Biomedical subjects

H Gluch

Publications and source records attributed to H Gluch.

At least 19 recordsLinked to original sources

PubMed2001

Treatment of idiopathic scoliosis with CD-instrumentation: lumbar pedicle screws versus laminar hooks in 66 patients.

We studied whether the pedicle screw is better than laminar hooks for fixation of the lumbar spine in the treatment of idiopathic scoliosis. 66 consecutive patients with idiopathic scoliosis (King I and II) were studied retrospectively. Group S included 33 patients (25 females) treated with pedicle screws. Their mean age at operation was 17 (13-54) years. Group H included 33 patients (30 females) treated exclusively with hooks. Their mean age at operation was 16 (1140) years. The preoperative mean angles of the thoracic curve in group S was 66 (42.115) degrees, and in group H 65 (42-121) degrees. The lumbar curve averaged 46 (20-85) degrees in group H and 53 (33-86) degrees in group S. All patients were fused only posteriorly with Cotrel-Dubousset instrumentation and an autogenic bone graft. The mean follow-up time was 4 (2-7) years. Mean correction of the thoracic curve was 45% in group S and 50% in group H. The lumbar curve was corrected by 50% in group S and 51% in group H. Loss of correction of the thoracic curve occurred in 5% in group S and 6% in group H and of the lumbar curve in 3% in group S and 10% in group H (p = 0.04). Group S better maintained the correction of the lateral tilt of the uninstrumented segment adjacent to the fusion (p = 0.04). Derotation, according to Perdriolle, in the distal segment adjacent to the fusion was 6% in group S and 2% in group H. We found no difference between correction of the thoracic and lumbar curves using pedicle screws and laminar hooks in the lumbar spine. Pedicle screws better maintained the correction of the lumbar curve and the lateral tilt in the distal segment adjacent to fusion.

Adolescent↗

PubMed1999

Autogenic versus allogenic bone grafts in anterior lumbar interbody fusion.

Between 1987 and 1993, 94 consecutive patients with painful spondylolisthesis underwent combined anterior and posterior fusion. The average age at operation was 40 years (range, 16-65 years). Posterior fusion was performed in all patients using pedicle screw systems, and anterior fusion was accomplished with autogenic or allogenic bone grafts. Patients retrospectively were assigned to two groups. In Group 1, anterior fusion was performed with autogenic bone grafts harvested from the iliac crest (n = 65; 146 segments) and in Group 2 allogenic bone grafts were taken from femoral heads (n = 39; 86 segments). The incidence of pseudarthrosis was evaluated on lateral tomograms 24 months after surgery. The mean clinical followup time was 4 years (range, 3-8 years). Pseudarthrosis was found in seven fused levels (3%) managed with autogenic bone grafts (Group 1) and in seven patients (8%) managed with allogenic bone grafts (Group 2). This incidence of pseudarthrosis was not significantly different between the two groups. Considering the possible complications associated with harvesting iliac crest bone, the use of allogenic bone appears justified.

Adolescent↗

PubMed1998

Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures.

A retrospective survey of 850 spinal procedures was conducted to determine risk factors for postoperative spinal infection. Some 574 posterior and 276 anterior procedures were evaluated. Infections were classed as early (within 19 weeks postoperatively) and late (> or = 20 weeks postoperatively), as well as deep and superficial infections. Previously postulated risk factors (i.e., diabetes, corticosteroid therapy, previous spinal surgery, obesity, chronic infection, and smoking) were investigated. Furthermore, it was hypothesized that three additional factors: extended preoperative hospitalization, prolonged operation duration, and high blood loss were risk factors not previously considered. A postoperative infection was evident in 22 of 850 procedures (19 early/three late infections, four superficial/18 deep infections). Most infections (n = 21) occurred with posterior instrumentation. Previously described factors were proven as risk factors. Extended preoperative hospitalization (p < 0.04), high blood loss (p < 0.01), and prolonged operation time (p < 0.001) were additionally determined as risk factors. The results suggest that routine prophylactic antibiotics might be unnecessary in anterior surgery, whereas extended prophylactics should be considered in posterior instrumentation, especially when risk factors are apparent.

Adolescent↗

PubMed1998

Aseptic loosening after CD instrumentation in the treatment of scoliosis: a report about eight cases.

We report eight patients who had had operative treatment of idiopathic scoliosis with CD instrumentation and developed radiolucency around pedicle screws and a discharging sinus. There are two recent reports (Dubousset J, Shuffleberger H, Wenger D. Late infection with CD instrumentation. Orthop Trans 18:121, 1994; Richards BS. Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis. J Bone Joint Surg [Am] 4:524-529, 1995) describing delayed infection with spontaneous drainage after the treatment of scoliosis with CD instrumentation and Texas Scottish Rite Hospital system with controversial results. Eight patients had radiologic signs of implant loosening after a mean of 7 months, with radiolucency around the pedicle screws. Six patients developed a painful swelling and a discharging sinus after a mean of 21 months. Histopathologic results showed metal wear and chronic inflammatory reaction with granuloma formation. No evidence of pyogenic infection was present. We believe that this complication is caused by micromotion.

Adolescent↗

PubMed1997

[Advantages and disadvantages of retro- and transperitoneal approach for fusion of the presacral intervertebral disk].

In a retrospective study, we evaluated 180 patients treated for painful spondylolisthesis with combined anterior and posterior fusion. Group I included 90 patients treated by anterior fusion with the transperitoneal approach. Group II included 90 patients operated on with a retroperitoneal approach. Group II showed a higher incidence of pseudarthrosis L5/S1 (4%), tear of the common iliac vein (1%), postsympathectomy syndrome (4%) and reversible L4 nerve-root lesion (3%). On the basis of our findings, we recommend the transperitoneal approach for anterior interbody fusion L5 to S1 or L4 to S1.

Adolescent↗

PubMed1997

AP-translation in the proximal disc adjacent to lumbar spine fusion. A retrospective comparison of mono- and polysegmental fusion in 120 patients.

120 consecutive patients with painful spondylolisthesis underwent combined anterior and posterior fusion. Patients were divided retrospectively into two groups. In group I, 46 patients were treated with monosegmental fusion. In group II, 74 had polysegmental fusion. The mean follow-up time was 3 (2-7) years. Anterior posterior (AP)-translation in the first disc superior to fusion was measured according to Wiltse and Winter (1983). In group I, 3 and in group II, 10 patients developed an AP-translation of more then 3 mm in the disc adjacent to the fusion. AP-translation correlated with the number of fused segments and the follow-up time.

Adolescent↗

PubMed1996

Management of postoperative wound infection in posterior spinal fusion with instrumentation.

Successful treatment of an infection depends first on prompt diagnosis. Management of postoperative wound infections after spinal fusion with instrumentation often presents therapeutic difficulties. This study reviews a total of 28 wound infections. An infection rate of early infection with 3.6% and late infection with 1.9% was noted. The treatment of wound infection depends on the appearance of infection. In early wound infection, it is not always necessary to remove the instrumentation, if a successful suction-irrigation system was inserted. In late wound infection, we removed the hardware in all cases. No evidence of pyogenic infection was presented. Additionally, intravenous antibiotics were used after the antibiogram.

Adult↗

PubMed1972