INTRODUCTION AND AIM OF THE STUDY: Halm-Zielke Instrumentation (HZI), in german speaking countries also named the Münster Anterior Doublerod System, was developed to eliminate the disadvantage of VDS-Zielke in terms of lack of primary stability. Additionally sagittal plane control should be improved. Within a prospective clinical trial it was examined, if HZI fulfilled these demands. METHODS: HZI is an anterior doublerod system with a two screw per vertebral body fixation. The longitudinal components consist of a threaded VDS-rod and a solid rod. 12 consecutive patients with idiopathic scoliosis and curves ranging from 36 degrees to 77 degrees were treated with HZI. RESULTS: Correction of the frontal plane averaged 75% and 73.8% postoperatively and at follow-up, respectively. Derotation averaged 49.3%. Thoracolumbar kyphosis was present in four patients and always completely corrected. Implant related complications were not noted. All patients were treated without any additional external immobilisation. CONCLUSION: The aim of improvement of VDS in terms of primary stability and control or improvement of the sagittal plane was completely achieved.

Adolescent↗

PubMedDate not supplied

[Surgical treatment of kyphotic spinal deformities in ankylosing spondylitis using the Harrington compression system: long-term results based on the MOPO scales in the framework of a retrospective questionnaire].

INTRODUCTION: Meanwhile a lot of papers have been published concerning the operative treatment of kyphotic deformities of the spine in ankylosing spondylitis. Long term results from the patient's view-point on the basis of standardized parameters are not available. This was the intention of this study. MATERIAL AND METHODS: From 1979 to 1982 34 patients underwent surgical correction of a flexion deformity of the spine in ankylosing spondylitis. Correction was achieved with four v-shaped lumbar osteotomies using Harrington's compression system. Seven to ten years postoperatively the patients were asked to answer a questionnaire containing the Mopo-scales and a few additional questions in order to compare the patients pre- and postoperative status and evaluate the long-term quality of the operative procedure. The Mopo-scales exist of the 8 subscales mobility, physical-, daily-, household-, social activity, pain, depression, anxiety with 60 questions (items). The statistical analysis was carried out with the Wilcoxon- and Chi-Square-test using a level of significance of p < 0.01. RESULTS: Within all Mopo-subscales most items (n = 47) demonstrated significant improvement of function (p < 0.01). Whereas 11 times no significant changes could be proved, twice a significant impairment was noticed. The latter mentioned 13 items tested activities that would have been performed better in inclination, so that the results do not amaze. Visual analog scales for pain and general health status indicated significant improvement of both. 85.7% of the patients were very satisfied with the result of the operation. CONCLUSION: The results prove the long term value of the operative treatment of kyphotic deformities of the spine in ankylosing spondylitis using Harrington's compression system, although meanwhile transpedicular screw fixation instead of hooks is used, as it is well known. It can now be said in detail, which long term influences vertebral osteotomies of the spine for correction have on specific activities and health conditions in these patients.

Activities of Daily Living↗

PubMedDate not supplied

[10-year results following surgery of idiopathic scoliosis using the Harrington technique (work by the "Conference of German-language Spinal Surgeons)].

From 1972 through 1976 90 patients with idiopathic scoliosis underwent posterior spine fusion using Harrington instrumentation. Follow up was 10 years or more with an average of 12 years. The most frequent and most serious complications occurred in adults with scoliotic deformities of more than 90 degrees. Vital capacity of adults improved more than 20 percent. In young patients with low grade scoliotic spines a better immediate postoperative correction was achieved. There was also a higher loss of correction later on in this group. Thus in the long term follow up there was no correlation between magnitude of the preoperative curve and postoperative correction.

Adolescent↗

PubMedDate not supplied

[Spondylodiscitis in kyphotic deformity of ankylosing spondylitis and its healing affected by dorsal correction osteotomies. Report of 33 patients].

Out of 144 patients with kyphotic deformities in Ankylosing spondylitis 33 (23%) had 45 disco-vertebral lesions of the spondylodiscitic type. They were characterized by osteolyses, scleroses and absence of syndesmophytes. 5 had additional arch fractures. All were localized in or below the apical vertebra in the lumber or the lower thoracic spine. Compared with the total collective strong pain, high sedimentation rates and extravertebral manifestations were more frequent, osteoporosis rare, and the degree of kyphosis and the types of ossification same. The radiology showed the lesions as inflammatory etiology. Functionally, however, they are pseudarthroses. All spines were lordosed by dorsal osteotomies and therewith statically corrected and for one year externally immobilized. The spondylodeses fusioned in this time. Complications did not occur on account of the spondylodiscites. The therapy of kyphosis had an influence on the spondylodiscites. They all healed except for one. After a follow up of two years 98% were completely fused, also those with non-identical levels of correction and lesion. The loss of correction in the segments of lesion was negligibly more than in the total collective. 91% of the patients were pain-free compared to 12% preoperatively. The spondylodiscites were no hindrance for dorsal lordosing osteotomies and can be treated successfully by means of this static correction and the immobilisation.

Adult↗

PubMedDate not supplied

[A 10-year follow-up of the Harrington operation in congenital scoliosis and scoliosis due to poliomyelitis and neurofibromatosis].

From 1972 through 1976 40 patients with congenital scoliosis, scoliosis in neurofibromatosis and scoliosis following poliomyelitis underwent posterior spine fusion using Harrington instrumentation. Follow up was 10 years or more with an average of 12 years. 63 percent of all patients showed a curve of more than 90 degrees before operation. The different types of scolioses revealed characteristical results according to their etiology during long time follow up. Concerning long time reduction of curve the best results were obtained in patients following poliomyelitis. Patients with congenital and neurofibromatous scoliosis showed loss of correction 2 and 5 years postoperatively.

Adolescent↗

PubMedDate not supplied

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

Due to incorrect use of nomenclature, scolioses are incorrectly classified in the paper by Altekruse and Heine. The angle measurement is inaccurate and does not correspond to Cobb's measuring method. The accuracy of the scientific statement and its value can be derived from this. The results of treatment obtained by Altekruse and Heine were improvement in or standstill of the scoliosis in 80% of the cases and progression in over 17%. This corresponds to the "Natural History of Scoliosis:" 5 to 25% of juvenile scolioses (age 3 to 10 years according to Drummont) are progressive, the figure for adolescent scolioses being lower. Therefore, electrostimulation is used to 70-80% in cases requiring no treatment, where there is no progression, in which there are no structural changes or which should be classified as malposture, in which spontaneous remission usually occurs or which remain stationary. In scolioses of over 25 degrees, with proven progression and structural changes, and possibly also with positive family history, electrostimulation fails. As in almost all papers published to date, Altekruse and Heine's paper disregards the behavior of the sagittal curvature of the spine under electrostimulation. We demonstrate in two cases that electrostimulation can have a considerable pathologic effect, causing lordosis. Since, on the basis of recently adopted opinions, there is reason to believe that there is a causal connection between lordosis and the pathogenesis of scoliosis, it must be assumed that in such cases electrostimulation incites or aggravates the development of scoliosis or is at least potentially capable of doing so. At any rate, in the two cases in which it was demonstrated that electrostimulation caused lordosis, the scoliosis was significantly aggravated, so that in these cases at least it must be assumed that the method has a health-damaging effect. Electrostimulation is a cost factor which does not seem justifiable today, with economy an obligation. The cost of using it in a mere 100 cases would be sufficient to pay for proper screening of all the children in one school year in the Federal Republic. Children who are really at risk could be given effective treatment. In Sweden, this has resulted in 60% of the scoliosis operations previously required in populations of the same size no longer being necessary.

Adolescent↗

PubMedDate not supplied

[Comparison of the effects of lordosis on the thoracic spine using the Milwaukee and Gschwend brace in scoliosis and kyphosis].

64 patients in Milwaukee-Brace and 32 patients in Gschwend-Brace have been assessed for creating lordosis of the thoracic spine. In both types of braces induction of lordosis can be observed although there did not seem to exist a directly proportionate relationship towards the period of treatment. The degree of correction in the thoracic spine depends on the kyphosis at the onset of treatment. In marked kyphosis exceeding 60 degrees or corresponding kyphotic components in scoliosis the Milwaukee-Brace is preferred over against the Gschwend-Brace. In a pure kyphosis with minimal scoliotic curve the Gschwend-Brace remains the treatment of choice.

Adolescent↗

PubMedDate not supplied

[Stabilization of the lumbosacral segment by distracting posterolateral spondylodesis using the Zielke divided sacral strut. Analysis of 400 cases based on indications, results and cause of errors].

Out of 400 patients who underwent posterolateral or purely dorsal spondylodesis of the lumbosacral joint with a divided sacral strut or sacral knee using distracting Harrington struts, a total of 68.5% were free of complaints--100% in cases of fractures and destruction, spondylarthroses and osteochrondroses, 73% in cases of spondylolyses with and without spondylolistheses, and only 49% among the so-called "failed-back" patients who had already undergone one or more previous operations. Where results were poor, particularly in the group of failed-back patients, when surgical error, pseudarthroses, or inadequacies of instruments were ruled out, it could be assumed in approximately 80% of the cases that these patients simultaneously had a pension claim under review or had attempted to institute proceedings at a social insurance tribunal. In such cases the goal of treatment desired by the surgeon, i.e., pain-free stability, cannot be the aim of the patients. Freedom from pain means ability to work, and loss of the pension or the pension litigation. It is almost endemic among these patients to put the blame on the same exogenous mechanisms, as far as both time and cause are concerned, in order to obtain certification of their inability to work. The suspicion that they use the operation to prove the severity of their disability is in many cases justified. The high incidence of psychosocial problems is at least a partial explanation of why the measures we took in our efforts to improve the results of surgery failed. We changed the position of the patient, extended the duration of hospitalization, revised our implantation method, verified plasters and braces. To no avail. Essentially, the result of surgery was influenced by four factors: the number of previous operations, drug and alcohol abuse, pseudarthrosis, and simultaneous pension claims. In 1983 and 1984 the number of patients without pain soared. Basically, this is probably due to the fact that in the light of the results of this investigation, more stringent criteria were applied with regard to the selection of patients. If the patient has a claim against a social insurance institution, a private insurer, or physicians who have treated him/her previously (!!!) we refuse to operate. It is unlikely that these patients will be pain-free before the proceedings in question are terminated. This much we have learned from this analysis.(ABSTRACT TRUNCATED AT 400 WORDS)

Follow-Up Studies↗

PubMedDate not supplied

[Study of dorsal erection osteotomy in kyphosis].

Presented is a procedure for the correction of the juvenile kyphosis and the kyphotic false posture upon spondylitis ankylopoietica. Upon spine dissects the extraction and outbreak force of screws and screw pairs dorsally brought into the vertebral body were measured. It has been showed that the pedicle screws tolerate very high extraction forces upon sagittal and right-angle stress as well. The correction of the juvenile kyphosis upon rigid kyphosis and the correction by lordosing the thoraco-lumbar transition upon patients with a spondylitis ankylopoietica is clinically possible with good results.

Adolescent↗