[Direct screwing in spondylolysis: results and observations on indications]. / Direktverschraubung bei Spondylolyse: Resultate und Uberlegungen zur Indikation.

Ten patients suffering from persisting low-back pain underwent direct repair of spondylolysis L5 with hook screws. At a follow-up three to four years after the operation, four patients showed good and six unsatisfactory results. Four patients had a secondary procedure. Average age was relatively high in the study group compared with the literature, and pain tended to be chronic. In five of the six patients with a poor clinical result, radiological consolidation of the lytic defect could not be demonstrated. We are discussing indications based on a literature review.

[Does geometry of the lumbosacral inclination have an effect on the etiology of isolated osteochondrosis of L5/S1?]. / Hat die Geometrie am lumbosacralen Ubergang Einfluss auf die Ausbildung einer isolierten Osteochondrose L5/S1?

Men and women with isolated osteochondrosis L5/S1 (excluding transitional anomalies) were compared against a corresponding group of healthy volunteers to see whether there is any geometric or statistical evidence that might constitute predisposing factors for isolated osteochondrosis L5/S1. Arithmetic means, variances, standard deviations, and correlation coefficients were calculated for all the characteristics determined for the two groups. Multiple linear discriminant analysis was used to try to reproduce any classifications our groupings of the characteristic bearers on the basis of their characteristics. It was found that the position of the sacrum in the pelvis and the extent of lumbar lordosis play a major role. To detect a predisposition for isolated osteochondrosis L5/S1, it is thus necessary to evaluate: the position of the sacrum with regard to the pelvis and the degree of lumbar lordosis-excluding that of the fifth lumbar vertebra-in the angle system. This evaluation can be performed by measuring the dorsal inclination of the sacrum (the delta angle) and the Albrecht inclination.

[Nerve compression syndrome caused by synovial cyst of the hip joint]. / Nervenkompressionssyndrom durch Synovialzyste am Hüftgelenk.

Synovitis of the iliopectineal bursa have been described in pigmented villanodular synovitis, synovial chondromatosis, rheumatoid arthritis, osteoarthritis and necrosis of the femoral head. We report a case of enlargement of such a cyst in necrosis of femoral head and consecutive osteoarthritis, leading to entrapment of the femoral nerve. Simple drainage of the cyst did resolve pain for a short period and only elimination of the primum pathologicum agens did definitively release pain, irradiating to the ipsilateral leg.

[Rehabilitation of paraplegic patients]. / Rehabilitation bei Querschnittgelähmten.

Comprehensive management and care of spinal-cord-lesioned patients start at the site of injury or at the moment of the onset of paralysis, depend with its consequences on the treatment in the acute phase, pass to the reactivation and rehabilitation phase and continue throughout all life of such patients. Considering that even a complete transverse lesion is only an instable, temporarily balanced situation, every small complication can destroy this balance and may lead from total independence to total dependence. Orthopedic, neurological, neurosurgical, urological, physio- or ergotherapeutic, socio-professional or other aspects in the field of comprehensive care and rehabilitation can never be analyzed or managed singularly, but have to be seen always in the context of the whole final outcome. The coordinating role of the paraplegiologist and the importance of adequate spinal cord injury units is stressed. The changing pattern of aetiopathogenesis or epidemiology of spinal cord lesions (increase of medical causes such as vascular lesions, tumors, infection disease) and the definition for rehabilitability due to the higher amount of elderly people will bring a new challenge for all careers in the field of rehabilitation.

[Evaluation and treatment of Scheuermann's disease]. / Beurteilung und Behandlung der Scheuermann-Krankheit.

Scheuermann's disease is considered a kyphoscoliotic process of specific segments of the vertebral column expanding on the original definition of thoracic hyperkyphosis. More important for prognosis than the description of anomalies of single vertebrae is the competent assessment of static imbalance. Because of lacking long-term results no strategies for treatment can be recommended today. Conservative as well as surgical therapies are laborious and their success often rather limited.

[Destructive spondylopathy in chondrocalcinosis ("pseudospondylodiscitis")]. / Destruktive Spondylopathie bei Chondrokalzinose ("Pseudospondylodiszitis").

A case of degenerative spondylopathy in chondrocalcinosis (pseudospondylo-discitis) is presented. The incidence of vertebral involvement in chondrocalcinosis reported in the literature is reviewed. In approximately 4-10% of all cases of chondrocalcinosis the vertebral column is involved as well. Especially in elderly patients, a differential diagnosis based on clinical, radiological and laboratory findings must include infectious spondylodiscitis. In the presence of additional degenerative spondylolisthesis, as well as radiculopathy and/or symptoms of spinal stenosis, surgery is often performed. However, there are cases reported in which improvement occurs after spontaneous vertebral fusion without surgical intervention. If any vertebral change is detected that is suggestive of chondrocalcinosis, even in asymptomatic patients, it is recommended to obtain radiographs of other joints, for example, the knee and wrist, which are frequently also involved in chondrocalcinosis.

[G. Homann's operation on the elbow--surgical treatment of a symptom?]. / Der Eingriff nach G. Hohmann am Ellbogen--operative Behandlung eines Symptoms?

Lateral epicondylopathy, well known as "tennis elbow", sometimes may only be a symptom of cervical spine and shoulder diseases or may also occur in neuropathy or arthropathy of the elbow or wrist joint. A follow-up of 63 patients, four years after Hohmann's procedure, shows that there really exists an idiopathic form of this disease. Careful differential diagnosis and special consideration of the epidemiology is of prime importance if conservative treatment and surgery is to be successful.

[The Haglund exostosis--a surgical indication and a minor intervention?]. / Die Haglund-Exostose--eine Operationsindikation und ein kleiner Eingriff?

From 1946 to 1985 a total of 594 patients with Haglund's disease were treated. 165 of the 266, who had been surgically treated were questioned extensively and 32 of them clinically and radiologically examined. Besides details of indication, surgical technique and perioperative issue, the subjective result as compared with the morphological state after removal of exostoses, was noted particularly. This necessitated the introduction of new X-ray quantification techniques in addition of the procedures described in literature. 73% good, and further 20% acceptable results confirm the indication. Nevertheless the success of the method depends largely on a good surgical technique and especially on the post-operative care.

[Lateral ligament replacement of the ankle joint--cialit graft or tendon graft? A comparative clinical study from the Balgrist Orthopedic University Hospital, Zürich]. / Lateraler Bandersatz am Sprunggelenk--Cialithautplastik oder Sehnenplastik? Eine vergleichende klinische Studie aus der Orthopädischen Universitätsklinik Balgrist, Zürich.

Of a total of 268 patients who were operated because of ankle instability, 125 who were treated with cialit skin graft and 101 who received a peroneal tendon graft were interrogated. 36 were clinically and radiologically examined. Apart from some very minor disturbances, neither during the period immediately after surgery nor later, were the subjective or objective results significantly different. This observation demands that no surgical technique should be employed that could interfere with the function of proprioceptive or constraining structures.