Ralph Kothe

• MD, PhD
• Head of Department at Schön Klinik Hamburg

Study Design Retrospective bicentric Cohort Study. Objective Posterior (PLIF) and transforaminal lumbar interbody fusion (TLIF) have been clinically proven for the surgical treatment of degenerative spinal disorders. Despite many retrospective studies, the superiority of either technique has not been proven to date. In the literature, the complica...

Zusammenfassung Osteoligamentäre Verletzungen der Halswirbelsäule können gerade bei älteren Patienten mit einer vorbestehenden Enge des Spinalkanales einhergehen. Die Frage der operativen Behandlungsnotwendigkeit ist abhängig von verschiedenen Faktoren. Neben der strukturellen Schädigung der Halswirbelsäule ist das Ausmaß der traumatisch bedingten...

Zusammenfassung Analog zur Chirurgie an der Brust- und Lendenwirbelsäule, ist es auch an der Halswirbelsäule das Bestreben der minimalinvasiven-Techniken (MIS), hinsichtlich der „target surgery“ vergleichbare Ergebnisse zu den konventionellen Verfahren zu erzielen. Gleichzeitig aber die Vorteile einer weniger traumatisierenden „access surgery“ zu b...

Objective: Anterior stabilization of the spine with a lateral approach to insert a large and broad cage creating a better bearing surface to restore or maintain the lumbar lordosis. Indications: Degenerative scoliosis as well as revision surgery for stenosis of the neuroforamen. Lumbar corpectomies between L2/3 and L4/5 can be approached as well...

Zusammenfassung Die kollegiale Teamführung hat in der deutschprachigen „Kliniktradition“ nicht den Stellenwert wie in dem angelsächsischen Sprachraum. Transformationale Führung ist hingegen in der Wirtschaft ein Begriff: der Konsens über vereinbarte Werte und gemeinsame übergeordnete Ziele bilden die Grundlage der Teamleistung. Vorteile der kollegi...

Objective: Improved accuracy of spinal instrumentation with the use of intraoperative CT (iCT). Indications: All types of posterior spinal instrumentation. Contraindications: None. Surgical technique: After fixation of the spinal clamp, an intraoperative CT (iCT) is performed. The image data set can then be used for navigation of the spinal...

Objective We compared open-door laminoplasty via a unilateral approach and additional unilateral lateral mass screw fixation (uLP) with laminectomy and bilateral lateral mass screw fixation (LC) in the surgical treatment of multilevel degenerative cervical myelopathy (mDCM). Methods A retrospective cohort analysis of 46 prospectively enrolled patie...

Sollte eine Operation bei einer zervikalen Radikulopathie indiziert sein, stehen verschiedene OP-Möglichkeiten zur Verfügung. Welche die passende ist, hängt unter anderem von der Lokalisation der Engstelle und dem Ausmaß der Degeneration ab. Gemein ist aber allen Verfahren, dass sie bei richtiger Indikationsstellung eine sehr gute Erfolgsrate haben...

Purpose The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy gr...

Purpose Decompression is one of the most common interventions in spinal surgery. Obesity has become an increasing issue in surgical patients. Therefore, the aim of this study was to analyze the clinical outcome following lumbar microsurgical decompression in correlation with the patient’s body mass index (BMI). Materials and methods A toal of 744...

Zusammenfassung Die Zusatzweiterbildung „Spezielle Wirbelsäulenchirurgie“ soll zukünftig eine strukturierte Ausbildung von Wirbelsäulenchirurgen ermöglichen. Zugangsberechtigt sind Fachärzte für Neurochirurgie sowie Fachärzte für Orthopädie und Unfallchirurgie. Die Ausbildungsdauer beträgt 24 Monate und orientiert sich in den Inhalten an dem Weiter...

Zusammenfassung Die Dekompression des cervicalen Rückenmarks ist über einen ventralen oder dorsalen Zugangsweg möglich. Bei cervicaler Myelopathie, der häufigsten Ursache für eine Funktionsstörung des Rückenmarks, bieten sich insbesondere für Multilevelstenosen dorsale Verfahren an. Die Laminektomie mit Fusion stellt das Standardverfahren zur poste...

Objective Management of the intradural structures safely, closure of the dura according to the tear, and minimizing the epidural dead space. Indications Incidental durotomy (ID). Contraindications None. Surgical technique 1. Bone removal until whole dural tear is visible (if necessary); 2. intradural inspection; 3. reposition the fibers; 4. perf...

Purpose: To validate with a prospective study a decision-supporting coding system for the surgical approach for multi-level degenerative cervical myelopathy (mDCM). Methods: Ten cases were presented on an internet platform, including clinical and imaging data. A single approach (G1), a choice between two (G2), or three approaches (G3) were optio...

Zusammenfassung Durch den zunehmenden Einsatz von Biologika hat sich das klinische Erscheinungsbild der rheumatoiden Arthritis (RA) in der täglichen Praxis verändert. Patienten mit einer isolierten atlanto-axialen Instabilität sind seltener geworden. Dafür rücken Patienten mit therapierefraktären Schmerzsyndromen der oberen Halswirbelsäule (HWS) un...

Zusammenfassung Durch den zunehmenden Einsatz von Biologika hat sich das klinische Erscheinungsbild der rheumatoiden Arthritis (RA) in der täglichen Praxis verändert. Patienten mit einer isolierten atlanto-axialen Instabilität sind seltener geworden. Dafür rücken Patienten mit therapierefraktären Schmerzsyndromen der oberen Halswirbelsäule (HWS) un...

Study design: Non-randomized prospective and single center clinical trial of the ProDisc Vivo prosthesis. Objective: Investigate the clinical and radiological results of a refined cTDR - the ProDisc Vivo - with two years of follow up (FU). The incidence of implant-related complications was recorded as a secondary outcome variable. Summary of ba...

Background: Spinal navigation has made significant advances in the last two decades. After initial experiences with pedicle screws in the thoracic and lumbar spine, technological improvements have resulted in their increased application in the cervical spine. Instrumentation techniques like cervical pedicle screws, lateral mass screws in C1 and tr...

Background: The involvement of the cervical spine in rheumatoid arthritis (RA) continues to be of clinical importance even in this age of biologics. Pathophysiological changes begin with an isolated atlantoaxial subluxation and may progress to a complex craniocervical and subaxial instability. The onset of cervical myelopathy can occur at any time...

Zusammenfassung Das Central Cord Syndrome (CCS) ist definiert durch eine armbetonte motorische Schädigung, eine Blasenentleerungsstörung, sowie ein wechselhaftes sensibles Defizit kaudal der Läsion. Das CCS ist zudem die häufigste akute inkomplette zervikale Rückenmarksschädigung. Typischerweise sind ältere Patienten mit einer vorbestehenden spondy...

Background Impaired bone quality is associated with poor outcome of spinal surgery. The aim of the study was to assess the bone mineral status of patients scheduled to undergo spinal surgery and to report frequencies of bone mineral disorders. Methods We retrospectively analyzed the bone mineral status of 144 patients requiring spinal surgery inclu...

Objective: Multilevel posterior decompression of subaxial cervical spinal canal stenosis through a less-invasive unilateral approach. Indications: Degenerative cervical myelopathy due to multilevel subaxial spinal canal stenosis. Contraindications: Cervical kyphosis or instability, bilateral radiculopathy due to foraminal stenosis, involvement...

Correction to: Oper Orthop Traumatol 2017 https://doi.org/10.1007/s00064-017-0516-6 In this article the following acknowledgement was missing:Acknowledgement: With the kind assistance of Deutsche Arthrose-Hilfe e. ….

Purpose Incidental durotomy is one of the most common complications in lumbar spine surgery. There are conflicting reports whether a dural lesion is associated with an inferior outcome after lumbar decompression. This study analyzed the effect of incidental durotomy in this specific group of patients (Dura+) and compared the results with the remain...

Objective: To relieve foraminal root impingement due to lateral soft disc fragments, bony spurs, or other rarer causes. Indications: Soft disc fragment whose bulk is >2/3 lateral to the lateral border of the thecal sac. Intraforaminal dorsal bony narrowing of the root canal. Intraforaminal synovial cyst, extra/intradural tumor. Contraindication...

Schmerzen im Bereich der Lendenwirbelsäule haben bei Patienten mit rheumatoider Arthritis (RA) bislang nur wenig Beachtung gefunden. Wissenschaftliche Arbeiten beschäftigten sich überwiegend mit der rheumatischen Instabilität der Halswirbelsäule. In einer aktuellen Studie konnten wir jedoch nachweisen, dass Kreuzschmerzen beim RA-Patienten zu einer...

Purpose: Previous studies have demonstrated that total cervical disc replacement (cTDR) represents a viable treatment alternative to the 'gold standard' anterior cervical discectomy and fusion for the treatment of well-defined cervical pathologies at short- and mid-term follow-up (FU). However, the implementation and acceptance of a non-fusion phi...

This study tested the experimental placebo effect in a group of chronic pain patients. Forty-eight patients suffering from chronic back pain participated in a randomized clinical trial that tested the efficacy of a sham opioid solution (NaCl) compared to an alleged neutral, completely inactive solution (NaCl). We shaped the placebo effect by two in...

Study design: A case-control study OBJECTIVE.: To determine whether parity and abdominal surgeries are associated with degenerative spondylolisthesis (DS). Summary of background data: DS is considered to be a major cause of low back pain (LBP) in the older population, with greater prevalence of DS among women. Because LBP and impaired abdominal...

Die zervikale spondylogene Myelopathie (ZSM) führt zu einer funktionellen Schädigung des Rückenmarkes. Der klinische Verlauf ist variabel und zeitlich schwer einschätzbar. Die anhaltende Kompression des Rückenmarkes durch Bandscheibengewebe, dorsale Osteophyten oder ein verkalktes hinteres Längsband verursacht sowohl eine direkte mechanische Schädi...

The involvement of the cervical spine in rheumatoid arthritis (RA) is of continued clinical importance despite the introduction of biological agents. Pathophysiological changes begin with isolated atlantoaxial subluxation (AAS) and may progress to complex craniocervical and subaxial instability. Cervical myelopathy can occur at any time and leads t...

Die Wirbelsaulenchirurgie steht in der Kritik. Die Hauptkritikpunkte sind, dass nicht nur generell zu viel operiert wird, sondern auch, dass uberwiegend finanzielle Vorteile das Handeln von Kliniken und Wirbelsaulenchirurgen bestimmen.

Die Sektion Wirbelsaule vertritt die Interessen von Wirbelsauleninteressierten innerhalb der DGOU. Sie berat das Prasidium und die Gremien der DGOU in Fachfragen und entwickelt und bearbeitet wissenschaftliche Projekte. Der Vorsitzende der Sektion (F. Kandziora) und sein Stellvertreter (A. Korge) vertreten die Wirbelsauleninteressierten im Vorstand...

Zusammenfassung Die Inzidenz von Rückenschmerzen aufgrund osteoporotischer Wirbelkörperfrakturen nimmt vor dem Hintergrund der demogra-fischen Entwicklung in Deutschland zu. Die Diagnostik umfasst neben Anamnese und Untersuchung ein Röntgenbild möglichst im Stand. Bei Frakturverdacht sollte ein MRT erfolgen, bei instabilen Frakturen zusätzlich ein...

Die spondylogene zervikale Myelopathie ist der häufigste Grund für eine Funktionsstörung des Rückenmarks und bei älteren Menschen die wichtigste Ursache für eine Spastik. Die operative Behandlung sollte im Fall eines progredienten Verlaufs der Myelopathie zeitnah erfolgen. Die Art des operativen Vorgehens hängt von den jeweiligen individuellen path...

Surgery for isthmic and degenerative spondylolisthesis (SL) in adults is carried out very frequently in everyday practice. However, it is still unclear whether the results of surgery are better than those of conservative treatment and whether decompression alone or instrumented fusion with decompression should be recommended. In addition, the role...

Purpose To compare the stabilization behavior of additional unilateral mass screw fixation with current standard procedures in patients with cervical spondylotic myelopathy (CSM) in a biomechanical study. Methods Ten human C2–C7 cervical specimens were tested under various segment conditions: native (NAT), laminoplasty (LP), laminoplasty with unila...

Die lumbale Spinalkanalstenose ist die Folge exzessiver degenerativer Veränderungen eines oder mehrerer Wirbelsäulensegmente mit oder ohne begleitende Instabilität. Rückenschmerzen und eine Verkürzung der Gehstrecke beeinträchtigen zunehmend die oft älteren Betroffenen, denen jedoch ein aktiver Lebensstil wichtig ist. Die Indikationen und technisch...

Incidental durotomy (ID) is the most common complication of spine surgery. Revision procedures, ossification of the yellow ligament, or synovial cysts are well-known risk factors. The size, shape, and severity of ID are unpredictable, ranging from a pinpoint hole to a several centimeters large dural laceration with transected fibers following the s...

Objective: To remove extruded disc fragments impinging the exiting root. To spare the interlaminar space and the facet joint. Indication: Cranially migrated disc herniation. Contraindication: Severe spinal canal stenosis. Surgical technique: Microscope from skin to skin, 25 mm skin incision about 5 mm off the midline, conventional subperiost...

Objective: To decompress the lumbar spinal nerve impinged peripherally to the lateral recess. To avoid in selected cases the pedicle screw fixation and fusion of the segment. Indication: Single level radiculopathy in degenerative scoliosis or in degenerative disc disease without segmental instability. Contraindications: Scoliosis > 30° at the...

Muscular tension is assigned an important role in the development and maintenance of chronic pain syndromes. It is seen as a psychophysiological correlate of learned fear and avoidance behavior. Basic theoretical models emphasize classical conditioning of muscular responses as a mechanism of pain chronification. However, the empirical basis for thi...

We describe a prospective cohort study that investigated the effectiveness of microsurgical bilateral decompression using unilateral laminotomy for lumbar spinal stenosis and assessed the factors influencing the outcome. A total of 165 consecutive patients underwent decompression for lumbar spinal stenosis. They were divided into 3 age groups: A (<...

The number of surgical interventions for spinal diseases has greatly increased due to rapid improvements in surgical techniques. The close anatomical relationship between neural and bony structures and the various anatomical approaches to the spinal column lead to a large variety of possible surgical complications. Therefore, it seems helpful to di...

Zusammenfassung Die rasche Entwicklung in der chirurgischen Behandlung von spinalen Erkrankungen hat zu einer starken Zunahme operativer Eingriffe an der Wirbelsäule geführt. Die anatomische Nähe von neurogenen und knöchernen Strukturen, sowie die vielfältigen operativen Zugänge haben eine Vielzahl verschiedener Komplikationsmöglichkeiten zur Folge...

We undertook a prospective, non-randomized study on the translaminar approach for the treatment of cephalad extruded disc fragments impinging the exiting root. Between May 2000 and July 2004, 104 patients (59 men)-presenting with upper lumbar root compression in 74% of the cases -underwent a translaminar approach. The mean age was 57 years (range,...

A male patient developed neurological deficits after an uneventful spinal anesthesia. After 2 months without any improvement an epidural hematoma was presumed. Magnet resonance imaging detected inflammatory tissue and destruction at lumbar levels L2/3. The inflammatory tissue had to be removed via laminectomy. Histology of the excised tissue reveal...

Ein männlicher Patient entwickelte nach einer ereignislosen Spinalanästhesie neurologische Defizite. Nach zwei Monaten ohne Besserung wurde unter der Verdachtsdiagnose eines epiduralen Hämatoms ein Magnetresonanztomogramm (MRT) durchgeführt, das eine Entzündung und eine Destruktion auf Höhe L2/3 zeigte. Das inflammatorische Gewebe wurde mithilfe ei...

Low back pain (LBP) and rheumatoid arthritis (RA) are common orthopedic problems, but there is little information on the importance of LBP in RA patients. The aim of this study was to investigate how LBP affects functional limitations, depressed mood, and quality of life in patients with RA. A complex questionnaire was answered by 281 RA patients,...

Degeneration of the spine is a common reason for pain in the musculoskeletal system. Radiography is an important tool for diagnosis and differential diagnosis. Cost efficacy and economy of time are advantages in using conventional x-rays. Although narrowing of intervertebral disc spaces, irregular ossification of the vertebral end-plate as well as...

Degeneration of the spine is a common reason for pain in the musculoskeletal system. Radiography is an important tool for diagnosis and differential diagnosis. Cost efficacy and economy of time are advantages in using conventional x-rays. Although narrowing of intervertebral disc spaces, irregular ossification of the vertebral end-plate as well as...

In October 2004, the medical faculty of Hamburg University started a program to restructure completely clinical teaching according to new state regulations of June 2002. In this new curriculum design, the surgical disciplines were horizontally and vertically interconnected and integrated, with a focus on practical training and problem-based teachin...

Mit dem Sommersemester 2004 wurde an der Medizinischen Fakultät der Universität Hamburg ein neues Curriculum implementiert und evaluiert, welches eine integrierte Unterrichtskonzeption für die chirurgischen Fächer beinhaltet. Die operativen Fächer werden dabei in stark verzahnter Form in einem 12-wöchigen Trimester angeboten. Inhaltlich zeichnet si...

This paper presents the results of the evaluation of a new undergraduate curriculum at the Medical Faculty of Hamburg University. This curriculum is based on the new law on medical board certification of 2002, and was tested for the first time in the summer term of 2004. The results were compared with those obtained under the previous law. The data...

An in vitro biomechanical study to compare 2 different dorsal screw fixation techniques in the cervical spine with respect to primary stability and stability after cyclic loading. To investigate if the biomechanical stability is better in pedicle screw or in lateral mass fixation. In patients with poor bone quality who require multisegmental fixati...

Rheumatoid arthritis leads to characteristic findings at the synovial joints, the intervertebral discs and the processes of the cervical spine. Isolated findings are not specific for rheumatoid arthritis. In fact, due to common underlying pathophysiologic changes they also develop in other inflammatory diseases affecting the cervical spine. Therefo...

The rheumatoid involvement of the cervical spine can be divided into three phases. In the early stage of the disease there is an isolated atlantoaxial subluxation (AAS), followed by vertical instability and subaxial instability. If patients show clear symptoms of cervical myelopathy, which can occur during any stage of the disease, the progression...

The rheumatoid involvement of the cervical spine can be divided into three phases. In the early stage of the disease there is an isolated atlantoaxial subluxation (AAS), followed by vertical instability and subaxial instability. If patients show clear symptoms of cervical myelopathy, which can occur during any stage of the disease, the progression...

Rheumatoid arthritis leads to characteristic findings at the synovial joints, the intervertebral discs and the processes of the cervical spine. Isolated findings are not specific for rheumatoid arthritis. In fact, due to common underlying pathophysiologic changes they also develop in other inflammatory diseases affecting the cervical spine. Therefo...

Major spinal surgery is associated with high postoperative pain scores and opioid requirement. The aim of the current prospective, randomized, placebo-controlled, double-blind study was to assess the reduction of opioid requirement and pain scores using an intraoperatively placed epidural catheter with infusion of 0.1% ropivacaine during the postop...

To date, only one patient with spinal affection of Gaucher's disease requiring surgery for spinal compression has been reported. We present an additional case with extensive affection of three consecutive vertebral bodies, and present a review of the literature relating to the management of therapy and follow-up of this disease.

The involvement of the cervical spine in patients with rheumatoid arthritis (RA) is common,and has recently received growing attention. In the early stage of the disease, there is an isolated atlantoaxial subluxation (AAS). With further progression, osseous destruction of the joints can lead to vertical instability. While the involvement of the mid...

The involvement of the cervical spine in patients with rheumatoid arthritis (RA) is common,and has recently received growing attention. In the early stage of the disease, there is an isolated atlantoaxial subluxation (AAS). With further progression, osseous destruction of the joints can lead to vertical instability. While the involvement of the mid...

The spine is the central component for the mobility of the human body. Both locally limited and diffuse pathologies of the spine are a challenge for the treating physician due to the difficult anatomy. The biopsy of a pathologically altered vertebral body is a fast and reliable basis for further therapy but until now this has not regularly been mad...

Zusammenfassung Die Wirbelsäule ist das zentrale Organ für alle Bewegungsabläufe des menschlichen Organismus. Sowohl lokal begrenzte als auch diffuse Erkrankungen der Wirbelsäule stellen aufgrund der komplizierten topographischen Verhältnisse den behandelnden Arzt im Einzelfall vor erhebliche Probleme. Mit einer bioptischen Untersuchung eines path...

The purpose of this study was to evaluate the technique and value of fluoroscopy-guided percutaneous transpedicular trocar biopsy in obtaining diagnostic tissue from vertebral body lesions and to review the current literature. The bone cores from 32 patients who underwent 34 transpedicular Jamshidi trocar biopsies for lesions in the thoracic, lumba...

An in vitro study to investigate the advantages of computer assistance for the purpose of parapedicular screw fixation in the upper and middle thoracic spine. To evaluate the feasibility and application accuracy of parapedicuar screw insertion with the assistance of an optoelectronic navigation system. Because of anatomic limitations, thoracic pedi...

An examination of the accuracy of percutaneous pedicle screw placement in the lumbar spine. Using computed tomography scan analysis after implant removal, the screw tracts could be analyzed regarding the degree and direction of screw dislocation. To investigate the misplacement rate and related clinical complications of percutaneous pedicle screw i...

We report on a fibrous dysplasia with rare localization within the lumbar spine and the os sacrum. The female patient complained about relapsing lumbago over years with increasing intensity within the last 5 months. The radiographs as well as the CT showed polycyclic lesions within the vertebral bodies and the os sacrum. Further osseous manifestati...

An in vitro study in which a human cadaver model was used to examine the accuracy of two different techniques of percutaneous pedicle screw insertion in the lumbar spine. To investigate the in vitro misplacement rate of pedicle screw insertion for two different percutaneous techniques: 1) the well established Magerl technique, and 2) a new modified...