H Halm

Schön Kllink Neustadt, Neustadt (Eichsfeld), Thuringia, Germany

Are you H Halm?

Claim your profile

Publications (119)154.29 Total impact

  • Markus Quante, Henry Halm
    [Show abstract] [Hide abstract]
    ABSTRACT: Extreme lateral interbody fusion (XLIF) is an interbody fusion technique, in which access to the lateral part of the disc is achieved via a strong lateral transpsoatic approach. In general, the technique can be applied between T5 and L5. For lumbar segments, neuromonitoring is mandatory to protect the iliolumbar plexus during the psoas passage. In this article, the results regarding use of the XLIF technique are summarized and compared with other anterior and anterolateral approaches. In addition, current publications regarding indication, technique, complications and clinical/radiological outcome measures are discussed. The results of a literature review are presented and discussed. Regarding the indication and the surgical options for segmental restoration, the XLIF technique is comparable to anterior or anterolateral and open lateral interbody fusion. The minimally invasive XLIF access promises potentially lower morbidity than open procedures and the risk of injury of the iliac vessels is lower than in anterior and anterolateral approaches. Increasing numbers of spine surgeons are using the XLIF method. Current results indicate that XLIF is a safe and reproducible technique for deformities, adjacent level disease, and instability.
  • [Show abstract] [Hide abstract]
    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; DOI:10.1097/BSD.0b013e31825f7203 · 1.89 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Posterior pedicle screw instrumented correction and fusion have become the gold standard in the surgical treatment of thoracic scoliosis. However, in thoracic Lenke type C curves selective posterior fusion of the thoracic curve may lead to spinal imbalance. The aim of the study was to analyse the radiological results of selective anterior thoracic fusion using a standard open dual rod technique with special respect to spontaneous lumbar curve correction (SLCC). METHODS: Twenty-eight patients (26 patients with Lenke 1C and 2 patients with Lenke 2C curves) with an average age of 15 years were surgically treated with an anterior dual rod system through a standard open double thoracotomy approach. Average clinical and radiological follow-up was 4 years (24-84 months). RESULTS: Fusion was carried out mostly from end-to-end vertebra. The primary curve was corrected from 61.6° (average correction on reverse bending films 42.9 %) to 27.1° (56.0 % correction) with an average loss of correction of 2.2°. The secondary lumbar curve measured 47.7° preoperatively (40-56°, average correction on reverse bending films 66.2 %) and corrected spontaneously to 30.1° (36 % SLCC) and remained stable without any cases of deterioration or decompensation during follow-up. Lumbar apical vertebral translation increased minimally by an average of 4 mm directly, postoperatively, and returned to an average of preoperative values during follow-up. All but two curves remained as type C lumbar modifier at follow-up. Preoperatively, three patients showed a marked coronal imbalance of more than 3 cm (all left, average 4.0 cm); at follow-up, two patients were still out of balance by more than 3 cm (all to the left, average 3.4 cm). Preoperatively, a marked shoulder imbalance of more than 1.0 cm was found in 11 patients; this was corrected in all patients to <1.0 cm at follow-up. The apical vertebral rotation measured according to Perdriolle was corrected from 23.5° to 15.0° in the thoracic spine (36.2 % correction) with an average clinical reduction of the rib hump of 63.2 %. In the lumbar spine, there was no relevant radiological derotation; however, clinically, the lumbar hump corrected spontaneously by 44.3 %. Thoracic kyphosis measured 28.5° preoperatively and 32.3° at follow-up. All six patients with a preoperative hypokyphosis (<20°) of an average of 9.5° were successfully corrected to an average thoracic kyphosis of 23.8° at follow-up. There were no cases of junctional thoracolumbar kyphosis. There were neither reoperations nor implant failures with pseudarthrosis. CONCLUSION: Selective anterior correction and fusion in primary thoracic curves with lumbar modifier type Lenke C resulted in a reliable and satisfactory SLCC. Advantages of anterior versus posterior techniques are the true segmental derotation with excellent rib hump correction and a superior restoration of thoracic kyphosis.
    European Spine Journal 04/2012; 22(S2). DOI:10.1007/s00586-012-2299-7 · 2.47 Impact Factor
  • [Show abstract] [Hide abstract]
    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. · 0.67 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hintergrund Die degenerative Spondylolisthese (DS) ist eine häufige Ursache chronisch rezidivierender Lumbalgien sowie radikulärer Beinschmerzen. Bei einer Fusion sollten symptomatische degenerierte Nachbarsegmente („degenerative disc disease“, DDD) einbezogen werden. In dieser Arbeit wird die tansforaminale lumbale interkorporelle Fusion (TLIF) hinsichtlich ihrer Ergebnisse bei Patienten mit monosegmentaler degenerativer Spondylolisthese und einem degenerierten Anschlusssegment untersucht. Material und Methoden Es handelte sich um 28 Patienten mit monosegmentaler DS und einem symptomatischen Anschlusssegment mit DDD (alle bisegmental dorsal instrumentiert und fusioniert, ventral 14 bisegmentale TLIF, 14 monosegmentale TLIF). Die Werte der visuellen Analogskala (VAS) Schmerz und des Oswestry Disability Index (ODI) wurden ermittelt, außerdem erfolgte eine radiometrische Auswertung prä- und 12 Monate postoperativ. Weiter wurde die vergleichende Subanalyse der bi- mit monosegmentaler interkorporeller Abstützung vorgenommen. Ergebnisse Die Schmerzreduktion war signifikant (VAS von 8,7 auf 3,1), der ODI verbesserte sich ebenfalls signifikant von 63 auf 28%. Radiologisch wurden die Segmenthöhe und das Wirbelgleiten (Etagen mit TLIF und Spondylolisthese) signifikant verbessert. Die bisegmentale ventrale Abstützung zeigte gegenüber der monosegmentalen Vorgehensweise eine signifikant bessere Relordosierung. Schlussfolgerung Bei monosegmentaler DS mit symptomatischem Anschlusssegment stellt die Versorgung der Spondylolisthese mittels TLIF ein sicheres und effektives Verfahren dar. In der klinischen Ergebnislage zeigt sich für das degenerierte Nachbarsegment kein Unterschied zwischen der zusätzlichen interkorporellen Abstützung und der alleinigen dorsalen Fusion. Allerdings ergeben sich durch eine zusätzliche ventrale Abstützung Vorteile für die Relordosierung des Segments, sodass mögliche langfristige Effekte zugunsten der bisegmentalen TLIF diesbezüglich untersucht werden sollten.
    Der Orthopäde 01/2012; 41(2). DOI:10.1007/s00132-011-1832-4 · 0.67 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    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 02/2011; 5:45. DOI:10.1186/1752-1947-5-45
  • [Show abstract] [Hide abstract]
    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. DOI:10.1007/s00064-010-9040-7 · 0.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A number of interspinous process devices have recently been introduced to the lumbar spinal market as an alternative to conventional surgical procedures in the treatment of symptomatic lumbar stenosis. One of those "dynamic" devices is the Coflex device which has been already implanted worldwide more than 14,000 times. The aim of implanting this interspinous device is to unload the facet joints, restore foraminal height and provide stability in order to improve the clinical outcome of surgery. Published information is limited, and there are so far no data of comparison between the implant and traditional surgical approaches such as laminotomy. The purpose of our prospective study is to evaluate the surgical outcome of decompressive surgery in comparison to decompressive surgery and additional implantation of the Coflex interspinous Device. 60 patients who were all treated in the Spine Center of Klinikum Neustadt, Germany for a one or two level symptomatic LSS with decompressive surgery were included. Two groups were built. In Group one (UD) we treated 30 patients with decompression surgery alone and group two (CO) in 30 patients a Coflex device was additional implanted. Pre- and postoperatively disability and pain scores were measured using the Oswestry disability index (ODI), the Roland-Morris score (RMS), the visual analogue scale (VAS) and the pain-free walking distance (WD). Patients underwent postoperative assessments 3, 6 and 12 month including the above-mentioned scores as well as patient satisfaction. In both groups we could see a significant improve (p < 0.001) in the clinical outcome assessed in the ODI, in the RMS for evaluation of back pain, in the VAS and in the pain-free WD at all times of reinvestigation compared to base line. At 1-year follow up there were no statistically differences between both groups in all ascertained parameters including patient satisfaction and subjective operation decision. Because there is no current evidence of the efficacy of the Coflex device we need further data from randomized controlled studies for defining the indications for theses procedures. To the best of our knowledge this is the first prospective controlled study which compares surgical decompression of lumbar spinal stenosis with additional implanting of an interspinous Coflex device in the treatment of symptomatic LSS.
    European Spine Journal 12/2009; 19(2):283-9. DOI:10.1007/s00586-009-1229-9 · 2.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A prospective, nonrandomized multicenter study of lumbar disc nucleus replacement using the DASCOR Disc Arthroplasty Device. An interim analysis of clinical results is presented, obtained from European patients enrolled in 2 studies. To determine the safety and efficacy of the DASCOR Device for the treatment of symptomatic single-level degenerative disc disease (DDD). Patients suffering from DDD have been limited to a choice between nonoperative therapies or invasive surgical treatments such as total disc replacement or spinal fusion. The DASCOR Device was developed to provide an alternative treatment with a less invasive surgical intervention. A total of 85 patients from 11 European centers were enrolled in 1 of 2 studies between February 2003 and July 31, 2007. Data were collected before surgery and after surgery at 6 weeks and at 3, 6, 12, and 24 months. The clinical outcome measures were obtained from the Visual Analog Scale (VAS) for back pain, the Oswestry Disability Index (ODI), radiographic assessments, and records of analgesic medication use. Mean VAS and ODI scores improved significantly after 6 weeks and throughout the 2 years. Radiographic results demonstrated, at a minimum, maintenance of disc height with no device expulsion and, despite Modic-Type 1 changes, no subsidence. Fourteen patients had serious adverse events including device explants in 7 patients (7 of 85), in which the main complication was resumed back pain after time. Patients' rate of analgesic medication decreased dramatically over time, with all patients experiencing significant improvements after 3 months and nearly no analgesic medication or narcotic drug use at 2 years. The interim outcomes showed significant improvements in mean ODI and VAS scores. The results of these European studies suggest that the DASCOR Device may be a safe and effective less-invasive surgical option for patients with DDD.
    Spine 06/2009; 34(13):1376-84. DOI:10.1097/BRS.0b013e3181a3967f · 2.45 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Study to determine the internal consistency and validity of adapted German version of Scoliosis Research Society-22 (SRS-22) questionnaire. To evaluate the validity and reliability of adapted German version of SRS-22 questionnaire. The SRS-22 questionnaire was developed to assess the health-related quality of life for English-speaking patients with idiopathic scoliosis. For scientific purpose and standardized comparison of outcome studies for the treatment of idiopathic scoliosis its adaptation into German is necessary to respect cultural and lingual differences. Translation/retranslation of the English version of the SRS-22 was conducted, and all steps for cross-cultural adaptation process were performed. Thus, SRS-22 questionnaire and previously validated Roland-Morris score were mailed to 222 patients who had been treated surgically or conservatively for idiopathic scoliosis. Seventy-eight patients (35%) responded to the first set of questionnaires and 54 of the first time responder returned their second survey. The median age of all patients who joined the study was 19 years. Measures of reliability namely, selectivity, internal consistency, and reproducibility were determined by Cronbach's alpha statistics and intraclass correlation coefficient, respectively. Concurrent validity was measured by comparing with an already validated questionnaire (Roland-Morris score). Measurement was made using the Spearman correlation coefficient. The study demonstrated satisfactory internal consistency with high Cronbach's alpha values for 4 of the corresponding domains (pain, 0.75; self-image, 0.84; mental health, 0.88; and satisfaction, 0.61). However, the Cronbach's alpha value for function/activity domain (0.67) was considerably lower than the original English questionnaire. For the same domains intraclass correlation coefficient demonstrating satisfactory test/retest reproducibility. The adapted German version of the SRS-22 questionnaire can be used to assess the outcome of treatment for German-speaking patients with idiopathic scoliosis.
    Spine 05/2009; 34(8):818-21. DOI:10.1097/BRS.0b013e31819b33be · 2.45 Impact Factor
  • [Show abstract] [Hide abstract]
    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. · 0.67 Impact Factor
  • [Show abstract] [Hide abstract]
    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. · 0.67 Impact Factor
  • [Show abstract] [Hide abstract]
    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.
    Der Orthopäde 02/2009; 38(2):159-169. DOI:10.1007/s00132-008-1391-5 · 0.67 Impact Factor
  • [Show abstract] [Hide abstract]
    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. DOI:10.1007/s00132-008-1366-6 · 0.67 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Als Goldstandard der Formkorrektur und Stabilisierung von Skoliosen über den vorderen Zugangsweg wurde über mehr als 2Jahrzehnte die ventrale Derotationsspondylodese (VDS) nach Zielke als maßgebliche Weiterentwicklung der Dwyer-Instrumentation (DI) angesehen. Sie ermöglicht als erstes Implantatsystem eine effektive dreidimensionale Formkorrektur. Nachteilig sind die geringen internen Stabilisierungseigenschaften des Implantats mit dem Risiko des Stabbruches und der Pseudarthrose, die eine langmonatige Ruhigstellung im Rumpfgips oder Korsett notwendig machen. Durch die Entwicklung primärstabiler ventraler Einstab- und insbesondere Doppelstabsysteme können diese Nachteile mittlerweile vollständig eliminiert werden. Thorakoskopische Skolioseoperationen haben sich mit einem Anteil von <2% wegen langer Operationszeiten und hoher Lernkurve nicht entscheidend durchsetzen können. Dorsal galt über lange Zeit das Cotrel-Dubousset-Instrumentarium (CDI), ein hakengetragenes polysegmental angreifendes Doppelstabsystem als „state of the art“, da es die Nachteile des weitgehend eindimensional korrigierenden, nicht primärstabilen Harrington-Systems (HI) weitgehend eliminierte, wenngleich eine effektive Derotation nicht möglich war. Bei den dorsalen Verfahren gibt es zzt. sowohl für den Lumbal- als auch Thorakalbereich einen starken Trend weg von hakengetragenen, polysegmental angreifenden Doppelstabsystemen zu transpedikulär segmental fixierten Doppelstabsystemen mit dem Vorteil kürzerer Fusionsbezirke, besserer Korrektur und geringerem Korrekturverlust im Nachbeobachtungszeitraum. Vorteile moderner ventraler Instrumentationssysteme sind im Vergleich zu modernen dorsalen transpedikulär getragenen Doppelstabsystemen insbesondere der geringere Blutverlust, die bessere Derotation, der im Trend immer noch kürzere Fusionsbereich und der bessere Einfluss auf das Profil der Wirbelsäule bei hypokyphotischen Thorakalskoliosen. Unsere Daten belegen auch eine bessere Spontankorrektur der lumbalen Nebenkrümmung bei selektiver Korrektur von Thorakalskoliosen (Lenke-Typ1B+C), obwohl andere Studien keine signifikanten Unterschiede finden konnten. Nach unserer Erfahrung ist auch das neurologische Risiko geringer, selbst wenn die Morbiditäts- und Mortalitätsstatistiken der „Scoliosis Research Society“ dieses in den letzten Jahren nicht mehr belegt haben. Nachteilig ist nach neueren Untersuchungen der negativere Effekt ventraler (transthorakaler) Eingriffe auf die Lungenfunktion, die sich im Vergleich zu dorsalen Verfahren postoperativ langsamer erholt und nicht ganz die Werte dorsaler Verfahren erreicht. Neueste Untersuchungen belegen aber auch für dorsale pedikelschraubengetragene Korrekturen einen lordosierenden Effekt mit negativem Einfluss auf die Lungenfunktion 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 02/2009; 38(2):131-145. DOI:10.1007/s00132-008-1365-7 · 0.67 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In primary tumors of the spine and, with limitations, solitary metastasis, the surgical approach should aim for curative treatment of the disease. Because the prognosis of malignant bone tumors is extremely limited, if an intralesional approach is performed, an extralesional en bloc resection is the treatment of choice. Therefore, it is mandatory to use an appropriate staging system. For the spine, the WBB staging system has been approved, which transfers the principles of the Enneking classification for treating primary malignant tumors of the limb to the spine. After en bloc spondylectomy, rigid and primary stable instrumented dorsoventral reconstruction must be performed - posteriorly with a dual-rod system using pedicle screws, and anteriorly in the ideal case by means of a vertebral body replacement cage. The possibility of extralesional (wide or marginal) resection of spinal tumors depends on tumor size and location. Extralesional resection and, if indicated, other neoadjuvant, adjuvant, or local therapeutic modalities have a strong positive influence on long-term survival rates. A good prognosis for primary tumors is associated with a good response to chemotherapy and extralesional resection. Solitary metastases have a much worse quod vitam prognosis. Therefore, local control of the disease in en bloc resections of solitary metastasis is a second relevant goal, although curative treatment is the primary aim.
    Der Orthopäde 05/2008; 37(4):356-66. · 0.67 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: En bloc spondylectomy is a technique that enables wide or marginal resection of malignant lesions of the spine. Both all posterior techniques as well as combined approaches are reported. Aim of the present study was to analyse the results of 21 patients with malignant lesions of the spine, all treated with en bloc excision in a combined posteroanterior (n = 19) or all posterior approach (n = 2). Twenty-one consecutive patients, operated between 1997 and 2005, were included into this retrospective study. Thirteen patients had primary malignant lesions, eight patients had solitary metastases, all located in the thoracolumbar spine. There were 16 single level, three two-level, one three-level and one four-level spondylectomy. The patients were followed clinically and radiographically (including CT studies) with an average follow-up of 4 years. Out of 11 patients with primary Ewing or osteosarcoma seven patients are alive without any evidence of disease. One patient died after 5 years from other causes and three are alive with evidence of disease. Latter had either a poor histologic response to the preoperative chemotherapy (n = 2) or an intralesional resection (n = 1). All three patients with solitary spinal metastases of Ewing or osteosarcoma died of the disease. Five patients with solitary metastases of mainly hypernephroma are alive. In total, six resections were intralesional, mainly due to large intraspinal tumor masses, with two patients having had previous surgery. In the remaining cases, wide (n = 10) or marginal (n = 5) resection was accomplished. There were one pseudarthrosis requiring extension of the fusion and two cases with local recurrences and repeated excisional surgery. At follow-up CT studies, all cages were fused. Health related quality of life analysis (SF-36) revealed only slightly decreased physical component and normal mental component scores compared to normals in those patients with no evidence of disease. En bloc spondylectomy enables wide or marginal resection of malignant lesions of the spine in most cases with acceptable morbidity. Intralesional resection, poor histologic response, and solitary spinal metastases of Ewing and osteosarcoma are associated with a poor prognosis.
    European Spine Journal 05/2008; 17(4):600-9. DOI:10.1007/s00586-008-0599-8 · 2.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bei Primärtumoren der Wirbelsäule und mit Einschränkungen bei Solitärmetastasen ist das Ziel der operativen Behandlung die Heilung der Erkrankung. Da die Prognose primär maligner Knochentumoren bei intraläsionalem Vorgehen extrem schlecht ist, muss eine extraläsionale En-bloc-Spondylektomie bzw. Resektion angestrebt werden. Hierfür ist es zur Therapieplanung wichtig, ein erprobtes chirurgisches Stagingsystem zu benutzen. An der Wirbelsäule hat sich dabei das WBB-Stagingsystem bewährt, welches die Prinzipien der Enneking-Klassifikation für Extremitätentumoren an die Wirbelsäule transferiert. Im Anschluss an die möglichst extraläsionale En-bloc-Spondylektomie erfolgt eine primärstabile dorsoventrale Rekonstruktion und Stabilisation der Wirbelsäule, dorsal mit winkelstabilem Fixateur, ventral idealerweise mittels Wirbelkörperersatzimplantat. Ob eine extraläsionale Resektion möglich ist, hängt von der Lage und Ausdehnung des Tumors ab. Literatur und eigene Ergebnisse belegen für primär maligne Knochentumoren eine gute Prognose, sofern der Tumor extraläsional resektabel war und einen guten Regressionsgrad aufwies. Deutlich schlechter ist die Prognose bei Vorliegen einer Solitärmetastase, sodass hier v. a. die lokale Tumorkontrolle im Vordergrund steht, wenn gleich auch hier primär ein kurativer Therapieansatz besteht.
    Der Orthopäde 04/2008; 37(4). DOI:10.1007/s00132-008-1231-7 · 0.67 Impact Factor
  • The Spine Journal 09/2007; 7(5):103S. DOI:10.1016/j.spinee.2007.07.235 · 2.80 Impact Factor

Publication Stats

2k Citations
154.29 Total Impact Points

Institutions

  • 2012
    • Schön Kllink Neustadt
      Neustadt (Eichsfeld), Thuringia, Germany
  • 2009
    • Schön Klink Berchtesgadener Land
      Schonau, Bavaria, Germany
    • Universität zu Lübeck
      Lübeck Hansestadt, Schleswig-Holstein, Germany
    • University Medical Center Schleswig-Holstein
      Kiel, Schleswig-Holstein, Germany
  • 1992–2004
    • University of Münster
      • Clinic for General Orthopedics and Tumor Orthopedics
      Münster, North Rhine-Westphalia, Germany
  • 2002–2003
    • Universitätsklinikum Münster
      • Klinik für Allgemeine Orthopädie und Tumororthopädie
      Münster, North Rhine-Westphalia, Germany