A new method for the treatment of scoliosis is described in which a metal system of rods and hooks is implanted, and distraction and compression forces applied, to correct the curve and stabilize the treated segments in the corrected position by skeletal fixation. The technique and principles of this method of treatment and a summary of the preliminary results are given.

JBJS classics: Treatment of scoliosis: Correction and internal fixation by spine instrumentation

In this retrospective study 27 patients who had undergone revision discectomies for recurrent lumbar disc herniations were surveyed to assess their clinical outcomes. The patients chosen for the study were compared to a control group of 30 matched patients who had undergone only a primary discectomy. The spine module of the MODEMS® outcome instrument was used to evaluate the patients’ satisfaction, their pain and functional ability following discectomy, as well as their quality of life. All patients were also asked whether they were improved or worsened with surgery. Those undergoing revision surgery were asked whether the improvement following the second surgery was more or less than the improvement following the first surgery. Differences in residual numbness/tingling in the leg and/or the foot as well as in frequency of back and/or buttock pain were identified. Nevertheless improvement due to the repeat discectomy was not statistically different from those who underwent just the primary operation. Based upon patient derived outcome data with a validated instrument, revision discectomy is as efficacious as primary discectomy in selected patients.

Outcome of revision discectomies following recurrent lumbar disc herniation

Die Wirbelsaule entsteht aus der Chorda dorsalis. Die Chorda bildet den spateren Gallertkern der Bandscheiben. Bei Geburt ist die Wirbelsaule in ihrer Anlage voll entwickelt. Vor dem 4. Lebensjahr ist die Bandscheibe bis in den auseren Faserring vaskularisiert. Nach dem 4. Lebensjahr erfolgt die Ernahrung der Bandscheibe ausschlieslich per Diffusion, Gefase sind dann nicht mehr nachweisbar. Die Wirbelsaule durchlauft einen naturlichen Alterungsprozess. Schon mit dem 30. Lebensjahr treten beim Menschen physiologischerweise degenerative Veranderungen der Bandscheibe auf. Der Nucl. pulposus hat einen hohen Proteoglykan- und damit einen hohen Wassergehalt. Bei der kindlichen Bandscheibe liegt der Wassergehalt bei 90%, dieser nimmt im Alter auf ca. 70% ab (Gower u. Pedrini 1969). Er ist von einem kraftigen Anulus fibrosus und von Poren enthaltenden kartilaginaren Endplatten umgeben. Nach innen verlaufen die Fasern in einem Winkel von ca. 60°, wodurch die Wirbelsaule eine wesentliche Stabilitat fur Rotationsbewegungen erhalt (Krismer et al. 1997). Der intradiskale Ruhedruck einer intakten Bandscheibe betragt ca. 500 kPa, kann aber in Abhangigkeit von der Belastung bis auf 2300 kPa ansteigen (Eysel et al. 2000, Wilke et al. 2001). Unter Belastung verliert die Bandscheibe Wasser, der osmotische Druck nimmt umgekehrt proportional zur Belastung zu (Kolditz et al. 1985).

https://link.springer.com/content/pdf/10.1007%2F978-3-540-88507-8_5.pdf

Therapeutische Möglichkeiten – interventionelle und operative Verfahren

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Therapeutische Möglichkeiten – interventionelle und operative Verfahren