Causal Relation of Psychical Stress to Acute Back Pain.

PURPOSE OF THE STUDY There s a known relation between the chronical back-pain-syndrome and psychical problems. We suppose a direct causality between acute stress and onset of the backpain syndrome. MATERIAL AND METHODS A prospective cohort-study (IV/2014 - VIII/2014) of patients who came to our emergency department with acute backpain-syndrome, with no relevant previous history - such as operations or chronic pain. We questioned together 39 patients (19 female and 20 male). The patients filled in two charts: FW7, and also a modified HADS-D. In the later one the patients were questioned in two extra points regarding contingent excessive emotional or existential problems in their brief history. The Pain-Severity-Score was assessed as well. RESULTS Combined together, relevant score-results and / or anamnesis of excessive emotional or existential problem was found in 79.5% (SD 0.4%) of the whole cohort. CONCLUSIONS This could have implications for guidelines, introducing the psychotherapy-first into the concepts. Key words:stress; well-being; depression; back-pain-syndrome.

Influence of blood supply on fracture healing of vertebral bodies.

INTRODUCTION: The relevance of blood supply for bone fracture healing has been discussed throughout the literature, using scaphoids as the most referred to. But, there is virtually nothing known about the relevance of blood supply for the vertebral fracture healing and even the guidelines of AO do not deal with this issue. MATERIALS AND METHODS: A prospective cohort study of 107 patients was run from January 2016 to December 2016, with 54 male and 53 female patients, who were treated for traumatic vertebral fractures of thoracolumbar spine using posterior stabilization only. The average age was 67 years and the follow-up 12.3 weeks. The total number of vertebrae was 129. We analyzed the fracture morphology and measured the vertebral bodies in all three dimensions, with five reference planes. The progress of vertebral deformity in time measured before and after the surgery was correlated with the potential damage of the main vascular canal in the rear of each vertebral body. The bone pattern and morphology were analyzed in detail as well. Pathological fractures were not taken into our consideration. RESULTS: The overall deformity progression of vertebral bodies in the fractures with morphologically damaged blood supply was in all measured dimensions significantly higher than in the fractures with supposedly maintained perfusion. The osteoporosis played its role as well, but only with medium effect size compared with strong effect size of the vessel canal damage (Cohen). The combination of the both factors (damage to the vessel canal together with osteoporosis) showed also a strong correlation with a relevant deformity progression (Evans), but not much different from the vessel canal damage alone. With regard to the relevant changes of the vertebral body dimensions/volume, we found relevant changes in 52% of all fractures (SD 0.5017) generally, for the subgroup with the canal damage in 84% (SD 0.3691), with strong correlation (Evans, 0.7721). In the group of fractures with maintained perfusion, we found such changes in only in 5% of fractures (SD 0.2333). CONCLUSION: For decision making, we should take mechanical fracture analysis and dynamic processes within traumatized tissue a part of whose is the blood supply and oxygenation into surgical consideration. We recommend anterior rather than posterior stabilization for the cases with damaged vessel canal, and the vertebroplasty could pose an alternative in the elderly.

Trauma of the extracranial cerebral arteries due to injuries of the cervical spine.

INTRODUCTION: Cervical spine injuries are immanently accompanied by trauma to cerebral neck arteries. METHOD: A prospective two-cohort study, from oct. 2013 to oct. 2015. Overall 76 Patients (39W/37M) of median age 77 years, with either fractures or discoligamentary injuries have been examined with duplex-sonography and or CT-angiography. From October 2013 to October 2017 we examined 155 Patients (49% female and 51% male), with the average age of 39 years, SD 19 and age median of 34 years, with cervical-spine-distortion, using the same diagnostic modalities. We used the statistics-program Bias 11.01. RESULTS: The overall incidence of traumatic dissection of the internal carotid artery was 2.5%, in 50% of cases (1.2%) with neurological symptomato-logy. For the vertebral artery seems the incidence of 10.5%, with 25% of symptomatic patients (2.6%) comparably high. We have identified the osteophytes and dislocation as the significant risk factors. The canalis vertebralis and the skull-base are regions mostly prone to vascular injury. In the group of cervical spine distorsions we found no vascular trauma at all. The osteophytes were here identified as the main risk factor for collateral damage. CONCLUSION: One should look for vascular injuries in case of cervical relevant spine trauma. Moreover,  a rather relevant osteoligamentous injury should be assumed, when cervical vascular trauma was diagnosed. Key words: cervical spine trauma vessel-dissection duplex-sonography CT-angiography.

Omphalocele with ectopic liver forming a mesodermal cyst.

BACKGROUND: Congenital anomalies of the abdominal wall are classified as anomalies with the abdominal wall defect (omphalocele, gastroschisis) and without the defect (umbilical hernia, persistent ductus omphaloentericus or urachus). Clinical presentations of these conditions are different, and so is the timing of surgical intervention and approach with or without the exploration of the peritoneal cavity. CASE: The presented case report refers to a rare finding of ectopic liver forming mesodermal cyst within the umbilical region. Full term neonate girl with 5 cm spheroid tumor in umbilicus was otherwise without problems. Ultrasonography (USG) of the lesion detected a tissue with good vascularization and a cystic cavity. There was no flow in the umbilical vessels and no evidence of intestinal loop in the sac. USG of the liver was normal. During surgery an additional narrow canaliculus was identified connecting the spheroid along with umbilical vessels to the liver. The whole spheroid together with the canaliculus was surgically removed without exploration of the abdominal cavity. Histological evaluation of the surgical specimen discovered liver tissue with a mesodermal cyst in the center. The sphere was connected to the liver by a bile duct. Six months after the operation the child is in a good clinical condition. CONCLUSION: In conclusion omphalocele may contain liver. Ectopic liver is an extremely rare condition. Surgical treatment in the presented case focused only on umbilicus without exploration of the abdominal cavity and appeared to be sufficient. Long-term postoperative follow up typical in pediatrics will be applied also in this patient (Fig. 3, Ref. 25).

Tethered spinal cord syndrome--the importance of time for outcomes.

OBJECTIVES: Tethered spinal cord syndrome is a relatively uncommon disorder of the medullary spine, usually associated with other congenital diseases of the caudal end of the spinal cord. However, it often remains unrecognised and due to its progressive character has serious consequences for those affected. METHODS: We analysed a group of 22 patients, treated for TTS during the period from 1990 to 2005, focussing on the time period between the onset of symptoms and their treatment. The initial data from the year 1998 already pinpointed this time-lag as a crucial prognostic factor for outcomes. RESULTS: Nine of the 22 treated patients showed an improvement of symptoms, 2 of them ad integrum. Eleven remained unchanged, without further progress and 2 patients worsened after surgery or despite it. Our results showed a direct correlation between the time-lag and the outcome of therapy. The average time span between recognition of disease and operation in those patients whose symptoms improved was about 16.7 months, whereas for those who remained unchanged it was 52.4. In the patients who worsened it was 54 months. CONCLUSION: Virtually all patients operated within the first year showed a subsequent improvement of symptoms. Only 25 % of patients operated at a later stage achieved some measure of improvement. Time is a relevant factor for success.