[Surgical method in treatment of total kyphosis in ankylosing spondylitis]. / Operationsmethoden zur Behandlung der Totalkyphose bei der Spondylitis ankylosans.

In spite of extensive, conservative methods for treating spondylitis, more or less distinct kyphotic deformities are common. Pain usually plays a minor role as an indication for surgery either as local instability or as impairment of the large hip or knee joints. Much more common are the loss of social contact and the lack of visual contact with the surroundings, both of which the patients find unacceptable. The monosegmental, lumbar correction method as used at an early stage implicated a high rate of complications. The implant supported methods, and in particular those that allow the potential for dorsal transpediculated fixation, allowed, in the early 1980s, dorsal lordotic measures in the form of a multilocus method and, in the mid-1980s, a modified monosegmentary method as well. Both of these methods are widely accepted because of their good long-term results. The possible complications no longer include the disturbance of the spinal cord but are rather to be found in the poor general condition of the patient. The restoration of a largely normal equilibrium of the backbone relieves the musculature and is therefore a definitive pain therapy for muscle tension problems. Straightening the backbone also relieves the hip joints and therefore it is possible in many cases to delay the implantation of a hip prosthesis.

[Treatment of scoliosis and scoliokyphosis in Recklinghausen neurofibromatosis]. / Behandlung der Skoliose und Skoliokyphose bei Neurofibromatosis Recklinghausen (NF).

Spine deformities are a frequent symptom of neurofibromatosis Recklinghausen. Especially NF1 shows next to numerous alterations in the skeleton in some cases massive scoliosis and kyphosis. There are different theories for the development of the spine deformities, one of them is that specific alterations of the vertebra are caused by an elevated intraspinal pressure on the osteoporotic bone. A classification from a clinical point of view discriminates 3 types of severity. Type 1 shows instead of the in x-rays inconspicuous findings neurofibromatosistypical alterations in other diagnostic procedures (e.g. MRI). Extreme variations like short curved scoliokyphosis with massive destruction and severe spine imbalance are described as type 3. Operative treatment is dependent on the severity of the deformity. Intraspinal tumors have to be removed. Because of the elevated neurological risk the proceeding has to be very careful, sometimes there is a temporary Halo-extension necessary. Anterior substance defects are filled with bone or cages. The posterior instrumentation (in most of the cases a 2-rod-stabilization) is performed by transpedicular screws. Frequently there is a concave chest wall plastic (CTP) indicated. To prevent neurological complications early surgical procedure is sometimes necessary. Complications can be reduced by careful proceeding, exact preoperative diagnostic and classification. But next to operative experience a qualified anaesthesiological and intensive care units are absolutely necessary.

Physical performance and cardiovascular and metabolic adaptation of elite female wheelchair basketball players in wheelchair ergometry and in competition.

Spinal cord injury leads to a pronounced reduction of cardiovascular, pulmonary, and metabolic ability. Physical activity, up to and including high-performance sports, has obtained importance in the course of rehabilitation and the postclinical phase. Thirteen elite female wheelchair basketball players from the German National Basketball Team and 10 female sedentary spinal cord-injured persons were examined in the study. Heart volume was measured by an echocardiography. All subjects underwent a graded exercise test on a wheelchair ergometer. Additionally, heart rate, lactate, and player points were measured during a competitive basketball game in wheelchair basketball players. Cardiac dimensions were larger for spinal cord-injured wheelchair basketball players (620.3 ml; 9.6 ml x kg(-1)) in comparison with spinal cord-injured persons (477.4 ml; 8.2 ml x kg(-1)) but did not exceed the heart volume of untrained nonhandicapped persons. In contrast, athletes with amputations or those having had poliomyelitis reached training-induced cardiac hypertrophy in relation to body mass (713.7 ml; 13.2 ml x kg(-1)), as observed in nonhandicapped athletes. During graded wheelchair ergometry, wheelchair basketball players showed a higher maximal work rate (59.9 v 45.5 W), maximal oxygen consumption (33.7 v 18.3 ml x min(-1) x kg(-1)), and maximal lactate (9.1 v 5.47 mmol x l(-1)) without a difference in maximal heart rate and workload at AT4 than did spinal cord-injured persons. The average heart rate during the wheelchair basketball game was 151 x min(-1), and the lactate concentration was 1.92 mmol x l(-1). Female athletes with a less severe handicap and higher maximal oxygen consumption during the graded exercise test reached a higher game level in the evaluation. During the competitive basketball game, high cardiovascular stress was observed, indicating a fast aerobic metabolism; the anaerobic lactic acid capacity played a subordinate role. Wheelchair basketball is an effective and suitable sport to enhance physical performance and to induce positive physiological adaptations.

Treatment of the spondylolisthesis. : Operation in situ or reposition spondylodesis.

The indication for operative treatment of spondylolisthesis in children and juvenile patients relies mainly on the progressive slipping of the vertebra, with consecutive deformation, on the other hand on neurological disorders, that may be seen as rigid lumbar extension with contractation of hip and knee joints. In the adult patient the main reason for treatment is the painful instability, often accompanied by root pain caused by degenerative changes as a result of repairment. The treatment consists of comlete reduction of the slipping vertebra, and reconstruction of the physiological lumbar lordosis through a postolateral and anterior interbody fusion. In case of additional compression of neurological structures, an extensive decompression must be performed. Today it is possible to reposition nearly every spondylolisthesis, even ankylosed spondyloloptosis. In some cases it is necessary to performe the reposition step by step in two sessions in order to allow the neurological structures to accomodate. Finally you reach through a complete reposition a physiological curve with correct impact of the biomechanic forces and a harmonic relation between posterior compression and anterior axial force. A complete reposition with an negativ angle in the slipping segment brings the axial force back into physiological position and prevents early degenerative changes in the neighbouring segments. A posterior fusion in situ can not reduce the pathological biomechanics and has to lead to a high rate of pseudarthrosis with an increase of the anterior slipping. Even anterior fusion only is not sufficient, as the posterior interarticular portion remains divided, the disposition or dysplasia of the facett joints increases the segmentmovement. As a result you see resorption and pseudarthrosis of the anterior fusion. Only in case of undamaged discs and ligaments in juvenile patients without anterior slipping a try with a posterior laminoplastic is allowed.

[Treatment of spondylolisthesis. Operation in situ or repositioning spondylodesis]. / Behandlung der Spondylolisthese. Operation in situ oder Repositionsspondylodese.

The indication for operative treatment of spondylolisthesis in children and juvenile patients relies mainly on the progressive slipping of the vertebra, with consecutive deformation, on the other hand on neurological disorders, that may be seen as rigid lumbar extension with contractation of hip and knee joints. In the adult patient the main reason for treatment is the painful instability, often accompanied by root pain caused by degenerative changes as a result of repairment. The treatment consists of comlete reduction of the slipping vertebra, and reconstruction of the physiological lumbar lordosis through a postolateral and anterior interbody fusion. In case of additional compression of neurological structures, an extensive decompression must be performed. Today it is possible to reposition nearly ever spondylolisthesis, even ankylosed spondyloloptosis. In some cases it is necessary to performe the reposition step by step in two sessions in order to allow the neurological structures to accomodate. Finally you reach through a complete reposition a physiological curve with correct impact of the biomechanic forces and a harmonic relation between posterior compression and anterior axial force. A complete reposition with an negativ angle in the slipping segment brings the axial force back into physiological position and prevents early degenerative changes in the neighbouring segments. A posterior fusion in situ can not reduce the pathological biomechanics and has to lead to a high rate of pseudarthrosis with an increase of the anterior slipping. Even anterior fusion only is not sufficient, as the posterior inter-articular portion remains divided, the disposition or dysplasia of the facett joints increases the segmentmovement. As a result you see resorption and pseudarthrosis of the anterior fusion. Only in case of undamaged discs and ligaments in juvenile patients without anterior slipping a try with a posterior laminoplastic is allowed.