Impact of Anxiety During Hospitalization on the Clinical Outcome of Patients With Osteoporotic Thoracolumbar Vertebral Fracture.

STUDY DESIGN: Multicenter prospective cohort study. OBJECTIVES: Anxiety in combination with osteoporotic vertebral compression fractures (OVCFs) of the spine remains understudied. The purpose of this study was to analyze whether anxiety has an impact on the short-term functional outcome of patients with an OVCF. Furthermore, a direct impact of the fracture on the patient's anxiety during hospitalization should be recognized. METHODS: All inpatients with an OVCF of the thoracolumbar spine from 2017 to 2020 were included. Trauma mechanism, analgetic medication, anti-osteoporotic therapy, timed-up-and-go test (TuG), mobility, Barthel index, Oswestry-Disability Index (ODI) and EQ5D-5L were documented.For statistical analysis, the U test, chi-square independence test, Spearman correlation, General Linear Model for repeated measures, Bonferroni analysis and Wilcoxon test were used. The item anxiety/depression of the EQ5D-5L was analyzed to describe the patients' anxiousness. RESULTS: Data from 518 patients from 17 different hospitals were evaluated. Fracture severity showed a significant correlation (r = .087, P = .0496) with anxiety. During the hospital stay, pain medication (P < .001), anti-osteoporotic medication (P < .001), and initiation of surgical therapy (P < .001) were associated with less anxiety. The anxiety of a patient at discharge was negatively related to the functional outcomes at the individual follow-up: TuG (P < .001), Barthel index (P < .001), ODI (P < .001) and EQ5D-5L (P < .001). CONCLUSIONS: Higher anxiety is associated with lower functional outcome after OVCF. The item anxiety/depression of the EQ5D-5L provides an easily accessible, quick and simple tool that can be used to screen for poor outcomes and may also offer the opportunity for a specific anxiety intervention.

Open-door laminoplasty : What can the unilateral approach offer?

OBJECTIVE: Multilevel posterior decompression of subaxial cervical spinal canal stenosis through a less-invasive unilateral approach. INDICATIONS: Degenerative cervical myelopathy due to multilevel subaxial spinal canal stenosis. CONTRAINDICATIONS: Cervical kyphosis or instability, bilateral radiculopathy due to foraminal stenosis, involvement of C2 or C7. SURGICAL TECHNIQUE: Unilateral subaxial approach with detachment of muscles only on one side. The ipsilateral laminae C6 to C3 are cut at the laminofacet junction and opened up. The loss of resistance is usually due to a greenstick fracture in the proximity of the contralateral laminofacet junction. The opened laminae are fixed with Z­shaped thin titanium plates. If necessary, the laminoplasty can be combined with a unilateral fixation and fusion by the same approach. POSTOPERATIVE MANAGEMENT: Early mobilization 4-6 h postoperatively. No orthosis necessary. RESULTS: A total of 131 patients (77 men, mean age 67 years) with a multilevel cervical spondylotic myelopathy (CSM) underwent surgery using a posterior approach. In 52 patients (40%), a unilateral approach was performed (laminoplasty: n = 30; laminoplasty/fusion: n = 22). In this group, the mean operation time was less compared with two other techniques (unilateral approach: 110 min; laminectomy/fusion: 150 min; 360° approach: 210 min). The postoperative European myelopathy score (EMS) improved from 12.8 to 15.2. The overall complication rate was 17% (unilateral approach: 9%; laminectomy/fusion: 18%; 360° approach: 27%).

Anatomic basis for a minimally invasive approach to the subtalar joint.

INTRODUCTION: An isolated arthrodesis of the talocalcaneonavicular joint is a common indication in cases of pain and post-traumatic arthroses. MATERIALS AND METHODS: Because of the high infection rate after surgery with the lateral incision, the authors decided to evaluate an alternative, minimally invasive procedure. Joint destruction was carried out via a posterolateral access after the insertion of two guidewires. For an evaluation of the risk for vessel and nerve structures, 102 ankle joint specimens preserved in formalin/alcohol were examined. Additionally, the minimally invasive access was evaluated in ten ankle joint specimens. RESULTS: Neither in the specimen nor during evaluation of the minimally invasive access could injuries of vessels or nerve structures larger than 1 mm in diameter be found. The authors did not encounter any problems when drilling open the articular surface with a destruction of 65% of the overall surface and when performing the following arthrodesis using a plug technique. Using a posterolateral, minimally invasive access between the Achilles tendon and lateral malleolus, it is possible to resect about 65% of the subtalar articular surface for arthrodesis without impact on major vessels and nerves. Postoperative complications such as sensitive and sensory failure as well as wound healing impairment at the lateral side of the foot are not to be expected when choosing the minimally invasive access. CONCLUSION: It has to be said, however, that this technique does not offer the opportunity of performing a corrective arthrodesis as the hindfoot cannot be displayed during surgery. As the result of this study was positive, clinical evaluation was started.

[Retrograde intramedullary nailing of knee para-articular fractures in paraplegic patients]. / Die retrograde Marknagelung kniegelenknaher Frakturen bei Querschnittgelähmten.

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.

The popliteal region: an anatomical study and a new approach to the tibial attachment of the posterior cruciate ligament.

Surgical treatment of posterior cruciate ligament injuries is gaining more and more importance. The central posterior approach according to Abbott (1945) has been considered a standard, with various complications involved owing to the local anatomic conditions. This study is intended to present a modified dorsomedial approach to the posterior capsule of the knee joint that is better adapted to the anatomic conditions. As a basis, the popliteal region was dissected in 150 knee joints, and the course of the popliteal artery with its branches as well as the bifurcation of the sciatic nerve were identified. The medial joint line served as a reference point. It has been shown that the knee joint arteries and the two sural arteries arose at relatively constant levels. At least one of the meniscofemoral ligaments was found in all of the knee joints examined; the anterior ligament was present in a slightly higher percentage than the posterior ligament. The modified dorsomedial approach to the posterior joint capsule was evaluated in 50 knee joints. Dissection was achieved by blunt division of the medial head of the gastrocnemius muscle, with careful preservation of the proximal vascular supply of that muscle. It was necessary to expose neither the popliteal artery and vein nor the tibial nerve. The tibial attachment of the posterior cruciate ligament could be exposed in every knee. The advantage of the new approach to the posterior cruciate ligament described in this study consists in the preservation of the central neurovascular bundle and the excellent exposure of the tibial attachment.

[The anatomy and function of the pelvic floor]. / Anatomie und Funktion des Beckenbodens.

PELVIC FLOOR: Anatomy of the pelvic floor seemed to be clearly. In opposite the physiology of the Levator ani and the endopelvic fascia is not yet fully understood. Especially the anatomic form of the levator plate does not conform with physiologic concepts. PELVIC STRUCTURES: Pelvic structures can be divided in three groups: the hollow organs, the endopelvic fascia and the muscles. The M. levator ani is the muscle of the pelvic diaphragm. Its parts were given different names (Fig. 1, 4) depending on their function or localization. In anatomic studies the pelvic floor is described as basin-shaped. In contrast to the anatomic results based upon the evaluation of cadavers, dynamic MRI gave different concepts: at rest the levator ani probably has the shape of a dome and differ when contract. The urogenital diaphragm is mostly a fascia and contains only fair muscular components. Therefore, many authors do not accept the term "diaphragm" and the physiologic function is still a matter of discussion. The endopelvic fascia has to fix the organs in the pelvis and forms "streets" for vascular and nervous supply. CONCLUSION: Describing anatomic structures in the common planes (transversal, sagittal, frontal) will help to understand CT- and MRI-imaging.