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Biomedical subjects

Mathias Haefeli

Publications and source records attributed to Mathias Haefeli.

3 recordsLinked to original sources
PubMed2006

The course of macroscopic degeneration in the human lumbar intervertebral disc.

STUDY DESIGN: Assessment of age-related macroscopic changes in human lumbar intervertebral discs (IVD) and vertebral bodies. OBJECTIVES: To determine the sequence of macroscopic changes during aging/degeneration. SUMMARY OF BACKGROUND DATA: Descriptive studies on macroscopic alterations of the IVD during aging/degeneration are readily available, but quantitative analyses are sparse. METHODS: A total of 248 mid-/parasagittal sections of lumbar IVD and vertebral bodies from 41 routine autopsies (range, 7 months to 88 years) were semiquantitatively assessed for macroscopic parameters and correlated with age. RESULTS: Nuclear fibrous transformation, anular disorganization, endplate, and vertebral body alterations progress predominantly in the first two and in the fifth to seventh decades. In the third and fourth decade, little progression occurs. Nuclear clefts and anular tears appear later, mostly starting in the second decade, with clefts preceding tear formation. Radial and concentric tears develop similarly over time, whereas rim lesions mostly develop after the sixth decade. Significant differences are observed between upper and lower lumbar spine. CONCLUSION: Our data show that fibrous nuclear transformation during aging/degeneration precedes cleft formation. The temporal sequence suggests a strong correlation of cleft and tears formation starting with clefts in the second decade. Our results support the hypothesis that disc degeneration starts in the nucleus. Extensive macroscopic alterations already apparent in the second life decade present a challenge to any tissue engineering and repair attempt.

Adolescent↗
PubMed2006

Nonoperative treatment for adolescent idiopathic scoliosis: a 10- to 60-year follow-up with special reference to health-related quality of life.

STUDY DESIGN: Retrospective study on patients 10 to 60 years of age after nonoperative treatment for adolescent idiopathic scoliosis (AIS). OBJECTIVES: To investigate long-term outcome with regard to pain, disability, psychological disturbance, and health-related quality of life (HRQOL) in nonoperatively treated patients with AIS. SUMMARY OF BACKGROUND DATA: Only little is known on the long-term quality of life and disability in patients nonoperatively treated for AIS. A detailed knowledge of the nonoperative treatment results is important when advising patients for surgery. METHODS: A total of 135 nonoperatively treated AIS patients with a minimum follow-up of 10 years were included in this investigation, 121 of whom responded to a questionnaire containing questions on pain, disability (Oswestry Disability Index [ODI], Hannover Functional Ability Questionnaire [HFAQ], psychological general well-being [PGWB], and health-related quality of life [WHOQOLBREF]). Eighty-one patients participated in a clinical/radiologic follow-up examination. Nonoperative treatment consisted of bracing (n = 60), physiotherapy (n = 59), and electrical stimulation (n = 2). The overall follow-up rate was 89.6%. The mean age at follow-up was 38.0 years (range, 20-73 years.). RESULTS: In general, patients achieved a satisfactory outcome 10 to 60 years (mean, 23 years) after nonoperative treatment with regard to pain, disability, and HRQOL. The average curve at first diagnosis measured 29.5 degrees (range, 15 degrees -59 degrees ) for the thoracic spine, 21.3 degrees (range, 15 degrees -28 degrees ) for the thoracolumbar spine, and 26.8 degrees (10 degrees -44 degrees ) for the lumbar spine. Thirteen patients showed a substantial change in curve size (+/-10 degrees ) between first diagnosis and end of growth: 11 curves progressed more than 10 degrees showing an average increase of 19.0 degrees (range, 12 degrees -30 degrees ) and 2 patients presented with less severe curves at follow-up (-10 degrees and -13 degrees ). After end of growth, 7 patients showed a substantial average increase of 16.3 degrees (range, 10 degrees -31 degrees ). Five of eight patients with thoracic curves greater than 80 degrees had restrictive pulmonary disease. Patients with curves greater than 45 degrees reported significantly higher pain levels than those with smaller curves. Patients only showed a minimal absolute disability (Oswestry and HFAQ), and no significant correlation was found between curve size and curve type, respectively. Compared with a healthy control group that was matched for age and gender, no significant differences were found in terms of HRQOL as assessed by the WHOQOLBREF questionnaire. No significant differences in pain, disability, or HRQOL were found between patients with and without brace treatment. CONCLUSIONS: Although pain, disability, HRQOL, and psychological general well-being are quite satisfactory on an absolute level, curve size was found to be a significant predictor for pain in a long-term follow-up.

Adolescent↗
PubMed2005

Pain assessment.

Pain usually is the major complaint of patients with problems of the back, thus making pain evaluation a fundamental requisite in the outcome assessment in spinal surgery. Pain intensity, pain-related disability, pain duration and pain affect are the aspects that define pain and its effects. For each of these aspects, different assessment instruments exist and are discussed in terms of advantages and disadvantages. Risk factors for the development of chronic pain have been a major topic in pain research in the past two decades. Now, it has been realised that psychological and psychosocial factors may substantially influence pain perception in patients with chronic pain and thus may influence the surgical outcome. With this background, pain acceptance, pain tolerance and pain-related anxiety as factors influencing coping strategies are discussed. Finally, a recommendation for a minimum as well as for a more comprehensive pain assessment is given.

Adaptation, Psychological↗