologic in all patients. Pathologic changes of the fourth lumbar disc were frequent. Concerning disc degeneration, there was poor correlation between findings in plain radiography compared with those seen in MRI or discography. MRI findings correlated with those of discography in most cases. However, MRI was normal in two discs with a pathologic discogram.

Adolescent↗
PubMed1991

Progression of spondylolisthesis in children and adolescents. A long-term follow-up of 272 patients.

The radiologic progression of spondylolisthesis during a long-term follow-up was studied in 272 children and adolescents. There were 134 girls and 138 boys. The mean age at the first visit was 14.3 years (girls, 13.8 years; boys, 14.9 years). The radiologic follow-up time was 14.8 years on average (range, 5-32). The operation was done in 190 patients younger than 20 years of age. Fusion in situ, using a posterior or posterolateral technique, had no statistically significant effect on progression. Surgically treated patients did not differ from conservatively treated patients. Ninety percent of the slip, on average, had already occurred at the first radiologic examination compared with the final amount of slip. More than 10% progression occurred in 62 patients, mainly within the first year postoperatively or after the first examination. Progression of the lumbosacral kyphosis and sinking of the vertebral body was noted in severe slips. Although female gender and dysplasia (spina bifida) at the lumbosacral junction were more frequent in severe slips, they statistically had no value in predicting progression. A wedge form of L5 or sacral rounding also had no prognostic value. These were secondary to the slip and expressed it but did not predict it. The only radiologic variable with predictive value of progression was the percentage amount of the primary slip. In age groups corresponding to the growth spurt in early puberty (girls, 9-12 years; boys, 11-14 years), there was a tendency to progress.

Adolescent↗
PubMed1991

Scoliosis in growing rabbits induced with an extension splint.

An external splint was applied to 49, 6-week-old rabbits to induce lordosis in the thoracolumbar junction. The splint was retained for 8 weeks, and the animals were killed after 6 months. Scoliosis developed in 23 rabbits during the splinting period. The deformity occurred about the thoracolumbar junction, and was more frequent in rabbits whose lordosis was sustained when the splint was removed after 8 weeks. The results support the view that sagittal changes are primarily or secondarily involved in the pathomechanics of scoliosis.

Animals↗
PubMed1990

Spinal stenosis subsequent to juvenile lumbar osteochondrosis.

This paper describes eight patients with spinal stenosis associated with marked osteochondrous changes in the vertebral bodies due to juvenile lumbar osteochondrosis (Scheuermann's disease). In no case was the midsagittal or interpedicular diameter of the spinal canal indicative of bony stenosis. On the other hand, in the myelograms the sagittal diameter of the dural sac was in all cases significantly narrowed, a diagnostic sign of central spinal stenosis. Therefore, myelography should always be contemplated when osteochondrous changes are present and spinal stenosis is suspected clinically regardless of whether the spinal canal diameters are normal in plain films.

Adult↗
PubMed1990

Severe spondylolisthesis in children and adolescents. A long-term review of fusion in situ.

From 1948 to 1980, 93 children and adolescents had fusion in situ for severe spondylolisthesis with a slip of 50% or more, at a mean age of 14.8 years. Of these, 52 girls and 35 boys were reviewed after a mean follow-up of 13.8 years. The mean pre-operative slip was 76% and pain frequency correlated with the severity of the lumbosacral kyphosis but not with that of the slip. Posterior fusion was used in 54, posterolateral in 30 and anterior fusion in three patients. There were no major complications but 16 had re-operations for non-union or root symptoms. At follow-up there were three non-unions. After operation, 19 patients had 10% or more progression of the slip, but 10 showed correction by more than 10% as a result of remodelling. The lumbosacral kyphosis had increased by more than 10 degrees in 45%. Postoperative progression of the slip and of lumbosacral kyphosis was significantly more if the posterior element had been removed. At follow-up 77 patients were subjectively improved, four were unchanged, and one was worse. These results did not correlate with either the degree of the slip, or the angle of lumbosacral kyphosis. Fusion in situ is safe and gives good long-term clinical results. Secondary changes are associated with increased lumbosacral kyphosis, so reduction of this should be considered in severe cases.

Adolescent↗
PubMed1990

[Experiences with lateral electric surface stimulation in the treatment of idiopathic scoliosis].

Lateral electrical surface stimulation (LESS) was used for treatment of idiopathic scoliosis in 20 children and adolescents (mean age 10.9 years, mean Cobb angle 26 drs.). Six patients were treated until skeletal maturity showing a mean curve progression of 8 degrees at follow-up. In 14 patients treatment failed due to skin irritation, sleeping disturbances or progression. Five patients had to be operated on. Twenty patients of a control group treated with Boston brace (mean age 11.9 years, mean Cobb angle 34 drs.) showed mean curve improvement of 2 degrees at follow-up. Only one patient of the control group had to be operated on. Brace treatment was superior to stimulation in this small patient group presented.

Adolescent↗
PubMed1989

Patellar motion analyzed by magnetic resonance imaging.

We have analyzed the normal patellar motion during the first 30 degrees of knee flexion by magnetic resonance imaging (MRI). Ten males and 10 females without knee symptoms were examined. The patellar articulation was imaged both sagittaly and axially with the knee flexed 0, 10, 20, and 30 degrees. The axial images were produced through the middle of the patellar articular cartilage. When the knee was in extension compared to 30 degrees flexion, the sulcus angle was greater, the lateral patellofemoral angle was smaller, there was more lateral patellar displacement, the patella tilted more laterally, and the congruence angle was directed more laterally. Differences between males and females were found.

Adult↗