[The radicular and pseudoradicular syndrome of infectious spondylitis and its differential diagnostic significance]. / Die radikulären und pseudoradikulären Syndrome der Spondylitis infectiosa und ihre differentialdiagnostische Bedeutung.

Infectious spondylitis is now the most common form of hematogenous osteomyelitis. In 37% of patients followed up it causes root irritation without peripheral paralysis, and radicular and pseudoradicular syndromes. Accounting for 8.2% of the cases, incomplete paraplegias are not as rare as is usually assumed. In certain sections of the spine infectious spondylitis is encountered very frequently (T7/8, T9/10, L3/4, and L4/5). The distribution pattern of the paralyses does not correspond to the frequency of the spondylitis in the individual segments of the spine. Radicular syndromes are more common in the lumbar spine, incomplete paraplegias in the thoracic spine. The neurologic risk depends on the patient's age: while very low in children, it is distinctly higher in patients aged over 70. Only the paraplegia risk is dependent on the extent of vertebral destruction. This in turn depends on the time that elapses until diagnosis. Almost all cases of spondylitis are still diagnosed unnecessarily late. Radicular and pseudoradicular symptoms accelerate diagnosis of spondylitis. Inflammatory and mechanical factors cause the radicular and pseudoradicular syndromes. Detection by radiologic examination is not usually possible. As regards formal pathogenesis, degenerative and inflammatory vertebragenous syndromes are indistinguishable, and spondylitis can only be clinically recognized from its general symptoms. No signs of paralysis occurred in any of the patients in whom spondylitis had been diagnosed in good time. Therefore, spondylitis diagnosis must also be improved in order to prevent neurologic complications.

[Morphology and diagnosis of bone tumors of the foot]. / Morphologie und Diagnostik von Knochentumoren des Fusses.

We report on 554 bone tumors and tumor-like lesions of the foot, which have been diagnosed within the period from 1945-1985 in the Department of Diagnostic Radiology, in the Surgical and Orthopedic Departments and in the Division of Pathology of Bone Tumors of the University of Freiburg. Schajowicz' WHO classification criteria for bone tumors were used. Morphological aspects, clinical symptoms and pattern of distribution differ widely from lesions of other skeletal regions. Bone tumors of the foot are much more frequently associated with pain caused by the special anatomy of the foot. Malignant lesions are very rare in the foot. We found only 42 malignant tumors corresponding to 1.4% of all malignant bone tumors. By contrast 13% of all benign bone tumors are localized in the foot. However, 90% of them are osteochondromas and chondromas. Other benign lesions are rare, especially tumors arising from connective tissue of bone. In several cases correct diagnosis was only possible by histologic examination whereas modern digital imaging did not substantially add to conventional plain film and tomographic examination. Preoperative CT scans were very useful for exact planning of surgical procedures especially in benign tumors.

[Therapy of gonarthrosis using chondroprotective substances. Prospective comparative study of glucosamine sulphate and glycosaminoglycan polysulphate]. / Die Therapie der Gonarthrose mit chondroprotektiven Substanzen. Prospektive Vergleichsstudie zwischen Glukosaminsulfat und Glykosaminoglykanpolysulfat.

68 patients with mild or moderate gonarthritis were treated with intra-articular injections of glucosamine sulphate or glycosaminoglycan polysulphate over a period of six weeks. The therapy was successful in two thirds of these patients. "Loading" pain was eliminated or improved in about 80%, "getting-going" pain in about 64%, and signs of synovialitis in about 66%. Gait function and mobility were improved. Glucosamine had a superior effect, in particular in mild arthritis, achieving an improvement of pain in 90%, while glycosaminoglycan polysulphate was successful in advanced cases. The tolerance of the two substances was 94%. The results and the underlying modes of action of the substances are discussed.

[Computertomographic findings in pigmented villonodular synovitis]. / Computertomographische Befunde bei der pigmentierten villonodulären Synovitis.

The CT findings in two patients with synovitis of the knee joint were analysed. Angiography is a non-specific method for the differential diagnosis of synovitis; CT, however, can be pathognomonic by showing a strikingly thick and hyperdense synovial membrane because of the iron content of the hyperplastic synovia. This is not found in non-specific synovitis.

[Diagnosis of vertebral diseases by vertebral biopsy]. / Diagnostik von Wirbelsäulenerkrankungen durch Wirbelpunktion.

Vertebral biopsies were performed in 28 patients, 17 males and 11 females, because of vertebral body and disc changes between June 1978 and May 1982. In two patients biopsy was performed in two segments. Punctures were done in local and superficial anaesthesia of the vertebral body periosteum during continuous fluoroscopy control using Jamshidi's instrumentation. Aspiration and tissue cylinders were evaluated histologically and bacteriologically. There were no complications among the 8 thoracic and 22 lumbar biopsies. A histologic diagnosis could be established in 22 cases (78.6%): plasmocytoma (n = 2), spontaneous deformation of the spine in osteoporosis (n = 3), Scheuermann's disease (n = 1), specific (n = 2) and nonspecific (n = 14) spondylitis. Demonstration of bacteria was possible in 5 out of the 16 cases of spondylitis (31.25%): in two cases tubercle bacilli were demonstrated and once each salmonella group B, Haemophilus aphrophilus and coagulase-negative staphylococci. Only in 6 cases a diagnosis could not be established from the biopsy material.