[Long-term results, status of studies and differential indication regarding the DIAM implant]. / Langzeitergebnisse, Studienlage und Differenzialindikation des DIAM-Implantats.

The DIAM (Device for Interspinous Assisted Motion) interspinous device offers the possibility of a viscoelastic supplementation of the lumbar motion segment with a small, reversible operation. It is intended as a restabilisation procedure after a discectomy to avoid facet joint overload and as a topping of procedure for the segment adjacent to a fusion. The device has been on the German market since 2004. There are several biomechanical studies available showing an effect mainly in extension and flexion, but hardly any in rotation and lateral inclination. Despite frequent clinical use, there have only been a few, mainly retrospective clinical studies indicating the success of the implant; however, sound scientific data are missing. Several prospective, randomised, controlled studies are now underway to fill that gap. Only then will it be possible to assess whether this implant is of true value to improve clinical results and to slow down the degenerative cascade or not.

[Value of ultrasound, CT, and MRI in the diagnosis of slipped capital femoral epiphysis (SCFE)]. / Der Stellenwert von Sonographie, Computertomographie und Kernspintomographie bei der Epiphyseolysis capitis femoris.

Traditionally, radiographic assessment of the hip with anteroposterior and lateral views is the gold standard of diagnosis in SCFE. This paper evaluates the possible contributions of other methods of modern imaging to the early diagnosis and treatment. There is scientific evidence that ultrasound can diagnose the disease earlier than conventional radiography and also has the possibility to differentiate the classification between stable and unstable. MRI depicts marrow changes earlier than any other imaging method available and has a role in cases where the diagnosis is difficult to make as well as in assessing the risk of chondrolysis and avascular necrosis. To show the anatomic deformity, anteroposterior and lateral radiographs remain the mainstay of preoperative planning.

[Can TOF MRA replace duplex and Doppler sonography in preoperative assessment of the carotid arteries? A prospective comparison and review of the literature]. / Kann die Time-of-Flight-Angiographie in der MRT die präoperative Duplex- und Doppler-Untersuchung der Arteria carotis ersetzen? - Ergebnisse eines prospektiven Vergleichs mit Literaturübersicht.

AIM: To examine the quality and usefulness of time-of-flight MR-angiography and duplex-doppler sonography, respectively, in assessment of the extracranial arteries before cervical spine operations. METHODS: Patients scheduled for operations of the cervical spine had an MRI plus TOF as well as a duplex and Doppler scan. At the time of the examination the radiologist and the neurologist in charge were blinded for the study. Endpoints were not only the accuracy of the procedures but more so which method improved the preoperative process most. RESULTS: Twenty patients were examined so far. Only in one case did the result differ when a complete occlusion diagnosed sonographically was judged as a severe stenosis on MRA. One patient did not tolerate the MRA for the extra 5 minutes necessary, therefore a contrast-enhanced MRA was performed. MRA eased the preoperative process as imaging of the pathology and the carotids were realised in one step. The costs were slightly higher for MRA than for duplex-doppler sonography. CONCLUSION: TOF-MRA can replace the duplex-doppler examination in the preoperative assessment of the carotids and has the potential to streamline the preoperative time schedule. Similar to duplex and doppler, in order to be accurate enough the method requires a high degree of expertise from the radiologist.

[MRI diagnosis of intervertebral disk disease]. / Diskusdiagnostik im MRT.

Magnetic resonance imaging (MRI) is the leading diagnostic procedure for disk pathology and has overtaken other imaging modalities in frequency of use. However, one must be cautious not to overinterpret small abnormalities that are also frequent in asymptomatic subjects. There is conflicting evidence about the correlation of high-intensity zones with clinical symptoms. Bulging disks and protrusions are a common finding in asymptomatic individuals, whilst extrusions are almost always accompanied by back pain and sciatica. In patients with back pain or sciatica, MRI is indicated after failure of conservative management or neurological deterioration. Contrast-enhanced MRI is well suited to differentiate a recurrent disk extrusion from epidural fibrosis. In all cases suspicious of tumor or infection, MRI is indicated as a first-line investigation. The indications and pitfalls of the state of the art of MRI are delineated in this article.

[Efficacy of MRI--whole spine image in diagnosis of vertebral metastases--results of a prospective study]. / Die Effizienz der MRT--Wirbelsäulenganzaufnahme in der Diagnostik von Wirbelmetastasen--Ergebnisse einer prospektiven Untersuchung.

AIM: To prospectively investigate the outcome efficacy of whole spine MRI for diagnosis and treatment in patients with suspected metastases of the spine. METHODS: All patients older than 50 years with newly diagnosed back pain and/or newly diagnosed spine-related neurological symptoms without a diagnosis by other imaging modalities were accepted in this study. A whole spine MRI and a detailed MRI per spine region with suspicious lesions were performed using a Siemens Magnetom Expert 1.0 Tesla machine. Outcome efficacy was determined by assessing further therapy and result for the patient. RESULTS: In all 15 patients of the year 1999 whole spine MRI allowed us to determine the definite diagnosis and treatment. Plain X-ray and 99mTc bone scanning gave a diagnostic suspicion but no definite diagnosis or therapeutic consequence. CONCLUSIONS: MRI of the spine including whole spine images allows clear cut decision making in diagnosis and treatment of cases suspicious for metastatic disease of the spine. Careful history taking and clinical examination provide enough information to opt for whole spine MRI as the first choice investigation. This will provide maximum benefit to the patient and avoid examination cascades.

Failure of osteosynthesis and prosthetic joint infection due to Mycobacterium tuberculosis following a subtrochanteric fracture: a case report and review of the literature.

We report a patient with a subtrochanteric fracture, for whom internal fixation failed and a prosthetic joint replacement was complicated by a local reactivation of a Mycobacterium tuberculosis infection. After hip replacement with revision and adequate medical therapy, a full recovery was attained without the necessity of removing the artificial joint.

[Current role of ultrasonography in orthopedics. Results of a nationwide survey]. / Der heutige Stellenwert der Sonographie in der Orthopädie. Ergebnisse einer bundesweiten Umfrage.

The purpose of this study was to determine the current position of diagnostic ultrasound imaging in the day to day orthopaedic practice. A questionnaire was sent to all the 387 conservative and operative orthopaedic hospitals and orthopaedic university departments in Germany. 167 of these hospitals completed the forms and provided the basis for this evaluation (response rate 43.2%). Screening of the fetal hip for CDH was by far the most common indication, the shoulder was ranking second, the knee and the hip joint in children and adults rank third and fourth. Other frequent indications were injuries of the achilles tendon, the menisci of the knee, the knee in rheumatoid arthritis and muscle injuries. Ultrasound imaging is clearly established as a diagnostic tool at least in the named areas. It is therefore of importance to include ultrasound examination techniques in the curriculum of the orthopaedic training scheme.

[Sonographic diagnosis of anterior syndesmosis rupture]. / Die Sonographische Diagnostik der vorderen Syndesmosenruptur.

In a prospective trial we evaluated the diagnostic value of ultrasound imaging in the diagnosis of injuries to the anterior syndesmosis of the ankle joint. In an initial series of 20 patients using a basic standard ultrasound machine (Siemens Sonoline SL 1 with a 7.5 MHz piece) and a simple dynamic testing protocol as described in this article we found a significant difference between the ultrasound result for the ruptured syndesmosis versus non rupture and a specificity similar to that of arthrography. We conclude that ultrasound imaging is a useful tool in the diagnosis of syndesmotic rupture. Given the statistical significance of these results we feel confident that-despite the small amount of patients of this series and after an individual learning curve-ultrasound will eventually replace arthrography as the standard of investigation for this type of injury.

Arthroscopic excision of symptomatic medial plica. A study of 118 knees with 1-4 year follow-up.

We retrospectively reviewed 93 patients (118 knees) treated by arthroscopic excision of painful medial plica. A scoring scale 0-100 was used to evaluate the symptoms. After an average of 2 (1-4) years, 109 of 118 knees had little, if any, pain and the average improvement in the score was 41 points. Thus arthroscopic excision of a painful medial plica can provide lasting and satisfactory relief of symptoms.