Translaminar screw fixation of the lumbar spine.

Lower lumbar spinal fusion was carried out in 72 patients by a technique which involved screw fixation of the facet joints. Stability was achieved and mobilisation was allowed immediately. Radiographs after operation showed bony fusion in 94.5%. Pain was diminished and 76% of the patients would undergo the same treatment again. There were no neurological complications. The technique is useful and safe for the fusion of short segments of the lumbar spine.

[Orthopedic problems of the upper cervical spine in children and adolescents]. / Orthopädische Probleme an der oberen Halswirbelsäule bei Kindern und Jugendlichen.

Because of relatively low frequency of pathological changes of the upper cervical spine in childhood and adolescence, their management is not well known. Diagnostic problems occur due to the variety of malformations possible, persisting growth plates and ligamentous laxity. Because of this laxity, conservative treatment with immobilization is advocated even in severe dislocations as long as they are reducible. Persistent dislocations, chronic atlantoaxial instability (ADI greater than 5 mm), dens fractures type II and existing or progressing neurological deficits all indicate surgical intervention. Internal fixation allows easier postoperative care. Complications are rare. Patients with orthopedic problems of the upper cervical spine are presented, together with their management.

Circumferential fusion of the lumbar and lumbosacral spine. Comparison of two techniques of anterior spinal fusion.

Thirty-two patients with therapy-resistant low-back pain and justified indication for fusion were divided into two groups: 16 patients were treated with anterior fusion of the lumbosacral spine, with insertion of tricortical bone grafts of the iliac crest, and 16 patients with insertion of a fibular peg. Additional dorsal fusion of the same segments was performed. Comparison of the two techniques of circumferential fusion of the lumbosacral joint reveals comparable clinical results. A marked difference in roentgenographical criteria such as disk height, retrolisthesis, and anterior osteophytes in the adjacent segment between the two techniques was noted at the time of follow-up evaluation after 89 months and motivated the authors to abandon the fibular-peg technique.

Circumferential fusion of the lumbar and lumbosacral spine.

Seventy-four patients with circumferential fusion of the lumbosacral spine have been assessed after a mean follow up of 49.8 months. For the ventral procedure, an anterior interbody fusion with tricortical iliac bone graft was performed. The additional dorsal fusion was according to various techniques with mainly transpedicular internal fixation. Forty-six patients underwent a one-stage operation while 28 underwent the ventral and dorsal procedure in different sittings. The results favour the technique of a combined anterior/posterior approach for fusion of the lumbosacral spine in patients with instability and deformity of all three columns, such as fractures and spondylolisthesis of more than 50%. Optimal stability with satisfactory reduction of the deformity may be achieved. The one-stage operation proved to be superior, with less complications and a shorter hospital stay.

[Secondary correction on the forefoot]. / Nachkorrekturen am Vorfuss.

If the results after operation on the forefoot are insufficient, in our opinion this is due to: (1) indications that are not strict enough (cosmetic of semicosmetic indication); (2) inadequate technique: insufficient consideration of the length of the toes and the metatarsus or correction of individual toe deformities instead of homogeneous treatment of the whole forefoot. As our results show, when considering all of these points, we obtain a substantial improvement in these feet. The metatarsal length was corrected by the Helal osteotomy or by resection of the head of the metatarsal bone. When the differences were extreme, the forefoot was corrected following the Lelièvre procedure. Full capacity, however, is reached in only one-third of the cases. From this fact, it must be concluded that first operations should be carried out only when there are functional limitations. If the foot is initially free of pain and there is pain after an operation, however slight it might be, the result is always considered poor.

[Results of tibia condyle osteotomy]. / Ergebnisse der Tibiakopf-Osteotomie.

The subjective and objective results of infra-condylar tibia condyle osteotomy are presented, based on a study of 71 cases. Arthroplasty of the knee joint can often be avoided by performing an infra-condylar tibia condyle osteotomy, taking into consideration the contra-indications, in cases of painful (varus) gonarthrosis becoming mainly manifest in a joint compartment, combined with an axis shift. The gait capacity can be improved, the subjective pain symptomatology be diminished and progression of the arthrosis might be avoided. The good results correlate with an optimal correction of the axis condition; in cases of varus gonarthrosis a slight overcorrection beyond the physiological valgus position of 7 degrees and in cases of valgus gonarthrosis a physiological valgus position of 7 degrees should be aimed at.

The GSB knee arthroplasty.

The GSB knee joint is briefly described. Its main features are that it is a non-constrained hinge joint with a polycentric axis of rotation and the load is transmitted over a large area of condylar support. Two hundred and twenty-four patients operated upon in the preceeding 6 years have been reviewed and analysed by an independent observer and the reuslts are presented. Complications that have been encountered are discussed.

[Own experiences in the orthopedic treatment of meningomyelocele]. / Eigene Erfahrung bei der orthopädischen Behandlung der Myelomeningocele.

30 myelomeningocele patients which were surveyed at Zurich's Children's Hospital and at the Wilhelm Schulthess Clinic in the years from 1962 to 1976 have been postexamined. Significant for the rehabilitation of these children in respect for the gaining of their best ever possible independence and capability to walk are primarily the neurosegmental level of the lesion, the remaining motor power as well as intelligence and motivation. Of secondary significance is the orthopaedic operation whereby specifically the correction of fixed deformity is important. The quantity of anesthesias should be hold at minimum, bilateral hip-dislocations can be left alone, and psoas-transfers (SHARRARD) should be made on children with strong quadriceps only.