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M Potulski

Publications and source records attributed to M Potulski.

At least 19 recordsLinked to original sources
PubMed2004

[Conventional and semi-open kyphoplasty].

Kyphoplasty is a young method which was developed for the minimally invasive augmentation of osteoporotic vertebral fractures. In contrast to vertebroplasty, the kyphoplasty technique allows an age-dependent fracture reduction through the inflation of a special balloon in the fractured cancellous bone of the vertebral body. The cancellous bone of the fracture zone is compressed by the balloon, so that a cavity remains in the vertebral body after removing the balloon, which is filled with highly viscous augmentation material. The reduced risk of serious complications, for example epidural leakage of augmentation material, justifies progressively expanding the indications for this technique to traumatic fractures with involvement of the posterior vertebral wall and neoplastic vertebral collapse due to osteolytic metastasis. Besides the indications for the conventional percutaneous approaches, the microsurgical interlaminary approach allows the use of kyphoplasty in more complex fractures involving compression of the neural structures. Kyphoplasty induces swift pain relief and allows rapid mobilisation of patients due to the immediate stabilisation of the affected vertebral bodies. Apart from the operative intervention, the medical treatment of the primary disease and the rehabilitation of the individual patient should be optimised through an interdisciplinary approach.

Female↗
PubMed2003

[Psoas abscess after anterior spinal fusion].

We present 3 cases of secondary psoas abscess after anterior spinal fusion. Psoas abscess is still a rare clinical entity. It is often associated with unspecific symptomatology and may present as late infection. A high index of suspicion is required for early diagnosis and treatment. Computed tomography is the imaging technology of choice. Treatment includes open abscess drainage and antibiotic therapy. In secondary psoas abscess causative treatment of the primary infection focus is essential. For psoas abscess after anterior spondylodesis this includes treatment of a deep wound infection. Predisposing factors for postoperative infection are large implants, bone grafting, long operating times, previous spinal surgery, immunodeficiency and metabolic disorders. Usually several operations are necessary to eradicate infection. As long as stability is guaranteed, implant materials should be removed. Continuing antibiotic therapy for 2-3 weeks after normalization of infectious parameters is suggested. Delayed therapy results in an increase of the morbidity and mortality of psoas abscess.

Adult↗
PubMed2002

[Retrograde intramedullary nailing of knee para-articular fractures in paraplegic patients].

INTRODUCTION: Patients with spinal cord lesions suffer injury even by marginal trauma, especially in the area of the knee joint. Because of lost sensitivity and proprioception, the treatment of the fracture has to be minimally invasive but stable enough for physiotherapy. METHODS: There were 18 patients with 20 fractures near the knee: 15 fractures of the supracondylar femur were treated with a retrograde intramedullary GSH nail and 5 fractures of the proximal tibia with a new retrograde nailing technique. RESULTS: At review all patients had a good motion range of the knee joint (> 100 degrees), and ankle joint motion was free. CONCLUSION: We saw in this study that the GSH nail is an excellent method for stabilizing supracondylar fractures of the femur in paraplegic patients because the treatment is minimally invasive and the fracture is stable enough for physiotherapy. The retrograde nailing of proximal fractures of the tibia is a good alternative method for treatment of patients with spinal cord lesions.

Adult↗
PubMed2002

[Extended kyphoplasty indications for stabilization of osteoporotic vertebral compression fractures].

OBJECTIVES: Percutaneous vertebroplasty with polymethylmethacrylate allows minimally invasive stabilization of osteoporotic vertebral fractures. Fracture reduction is, however, not possible and the risk of uncontrolled epidural cement leakage with burst fractures is increased. Kyphoplasty, in contrast, allows a degree of fracture reduction and provides an extended spectrum of indications through open approaches, which enable spinal decompression and augmentation of incomplete burst fractures. METHODS. In kyphoplasty a contrast-filled balloon is inflated in the vertebra until a cavern is created. A degree of reposition may be achieved depending on fracture age. Augmentation is performed with high-viscosity polymethylmethacrylate under low pressure. In cases of neural compression, interlaminary spinal decompression and kyphoplasty through the posterior wall is performed. With anterior spinal procedures, kyphoplasty can be performed without extending the approach. RESULTS: Vertebral augmentation was performed by percutaneous, interlaminary, and anterior approaches for incomplete burst fractures. Four representative cases are presented from a collective of 120 augmentations. CONCLUSIONS: Percutaneous kyphoplasty, supplemented by open approaches, enables augmentation of osteoporotic incomplete burst fractures.

Aged↗
PubMed2002

[Mechanical testing of implant properties of thoracoscopic implantation of ventral spinal stabilizing systems. Comparative study with the ISO/DIS 12189-2 corpectomy model and an improved synthetic model].

A new modular anterior fixation system MACS TL (modular anterior construct system for the thoracic and lumbar spine) has been developed for use in thoracoscopic spondylodesis. This system demonstrates high angular stability and meets the surgical requirements for an endoscopic approach. The objective of the current study was fatigue testing of the MACS TL implant system using a corpectomy model according to ISO/DIS 12189-2 and a synthetic model recently developed by Kotani et al. [6]. The MACS TL system demonstrated good mechanical properties with a high stiffness compared to the published data reviewed. The importance of dynamic testing in a corpectomy model has been demonstrated by comparing the MACS TL plate system with an early prototype, which has not yet been clinically evaluated. The corpectomy model according to Kotani et al. offers an interesting alternative to the ISO/DIS 12189-2 test method for asymmetrically designed and antero-laterally positioned spinal implants due to the unconstrained ball joint.

Biomechanical Phenomena↗
PubMed2002

[Development and clinical application of a thoracoscopy implantable plate frame for treatment of thoracolumbar fractures and instabilities].

The evolution of endoscopic spinal approaches and the associated possibilities for stabilization of the anterior column demands a new generation of spinal implants. Of particular interest is the possibility to implant using an endoscopic approach and the ability to achieve real angular stability so that for a suitable injury pattern an exclusively anterior procedure can be carried out. Since November 1999, a new type of anterior plate, MACS TL, developed to meet minimally invasive clinical requirements, has been used in the Berufsgenossenschaftliche Unfallklinik in Murnau, Germany for treating the mid and lower thoracic and lumbar region. The following reports on the results of the first 100 procedures carried out over a period of 15 months, of which 93% were performed endoscopically. The results convey a trend toward anterior endoscopic treatment of injuries of the anterior column using an implant with angular stability. The results now available on healing after fusion indicate the favorable influence of the stability provided by the implants on the bone-healing rate.

Adolescent↗
PubMed1999

[Not Available].

Explore the source record for details and available documents.

Journal Article↗
PubMed1999

[Surgical management of tetraplegia].

The traumatic lesion of the cervical cord implies one of the most serious sequale after accident with severe consequences for lifetime. In patients with a relevant injury of the cervical spine in 28% neurological deficits are seen with an even higher incidence of 44% in the lower cervical spine. The risk of traumatic cervical cord injury further increases with progressing stenosis of the spinal canal and therefore a second peak of occurrence has to be observed in the elderly. In the preclinical phase even suspicion of a cervical cord lesion should lead to effective stabilization of the cervical spine and should be removed only after imaged proof of integrity. A high dosage therapy of methylprednisolon should be started as early as possible in every case of spinal cord injury. Diagnostic procedures are including x-rays of the whole spine, CT-scans for clearance of suspicious findings and pre-operative planning, image intensifiing under controlled stress for hidden instabilities and MRI for spinal cord injuries without abnormal radiological findings. Aims of operative treatment are consisting of decompression, reduction and stabilization with the aims of protection of the neurogenic structures and to secure intensive care treatment. These objectives can be met sufficiently by a single ventral approach in most instances. Dorsal approaches should be avoided whenever possible leaving the important innervation of the paracervical muscles intact. The postacute phase is marked by loss of systemic control mechanis as a consequence of the spinal shock. The consecutive deficits can be mastered only by treatment under intensive care standards. Respirator therapy is advisable especially for higher plegic lesions. Typical complications are frequent and should be watched for carefully because of the absence of pain sensation. Patients with cervical cord injuries should transferred to specialized paraplegic units for early rehabilitation as soon as possible since the rate of specific complications like decubital ulcera increases with the days of stay in non-specialized units.

Aged↗
PubMed1999

[Thoracoscopy-guided management of the "anterior column". Methods and results].

Anterior thoracoscopic interbody stabilization and fusion was performed in 163 patients. Lesions treated were located between T4 and L3, most frequently occurring at T12/ L2. Operative time decreased dramatically as experience was gained with the procedure. 2 patients early in the series successfully were converted to an open procedure. One positioning related pressure harm on the thoracodorsal nerve and one irritation of the L1 root at the entrance site were both transitory. Postoperative control by X-ray and CTscan showed correct positioning of the bone graft, as well as the fixation device in all patients. Our experience with this minimally invasive procedure demonstrated the feasibility of the method. Major advantages compared to the open procedure are reduced morbidity of the approach, postoperative pain reduction, early recovery of function and shortened hospital stay.

Diaphragm↗
PubMed1998

[Endoscopically controlled division of the diaphragm. A minimally invasive approach to ventral management of thoracolumbar fractures of the spine].

On 90 patients with 93 unstable fractures of the thoracic spine and the thoracolumbar junction we treated by a minimal invasive procedure between may 1996 and april 1998, in 46 patients an endoscopic splitting of the diaphragm was performed. The diaphragma was dissected at its attachment at the spine and the adjoining costal base. After partial corporectomy and discectomy, a tricortical bone graft has been inserted. An additional stabilization was done by using a plate and screw system. The incision of the diaphragm was closed by suturing or using an universal endostapler. Controlling the postoperative results a complete closure of the incision was documented by X-ray and CT-scan. There was no conversion to the open procedure or postoperative infection. Splitting the diaphragma opens also the thoracolumbar junction to a minimal invasive treatment and stabilization of fractures.

Adult↗
PubMed1998

[Indications for surgical management of injuries of the cervical spine].

The indication for operative treatment of serious injuries to the cervical spine is basically determinated by instability and dislocation. Timing of the operation is based on the neurological deficit. If there is a chance for recovery operative treatment is urgent. For the upper cervical spine defined indications are existing for type-2-fractures of the dens and C 2/C 3-instabilities of the hangman-type with major dislocation. Fractures of C 0 and C 1 are preferably treated by conservative methods. Only cases with compound injury patterns with a high degree of ligamentous instability may require dorsal fusion. For serious injuries of the lower cervical spine operative treatment is needed in most instances. Conservative treatment is only indicated if functional stability can be proofed and injuries to the discs and compression to the myelon are ruled out.

Cervical Vertebrae↗
PubMed1997

[Minimally invasive ventral spondylodesis in injuries to the thoracic and lumbar spine].

Thirty-eight patients with 40 fractures of the thoracic spine and the thoracolumbar junction were treated by a minimally invasive procedure, which includes partial corporectomy, the interposition of a tricortical bone graft and anterior stabilization by plate spondylodesis under thoracoscopic control. For 36 patients the operation was successfully performed in a complete thoracoscopic way; in 2 patients conversion to an open technique was necessary. Two postoperative complications such as a reversible lesion of the thoracodorsalis nerve and a transient irritation of nerve root L1 on the approach side were encountered. Postoperative control by X-ray and CT scan showed correct positioning of the bone graft, as well as the fixation device in all patients. Our experience with this minimally invasive stabilizing procedure for injuries of the thoracic spine and the thoracolumbar junction demonstrated the feasibility of the method. Compared to the open method the benefit of minimally invasive surgery included postoperative pain reduction, shorter hospitalization, early recovery of function and reduced morbidity of the operative approach.

Adult↗
PubMed1991

[Reconstruction of large foot sole areas with microsurgical tissue transfers].

In 14 patients with microsurgically reconstructed areas of the sole videografic gait analysis was performed. The best results are reached after reconstruction of the forefoot. Loss of more than two thirds of the sole leads to functional impairment. For all reconstructed areas and all types of flaps gait is improved significantly by shoe adaptation: elevation of the shoe under the reconstructed part of the sole directs the main load to the opposite side of the foot and by this relieves the reconstructed area. Even bone corrections can reduce load on a circumscribed area.

Foot↗
PubMed1989

[A treatment concept using external transfixation in unstable defect trauma of the knee joint].

The main problems in the treatment of severe knee injuries with extensive soft tissue damage, ligamentary lesions and compound fractures consist in the high risk of infection and complex instability of the joint. 20 patients suffering such type of trauma were treated by a schedule comprising an extensive debridement and a combination of minimal internal osteosynthesis and external transfixation. Secondary operations were always performed as a second look in all patients and various surgical reconstructions of the soft tissue coverage under continuous protection of the external fixation. Most patients obtained satisfactory functional results, only 2 cases ended up with arthrodesis due to deep infection.

Adult↗
PubMed1987

[Surgical treatment of tumor-induced destruction of the spine].

Surgery for treatment of destructions of the spine varies depending on localization and tumour status. If the body of the vertebra is affected, the ventral approach allows radical tumour resection as far as possible. The following stabilization is effected by filling the defect and carrying out osteosynthetical fusion. Of 38 patients, three had benign tumours, whereas ten patients had primary malignant and 25 had metastatic tumours. The results show that surgical treatment is justified also in palliative indications; although survival time is not prolonged, the quality of life can be improved.

Adult↗
PubMed1985

[Management of complex pelvic injuries].

Compound pelvic fractures can be mastered only by means of an active surgical procedure. If the shock cannot be controlled by conservative treatment, early angiography followed by embolisation should be done. Alternatively to embolisation, control of haemorrhage can be achieved by specific ligation, reconstruction of the vessels or tamponade with mandatory laparotomy. Septic complications can be prevented by a liberal indication of derivative colostomy with irrigation of the rectal segment by copious amounts of saline solution, by suprapubic urinary drainage and meticulous "debridement" of soft tissue. The procedure is presented in detail.

Accidents, Traffic↗
PubMed1981

[Quantitative method for shape analysis of cross-sectional figures of bones].

By analogy with the statistical product-moment-correlation coefficient, an area-moment-correlation coefficient is defined for arbitrarily limited sectional areas. 2 numerical methods to determine the coefficient are deduced and exemplified using simple mathematical figures. The methods described are suitable for quantifying the shape of plane figures and for making the shape amenable to statistical analysis.

Anatomy↗