Markus Quante

University Medical Center Hamburg - Eppendorf, Hamburg, Hamburg, Germany

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Publications (33)60.22 Total impact

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    ABSTRACT: STUDY DESIGN:: 2 arm prospective controlled study. OBJECTIVE:: The aim of our study is to prospectively assess the outcome of symptomatic lumbar spinal stenosis (LSS) treated with decompressive surgery alone in comparison to additional implantation of the Coflex™ interspinous Device. SUMMARY OF BACKROUND DATA:: In symptomatic LSS decompression surgery is an established treatment. Recently a number of interspinous devices have been introduced as an alternative to conventional surgical procedures. The theoretical aim of the Coflex Device is to unload the facet joints, restore foraminal height and provide stability in order to improve the clinical outcome. Published information is limited, and there are no data which proof the superiority of the implant in comparison to traditional surgical approaches. METHODS:: Sixty-two patients with symptomatic LSS were treated with decompressive surgery, 31 of these patients received an additional Coflex™ device. Pre- and postoperatively disability and pain scores were measured using the Oswestry Disability Index (ODI), the Roland-Morris Disability Questionnaire (RMS), the Visual Analoge Scale (VAS) and the pain free walking distance (WD). Patients underwent postoperative assessments 3, 6 12 and 24 month including the above mentioned scores as well as patient satisfaction. RESULTS:: There was a significant improvement (P<0.001) in the clinical outcome assessed in the ODI, in the RMS, in the VAS and in the pain-free walking distance at all times of reinvestigation compared to the base line in both groups. Up to two years after surgery there were no significant differences between both groups in all ascertained parameters including the patient satisfaction and subjective operation decision. CONCLUSIONS:: The results of this first prospective controlled study indicate that the additional placement of a Coflex™ interspinous device does not improve the already good clinical outcome after decompressive surgery for LSS in the 24-month follow up interval.
    Journal of spinal disorders & techniques 05/2012; · 1.21 Impact Factor
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    ABSTRACT: Today there are different subcutaneous and three oral applicable medications for prevention of venous thromboembolism after knee and hip replacement. It is a general opinion that patients will prefer oral administration. However, until today there has been no study that analysed patient preferences and motives for deciding on the kind of administration. These data would be of interest since the consideration of patient preferences could improve adherence. The present study analysed patient preferences regarding oral or subcutaneous administration of medication after elective hip or knee replacement surgery. The results will have implications for clinical practice and for decision-making concerning the kind of administration. This prospective, multi-centric, observational study was conducted in six emergency hospitals and six rehabilitation hospitals. 178 current hip and knee replacement patients undergoing thromboprophylaxis and at least one further oral medication were interviewed. Subjective assessment data of patients were collected on study-specific questionnaires (epidemiological data, amount and background of general oral medication, details on subcutaneous thromboprophylaxis, preference of administration, causes for preference). 71.91 % of the interviewed patients preferred the daily intake of a tablet, whereas only 14.61 % favoured the daily subcutaneous injection. Main causes for the preference of oral administration were easier (86.6 % of nominations) and less complex (73.1 % of nominations) handling. 70.9 % reported that one more oral application would be unproblematic. Painlessness of oral administration was relevant for 65.7 %. Causes for preferring subcutaneous administration were "safety" (55.3 % of nominations) and an assumption of a generally better effectivity of subcutaneous (47.4 % of nominations) administration. Subjective discomfort induced by subcutaneus administration increased with the time interval since surgery. Less than 5 % of patients prefer subcutaneous administration due to the high volume of their existing oral medication. Patient approval of oral administration is governed by practical and comfort issues. In general, patients on existing oral medications are uncritical concerning a temporary additional oral medication. The clear discomfort measured in association with subcutaneous administration supports the idea that the oral route will have advantages for patient adherence. In particular this is of relevance with increasing time interval since surgery. Patients who have a very high volume of oral medications will probably profit from subcutaneous administration. The main reasons that patients gave for the preference of subcutaneous administration are based on incorrect knowledge. Therefore it is necessary to improve patient education concerning the existing alternatives for thromboprophylaxis.
    Zeitschrift fur Orthopadie und Unfallchirurgie 03/2012; 150(4):397-403. · 0.65 Impact Factor
  • M Quante, H Kesten, A Richter, H Halm
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    ABSTRACT: Degenerative spondylolisthesis (DS) is a common cause of lumbal and lumbosacral pain as well as radicular pain. Retention and fusion is a good treatment option. Some patients have a symptomatic adjacent degenerative disc disease (DDD) in addition to DS. In these cases the adjacent segments should be fused as well. There are different techniques of fusion available, such as posterior with instrumentation or additional anterior support. This study evaluated results of transforaminal lumbar interbody fusion (TLIF) in patients with monosegmental DS and adjacent DDD. A total of 28 patients with monosegmental DS and adjacent DDD were included into the study (all patients with bisegmental posterior instrumentation and fusion, 14 patients 1 level TLIF, 14 patients 2 level TLIF). Before surgery and 12 months after surgery the following measurements were made: pain (visual analog scale VAS), Oswestry disability index (ODI) and plain radiographs with radiometric analysis. In a sub-analysis patients with 1 and 2 level TLIF were compared. Pain reduction (average VAS from 8.7-3.1) and ODI (63% to 28%) showed significant improvements. Radiometric analysis showed a significant disc height reconstruction and a significant reduction of spondylolisthesis (TLIF level with spondylolisthesis). Bisegmental anterior support showed a significantly better relordosation compared to monosegmental anterior support. The complication rate was 21.4% including hemorrhages, dura leakage, wound infection and adjacent segment degeneration. There were no fatal complications. The TLIF procedure is a safe and effective treatment for monosegmental DS with adjacent symptomatic DDD. Clinical results (pain, function) show no difference between both kinds of fusion (dorsal fusion and instrumentation versus dorsal fusion with instrumentation and TLIF) for the adjacent DDD. However, additional anterior support is more effective for relordosation of the segment. This could have impact on the mid-term and long-term outcome or in cases of adjacent segment fusion.
    Der Orthopäde 02/2012; 41(2):153-62. · 0.51 Impact Factor
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    ABSTRACT: Only ten cases of primary pyogenic spondylitis following vertebroplasty have been reported in the literature. To the best of our knowledge, we present the first reported case of primary pyogenic spondylitis and spondylodiscitis caused by kyphoplasty. A 72-year old Caucasian man with an osteoporotic compression fracture of the first lumbar vertebra after kyphoplasty developed sensory incomplete paraplegia below the first lumbar vertebra. This was caused by myelon compression following pyogenic spondylitis with a psoas abscess. Computed tomography guided aspiration of the abscess cavity yielded group C Streptococcus. The psoas abscess was percutaneously drained and laminectomy and posterior instrumentation with an internal fixator from the eleventh thoracic vertebra to the fourth lumbar vertebra was performed. In a second operation, corpectomy of the first lumbar vertebra with cement removal and fusion from the twelfth thoracic vertebra to the second lumbar vertebra with a titanium cage was performed. Six weeks postoperatively, the patient was pain free with no neurologic deficits or signs of infection. Pyogenic spondylitis is an extremely rare complication after kyphoplasty. When these patients develop recurrent back pain postoperatively, the diagnosis of pyogenic spondylitis must be considered.
    Journal of Medical Case Reports 03/2011; 5:101.
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    ABSTRACT: Paragangliomas are rare tumors that originate from the autonomic nervous system-associated paraganglia. They metastasize infrequently. Malignancy can only be demonstrated by the presence of chromaffin tissue at sites where it usually is not present, such as bone, lung or liver, or local recurrence after total resection of a primary mass. Paragangliomas within the central nervous system are usually intradural near the conus medullaris. The metastatic spread of a retroperitoneal paraganglioma to a vertebral body is extremely rare, and there are only a few cases reported in the literature. We report the case of a 16-year-old Caucasian girl who had undergone resection of a retroperitoneal paraganglioma that measured 15 × 11.5 × 9.5 cm. After further staging, a solitary metastatic paraganglioma was detected in the first lumbar vertebral body. After initial chemotherapy, marginal en bloc resection and reconstruction were performed followed by radiotherapy. Histologic examination of the specimen revealed that the tumor cells did not show any response to preoperative chemotherapy, which is in line with a few other reports in the literature. Ten years after operative treatment, the patient is free of complaints, very satisfied with the result and without signs of local recurrence or distant metastases. We recommend en bloc spondylectomy and local radiotherapy in the treatment of solitary spinal metastatic paragangliomas.
    Journal of Medical Case Reports 01/2011; 5:45.
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    ABSTRACT: Surgical technique with an anterior double-rod system for thoracic, thoracolumbar, or lumbar scoliosis. The aim of the system is to correct the coronal plane deformity and normalize the sagittal balance. Scoliosis which should have a coronal Cobb measurement of at least 40 degrees and should usually not exceed 90 degrees in between T4 and L4. In the Lenke classification, the curve types 1 (main thoracic) and curve type 5 (thoracolumbar/lumbar) are amenable to anterior instrumentation and fusion. Osteoporosis. Infection. Allergic reaction to implants. Minor curves that do not correct to < 25 degrees on flexibility maneuvers. Structured kyphosis in the major curve. Severe sagittal plane malalignment with pathologic kyphosis cranial or caudal of the instrumented segments. The spine is exposed via an open thoracotomy or a thoracoabdominal approach. After completion of diskectomies at each level, the anterior double-rod system is fixed with two bicortical screws per vertebral body. The longitudinal components consist of a solid rod and a threaded rod. The rods are contoured to maintain normal sagittal and coronal contour. The proximal screws are engaged first and then a cantilever force is used to correct the deformity. Occasionally, a partial rod rotation maneuver or intersegmental compression is performed. Morselized autograft (typically rib) is placed in the disk spaces. Intraoperative radiographs are taken to evaluate the correction. Brace-free mobilization. Physiotherapy. Respiratory therapy. Very high rate of successful spondylodesis. Excellent frontal correction of about 60-70%. Very good spontaneous correction of adjacent minor curves of around 40%. Restoration of a physiological profile. Correction angle and length of fusion comparable to modern transpedicular double-rod systems.
    Operative Orthopädie und Traumatologie 05/2010; 22(2):164-76. · 0.47 Impact Factor
  • M Quante, R Pauschert, W Gogarten
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    ABSTRACT: Today the indication for thrombosis prophylaxis is a relevant and daily concern in orthopaedic surgery. Recently there are some changes concerning the German guidelines, which are approved by 27 German medical societies. For the first time the guidelines give distinct recommendations for the different indications, the kind of thrombosis prophylaxis and its duration. Some of the recommendations will lead to changes of both processes in outpatient and inpatient management. In parallel 2 new oral anticoagulants have been approved for the prevention of thromboembolic events after elective knee and hip replacement. Dabigatran is an oral thrombin inhibitor. Compared to enoxaparin it has a comparable profile of side effects and efficacy. Rivaroxaban is an oral Xa inhibitor which shows a significantly better efficacy compared to enoxaparin and no difference in side effects. The significant reduction of symptomatic thromboembolisms after elective knee and hip replacement was shown for rivaroxaban compared to enoxaparin in a pooled analysis of phase III data. This review discusses the main topics of the new German guideline and impact of the new oral anticoagulants on in- and outpatient treatment procedures.
    Zeitschrift fur Orthopadie und Unfallchirurgie 02/2010; 148(5):532-41. · 0.65 Impact Factor
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    Markus Quante, Jürgen Lorenz, Michael Hauck
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    ABSTRACT: The radicular pain syndrome is a major problem in public health care that can lead to chronic back and leg pain in 30%. Ischalgia and back pain are the most prominent signs of dorsal root affection. Until now, no clinical or neurophysiological test procedure exists that evaluates the function of the dorsal root and predicts the prognosis of patients suffering from RPS. We have recently demonstrated that laser-evoked potentials (LEP) are able to demonstrate dorsal root damage. With this study, we investigated 54 patients with acute radicular symptoms and compared LEP parameters (side to side difference of latency and amplitude, transformed to a z-score) with their state of health after 3 months to calculate their predictive value for outcome prognosis. Most significantly, the latency difference between the LEP of the affected dermatome relative to the contralateral healthy dermatome was able to predict the prognosis. Latency z score above two demonstrates a 91% specificity (33% sensitivity) for a poor outcome at 3 months. A significant relation between amplitude changes and the main outcome measure could not be shown. Only extreme changes (z score >10) in amplitude show a high specificity for the persistence of ischialgia in particular (specificity 0.94; sensitivity 0.35). All other parameters, such as clinical scores or other LEP parameters, were not able to predict the outcome of patients. We propose that clinical testing using LEP with latency analysis is a useful tool for estimating the course of disease, so that patients with poor predictive parameters can be treated more invasively at early disease stages to avoid persistence of radiculopathy.
    European Spine Journal 09/2009; 19(2):270-8. · 2.47 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the current situation of rotator cuff repair and follow-up treatment in German hospitals. An evaluated survey, enquiring about the year 2006, was sent to all 777 German orthopaedic and/or trauma surgery departments. The hospitals were chosen using the official index of hospitals from the German Federal Statistical Office. 44 % of the surveys were sent back, whereby 40 % were of use. Within the 309 departments, 26 % of the total number of 59,957 shoulder operations were rotator cuff repairs. Mini-open was the operation method in 49 %, open in 29 % and arthroscopic in 22 % of cases. Regarding the operational methods, there were differences between the departments and level of care. The arthroscopic technique was used sometimes in 48 % of the departments, whereas 52 % never used it. Specialised shoulder departments employed the total arthroscopic procedure more often. A set follow-up treatment occurred in 79 % of departments. Rotator cuff repair is mainly carried out using the mini-open method, which is nowadays regarded as gold standard.
    Zeitschrift fur Orthopadie und Unfallchirurgie 07/2009; 147(3):321-6. · 0.65 Impact Factor
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    ABSTRACT: As life expectancy in the population rises, osteoporotic fractures are seen most frequently in the proximal femur and the vertebral column. In balloon kyphoplasty and vertebroplasty, we have two minimally invasive treatment procedures available. Although they have both been controversially discussed in studies, they have seldom been directly compared. Between 2002 and 2004, patients with fresh thoracic or lumbar single-segment vertebral compression fractures not involving neurological deficits were treated by balloon kyphoplasty (n = 30) or vertebroplasty(n = 30) using PMMA cement, and the results of the two interventions were compared in a prospective, nonrandomised cohort study. Surgery was indicated when patients had painful, dislocated fractures of type A1 and type A3 according to Magerl's classification. The outcome of treatment was assessed with special reference to the angle of kyphosis, back pain (VAS), health-related quality of life (SF-36) and complications. At the time of the follow-up examination, significant improvement in the angle of kyphosis was found to have been achieved both by kyphoplasty and by vertebroplasty (P < 0.001 and P = 0.002, respectively). Comparison showed that correction of the angle was significantly (P < 0.001) better in the kyphoplasty group. Both surgical procedures led to significant (P < 0.001) attenuation of the patients' pain; no difference was observed between the groups in the degree of pain relief achieved. There was no demonstrable correlation in either group between the preoperative pain experienced by the patients and the degree of dislocation of their fractures. In both study groups, the quality of life was in keeping with that of a reference group matched for age and sex. Cement leakage was observed in 7% of patients after kyphoplasty and in 33% of patients after vertebroplasty (P = 0.021). Adjacent-level fractures were checked for, but occurred in only one patient in the vertebroplasty group. The two surgical procedures were both followed by significant pain relief, and the quality of life was similar regardless of the procedure used. Balloon kyphoplasty led to an ongoing reduction of freshly fractured vertebrae and was followed by a lower rate of cement leakage.
    Archives of Orthopaedic and Trauma Surgery 06/2009; 129(10):1391-9. · 1.36 Impact Factor
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    ABSTRACT: Adult scoliosis is defined as a spinal deformity with a Cobb angle of more than 10 degrees in the coronal plain in a skeletally mature patient. Patients predominantly suffer from back pain symptoms, often accompanied by signs of spinal stenosis (central as well as lateral). Asymmetric degeneration leads to asymmetric load and therefore to a progression of the degeneration and deformity as either scoliosis (0.5-1 degree per year), kyphosis, or both. The diagnostic evaluation includes static and dynamic imaging, magnetic resonance imaging, and myelo-computed tomography, as well as invasive diagnostic procedures such as discograms, facet blocks, and epidural and root blocks. The treatment, either conservative or surgical, is then tailored to the patient's specific symptomatology. Surgical management is usually complex and must take into account an array of specific problems, including the patient's age and general medical condition, the length of the fusion, the condition of the adjacent segments, the condition of the lumbosacral junction, osteoporosis, and any previous scoliosis surgery. The main goal of corrective surgery is a balancing of the coronal and sagittal planes.This review focuses on the special indications for vertebral body cement augmentation in patients with osteoporosis and the problem of adjacent level degeneration and its surgical management.
    Der Orthopäde 03/2009; 38(2):159-69. · 0.51 Impact Factor
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    ABSTRACT: For more than 2 decades ventral derotation spondylodesis (Zielke VDS) as a major improvement over Dwyer instrumentation (DI) was the gold standard of instrumented curve correction and stabilization from the anterior approach. As the first available system it enables a true three-dimensional curve correction. A disadvantage is the low internal stabilization capability with a need for long-term external stabilization by means of cast and brace treatment postoperatively. Meanwhile with the development of modern single and dual solid rod systems these disadvantages can be avoided completely. Video-assisted (thoracoscopic) anterior scoliosis surgery accounts for less than 2% of anteriorly treated scoliosis cases, mainly due to a long operating time and significant learning curve.From the posterior approach the Cotrel-Dubousset instrumentation (CDI) as a polysegmentally attached posterior hook threaded dual rod system used to be state of the art for a long time, since it eliminated the disadvantages of Harrington instrumentation (HI) in terms of only one-dimensional correction and low stabilization capabilities. However even with CDI effective derotation was impossible. In posterior scoliosis surgery there is a strong trend away from hook systems towards transpedicular segmentally fixed dual rod systems not only in the lumbar spine but also in the thoracic area. Advantages of these newer techniques are shorter fusion, improved correction, and less loss of correction over time.Advantages of modern anterior instrumentation systems in comparison to posterior transpedicular instrumented dual rod systems are less blood loss, better derotation, slightly shorter fusion levels, and a better influence on sagittal plane control or improvement especially for hypokyphotic thoracic scoliosis cases. Our data also document a superior spontaneous correction of the lumbar curve after selective anterior instrumented correction (Lenke 1B+C), although other studies could not find significant differences. In our experience the neurological risk of anterior instrumented correction is also lower than that of posterior scoliosis surgery, although the morbidity and mortality data of the Scoliosis Research Society could not prove that anymore in recent years. A negative effect of anterior transthoracic scoliosis surgery in comparison to posterior surgery is a more negative effect on lung function, which improves slower after surgery and does not quite reach the levels of posterior surgery at follow-up. But new data on posterior segmental transpedicular correction and fusion also prove a lordosating effect with negative effect on lung function.
    Der Orthopäde 03/2009; 38(2):131-4, 136-40, 142-5. · 0.51 Impact Factor
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    ABSTRACT: In the German health system the payment of a hospital stay is standardised. The common basis is the G-DRG System (German diagnosis-related groups) in which every stay is paid by a lump sum. Scoliosis correction in our times means pedicle screw-based multilevel double rod instrumentation or anterior plate-rod instrumentation with primary stability. The outcome of those methods has improved the results of correction and decreased the complication rate but also means high costs due to the implants. Scoliosis correction is covered by DRG I06. Due to constant efforts a general improvement took place in the assessment of DRG I06. That is the reason why the losses incurred in DRG I06C could be lowered to 38% and in I06D to 22% in 2008. For an appropriate assessment further improvements are required.
    Der Orthopäde 02/2009; 38(2):205-7, 210-2. · 0.51 Impact Factor
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    ABSTRACT: Myopathies can be sub-classified into congenital, hereditary, mitochondrial, and secondary myopathies.Congenital myopathies are usually diagnosed post partal or in early childhood. Manifestation in adolescence is uncommon and most cases occur as sporadic mutations. Therefore, there is a risk of under diagnosing this disease in middle-aged patients showing pain, dysfunction, recurrent trauma or falls, where muscle atrophy is seen as a secondary injury. Our report is about a 54 year old Caucasian woman with an extended history of pain, loss of function and weakness in her right shoulder. The clinical picture showed a frozen right shoulder. The main finding was a marked limb-muscle atrophy of both delta- und biceps-muscles and a rotator cuff tear that had developed over years. Previous medical consultations attributed the atrophy to recurrent falls, shoulder dysfunction and pain. Conservative treatment (analgesics, physiotherapy, training) had failed.The familiar anamnesis was free of any neurological diseases or other genetic diseases.MRI showed a sub-total proximal muscular limb atrophy and a rotator cuff tear in both shoulders. An incision-biopsy of the right delta- and biceps-muscle revealed a chronical myopathy. The level of creatinkinasis was expected to be high but measurements showed values only slightly above normal. Immunohistochemistry, eventually revealed a mild form of LGMD (type 2I). Due to the pattern of symptoms and diagnostic results we described the case as atypical LGMD. Our case presents a phenotype of a late onset of limb girdle muscular dystrophy syndrome associated with shoulder pain and dysfunction and recurrent falls. This kind of disease is not very common. In particular, muscle atrophy in the elderly is generally seen as a secondary injury. This case should remind us of the importance of a differential diagnosis of a late onset of muscular dystrophy-syndrome in the elderly, since an early diagnosis offers more treatment options, therefore preventing a rapid progression.
    Cases Journal 01/2009; 1(1):402.
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    ABSTRACT: Die adulte Skoliose ist als frontale strukturelle Seitausbiegung der Wirbelsäule von >10° bei Patienten nach Abschluss des Knochenwachstums definiert. Führende Symptome der Patienten sind der Rückenschmerz, oftmals wird dieser von einer Claudicatio spinalis als Folge einer zentralen, foraminalen oder rezessalen Stenose begleitet. Die pathophysiologisch maßgebliche asymmetrische Degeneration führt zu einer asymmetrischen Lastverteilung, was wiederum die weitere Degeneration und Deformität antreibt (Merkmale: frontale Dekompensation, segmentale Kyphose). Dabei entwickelt sich eine Progression der Skoliose (0,5–1,0°/Jahr) sowie der Kyphose. Zur Diagnostik gehören Röntgenbilder inklusive Funktionsaufnahmen, MRT, Myelo-CT und invasiv-diagnostische Maßnahmen wie Diskographien, Facettenblockaden, Wurzelblockaden und epidurale Injektionen. Die Therapie (konservativ oder operativ) zielt auf die individuelle Symptomatologie des Patienten. Insbesondere ist die chirurgische Therapie anspruchsvoll und mitunter wegen des Alters und der Komorbiditäten der Patienten, der Ausdehnung der Fusionsstrecke, des Zustands des Anschlusssegments und des Iliosakralgelenks, der Osteoporose oder Osteopenie und eventueller Voroperationen problematisch. Im Falle einer Korrektur ist das Hauptziel die Wiederherstellung der sagittalen und frontalen Balance. Diese Übersicht befasst sich mit den besonderen Indikationen für die Zementaugmentation bei Osteoporose und der Problematik der Anschlussdegeneration und deren chirurgischem Management. Adult scoliosis is defined as a spinal deformity with a Cobb angle of more than 10° in the coronal plain in a skeletally mature patient. Patients predominantly suffer from back pain symptoms, often accompanied by signs of spinal stenosis (central as well as lateral). Asymmetric degeneration leads to asymmetric load and therefore to a progression of the degeneration and deformity as either scoliosis (0.5–1° per year), kyphosis, or both. The diagnostic evaluation includes static and dynamic imaging, magnetic resonance imaging, and myelo-computed tomography, as well as invasive diagnostic procedures such as discograms, facet blocks, and epidural and root blocks. The treatment, either conservative or surgical, is then tailored to the patient’s specific symptomatology. Surgical management is usually complex and must take into account an array of specific problems, including the patient’s age and general medical condition, the length of the fusion, the condition of the adjacent segments, the condition of the lumbosacral junction, osteoporosis, and any previous scoliosis surgery. The main goal of corrective surgery is a balancing of the coronal and sagittal planes. This review focuses on the special indications for vertebral body cement augmentation in patients with osteoporosis and the problem of adjacent level degeneration and its surgical management.
    Der Orthopäde 01/2009; 38(2):159-169. · 0.51 Impact Factor
  • Zeitschrift Fur Orthopadie Und Unfallchirurgie - Z ORTHOP UNFALLCHIR. 01/2009; 147(03):321-326.
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    ABSTRACT: CHRONIC PAIN IS MAINLY A RESULT OF TWO PROCESSES: peripheral and central sensitization, which can result in neuroplastic changes. Previous psychophysical studies suggested a decrease of the so-called pain-inhibiting-pain effect (DNIC) in chronic pain patients. We aimed to study the DNIC effect on the neuronal level using magnetoencephalography and electroencephalography in 12 patients suffering from advanced unilateral knee osteoarthritis (OA). DNIC was induced in patients by provoking the typical OA pain by a slightly hyperextended joint position, while they received short electrical pain stimuli. Although the patients did not report a reduction of electrical pain perception, the cingulate gyrus showed a decrease of activation during provoked OA pain, while activity in the secondary somatosensory cortex did not change. Based on much stronger DNIC induction at comparable intensities of an acute counterirritant pain in healthy subjects this result suggests a deficit of DNIC in OA patients. We suggest that the strength of DNIC is subject to neuronal plasticity of descending inhibitory pain systems and diminishes during the development of a chronic pain condition.
    Journal of Pain Research 01/2008; 1:1-8.
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    ABSTRACT: We conducted a cross-sectional study of 40 radiculopathy patients in comparison with norm data from healthy subjects using a new electrophysiological method. Early manifestations of dorsal root impairment escape objective diagnosis by conventional somatosensory-evoked potentials due to the overlapping innervation of the affected dermatome by thickly myelinated mechanoreceptive afferents projecting to adjacent intact roots. Evidence suggested less intersegmental overlap for thermonociceptive afferents rendering laser-evoked potentials (LEP) sensitive to monosegmental dorsal root damage. Therefore we used this new method to study acute manifestations of monosegmental dorsal root pathology. Dorsal root function was tested in 12 healthy subjects and 40 sciatica patients by intraindividual interside comparison. Mechanosensibility and thermosensibility were clinically investigated. LEP were induced by moderately painful laser stimuli. The LEP were evaluated by amplitude and latency of the averaged electroencephalogram. Normal interside differences of LEP for amplitude were +/-22% (lower limb) and +/-35% (upper limb) and +/-15 to +/-16% for latency. Twenty-six patients (65%) showed significant LEP changes, mainly amplitude decreases. Six of these patients exhibited latency prolongations. Clinical testing yielded more frequent pathological results for pain compared to mechanosensibility. The study confirmed our preliminary evidence of LEP sensitivity to objectively document dorsal root impairment in patients suffering from acute monosegmental radiculopathy. This result opens the perspective of electrophysiologically differentiating the presence or absence of dorsal root pathology in patients with similar clinical symptoms but possibly different prognoses, which require different therapies.
    European Spine Journal 08/2007; 16(7):943-52. · 2.47 Impact Factor
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    Stefan Endres, Markus Quante
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    ABSTRACT: We report the case of a healthy 36 year old man who suffered from foot pain lasting for weeks, without having a specific medical history relating to it. The clinical evaluation was interpreted as a transfer metatarsalgia caused by a splayfoot. The radiographs revealed no pathology except the splayfoot deformity. Due to persistent pain and swelling of the entire forefoot, after two weeks of conventional treatment, magnet resonance images (MRI) and a blood sample were taken. The laboratory investigation showed raised levels of white blood cell count and C-reactive protein. The MRI showed up oedema in the metatarsal heads II-IV, as well as soft tissue swelling of the forefoot without any signs of decomposition.Because of this atypical inflammation of the forefoot a laboratory investigation to check for rheumatology disease was done and revealed borrelia burgdorferi infection. On the basis of these findings, antibiotic treatment was started and maintained over three weeks. The symptoms disappeared after 2 weeks, and the patient was able to resume his sports activities.
    Journal of Medical Case Reports 02/2007; 1:44.
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    ABSTRACT: Compared to median nerve somatosensory evoked potentials (SEP), less is known about activity evoked by nerve stimulation of the lower limb. To understand the mechanisms and the physiology of sensor- and motor control it is useful to investigate the sensorimotor functions as revealed by a standardized functional status. Therefore, we investigated SEPs of the lower limb in 6 healthy male volunteers. For each side, tibial and peroneal nerves were stimulated transcutaneously at the fossa poplitea. The tibial nerves were also stimulated further distally at the ankle joint. Source localization was applied to 64-EEG-channel data of the SEPs. In contrast to somatosensory areas, which are activated after median nerve stimulation, we found dipoles adjacent to motor areas near Brodmann area 4 (BA 4) for SEP components P 32/40 and P 54/60 and near the supplementary motor area (SMA) for the N 75/83 component. These sources could reliably be distinguished for each individual subject as well as for the grand mean data set. Our data show that afferent projections from the lower limb mainly reach primary motor areas (BA 4) and only subsequently, with a delay of 40 ms, higher order motor areas such as SMA. We conclude that a focused view on SEP of the lower limb could be a useful tool to investigate pathological states in motor control or peripheral deafferentiation.
    Brain Research 01/2007; 1125(1):17-25. · 2.88 Impact Factor

Publication Stats

802 Citations
60.22 Total Impact Points

Institutions

  • 2003–2012
    • University Medical Center Hamburg - Eppendorf
      • Institute of Synaptic Physiology
      Hamburg, Hamburg, Germany
  • 2011
    • Asklepios Klinik Barmbek
      Hamburg, Hamburg, Germany
  • 2007–2011
    • Philipps-Universität Marburg
      • Klinik für Orthopädie und Rheumatologie (Marburg)
      Marburg, Hesse, Germany
    • University of Hamburg
      • Department of Neurophysiology and Pathophysiology
      Hamburg, Hamburg, Germany
    • Universitätsklinikum Gießen und Marburg
      Marburg, Hesse, Germany
  • 2009–2010
    • Schön Klinik Roseneck
      Prien, Bavaria, Germany
    • Schön Klink Berchtesgadener Land
      Schonau, Bavaria, Germany
    • Universität zu Lübeck
      Lübeck Hansestadt, Schleswig-Holstein, Germany
  • 2002–2003
    • Medical School Hamburg
      Hamburg, Hamburg, Germany