Patient-Matched 3-D-Printed Guides for the Insertion of Cervical Pedicle Screws in Tumor Surgery.

BACKGROUND: Pedicle screw fixation in the cervical spine provides biomechanical advantages compared to other stabilization techniques. However, pedicle screw insertion in this area is challenging due to the anatomical conditions with a high risk of breaching the small pedicles and violating the vertebral artery or neural structures. Today, several techniques to facilitate screw insertion and to make the procedure safer are used. 3-D-printed patient-matched guides based on a CT reconstruction are a helpful technique which allows to reduce operation time and to improve the safety of pedicle screw insertion at the cervical spine. CASES: 3-D-printed patient-matched drill guides based on a CT scan with a 3-D reconstruction of the spine were used in two challenging cervical spine surgical tumor cases to facilitate the implantation of the pedicle screws. The screw position was controlled postoperatively by means of the routinely performed CT scan. RESULTS: Postoperative imaging (conventional radiographs and CT scan) revealed the correct position of the pedicle screws. The time needed for screw insertion was short, and the need for intraoperative fluoroscopy could be reduced. There was no intra- or postoperative complication related to the pedicle screw implantation. Both tumors could be removed completely. CONCLUSION: These preliminary results show that 3-D-printed patient-specific guides are a promising tool to support and facilitate the implantation of cervical pedicle screws. The time needed for insertion is short, and intraoperative fluoroscopy time can be reduced. This technique allows for both a meticulous preoperative planning and a correct and therefore safe intraoperative positioning of cervical spine pedicle screws.

[Spinal deformity in neurofibromatosis type 1]. / Wirbelsäulendeformitäten bei Neurofibromatose Typ 1.

BACKGROUND: With a prevalence of up to 60%, spinal deformity represents the most common skeletal manifestation of neurofibromatosis type 1. The deformity can occur as a non-dystrophic or as a less common dystrophic type. This distinction is of great relevance because the therapeutic strategy is completely different in each case. NON-DYSTROPHIC TYPE: The non-dystrophic type can be treated like idiopathic scoliosis due to the comparable behavior of both entities. However, care must be taken regarding the so-called modulation. Modulation describes the formation of dysplasias of the spine. This will result in a progression behavior as known from the dystrophic type. DYSTROPHIC TYPE: For the dystrophic type, different spinal dysplastic changes are typical. These lead to a rapid progression of deformity and a lack of response to conservative treatment. If untreated, severe and grotesque deformities can arise. This type of deformity requires early surgical intervention, even in childhood. The knowledge about the peculiarities of this disease in general, as well as the typical changes of the spine are prerequisites to managing these often-challenging situations.

[Cost coverage for complex paediatric spinal deformities with preoperative halo traction-an economic problem?] / Kostendeckung bei komplexen pädiatrischen Wirbelsäulendeformitäten mit präoperativer Halotraktion ­ ein wirtschaftliches Problem?

BACKGROUND: Spinal surgery is largely reimbursed in a differentiated manner via the DRG system. For treatments of complex paediatric deformities with increased pre and postoperative effort due to special treatment approaches, it seems that the costs for the treatment are not fully covered. MATERIALS AND METHODS: All paediatric cases with surgical treatment of the spine that were treated in a single spine centre from 2018-2020 were considered. The subgroup of patients with inpatient halo-gravity traction (halo group) before surgery was compared with all other cases treated in terms of economic and demographic factors. RESULTS: There were 86 cases that were treated surgically without halo traction and 6 cases with halo traction. The groups did not differ significantly in age (p = 0.41) or Patient Clinical Complexity Level (PCCL, p = 0.76). The average length of hospital stay in the halo group was significantly longer than in the other cases (84.2 ± 40.1 d vs. 11.0 ± 6.4 d; p = 0.001). Due to DRG grouping and long-stay surcharges, the mean revenue per case was significantly higher in the halo group than in the other cases (€ 63,615 ± 45,138 vs. € 16,836 ± 9356) (p = 0.003). The contribution margin for the period of the long-term surcharges varied between 11,394 and 9766 €. The high additional costs due to the necessary medical devices of halo traction were not sufficiently reflected in the reimbursement. CONCLUSION: Paediatric spine surgery can be challenging in special cases. In particular, severe deformities of the spine may require additional procedures. The subgroup of patients requiring preoperative halo traction is not adequately compensated by the DRG system.

[Chronic recurrent multifocal osteomyelitis of the spine : Children and adolescent]. / Chronische rekurrierende multifokale Osteomyelitis der Wirbelsäule : Kindes- und Jugendalter.

Chronic non-bacterial osteomyelitis (CNO) in childhood and adolescence is a non-infectious autoinflammatory disease of the bone with partial involvement of adjacent joints and soft tissue. The etiology is unknown. The disease can occur singular or recurrent. Individual bones can be affected and multiple lesions can occur. Chronic recurrent multifocal osteomyelitis (CRMO) shows the whole picture of CNO. Accompanying but temporally independent of the bouts of osteomyelitis, some patients show manifestations in the skin, eyes, lungs and the gastrointestinal tract. The article gives an overview of the clinical manifestations, diagnostic procedures, and treatment options for CRMO involvement of the spine based on the current literature and our own cases.

[Spondylosclerosis hemispherica: a rare radiological syndrome of the spine]. / Spondylosclerosis hemispherica: Ein seltenes bildmorphologisches Syndrom der Wirbelsäule.

BACKGROUND: Spondylosclerosis hemispherica is a rare syndrome of the spine and was described first by Dihlmann. The typical radiographic appearance is a hemispherical sclerosis of the vertebral body, which is accompanied by pain in the affected region. Usually it appears at the lower lumbar spine. The etiology varies and includes degenerative disk diseases, scoliosis, bacterial infections, ankylosing spondylitis, osteoid osteoma, and malignant diseases.The radiological findings of 2 patients with spondylosclerosis hemispherica are presented and the current literature discussed. MATERIAL AND METHODS: Two women (33 and 60 years old) with spondylosclerosis hemispherica of the lower spine suffered from low back pain and fulfilled all criteria of Dihlmann's description. Malignant disease was excluded in both cases with a broad diagnostic workup (lab values, x-ray, CT scan, MRI) and in one case a biopsy from the affected vertebra was taken. RESULTS: In both cases all radiological findings demonstrated the typical changes of spondylosclerosis hemispherica with sclerosis of the vertebra body and erosions at the upper and inferior end plates. Malignant disease was excluded in one case with a biopsy and in the other case with noninvasive diagnostic procedures. Both patients were treated nonsurgically. During clinical follow-up, the patients were in a good condition with decreasing regional low back pain and no ongoing radiological changes in the affected vertebral bodies. CONCLUSION: Spondylosclerosis hemispherica is a syndrome with a typical radiographic appearance. The etiology of spondylosclerosis hemispherica is manifold; however, malignancy must be excluded. In most cases, noninvasive diagnostics are sufficient to rule out malignant growth even in cases with concomitant degenerative changes of the affected segment. Thus, there is no need for a biopsy except in cases with ambiguous results. Subsequently, close clinical and radiological follow-up of the patients with spondylosclerosis hemispherica is necessary.

[Superinfected epidermal inclusion cyst of the thigh with development of squamous cell carcinoma--case report of a rare complication]. / Superinfektion einer epidermalen Inklusionszyste des Oberschenkels mit Ausbildung eines Plattenepithelkarzinoms--Fallbericht einer seltenen Komplikation.

Epidermal cysts (atheroma) are the most common benign tumours of the skin with ubiquitous localisation all over the body. However, rupture of the atheroma and formation of an inclusion cyst with additional superinfections are frequently seen. Malignant transformations have rarely been reported. Presented here is the unusual case of a 65-year-old woman with multiple atheromas and a distinctive tumour of the upper limb. Imaging diagnostics showed malignant deformation. Contrary to the imaging findings the histological/microbiological examination showed an enormous superinfected and ruptured epidermoid cyst with multiple abscess formation in the ventral upper limb. Radical surgical restoration with salvage of the limb was frustrated because of honey-combed anterior soft tissue and the changing bacterial spectrum. After resection of the complete ventral compartment, remission was realised approximately. In the follow-up there was a recurring infection with spontaneous fistula formation that histologically impressed as a squamous cell carcinoma. After proximal ablation of the upper limb, total rehabilitation of the infection as well as the malignoma could be achieved.

[Prognosis scores for spinal metastases]. / Prognostische Scores bei Wirbelsäulenmetastasen.

Advances in early detection and therapy of spinal metastasis have improved life expectancy of patients with various tumor entities. However, this and the demographic development have led to an increased risk for developing spinal metastases. Numerous prognostic factors have been determined to allow an assessment of outcome and survival time of patients with metastatic spinal tumors. The implementation of these factors into different scoring systems has been encouraging in the decision making process of spinal surgery. This overview highlights some of the most important prognostic factors and scores which may facilitate surgical considerations.