[Prospective evaluation of braces as treatment in idiopathic scoliosis]. / Prospektive Untersuchung zur Korsettbehandlung bei idiopathischen Skoliosen.

AIM: To prospectively evaluate the results of brace treatment in idiopathic scoliosis and to define risk factors of treatment failure. METHOD: Fifty-two patients with a Cobb angle of between 25 and 40 degrees were included in the study. Prior to initiation of brace treatment with the Chêneau-Toulouse-Muenster orthesis, skeletal age and flexibility of the curve (bending films) were evaluated. The average follow-up after weaning of the brace was 42 months (36-78 months). RESULTS: An average initial Cobb angle of 31 degrees was corrected to 18 degrees (43 %) under brace treatment with a flexibility to 6 degrees Cobb angle on bending films. Three years after weaning there was an overall increase of the Cobb angle to 37 degrees on average. The apical vertebral rotation was corrected from 16 degrees to 11 degrees (31 %) and increased to 20 degrees during follow-up. Thoracic kyphosis changed from 24 degrees to 18 degrees during treatment. At the latest follow-up kyphosis had returned to the pre-treatment angle again. Twenty-two patients had a curve progression during or after brace treatment of more than 5 degrees. In 14 patients surgical correction and fusion have been indicated. There was a positive correlation between flexibility and Cobb angle correction during brace treatment and a negative correlation between Cobb angle correction during brace treatment and curve progression (p < 0.05). CONCLUSIONS: Curve progression was prevented in 58 %. Prognostic risk factors are a young age at initiation of brace treatment, a thoracic curve, unsatisfactory curve correction in the brace and a male gender.

[Selective ventral derotation spondylodesis in idiopathic thoracic scoliosis: a prospective study]. / Selektive ventrale Derotationsspondylodese bei idiopathischen Thorakalskoliosen: eine prospektive Studie.

AIM: Radiometric curve analysis of instrumented primary and spontaneous secondary curve correction after anterior correction and fusion of idiopathic thoracic scoliosis. METHOD: Sixty-four patients with idiopathic thoracic scoliosis were prospectively evaluated. All patients were operated either with the Zielke-VDS or with a primary stable double rod instrumentation with selective fusion of the thoracic curve from end-to end-vertebra. Follow-up averaged 29 months (24 - 52 months). RESULTS: The Cobb angle of the primary curve averaged 63.2 degrees preoperatively and was corrected to 21.4 degrees postoperatively with an average loss of correction of 5.3 degrees (58 % final curve correction). Apical thoracic vertebral rotation was corrected by 48 %. The secondary lumbar curve measured 38.2 degrees preoperatively (72 % correction on the bending films) and was spontaneously corrected by 57 % to 16.4 degrees without significant loss of correction in the final follow-up. Apical vertebral rotation averaged 11.3 degrees in the lumbar curve and was corrected spontaneously by 24 % to 8.6 degrees without significant loss of correction. Lumbar apex vertebra deviation showed no significant reduction. There was no case of lumbar curve decompensation in either frontal or sagittal plane. Implant related complications were observed in 7 patients (rod breakage), but no pseudarthrosis occurred. There were no neurological complications noted. CONCLUSION: Selective anterior correction and fusion in idiopathic thoracic scoliosis enables a satisfactory correction of both primary and lumbar secondary curves. The advantage of selective anterior correction and fusion of thoracic scoliosis is the short fusion length, better derotation and satisfactory correction of the secondary lumbar curve. The disadvantages of single threaded rod techniques in terms of lack of primary stability and a kyphogenic effect have been eliminated by the development of a primary stable, small size double rod instrumentation.

Comparative analysis of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis.

Posterior correction and fusion with segmental hook instrumentation represent the gold standard in the surgical treatment of progressive idiopathic thoracic scoliosis. However, there is a debate over whether pedicle screws are safe in scoliosis surgery and whether their usage might enable a better curve correction and a shorter fusion length. The details of curve correction, fusion length and complication rate of 99 patients with idiopathic thoracic scoliosis treated with either hook or pedicle screw instrumentation were analyzed. Forty-nine patients had been operated with the Cotrel-Dubousset system using hooks exclusively ("hook group"). Fifty patients had been operated with either a combination of pedicle screws in the lumbar and lower thoracic and hooks in the upper thoracic spine or exclusive pedicle screw instrumentation using the Münster Posterior Double Rod System ("screw group"). The preoperative Cobb angle averaged 61.3 degrees (range 40 degrees-84 degrees ) in the hook group and 62.5 degrees (range 43 degrees-94 degrees ) in the screw group. Average primary curve correction was 51.7% in the hook group and 55.8% in the screw group ( P>0.05). However, at follow-up (2-12 years later) primary curve correction was significantly greater ( P=0.001) in the screw group (at 50.1%) compared to the hook group (at 41.1%). Secondary lumbar curve correction was significantly greater ( P=0.04) in the screw group (54.9%) compared to the hook group (46.9%). Correction of the apical vertebral rotation according to Perdriolle was minimal in both groups. Apical vertebral translation was corrected by 42.0% in the hook group and 55.6% in the screw group ( P=0.008). Correction of the tilt of the lowest instrumented vertebra averaged 48.1% in the hook group and 66.2% in the screw group ( P=0.0004). There were no differences concerning correction of the sagittal plane deformity between the two groups. Fusion length was, on average, 0.6 segments shorter in the screw group compared to the hook group ( P=0.03). With pedicle screws, the lowest instrumented vertebra was usually one below the lower end vertebra, whereas in the hook group it was between one and two vertebrae below the lower end vertebra. Both operative time and intraoperative blood loss were significantly higher in the hook group ( P<0.0001). One pedicle screw at T5 was exchanged due to the direct proximity to the aorta. There were no neurologic complications related to pedicle screw instrumentation. Pedicle screw instrumentation alone or in combination with proximal hook instrumentation offers a significantly better primary and secondary curve correction in idiopathic thoracic scoliosis and enables a significantly shorter fusion length.

[Long-term results of posterior correction and fusion of scoliosis using the Cotrel-Dubousset instrumentation]. / Langzeitergebnisse dorsaler Instrumentationsspondylodesen mit dem Cotrel-Dubousset-Instrumentarium bei idiopathischen Thorakalskoliosen.

AIM: Radiographic analysis of long-term results following CDI. METHODS: Retrospective analysis of radiographs of 43 patients with idiopathic right thoracic scoliosis with an average follow-up of 82 months. Extensive radiographic analysis with special regard to curve correction in the frontal and sagittal planes. RESULTS: The average Cobb-angle of the preoperative primary curve was 61.6 degrees (min.: 40 degrees, max.: 84 degrees ), the correction postoperatively was 51.1 % representing 29.9 degrees. Due to the loss of correction of 7.1 degrees, the overall outcome was 39.9 % by the time of follow-up. More than 90 % of the loss of correction occurred within the first 2 years. The lumbar secondary curve correction was 47.2 % (preop.: 37.5 degrees; postop.: 19.8 degrees ). Average fusion length was 11 segments, fusion usually ended two vertebrae below the end vertebra. Translation of the apex was corrected by 38.8 % (preop.: 4.9 cm; postop.: 3.0 cm), tilt of the last instrumented vertebra by 44.2 % (preop.: 18.2 degrees; postop.: 10.16 degrees ). The amount of derotation was negligible (preop.: 24.1 degrees; postop.: 22.6 degrees ). The readjustment of a preoperative pathologic sagittal profile, meaning a thoracic hypokyphosis, was successful in 12 out of 15 cases. Blood loss, duration of operation and complications were documented. CONCLUSION: CD-Instrumentation in scoliosis surgery offers a long-lasting suffcient correction of the fronal and a good correction of the sagittal plane. Stability of correction is achieved 2 years after operation.

[Incidence of injuries in parachuting]. / Verletzungsinzidenz beim Fallschirmsport.

During the German championships in parachuting 78 paratroopers were asked about acute injuries and chronic pain using a questionnaire. A total amount of 131 injuries was described. These were evaluated in terms of dimension and localisation. Upper and lower parts of the body were injured with a comparable frequency. Bruises (42%), fractures (19%), sprainings (16%) and dislocations (10%) were most often described. The overall injury rate according to the total number of descents (0.09%) was lower than that reported by previous literature. Therefore it can be concluded that parachuting for experienced jumpers is less dangerous than assumed until today.

Injury pattern and acceptance of passive and active injury prophylaxis for inline skating.

In a field study the injury pattern as well as the active and passive injury prophylaxis of 1036 inline skaters were evaluated. Of them, 60% had already been injured. Every 124 h an injury occurred during inline skating. While 61% of the injuries affected only soft tissue, 31% were joint distorsions, and 8% were fractures. Altogether 37% of the 626 injured skaters required medical treatment. The upper extremities are especially at risk: 78% of the fractures and 48% of the distorsions affected the fingers, wrist, forearm or elbow. It is obvious that the inline skaters' passive prophylaxis measures are still unsatisfactory. Only 17% of the questioned used complete protection, whereas 16% were wearing no protective gear at all. Of the rest, 49% were skating with wrist guards, 66% were using knee pads, and 31% elbow pads. A high percentage of injuries is due to the lack of basic knowledge and techniques. The survey revealed that only 24% can stop immediately. While 51% had only slight problems with braking, 16% admitted having great difficulties, and 7% were not able to brake at all. These numbers reveal that there are still large deficits regarding braking techniques and education on the risks of injury. Therefore, athletes who use this equipment for the first time should learn the basic techniques of skating, braking and falling with the help of a qualified instructor. Most of all those questioned wanted to have more information, and half would be interested in special educational programmes.