Markus Quante

Schön Klinik München Schwabing, München, Bavaria, Germany

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Publications (41)64.19 Total impact

  • Markus Quante · Henry Halm
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    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.
    No preview · Article · Jan 2015 · Der Orthopäde
  • M Quante · R Zamani · M J K Simon · J Klasen · V Bullmann
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    ABSTRACT: Hintergrund Die perioperative Gabe von Antikoagulanzien (AK) und Thrombozytenaggregationshemmern (TAH) in der Wirbelsäulenchirurgie (WSC) suggeriert eine erhöhte Rate epiduraler Blutungen, Daten dazu fehlen. Oft sind die Substanzen zur Verhinderung thromboembolischer Komplikationen unverzichtbar. Eine übergreifende Handlungsempfehlung zum Einsatz von AK und TAH fehlt. Ziel der Arbeit Ziel der Studie war eine Analyse der Ist-Situation (Einsatz von TAH und AK in der WSC) als Grundlage für Empfehlungen weiterer Studien und Leitlinienentwicklung. Material und Methoden Es erfolgten 2 unabhängige Umfragen an deutschen Wirbelsäulenzentren zur perioperativen Anwendung von AK und TAH und die Erfassung des perioperativen Einsatzes von AK und TAH, Risikoeinschätzung des thromboembolischen und Blutungsrisikos sowie zu Art und Umfang eingesetzter Substanzgruppen. Ergebnisse Trotz Risikoklassifikation wird eine Risikoadjustierung der Thromboembolieprophylaxe nicht vorgenommen, fast alle Patienten in der WSC erhalten perioperativ niedermolekulares Heparin (98 %), 64 % beginnen die medikamentöse Prophylaxe prä-, 36 % postoperativ. Die Dauer der medikamentösen Prophylaxe wird willkürlich festgelegt. Etwa 40 % der Befragten infiltrieren paravertebral, 19 % epidural unter TAH. Bei Operationen mit Spinalkanaleröffnung werden bei bis zu 30 % TAH toleriert, ohne Eröffnung bei bis zu 40 %. Die Risikoabschätzung der THA unterscheidet deutlich zwischen ASS und Rezeptorblockern sowie dualer TAH-Gabe. Diskussion Der Umgang mit AK und TAH in der WSC in Deutschland ist sehr heterogen, teilweise wird deutlich von Leitlinien abgewichen. Es lässt sich klar Bedarf für Studien erkennen, die Zahlen zur konkreten Risikobewertung der perioperativen AK- und TAH-Gabe liefern, um konkrete Handlungsempfehlungen abgeben zu können.
    No preview · Article · Jul 2014 · Der Orthopäde
  • M Quante

    No preview · Article · Dec 2012 · MMW Fortschritte der Medizin
  • Markus Quante
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    ABSTRACT: Frau K. stellt sich in der Ambulanz vor. Sie hat vor gut einer Woche bei der Gartenarbeit einiges geleistet. Danach kam es zu verstärkten Schmerzen im Bereich der „unteren Wirbelsäule“. Die Schmerzen haben sich dann von Tag zu Tag deutlich aufgebaut, nun sind sie so stark, dass sie kaum noch mit einer normalen Mobilisation vereinbar sind. Liegen ist deutlich besser. Die Rückenschmerzen sind lokal begrenzt und ziehen nicht in die Beine.
    No preview · Article · Dec 2012 · MMW Fortschritte der Medizin
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    ABSTRACT: STUDY DESIGN:: 2 arm prospective controlled study. OBJECTIVE:: The aim of our study is to prospectively assess the outcome of symptomatic lumbar spinal stenosis (LSS) treated with decompressive surgery alone in comparison to additional implantation of the Coflex™ interspinous Device. SUMMARY OF BACKROUND DATA:: In symptomatic LSS decompression surgery is an established treatment. Recently a number of interspinous devices have been introduced as an alternative to conventional surgical procedures. The theoretical aim of the Coflex Device is to unload the facet joints, restore foraminal height and provide stability in order to improve the clinical outcome. Published information is limited, and there are no data which proof the superiority of the implant in comparison to traditional surgical approaches. METHODS:: Sixty-two patients with symptomatic LSS were treated with decompressive surgery, 31 of these patients received an additional Coflex™ device. Pre- and postoperatively disability and pain scores were measured using the Oswestry Disability Index (ODI), the Roland-Morris Disability Questionnaire (RMS), the Visual Analoge Scale (VAS) and the pain free walking distance (WD). Patients underwent postoperative assessments 3, 6 12 and 24 month including the above mentioned scores as well as patient satisfaction. RESULTS:: There was a significant improvement (P<0.001) in the clinical outcome assessed in the ODI, in the RMS, in the VAS and in the pain-free walking distance at all times of reinvestigation compared to the base line in both groups. Up to two years after surgery there were no significant differences between both groups in all ascertained parameters including the patient satisfaction and subjective operation decision. CONCLUSIONS:: The results of this first prospective controlled study indicate that the additional placement of a Coflex™ interspinous device does not improve the already good clinical outcome after decompressive surgery for LSS in the 24-month follow up interval.
    No preview · Article · May 2012 · Journal of spinal disorders & techniques
  • M Quante · I Thate-Waschke · M Schofer
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    ABSTRACT: Today there are different subcutaneous and three oral applicable medications for prevention of venous thromboembolism after knee and hip replacement. It is a general opinion that patients will prefer oral administration. However, until today there has been no study that analysed patient preferences and motives for deciding on the kind of administration. These data would be of interest since the consideration of patient preferences could improve adherence. The present study analysed patient preferences regarding oral or subcutaneous administration of medication after elective hip or knee replacement surgery. The results will have implications for clinical practice and for decision-making concerning the kind of administration. This prospective, multi-centric, observational study was conducted in six emergency hospitals and six rehabilitation hospitals. 178 current hip and knee replacement patients undergoing thromboprophylaxis and at least one further oral medication were interviewed. Subjective assessment data of patients were collected on study-specific questionnaires (epidemiological data, amount and background of general oral medication, details on subcutaneous thromboprophylaxis, preference of administration, causes for preference). 71.91 % of the interviewed patients preferred the daily intake of a tablet, whereas only 14.61 % favoured the daily subcutaneous injection. Main causes for the preference of oral administration were easier (86.6 % of nominations) and less complex (73.1 % of nominations) handling. 70.9 % reported that one more oral application would be unproblematic. Painlessness of oral administration was relevant for 65.7 %. Causes for preferring subcutaneous administration were "safety" (55.3 % of nominations) and an assumption of a generally better effectivity of subcutaneous (47.4 % of nominations) administration. Subjective discomfort induced by subcutaneus administration increased with the time interval since surgery. Less than 5 % of patients prefer subcutaneous administration due to the high volume of their existing oral medication. Patient approval of oral administration is governed by practical and comfort issues. In general, patients on existing oral medications are uncritical concerning a temporary additional oral medication. The clear discomfort measured in association with subcutaneous administration supports the idea that the oral route will have advantages for patient adherence. In particular this is of relevance with increasing time interval since surgery. Patients who have a very high volume of oral medications will probably profit from subcutaneous administration. The main reasons that patients gave for the preference of subcutaneous administration are based on incorrect knowledge. Therefore it is necessary to improve patient education concerning the existing alternatives for thromboprophylaxis.
    No preview · Article · Mar 2012 · Zeitschrift fur Orthopadie und Unfallchirurgie
  • M Quante · H Kesten · A Richter · H Halm
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    ABSTRACT: Degenerative spondylolisthesis (DS) is a common cause of lumbal and lumbosacral pain as well as radicular pain. Retention and fusion is a good treatment option. Some patients have a symptomatic adjacent degenerative disc disease (DDD) in addition to DS. In these cases the adjacent segments should be fused as well. There are different techniques of fusion available, such as posterior with instrumentation or additional anterior support. This study evaluated results of transforaminal lumbar interbody fusion (TLIF) in patients with monosegmental DS and adjacent DDD. A total of 28 patients with monosegmental DS and adjacent DDD were included into the study (all patients with bisegmental posterior instrumentation and fusion, 14 patients 1 level TLIF, 14 patients 2 level TLIF). Before surgery and 12 months after surgery the following measurements were made: pain (visual analog scale VAS), Oswestry disability index (ODI) and plain radiographs with radiometric analysis. In a sub-analysis patients with 1 and 2 level TLIF were compared. Pain reduction (average VAS from 8.7-3.1) and ODI (63% to 28%) showed significant improvements. Radiometric analysis showed a significant disc height reconstruction and a significant reduction of spondylolisthesis (TLIF level with spondylolisthesis). Bisegmental anterior support showed a significantly better relordosation compared to monosegmental anterior support. The complication rate was 21.4% including hemorrhages, dura leakage, wound infection and adjacent segment degeneration. There were no fatal complications. The TLIF procedure is a safe and effective treatment for monosegmental DS with adjacent symptomatic DDD. Clinical results (pain, function) show no difference between both kinds of fusion (dorsal fusion and instrumentation versus dorsal fusion with instrumentation and TLIF) for the adjacent DDD. However, additional anterior support is more effective for relordosation of the segment. This could have impact on the mid-term and long-term outcome or in cases of adjacent segment fusion.
    No preview · Article · Feb 2012 · Der Orthopäde
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    ABSTRACT: Only ten cases of primary pyogenic spondylitis following vertebroplasty have been reported in the literature. To the best of our knowledge, we present the first reported case of primary pyogenic spondylitis and spondylodiscitis caused by kyphoplasty. A 72-year old Caucasian man with an osteoporotic compression fracture of the first lumbar vertebra after kyphoplasty developed sensory incomplete paraplegia below the first lumbar vertebra. This was caused by myelon compression following pyogenic spondylitis with a psoas abscess. Computed tomography guided aspiration of the abscess cavity yielded group C Streptococcus. The psoas abscess was percutaneously drained and laminectomy and posterior instrumentation with an internal fixator from the eleventh thoracic vertebra to the fourth lumbar vertebra was performed. In a second operation, corpectomy of the first lumbar vertebra with cement removal and fusion from the twelfth thoracic vertebra to the second lumbar vertebra with a titanium cage was performed. Six weeks postoperatively, the patient was pain free with no neurologic deficits or signs of infection. Pyogenic spondylitis is an extremely rare complication after kyphoplasty. When these patients develop recurrent back pain postoperatively, the diagnosis of pyogenic spondylitis must be considered.
    Preview · Article · Mar 2011 · Journal of Medical Case Reports
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    ABSTRACT: Paragangliomas are rare tumors that originate from the autonomic nervous system-associated paraganglia. They metastasize infrequently. Malignancy can only be demonstrated by the presence of chromaffin tissue at sites where it usually is not present, such as bone, lung or liver, or local recurrence after total resection of a primary mass. Paragangliomas within the central nervous system are usually intradural near the conus medullaris. The metastatic spread of a retroperitoneal paraganglioma to a vertebral body is extremely rare, and there are only a few cases reported in the literature. We report the case of a 16-year-old Caucasian girl who had undergone resection of a retroperitoneal paraganglioma that measured 15 × 11.5 × 9.5 cm. After further staging, a solitary metastatic paraganglioma was detected in the first lumbar vertebral body. After initial chemotherapy, marginal en bloc resection and reconstruction were performed followed by radiotherapy. Histologic examination of the specimen revealed that the tumor cells did not show any response to preoperative chemotherapy, which is in line with a few other reports in the literature. Ten years after operative treatment, the patient is free of complaints, very satisfied with the result and without signs of local recurrence or distant metastases. We recommend en bloc spondylectomy and local radiotherapy in the treatment of solitary spinal metastatic paragangliomas.
    Full-text · Article · Feb 2011 · Journal of Medical Case Reports
  • Alexander Richter · Markus Quante · Anja Macherei · Henry Halm
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    ABSTRACT: Surgical technique with an anterior double-rod system for thoracic, thoracolumbar, or lumbar scoliosis. The aim of the system is to correct the coronal plane deformity and normalize the sagittal balance. Scoliosis which should have a coronal Cobb measurement of at least 40 degrees and should usually not exceed 90 degrees in between T4 and L4. In the Lenke classification, the curve types 1 (main thoracic) and curve type 5 (thoracolumbar/lumbar) are amenable to anterior instrumentation and fusion. Osteoporosis. Infection. Allergic reaction to implants. Minor curves that do not correct to < 25 degrees on flexibility maneuvers. Structured kyphosis in the major curve. Severe sagittal plane malalignment with pathologic kyphosis cranial or caudal of the instrumented segments. The spine is exposed via an open thoracotomy or a thoracoabdominal approach. After completion of diskectomies at each level, the anterior double-rod system is fixed with two bicortical screws per vertebral body. The longitudinal components consist of a solid rod and a threaded rod. The rods are contoured to maintain normal sagittal and coronal contour. The proximal screws are engaged first and then a cantilever force is used to correct the deformity. Occasionally, a partial rod rotation maneuver or intersegmental compression is performed. Morselized autograft (typically rib) is placed in the disk spaces. Intraoperative radiographs are taken to evaluate the correction. Brace-free mobilization. Physiotherapy. Respiratory therapy. Very high rate of successful spondylodesis. Excellent frontal correction of about 60-70%. Very good spontaneous correction of adjacent minor curves of around 40%. Restoration of a physiological profile. Correction angle and length of fusion comparable to modern transpedicular double-rod systems.
    No preview · Article · May 2010 · Operative Orthopädie und Traumatologie

  • No preview · Article · Feb 2010 · Gesundheitsökonomie & Qualitätsmanagement
  • M Quante · R Pauschert · W Gogarten
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    ABSTRACT: Today the indication for thrombosis prophylaxis is a relevant and daily concern in orthopaedic surgery. Recently there are some changes concerning the German guidelines, which are approved by 27 German medical societies. For the first time the guidelines give distinct recommendations for the different indications, the kind of thrombosis prophylaxis and its duration. Some of the recommendations will lead to changes of both processes in outpatient and inpatient management. In parallel 2 new oral anticoagulants have been approved for the prevention of thromboembolic events after elective knee and hip replacement. Dabigatran is an oral thrombin inhibitor. Compared to enoxaparin it has a comparable profile of side effects and efficacy. Rivaroxaban is an oral Xa inhibitor which shows a significantly better efficacy compared to enoxaparin and no difference in side effects. The significant reduction of symptomatic thromboembolisms after elective knee and hip replacement was shown for rivaroxaban compared to enoxaparin in a pooled analysis of phase III data. This review discusses the main topics of the new German guideline and impact of the new oral anticoagulants on in- and outpatient treatment procedures.
    No preview · Article · Feb 2010 · Zeitschrift fur Orthopadie und Unfallchirurgie
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    M Quante · IM Thate-Waschke

    Preview · Article · Oct 2009 · Value in Health
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    Markus Quante · Jürgen Lorenz · Michael Hauck
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    ABSTRACT: The radicular pain syndrome is a major problem in public health care that can lead to chronic back and leg pain in 30%. Ischalgia and back pain are the most prominent signs of dorsal root affection. Until now, no clinical or neurophysiological test procedure exists that evaluates the function of the dorsal root and predicts the prognosis of patients suffering from RPS. We have recently demonstrated that laser-evoked potentials (LEP) are able to demonstrate dorsal root damage. With this study, we investigated 54 patients with acute radicular symptoms and compared LEP parameters (side to side difference of latency and amplitude, transformed to a z-score) with their state of health after 3 months to calculate their predictive value for outcome prognosis. Most significantly, the latency difference between the LEP of the affected dermatome relative to the contralateral healthy dermatome was able to predict the prognosis. Latency z score above two demonstrates a 91% specificity (33% sensitivity) for a poor outcome at 3 months. A significant relation between amplitude changes and the main outcome measure could not be shown. Only extreme changes (z score >10) in amplitude show a high specificity for the persistence of ischialgia in particular (specificity 0.94; sensitivity 0.35). All other parameters, such as clinical scores or other LEP parameters, were not able to predict the outcome of patients. We propose that clinical testing using LEP with latency analysis is a useful tool for estimating the course of disease, so that patients with poor predictive parameters can be treated more invasively at early disease stages to avoid persistence of radiculopathy.
    Full-text · Article · Sep 2009 · European Spine Journal
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    ABSTRACT: The aim of this study was to evaluate the current situation of rotator cuff repair and follow-up treatment in German hospitals. An evaluated survey, enquiring about the year 2006, was sent to all 777 German orthopaedic and/or trauma surgery departments. The hospitals were chosen using the official index of hospitals from the German Federal Statistical Office. 44 % of the surveys were sent back, whereby 40 % were of use. Within the 309 departments, 26 % of the total number of 59,957 shoulder operations were rotator cuff repairs. Mini-open was the operation method in 49 %, open in 29 % and arthroscopic in 22 % of cases. Regarding the operational methods, there were differences between the departments and level of care. The arthroscopic technique was used sometimes in 48 % of the departments, whereas 52 % never used it. Specialised shoulder departments employed the total arthroscopic procedure more often. A set follow-up treatment occurred in 79 % of departments. Rotator cuff repair is mainly carried out using the mini-open method, which is nowadays regarded as gold standard.
    No preview · Article · Jul 2009 · Zeitschrift fur Orthopadie und Unfallchirurgie
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    ABSTRACT: As life expectancy in the population rises, osteoporotic fractures are seen most frequently in the proximal femur and the vertebral column. In balloon kyphoplasty and vertebroplasty, we have two minimally invasive treatment procedures available. Although they have both been controversially discussed in studies, they have seldom been directly compared. Between 2002 and 2004, patients with fresh thoracic or lumbar single-segment vertebral compression fractures not involving neurological deficits were treated by balloon kyphoplasty (n = 30) or vertebroplasty(n = 30) using PMMA cement, and the results of the two interventions were compared in a prospective, nonrandomised cohort study. Surgery was indicated when patients had painful, dislocated fractures of type A1 and type A3 according to Magerl's classification. The outcome of treatment was assessed with special reference to the angle of kyphosis, back pain (VAS), health-related quality of life (SF-36) and complications. At the time of the follow-up examination, significant improvement in the angle of kyphosis was found to have been achieved both by kyphoplasty and by vertebroplasty (P < 0.001 and P = 0.002, respectively). Comparison showed that correction of the angle was significantly (P < 0.001) better in the kyphoplasty group. Both surgical procedures led to significant (P < 0.001) attenuation of the patients' pain; no difference was observed between the groups in the degree of pain relief achieved. There was no demonstrable correlation in either group between the preoperative pain experienced by the patients and the degree of dislocation of their fractures. In both study groups, the quality of life was in keeping with that of a reference group matched for age and sex. Cement leakage was observed in 7% of patients after kyphoplasty and in 33% of patients after vertebroplasty (P = 0.021). Adjacent-level fractures were checked for, but occurred in only one patient in the vertebroplasty group. The two surgical procedures were both followed by significant pain relief, and the quality of life was similar regardless of the procedure used. Balloon kyphoplasty led to an ongoing reduction of freshly fractured vertebrae and was followed by a lower rate of cement leakage.
    No preview · Article · Jun 2009 · Archives of Orthopaedic and Trauma Surgery

  • No preview · Article · Jun 2009 · Zeitschrift fur Orthopadie und Unfallchirurgie
  • M Quante · A Richter · B Thomsen · M Köszegvary · H Halm
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    ABSTRACT: Adult scoliosis is defined as a spinal deformity with a Cobb angle of more than 10 degrees in the coronal plain in a skeletally mature patient. Patients predominantly suffer from back pain symptoms, often accompanied by signs of spinal stenosis (central as well as lateral). Asymmetric degeneration leads to asymmetric load and therefore to a progression of the degeneration and deformity as either scoliosis (0.5-1 degree per year), kyphosis, or both. The diagnostic evaluation includes static and dynamic imaging, magnetic resonance imaging, and myelo-computed tomography, as well as invasive diagnostic procedures such as discograms, facet blocks, and epidural and root blocks. The treatment, either conservative or surgical, is then tailored to the patient's specific symptomatology. Surgical management is usually complex and must take into account an array of specific problems, including the patient's age and general medical condition, the length of the fusion, the condition of the adjacent segments, the condition of the lumbosacral junction, osteoporosis, and any previous scoliosis surgery. The main goal of corrective surgery is a balancing of the coronal and sagittal planes.This review focuses on the special indications for vertebral body cement augmentation in patients with osteoporosis and the problem of adjacent level degeneration and its surgical management.
    No preview · Article · Mar 2009 · Der Orthopäde
  • M. Quante · M.D. Schofer · A. Musch
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    ABSTRACT: In Europe the oral direct thrombin inhibitor dabigatran etexilate (Pradaxa®) was approved for the prevention of venous thomboembolism after elective hip and knee replacement surgery in adults at 27th of March 2008. This new anticoagulant is available on the market in Germany since april 2008. Dabigatran etexilate was compared against the standard regimen, low molecular weight heparin enoxaparin, in two phase-III-studies for the prevention of venous thromboembolism after elective hip and knee replacement surgery. In these studies dabigatran etexilate proved to be non inferior to enoxaparin. Concerning the drug safety and side effects or adverse events there was no difference between dabigatran etexilate and enoxaparin. The oral application, the lack of monitoring need and the effective prevention of HIT II are prominent features of the new drug that allow an assignment to current standards. Until now it is not clear if these features are convincing to prefer dabigatran etexilate in clinical practice. This will be discussed in the following article.
    No preview · Article · Mar 2009 · Arzneimitteltherapie
  • H Halm · A Richter · B Thomsen · M Köszegvary · M Ahrens · M Quante
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    ABSTRACT: For more than 2 decades ventral derotation spondylodesis (Zielke VDS) as a major improvement over Dwyer instrumentation (DI) was the gold standard of instrumented curve correction and stabilization from the anterior approach. As the first available system it enables a true three-dimensional curve correction. A disadvantage is the low internal stabilization capability with a need for long-term external stabilization by means of cast and brace treatment postoperatively. Meanwhile with the development of modern single and dual solid rod systems these disadvantages can be avoided completely. Video-assisted (thoracoscopic) anterior scoliosis surgery accounts for less than 2% of anteriorly treated scoliosis cases, mainly due to a long operating time and significant learning curve.From the posterior approach the Cotrel-Dubousset instrumentation (CDI) as a polysegmentally attached posterior hook threaded dual rod system used to be state of the art for a long time, since it eliminated the disadvantages of Harrington instrumentation (HI) in terms of only one-dimensional correction and low stabilization capabilities. However even with CDI effective derotation was impossible. In posterior scoliosis surgery there is a strong trend away from hook systems towards transpedicular segmentally fixed dual rod systems not only in the lumbar spine but also in the thoracic area. Advantages of these newer techniques are shorter fusion, improved correction, and less loss of correction over time.Advantages of modern anterior instrumentation systems in comparison to posterior transpedicular instrumented dual rod systems are less blood loss, better derotation, slightly shorter fusion levels, and a better influence on sagittal plane control or improvement especially for hypokyphotic thoracic scoliosis cases. Our data also document a superior spontaneous correction of the lumbar curve after selective anterior instrumented correction (Lenke 1B+C), although other studies could not find significant differences. In our experience the neurological risk of anterior instrumented correction is also lower than that of posterior scoliosis surgery, although the morbidity and mortality data of the Scoliosis Research Society could not prove that anymore in recent years. A negative effect of anterior transthoracic scoliosis surgery in comparison to posterior surgery is a more negative effect on lung function, which improves slower after surgery and does not quite reach the levels of posterior surgery at follow-up. But new data on posterior segmental transpedicular correction and fusion also prove a lordosating effect with negative effect on lung function.
    No preview · Article · Mar 2009 · Der Orthopäde

Publication Stats

1k Citations
64.19 Total Impact Points


  • 2012
    • Schön Klinik München Schwabing
      München, Bavaria, Germany
  • 2007-2011
    • Philipps-Universität Marburg
      • Klinik für Orthopädie und Rheumatologie (Marburg)
      Marburg, Hesse, Germany
    • Universitätsklinikum Gießen und Marburg
      Marburg, Hesse, Germany
  • 2009
    • Schön Klink Berchtesgadener Land
      Schonau, Bavaria, Germany
    • Universität zu Lübeck
      Lübeck Hansestadt, Schleswig-Holstein, Germany
  • 2002-2003
    • Medical School Hamburg
      Hamburg, Hamburg, Germany