Tobias L Schulte

Universitätsklinikum Münster, Muenster, North Rhine-Westphalia, Germany

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Publications (66)134.08 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The quality of the abstracts presented at a conference reflects the scientific work and level of activity of the scientific association concerned. The aim of the present study was to determine the rate of publications of podium presentations and posters at the conferences of the European Paediatric Orthopaedic Society (EPOS) from 2006 to 2008 and to identify factors that favor publication in peer-reviewed journals. The results are compared with those of other international societies. All 646 abstracts (including podiums, posters, and e-posters) presented at the EPOS conferences were investigated using the PubMed database to identify any corresponding published articles in the journals listed in the database. A period of 5 years before and after the relevant conference was used for the PubMed search. Factors influencing publication and the quality of the study, such as the type of presentation and the level of evidence, were also investigated. A publication rate of 36.7% was observed, corresponding to 237 publications of 646 abstracts. The period to publication showed a mean of 13.88±1.34 months. It was found that abstracts of podium presentations were published significantly more often than poster abstracts (P<0.001). Experimental studies, with a publication rate of 50.9%, showed better results than clinical studies (36.0%). Overall, the articles were published in 61 different journals, with the largest number (n=50) appearing in the Journal of Pediatric Orthopaedics. In addition, the present study shows that abstracts with a higher level of evidence were associated with a higher publication rate. At 36.7%, the rate of publication of EPOS abstracts is within the range reached by other specialist orthopaedics societies, such as the German Society of Orthopaedics and Trauma Surgery (36%) and the British Orthopaedic Association (36%). However, it is lower than the publication rate of the Pediatric Orthopaedic Society of North America (POSNA), at 50%. The high percentage of unpublished conference abstracts (63%), which did not go through a peer-reviewed process, casts doubts upon the practice of utilizing the citation of abstracts based purely on conference abstracts. Statistical study.
    Journal of pediatric orthopedics 03/2014; · 1.23 Impact Factor
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    ABSTRACT: BACKGROUND:Rotator cuff tears are a common cause of pain and disability of the shoulder. Information on the prevalence and identification of potential risk factors could help in early detection of rotator cuff tears and improve treatment outcome. HYPOTHESIS:Patients treated for a symptomatic rotator cuff tear on one side have a higher prevalence of rotator cuff tears and decreased shoulder function on the contralateral side compared with an age- and sex-matched group of healthy individuals. STUDY DESIGN:Case control study; Level of evidence, 3. METHODS:One group consisted of 55 patients who had been arthroscopically treated on one shoulder for rotator cuff tear (tear group). In this group, the nonoperated contralateral shoulder was examined. For comparison, the matching shoulder in a control group consisting of 55 subjectively healthy individuals matched by age (±1 year) and sex to the tear group was included. Diagnosis of a rotator cuff tear was made by ultrasound. Outcomes were measured using the Constant score. RESULTS:The prevalence of supraspinatus tears was significantly higher (P < .0001) in the tear group (67.3%) compared with the control group (11.0%). The Constant score for the activities of daily living subscale, however, was significantly lower (18.4) in the tear group compared with the control group (19.9; P = .012). No other subcategory score nor the overall score showed a significant difference. There was a significantly higher tear prevalence in the tear group of patients aged between 50 and 59 years (P < .001) and 60 and 69 years (P = .004). No tear was diagnosed in the control group in individuals younger than 60 years. CONCLUSION:Patients treated for partial and full-thickness rotator cuff tears have a significantly higher risk of having a tear on the contralateral side and have noticeable deficits in their shoulder function regarding activities of daily living even if the tear is otherwise asymptomatic.
    The American journal of sports medicine 02/2014; · 3.61 Impact Factor
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    ABSTRACT: Visually presented biological motion stimuli activate motor and somatosensory representations in the brain and thus provide an interaction of vision with motor and somatosensory systems. Premotor and intraparietal regions are not only involved in the perception and control of musculoskeletal actions, they also link to the pain matrix. We hypothesized that the perception of visually presented actions is impaired when the action involves body parts that hurt. Here we demonstrate impaired motion perception of visually presented actions involving the back in chronic back pain patients as compared to healthy controls. Participants judged the lifted weight from point-light biological motion displays. An actor, depicted by point-lights on the joints, either lifted an invisible container (5, 10, or 15~kg) from the floor and put it down again, or lifted and manipulated it from the right to the left. The latter manipulations involved twisting and bending movements of the lower back and would be very painful for patients with chronic lower back pain. We found that all participants recognized the displayed actions, but, consistent with our hypothesis, chronic back pain patients were impaired in judging the difference in handled weights between the stimuli. Healthy controls correctly judged the heavy containers heavier than the light ones, and this judgment was better for the motion that involved trunk rotation. The results indicate that the judgment of motor aspects of a visually displayed movement is specifically affected by chronic lower back pain.
    Human Movement Science 12/2013; 32(5):938-953. · 2.03 Impact Factor
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    ABSTRACT: Visually presented biological motion stimuli activate regions in the brain that are also related to musculo-skeletal pain. We therefore hypothesized that chronic pain impairs the perception of visually presented actions that involve body parts that hurt. In the first experiment, chronic back pain (CLBP) patients and healthy controls judged the lifted weight from point-light biological motion displays. An actor either lifted an invisible container (5, 10, or 15kg) from the floor, or lifted and manipulated it from the right to the left. The latter involved twisting of the lower back and would be very painful for CLBP patients. All participants recognized the displayed actions, but CLBP patients were impaired in judging the difference in handled weights, especially for the trunk rotation. The second experiment involved discrimination between forward and backward walking. Here the patients were just as good as the controls, showing that the main result of the first experiment was indeed specific to the sensory aspects of the task, and not to general impairments or attentional deficits. The results thus indicate that the judgment of sensorimotor aspects of a visually displayed movement is specifically affected by chronic low back pain.
    Human movement science 10/2013; · 2.15 Impact Factor
  • T Lange, T L Schulte
    European Spine Journal 08/2013; · 2.47 Impact Factor
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    ABSTRACT: Vertebral augmentation with PMMA is a widely applied treatment of vertebral osteoporotic compression fractures. Subsequent fractures are a common complication, possibly due to the relatively high stiffness of PMMA in comparison with bone. Silicone as an augmentation material has biomechanical properties closer to those of bone and might, therefore, be an alternative. The study aimed to investigate the biomechanical differences, especially stiffness, of vertebral bodies with two augmentation materials and two filling grades. Forty intact human osteoporotic vertebrae (T10-L5) were studied. Wedge fractures were produced in a standardized manner. For treatment, PMMA and silicone at two filling grades (16 and 35 % vertebral body fill) were assigned to four groups. Each specimen received 5,000 load cycles with a high load range of 20-65 % of fracture force, and stiffness was measured. Additional low-load stiffness measurements (100-500 N) were performed for intact and augmented vertebrae and after cyclic loading. Low-load stiffness testing after cyclic loading normalized to intact vertebrae showed increased stiffness with 35 and 16 % PMMA (115 and 110 %) and reduced stiffness with 35 and 16 % silicone (87 and 82 %). After cyclic loading (high load range), the stiffness normalized to the untreated vertebrae was 361 and 304 % with 35 and 16 % PMMA, and 243 and 222 % with 35 and 16 % silicone augmentation. For both high and low load ranges, the augmentation material had a significant effect on the stiffness of the augmented vertebra, while the filling grade did not significantly affect stiffness. This study for the first time directly compared the stiffness of silicone-augmented and PMMA-augmented vertebral bodies. Silicone may be a viable option in the treatment of osteoporotic fractures and it has the biomechanical potential to reduce the risk of secondary fractures.
    European Spine Journal 07/2013; 22(12). · 2.47 Impact Factor
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    ABSTRACT: INTRODUCTION: Aneurysmal bone cysts (ABCs) are expansive and destructive lesions positive for osteoclast markers, resembling benign giant cell tumors (GCTs). Treatment options include surgical resection, curettage and cavity filling, embolization, injection of fibrosing agents, or radiotherapy. Particularly in children and adolescents with spinal ABCs, these options may be unsatisfactory, and innovative forms of treatment are needed. Denosumab is a human monoclonal antibody that inhibits osteoclast function by blocking the cytokine receptor activator of the nuclear factor-kappa B ligand. Satisfactory results with denosumab in treating GCTs and immunohistochemical similarities suggest that it may also have positive effects on ABCs. METHODS AND RESULTS: This report is the first description of the therapeutic use of denosumab in two patients with spinal ABCs. Two boys (aged 8 and 11) had recurrent ABCs at C5 after surgery with intralesional tumor resection. Treatment options were discussed by the interdisciplinary tumor board. Arterial embolization was attempted, but failed due to an absence of appropriate afferent arteries. After the families had received extensive information and provided written consent, denosumab therapy was initiated as an individualized treatment, despite the absence as yet of scientific evidence. After the start of denosumab therapy, both patients recovered from pain and neurologic symptoms significantly and are now in a healthy condition with no severe side effects. Magnetic resonance imaging check-ups after 2 or 4 months of denosumab treatment, respectively, showed tumor regression in both patients. DISCUSSION: Longer follow-up and clinical studies are warranted to establish the value of denosumab in the treatment of ABCs.
    European Spine Journal 03/2013; 22(6). · 2.47 Impact Factor
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    ABSTRACT: Most people suffer musculoskeletal pain sometime in their lives. Although the pain usually disappears with the healing, it may become chronic. Recent evidence suggests that high-level cortical representations play a role in chronic pain. Here we hypothesized that the sensorimotor representations of the affected body parts are specifically inhibited with chronic pain. Thus, if these representations are not accessible for the actions performed by one's own body, neither should they be for the perception of actions performed by others. Chronic pain patients are often focused on possibly painful movements, but visual processes are not affected by chronic pain, so we expected that patients should have no problems recognizing point-light biological motion displays, but should be unable to extract detailed somatosensory and motor information from such displays. Indeed, we found that patients had no difficulty perceiving point-light biological motion, and were not impaired in judging manipulated weight from movements they would be able to perform. However, patients with chronic shoulder pain were specifically impaired to judge the weight from observed manual transfer movements, whereas chronic low-back pain patients were specifically impaired for trunk-rotation movements. This result gives important new insights into chronic pain. Also, this new impairment of biological motion perception is unique in that it is unrelated to visual deficits.
    Pain 05/2012; 153(7):1459-66. · 5.64 Impact Factor
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    ABSTRACT: INTRODUCTION: The surgical approach in the treatment of idiopathic thoracic scoliosis depends on the type of curve involved. In anterior correction, the rib hump is corrected by derotating the thoracic spine. In posterior scoliosis surgery, additional rib hump resection is sometimes necessary to achieve an optimal cosmetic result. The aim of this study was to compare pulmonary function in these two patient groups. MATERIALS AND METHODS: Forty patients in the anterior group (A) were treated with standard double thoracotomy, with an anterior derotation spondylodesis and a primary stable dual-rod system. The posterior group (P) included 29 patients who were treated with a pedicle screw-based posterior instrumentation spondylodesis, with additional rib hump resection. Pulmonary function was evaluated preoperatively, on the 12th postoperative day, and at 3, 6, 12 and 24 months during the follow-up. RESULTS: The patients' mean age was 15 years in group A and 19 in group P with a standard deviation 8.7 years and a significant difference. With regard to body height or weight there were no significant differences between the two groups. In group A, the deterioration in pulmonary function immediately after the operation (from [Formula: see text] 75.3 %/71.3 % preoperatively to 38.5 %/36.1 % postoperatively) was clearer than in group P ([Formula: see text] 71.6 %/65.7 % preoperatively to 47.7 %/48.4 % postoperatively). During a follow-up period of 3 months, the values improved in both groups in comparison with the values immediately after the operation. Up to the 2 year follow-up, pulmonary function in the posterior and anterior groups corresponded to the preoperative values, with no significant differences. There was a trend toward moderately increased values in the posterior group and moderately decreased values in the anterior group at the 2-year follow-up examination, in comparison with the preoperative baseline, but without a statistically significant difference. Two major complications occurred in the anterior group, with reintubation and several bronchoscopy examinations due to atelectasis. CONCLUSION: The severe deterioration in group A is caused by the substantial trauma with double thoracotomy in contrast to rib hump resection. For patients with severe restrictive pulmonary distress, posterior instrumentation in combination with rib hump resection would be preferable to an anterior procedure involving double thoracotomy. Respiratory physiotherapy exercise should be administered in order to minimise postoperative pulmonary distress. In conclusion opening of the chest wall leads to deterioration of pulmonary function with improvement to the preoperative values after 6 months in the posterior and after 24 months in the anterior group.
    European Spine Journal 04/2012; 22(S2). · 2.47 Impact Factor
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    ABSTRACT: Recently, a self-rating measure for pain perception based on imagined painful daily life situations, the Pain Sensitivity Questionnaire (PSQ), has been developed and shown to correlate with experimentally obtained pain intensity ratings in healthy subjects. Here, we assessed the validity of the PSQ for investigation of general pain perception (ie, pain perception outside the site of clinical pain) in chronic pain patients. PSQ scores were obtained in 134 chronic pain patients and compared to those of 185 healthy control subjects. In a subgroup of 46 chronic pain patients, we performed experimental pain testing outside the clinical pain site, including different modalities (heat, cold, pressure, and pinprick) and different measures (pain thresholds, pain intensity ratings). Results show that PSQ scores were significantly correlated with both experimental pain intensity ratings (Pearson's r=0.71, P<.001) and experimental pain thresholds (r=-0.52, P<.001). In addition, chronic pain patients exhibited significantly elevated PSQ scores as compared to healthy controls, consistent with the generalized increase of experimentally determined pain perception that has repeatedly been reported in chronic pain patients. These results demonstrate that the PSQ constitutes a valid self-rating measure of pain perception outside the clinical pain site in chronic pain patients and might serve as an alternative to experimental assessment of pain perception outside the clinical pain site in situations where experimental pain testing is not feasible.
    Pain 04/2012; 153(6):1210-8. · 5.64 Impact Factor
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    ABSTRACT: The quality of presentations at medical conferences is of major importance. The publication rate (PR) following congress presentation is an indicator of the extent and quality of a scientific society's activity. The purpose of this study was to investigate publication rates in the Spine Society of Europe (SSE), compare them with the results for American spine societies, and determine factors affecting publication. All 839 abstracts of podium and poster presentations at SSE congresses held in 2000-2003 were investigated. PRs in peer-reviewed journals within a period of 5 years were assessed. Subgroup analyses were performed for different study types. The consistency of abstracts with publications was also analyzed. The overall PR was 37.8%, with a mean of 17.7 ± 15.7 months between congress and publication and a mean impact factor of 1.8 ± 1.0 at the time of publication. Comparatively high PRs were found for podium presentations versus posters, studies with higher versus lower levels of evidence, experimental versus clinical studies, prospective versus retrospective studies, randomized versus nonrandomized studies, studies reporting significant main results versus those without, and multicenter studies versus single-center studies. Biomechanical studies also achieved high PRs. The PR was similar to that of NASS (40%) and only slightly inferior to that of SRS (47%) and ISSLS (45%). This shows the high quality of presentations at SSE congresses. The fate of unpublished abstracts is worth further consideration. It is questionable whether it is acceptable to cite abstracts that have not passed a journal's peer-review process and to implement their results in clinical practice.
    European Spine Journal 03/2012; 21(10):2105-12. · 2.47 Impact Factor
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    ABSTRACT: The quality of abstracts presented at medical conferences reflects the scientific activity in the organisations involved. The aims of this study were to evaluate the publication rate of studies presented at the annual congress of the German Society of Orthopaedics and Trauma Surgery and to investigate predictive factors for publication. The results were to be compared with other international meetings. All 1,100 abstracts presented at the Congress of the German Society of Orthopaedics and Trauma Surgery in 2003 were assessed. The publication rate for the corresponding articles in peer-reviewed journals within 5 years was examined using a PubMed search. The consistency of the congress abstracts with the publications was studied. Factors influencing publication rates were investigated, including level of evidence (LoE) and type of study. The publication rate was 36%, with a mean of 15 months between conference and publication (mean impact factor 1.50). No significant differences were observed between publication rates for oral presentations and posters. Experimental studies and those with LoE I and II had higher publication rates (47.1%; 55.2%; 39.8%) than clinical studies and those with LoE III and IV (30.8%; 29.2%; 28.0%). Abstracts of randomised studies and prospective studies showed publication rates of 43.2 and 35.6% and were published more often than abstracts of non-randomised studies and retrospective studies, with publication rates of 35.3 and 27.1%. The publication rate was in the lower range of rates available for comparable conferences--e.g., the American Academy of Orthopaedic Surgeons, with rates between 34 and 55%--but lower than those of the Orthopaedic Trauma Association, at 52-67%. However, 64% of the abstracts remained unpublished, calling into question the acceptability of citing conference abstracts in the scientific literature and implementing them in clinical practice.
    Archives of Orthopaedic and Trauma Surgery 02/2012; 132(2):271-80. · 1.36 Impact Factor
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    Pain 01/2012; · 5.64 Impact Factor
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    ABSTRACT: Postoperative subscapularis function has been identified as an essential factor influencing the outcome of shoulder arthroplasty. The goal of this study was an evaluation of subjective and objective subscapularis function after transosseous refixation. Twenty-three patients with an average age of 71 years (range, 51-86) and follow-up of 43 months (range, 24-67) were included in this study. The subscapularis was tenotomized from the lesser tuberosity and refixation was performed in a transosseous technique through bone tunnels with nonabsorbable sutures. Subscapularis function was evaluated subjectively by the ability to tuck a shirt and objectively with the lift-off test and strength measurement in internal rotation. Radiological assessment included ultrasound evaluation of the subscapularis and an axillary x-ray. No complete, but 7 partial subscapularis tears were found on ultrasound (30.4%). Five patients were not able to tuck their shirt postoperatively (22.7%). This was associated with an inferior clinical outcome (American Shoulder and Elbow Surgeons [ASES] score 53.3 vs 76.4; P = .023). The lift-off test was positive in 4 patients (17.4%), which was also associated with an inferior clinical result (Constant score 52.3% vs 74.2%; P = .021). Nineteen patients were able to go through an internal rotation strength testing in the lift-off position, and averaged 3.8 kg. Although overall reliable refixation of the subscapularis was achieved by transosseous repair, almost 25% of patients showed signs of decreased function and 30% showed signs of partial defects. Subjective and objective functional deficits had a significant influence on the clinical outcome.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 12/2011; 21(10):1322-7. · 1.93 Impact Factor
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    ABSTRACT: Bracing is an established method of conservative treatment for adolescent idiopathic scoliosis and kyphosis. Compliance among adolescents is frequently inadequate due to the discomfort of wearing a brace, cosmetic issues, and fear on the part of patients and parents that bracing may reduce everyday physical activities. The aim of this prospective, controlled study was to objectify the impact of spinal bracing on daily step activity in patients receiving conservative treatment for adolescent idiopathic scoliosis (AIS) or adolescent kyphosis (AK). Forty-eight consecutive patients (mean age 13.4 ± 2.3 years), consisting of 38 AIS patients (33 girls, 5 boys) and 10 AK patients (6 girls, 4 boys) were included. Once the decision to carry out bracing had been taken and while the patients were waiting for the individual brace to be built, step activity was assessed without braces by means of step activity monitoring (SAM) for seven consecutive days. After 8 weeks of brace wearing, step activity was assessed during regular brace treatment, again for seven consecutive days. In addition, brace-wearing times were simultaneously recorded using temperature probes implanted in the braces to measure compliance. Before and during brace treatment, patients completed the Scoliosis Research Society (SRS-22) questionnaire. The SAM was worn for an average of 12.7 ± 1.5 h/day during the first measurement and 12.3 ± 1.9 h on average during the second measurement. The mean gait cycles (GCs) per day and per hour before treatment were 5,036 ± 1,465 and 395 ± 105, respectively. No significant reduction in step activity was found at the follow-up measurement during bracing, at 4,880 ± 1,529 GCs/day and 403 ± 144 GCs/h. Taking the 23-h recommended time for brace wearing as a basis (100%), patients wore the brace for 72.7 ± 27.6% of the prescribed time, indicating an acceptable level of compliance. Girls showed a higher compliance level (75.6 ± 25.6%) in comparison with boys (56.7 ± 31.9%), although the difference was not significant (P = 0.093). The SRS-22 total score showed no differences between the two measurements (2.57 ± 0.23 vs. 2.56 ± 0.28). Implementing a simultaneous and objective method of assessing step activity and brace-wearing times in everyday life proved to be feasible, and it expands the information available regarding the impact of bracing on patients' quality of life. The results clearly show that brace treatment does not negatively interfere with daily step activity in AIS and AK patients. This is an important finding that should help reduce patients' and parents' worries concerning bracing.
    European Spine Journal 04/2011; 20(7):1127-36. · 2.47 Impact Factor
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    ABSTRACT: Posterior pedicle screw fixation is now the standard treatment for surgical correction of idiopathic scoliosis and has largely replaced anterior techniques, but there have been reports describing a lordogenic effect of segmental pedicle screw instrumentation in the thoracic spine. This clinical study compared anterior dual rod instrumentation with posterior pedicle screw fixation for idiopathic thoracic lordoscoliosis, including 42 patients (7 male, 35 female; average age 16 years, range 12-34) who underwent posterior pedicle screw fixation (n = 20) or anterior dual rod instrumentation (n = 22) at two centers. The average follow-up period was 33 months (24-108 months). Inclusion criteria were a diagnosis of adolescent idiopathic scoliosis with a structural thoracic curve (Lenke 1-3) and thoracic hypokyphosis (T4-T12 < 20°). The main thoracic curve magnitude and sagittal profile on standing radiographs were evaluated. Thoracic kyphosis was significantly restored from preoperatively 10.2° to 23.4° postoperatively in the anterior group and from 7.6° to 12.9° in the posterior group (P < 0.005). Kyphosis improved significantly better in the anterior group than in the posterior group (P < 0.005). The preoperative and postoperative main thoracic curve values were 63° (48-80°) and 25.2° in the anterior group and 60.6° (50-88°) and 23.6° in the posterior group, with no significant differences between the groups. No neurological or other severe complications were observed. Anterior dual rod instrumentation in patients with thoracic lordoscoliosis allows significantly better restoration of thoracic kyphosis than posterior pedicle screw instrumentation.
    European Spine Journal 04/2011; 20(7):1118-26. · 2.47 Impact Factor
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    ABSTRACT: OBJECTIVE: A retrospective analysis of clinical and radiological data was conducted, with an emphasis on perioperative complications and risk factors and a minimum follow-up period of two years. The postoperative quality of life was assessed using the SRS-22 questionnaire. METHODS: Between 1999 and 2009, 25 patients (nine male, 16 female) with LCTS, with a mean age of 13.7 years (2.3-29.8 years), were treated with correction and instrumented fusion at a single institution. Seven patients had congenital scoliosis and 18 patients had noncongenital scoliosis (idiopathic, n = 5; neuropathic, n = 4; neoplasm-associated/iatrogenic, n = 3; secondary to other conditions, n = 6). The average preoperative Cobb angle was 74° (49-102°). RESULTS: A mean correction of 51% was achieved postoperatively. The mean Cobb angle at the final follow-up examination was 45° (19-85°), with a significant loss of correction of 8.8° on average. Major complications affected five patients (20%): respiratory insufficiency requiring prolonged intubation, intraoperative cardiac arrest with resuscitation being necessary twice in one patient, persistent clonus, low-grade infection, implant-based complications requiring revision surgery, and adding-on. Minor complications were observed in 22 patients (88%), mainly gastrointestinal and pulmonary. No cases of paraplegia or death occurred. A noncongenital etiology had been diagnosed before the age of 10 years in all of the patients who had major complications. The best score on the SRS-22 questionnaire was achieved in the domain of pain (87%), while the poorest was in the domain of self-image (68%). CONCLUSIONS: The results of this study emphasize an increased complication rate in patients with LCTS scheduled for scoliosis surgery. Additional preoperative examinations (MRI, paediatric consultation, cardiologic consultation, pulmonary function test) are mandatory in patients with LCTS. Preoperatively, patients should be informed about the increased cardiopulmonary and neurological risk which may be associated with scoliosis surgery.
    Coluna/ Columna 01/2011; 10(3):205-210.
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    ABSTRACT: Degenerative musculoskeletal disorders are among the most frequent diseases occurring in adulthood, often impairing patients' functional mobility and physical activity. The aim of the present study was to investigate and compare the impact of three frequent degenerative musculoskeletal disorders--knee osteoarthritis (knee OA), hip osteoarthritis (hip OA) and lumbar spinal stenosis (LSS)--on patients' walking ability. The study included 120 participants, with 30 in each patient group and 30 healthy control individuals. A uniaxial accelerometer, the StepWatch™ Activity Monitor (Orthocare Innovations, Seattle, Washington, USA), was used to determine the volume (number of gait cycles per day) and intensity (gait cycles per minute) of walking ability. Non-parametric testing was used for all statistical analyses. Both the volume and the intensity of walking ability were significantly lower among the patients in comparison with the healthy control individuals (p < 0.001). Patients with LSS spent 0.4 (IQR 2.8) min/day doing moderately intense walking (>50 gait cycles/min), which was significantly lower in comparison with patients with knee and hip OA at 2.5 (IQR 4.4) and 3.4 (IQR 16.1) min/day, respectively (p < 0.001). No correlations between demographic or anthropometric data and walking ability were found. No technical problems or measuring errors occurred with any of the measurements. Patients with degenerative musculoskeletal disorders suffer limitations in their walking ability. Objective assessment of walking ability appeared to be an easy and feasible tool for measuring such limitations as it provides baseline data and objective information that are more precise than the patients' own subjective estimates. In everyday practice, objective activity assessment can provide feedback for clinicians regarding patients' performance during everyday life and the extent to which this confirms the results of clinical investigations. The method can also be used as a way of encouraging patients to develop a more active lifestyle.
    BMC Musculoskeletal Disorders 10/2010; 11:233. · 1.90 Impact Factor
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    ABSTRACT: During anterior scoliosis instrumentation with a dual-rod system, the vertebrae are dissected anterolaterally. After surgery, some patients report a change in temperature perception and perspiration in the lower extremities. Sympathetic lesions might be an explanation for this. The aim of this clinical study was to investigate sympathetic function after anterior scoliosis instrumentation. A total of 24 female patients with idiopathic scoliosis (mean age at follow-up, 23.8 years) who had undergone anterior instrumentation on average 6.6 years earlier were included. Due to the suspected relevance of the sympathetic L2 ganglion, two groups were created: a T12 group, in which instrumentation down to T12 was carried out (n = 12), and an L3 group, in which instrumentation down to L3 was done (n = 12). Sympathetic function was assessed by measuring skin temperature at the back of the foot, a plantar ninhydrin sweat test and sympathetic skin responses (SSRs) following electrical stimulation. The side on which the surgical approach was carried out was compared with the contralateral, control side. Health-related quality of life was investigated using the Scoliosis Research Society SRS-22 patient questionnaire. In the T12 group, mean temperatures of 29.6 degrees C on the side of the approach versus 29.5 degrees C on the control side were measured (P > 0.05); in the L3 group, the mean temperatures were 33.2 degrees C on the approach side versus 30.5 degrees C on the control side (P = 0.001). A significant difference between the T12 group and the L3 group (P < 0.001) was observed on the approach side, but not on the control side (P = 0.15). The ninhydrin sweat test showed reduced perspiration in 11 of 12 patients in the L3 group on the approach side in comparison with the control side (P = 0.002). In the T12 group, no significant differences were noted between the left and right feet. SSRs differed significantly between the two groups (P = 0.005). They were detected in all nine analyzable patients in the T12 group on both sides. In the L3 group, they were found on the approach side only in 4 of 11 analyzable patients versus 11 patients on the control side. The results of the SRS-22 questionnaire did not show any significant differences between the two groups. In conclusion, anterior scoliosis instrumentation with a dual-rod system including vertebrae down to L3 regularly leads to lesions in the sympathetic trunk. These are detectable with an increase in temperature, reduced perspiration and reduced SSRs. The caudal level of instrumentation (T12 vs. L3) has an impact on the extent of impairment, supporting the suspected importance of the L2 ganglion. The clinical outcome does not seem to be significantly limited by sympathetic trunk lesions.
    European Spine Journal 09/2010; 19(9):1558-68. · 2.47 Impact Factor
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    ABSTRACT: Biomechanical investigation of primary and revised cement-augmented pedicle screws in comparison with unaugmented screws. To evaluate revision of cannulated pedicle screws and investigate cement-augmented and nonaugmented screws biomechanically, testing the torque of primary screws and axial pullout force of revised screws in cadaver vertebrae. Cement augmentation increases the pullout force and stability of pedicle screws in vertebrae with low bone mineral density, but surgeons are concerned about complications during revision. Bone mineral density was measured using quantitative computed tomography (CT) in 23 osteoporotic thoracolumbar junction vertebrae from human cadavers. Cannulated pedicle screws, augmented with bone cement (on right) or unaugmented (left), were inserted into each vertebra. After CT control, extraction torque was measured and the pedicles were reinstrumented with larger-diameter screws. The right screws were augmented again, with another CT control, before pullout testing. Mean vertebral bone density was 52.6 mg/cm. No major screw malpositioning was observed on primary CTs. Cement leakage was observed anterolaterally and into the spinal canal. Mean maximal torque in augmented screws (1.2 Nm, SD: 0.6) differed significantly from nonaugmented screws (0.8 Nm, SD: 0.6). Screw removal did not lead to vertebral destruction. No relevant changes due to positioning or leakage were observed on CT after revision procedures compared with primary findings. Maximal pullout force in revised augmented screws (713.2 N, SD: 254.6) differed significantly compared with nonaugmented screws (554.0 N, SD: 296.5). Bone damage was observed in several vertebrae during pullout force testing in augmented screws. Revision of cement-augmented pedicle screws was feasible without bone destruction, and larger-diameter screws can be used in revision procedures. The pullout force after revision was significantly better in cement-augmented screws. During pullout testing, the cement-bone interface broke before the screw-cement interface in several vertebrae, fracturing the pedicles.
    Spine 09/2010; 35(19):E932-9. · 2.45 Impact Factor

Publication Stats

553 Citations
134.08 Total Impact Points

Institutions

  • 2004–2013
    • Universitätsklinikum Münster
      • Klinik für Allgemeine Orthopädie und Tumororthopädie
      Muenster, North Rhine-Westphalia, Germany
  • 2012
    • St. Franziskus-Hospital
      Köln, North Rhine-Westphalia, Germany
  • 2009–2012
    • University of Münster
      • • Department of Neurology
      • • Clinic for General Orthopedics and Tumor Orthopedics
      Muenster, North Rhine-Westphalia, Germany
  • 2006
    • Orthopädisch-Chirurgische Zentrum
      Cham Regen, Bavaria, Germany
  • 2002–2003
    • Freie Universität Berlin
      • Institute of Veterinary Pathology
      Berlín, Berlin, Germany