Translation, validation, and cross-cultural adaption of the Western Ontario Meniscal Evaluation Tool (WOMET) into German.

PURPOSE: The Western Ontario Meniscal Evaluation Tool (WOMET) was developed in order to investigate the health-related quality of life of patients with meniscal pathologies. The aim of the present study was to translate and validate the WOMET into German. METHODS: A standardized forward backward translation of the WOMET into German was first performed. One hundred ninety-two patients with isolated meniscal tears completed the German version of the WOMET as well as the Western Ontario McMasters University Arthritis Index, and the Knee Osteoarthritis Outcome Score. Furthermore, reliability, construct validity, feasibility, internal consistency, ceiling, and floor effects were then calculated. RESULTS: Excellent feasibility (85.4% fully complete questionnaire), internal consistency (Cronbach's α = 0.92), and test-retest reliability (ICC, r = 0.90) were found. The standard error of measurement and the minimal detectable change were ±4.6 and 12.7 points, respectively. All predefined hypothesises were confirmed. No floor or ceiling effects were found. CONCLUSIONS: The presented German version of the WOMET is a valid and reliable tool for investigating the health-related quality of life of German-speaking patients with meniscal pathologies. LEVEL OF EVIDENCE: Cross-sectional study, Level II.

Alternative technique of cement augmentation of loosened pedicle screws -- technical note and presentation of two cases.

An alternative cement augmentation technique for pedicle screws is described, which was applied in two patients with mono- and bisegmental non-union after preceding multisegmental lumbar fusion. The correctly placed pedicle screws in S1 with diameters of 6 and 8.5 mm had severely enlarged the screw cavities due to segmental instability. Revision screws with 10 mm diameter demonstrated sufficient purchase only on the left side. Therefore, cement augmentation was performed for the right sided screws. After verification of intact pedicle borders, the cavity was filled up with PMMA bone cement. Afterwards, a Kirschner wire was positioned centrally, the hardening of the cement was awaited, the cement was gradually drilled and the screw was placed. In both patients, sufficient purchase of the cemented pedicle screws was documented. Screw insertion after awaiting the hardening of the bone cement in pedicles and vertebral bodies with huge defect situations seems to be an alternative to previous cement augmentation techniques of pedicle screws with the advantage, that the screws could be more easily unscrewed, if necessary.

[Adjacent segment movement after monosegmental total disc replacement and monosegmental fusion of segments L4/5]. / Anschlusssegmentbeweglichkeit nach monosegmentaler Bandscheibenprothesenimplantation und monosegmentaler Fusion Segment L4/5.

BACKGROUND: Preservation of movement at the treated segment and possible reduction of adjacent segment effects is assumed to be an advantage of non-fusion technologies over fusion. The aim of this study was to compare the segmental range of motion (ROM) at the operative level, the cranial and caudal adjacent levels and the global lumbar spine ROM (L2-S1) after monosegmental fusion and total disc replacement (TDR). PATIENTS AND METHODS: Radiographic data was collected from 27 patients with level 1 degenerative disc disease operated at level L4/5. The ROM was assessed at the index level (L4/5), the cranial and caudal adjacent level and for the lumbar spine (L2-S1). RESULTS: In the TDR group no significant changes of lumbar spine ROM (L2-S1) and segmental ROM (index level, cranial and caudal adjacent level) were noticed. In the fusion group there was a significant reduction of lumbar ROM (L2-S1) and index level ROM. Additionally the relative ROM in the adjacent caudal segment significantly increased while no changes were seen in the cranial segment. CONCLUSION: The relative ROM was significantly increased in monosegmental fusion at level L4/5 compared to TDR. To what extent this fact may result in early adjacent segment degeneration in cases of fusion compared to TDR is still unknown.

[Perioperative morbidity in lumbar disc replacement]. / Perioperative Morbidität bei lumbaler Bandscheibenprothesenimplantation.

AIM: For several years now interbody fusion has been the gold standard procedure for treating degenerative disc disease. The problem of adjacent disc degeneration after interbody arthrodesis led to the development of non-fusion techniques. The device which best represents the philosophy of spine arthroplasty is the total lumbar disc replacement (TDR). An analysis of the perioperative morbidity of lumbar disc replacement was carried out in the current study. METHOD: 66 patients underwent lumbar disc replacement between 2001 and 2007. 78 protheses were implanted. Retrospectively patient-related variables (comorbidity, prior surgeries), perioperative blood loss, number and levels operated on, operation duration and technical and general complications were analysed. RESULTS: 54 patients had mono- and 12 patients bisegmental TDR. The mean operation time was 112 minutes with an average blood loss of 560 mL. Neither the type of comorbidity, prior surgery, operation duration, nor level operated on had an influence on the occurrence of perioperative morbidity. A significant influence could be shown for the number of levels operated on and the intraoperative blood loss. General complications were seen in 6 persons (9%) with urinary tract infection, technical complications occurred in 4 persons (6%) with severe blood loss (> 1500 mL) and erythrocyte/plasma substitution, 1 person (1.5%) with an injury of the iliac vein, 1 person (1.5%) with retrograde ejaculation and 1 person (1.5%) with dural tear and consecutive epidural infection. CONCLUSION: In our study the perioperative morbidity of lumbar disc replacement was similar to the data published so far and seems to be comparable with the perioperative morbidity of lumbar interbody fusion.

[Perioperative morbidity of lumbar stabilisation with Dynesys]. / Perioperative Morbidität bei Dynesys-Instrumentierung der Lendenwirbelsäule.

AIM: Several non-fusion technologies have been developed as an alternative to fusion procedures in the past decades, in order to avoid typical problems related to fusion. The Dynesys (Zimmer, USA), which was inaugurated 7 years ago, consists of pedicle screws, flexible spacers and cords and is intended to control segmental motion and to realign the lumbar spine. Since this device is new, it was the goal of this study to analyse the perioperative morbidity of lumbar stabilisation with Dynesys retrospectively. METHOD: 136 patients (74 men and 62 women) underwent posterior stabilisation of the lumbar spine with Dynesys between January 2002 and April 2006. We acquired retrospectively several patient-related variables, e.g. the number of instrumented and decompressed segments, the perioperative blood loss, the operation duration, prior surgeries and technical and general complications. RESULTS: The average age of the patients was 61.2 years (range: 33-84). 1.6 segments (range: 1-3) were instrumented and 1.2 segments (range: 0-3) were decompressed on average. The mean perioperative blood loss was 1100 ml (range: 50-3400) and the mean operation duration was 127.1 minutes (range: 30-270). Eighteen patients (13.2 %) had a urinary tract infection and 5 patients (3.7 %) had cardiovascular complications. Dura lesions were seen in 11 patients (8.1 %) with 1 patient having persistent bladder symptoms. Revision surgery was necessary in 3 patients (2.2 %) due to screw malposition with neurological deficits and radicular pain. Five patients (3.7 %) were revised due to postoperative seroma, 2 of them developing superficial infection. CONCLUSION: The perioperative morbidity of lumbar stabilisation with Dynesys seems to be similar to posterior fusion techniques. However, an additional morbidity due to interbody fusion, which may necessitate also autogenous bone, is avoided.

[Do injuries of the upper extremity in geriatric patients end up in helplessness? A prospective study for the outcome of distal radius and proximal humerus fractures in individuals over 65]. / Frakturen der oberen Extremität beim geriatrischen Patienten - Harmlose Monoverletzung oder Ende der Selbstständigkeit? Eine prospektive Studie zum Outcome nach distaler Radius- und proximaler Humerusfraktur bei über 65-jährigen.

In a prospective study 104 patients >or=65 years with distal radius fractures (DRF; n=52) and proximal forearm fractures (PHF; n=52) were followed up for a period of 4 months after injury. As an inception- cohort study, influence on treatment pattern was not part of the examination. A total of 53% of the DRF and 74% of the PHF patients underwent surgery. There were no significant changes in the ability of daily living management (IADL) with either fracture form. Functional outcome was better in PHF than DRF patients. PHF patients showed a high incidence in "fear of falling" throughout the whole study, whereas fear of falling rose significantly in DRF patients. 4% of DRF and 9.6% of PHF patients died during the observation period, while 6% of DRF and even 17% of PHF patients had to give up their own housekeeping. One third of both patient groups did not receive physiotherapy. In only 12% of DRF and 6% of PHF patients was osteoporosis treated. In both groups of patients there was a significant worsening in the ability of walking after injury, leading to two or more new falls in 24% of DRF and 28% of PHF patients.