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Biomedical subjects

J D Rompe

Publications and source records attributed to J D Rompe.

At least 19 recordsLinked to original sources
PubMed2005

The influence of bone allograft processing on osteoblast attachment and function.

In order to assess the influence of eight different sterilisation and disinfection methods for bone allografts on adhesion, proliferation, and differentiation of human bone marrow stromal cells (BMSC), cells were grown in culture and then plated onto pieces of human bone allografts. Following processing methods were tested: autoclavation (AUT), low-temperature-plasma sterilisation of demineralised allografts (D-LTP), ethylene oxide sterilisation (EtO), fresh frozen bone (FFB), 80 degrees C-thermodisinfection (80 degrees C), gamma-irradiation (Gamma), chemical solvent disinfection (CSD), and Barrycidal-disinfection (BAR). The seeding efficiency was determined after one hour to detect the number of attached cells before mitosis started. The cell viability was determined after 3, 7, and 21 days. Tests to confirm the osteoblastic differentiation included histochemical alkaline phosphatase staining and RT-PCR for osteocalcin. Human BMSC showed greatest attachment affinities for D-LTP-, 80 degrees C-, and CSD-allografts, whereas less cells were found attached to AUT-, EtO-, FFB-, Gamma-, and BAR-probes. Cell viability assays at day 3 revealed highest proliferation rates within the FFB- and 80 degrees C-groups, whereas after 21 days most viable cells were found in D-LTP-, 80 degrees C-, CSD-, and Gamma-groups. BAR-treatment showed a considerably toxic effect and therefore was excluded from all further experiments. Highest AP-activity and gene expression of osteocalcin were detected in the D-LTP-group in comparison with all other groups. In summary, our results demonstrate that cell adhesion, final population, and function of BMSC are influenced by different disinfection and sterilisation methods. Therefore, processing-related alterations of BMSC-function may be important for the success of bone grafting. The experimental setup used in the present work may be useful for further optimisation of bone allograft processing.

Alkaline Phosphatase↗
PubMed2005

[Shock wave treatment for tennis elbow].

Randomized controlled trials were evaluated to assess the effectiveness of extracorporeal shock wave treatment in the management of tennis elbow. Five trials had a mediocre methodology and four trials had a high-quality design. Well-designed randomized control trials have provided evidence of the effectiveness of shock wave intervention for tennis elbow.

Evidence-Based Medicine↗
PubMed2002

Side-effects of extracorporeal shock wave therapy (ESWT) in the treatment of tennis elbow.

Apart from a few observational reports, there are no studies on the side-effects of extracorporeal shock wave therapy (ESWT) in the treatment of insertion tendopathies. Within the framework of a randomised, placebo-controlled, single-blind, multicentre study to test the effectiveness of ESWT in the case of lateral epicondylitis (LE), side-effects were systematically recorded. A total of 272 patients from 15 centres was allocated at random to active ESWT (3 x 2000 pulses, energy flux density ED(+) 0.04 to 0.22 mJ/mm(2) under local anaesthesia) or placebo ESWT. In all, 399 ESWT and 402 placebo treatments were analysed. More side-effects were documented in the ESWT group (OR = 4.3, CI = [2.9; 6.3]) than in the placebo group. Most frequently, transitory reddening of the skin (21.1%), pain (4.8%) and small haematomas (3.0%) were found. Migraine was registered in four and syncopes in three instances after ESWT. ESWT for LE with an energy flux density of ED(+) 0.04 to 0.22 mJ/mm(2) is a treatment method which has very few side-effects. The possibility of migraine being triggered by ESWT and the risk of a syncope should be taken into account in the future. No physical shock wave parameters could be definitely identified as the cause of the side-effects observed.

Adult↗
PubMed2002

[Effect of design and implantation technique on risk of progressive sintering of various cervical vertebrae cages].

The aim of this study was to compare the subsidence of differently designed cervical interbody fusion devices under defined conditions. Forty-five bovine vertebral bodies were dissected from soft tissue and cartilage. The bony end plate was then taken off by 0, 1, and 2 mm. Five vertebral bodies of each abrasion depth were prepared for the uptake of a fusion device. Thus, three different fusion devices of comparable size underwent biomechanic testing in a Zwick testing machine with 4000 cycles of axial compression between 50 and 1000 N. Every 1000 cycles, the subsidence into the vertebral body was measured. Abrasion of the end plate resulted in an increased subsidence. The cage with rectangular shape and the cage with cylindric body and lateral wings showed better resistance to axial compression as long as the end plate remained intact. When the end plate was taken off, the subsidence was as high as in the cylindric cage, of which the subsidence did not correlate to the end plate abrasion. During preparation of the implant bed, the cortical bone of the end plate must be treated carefully. In cases of intact end plate, rectangular supporting areas can decrease the risk of subsidence.

Animals↗
PubMed2002

[High energy extracorporeal shockwave therapy (ESWT) in pseudarthrosis].

The gold standard for treatment of pseudarthrosis is operation with osteosynthesis and grafting. More than 10 years ago, extracorporeal shock wave therapy (ESWT) was additionally introduced as a noninvasive and low-risk treatment for pseudarthrosis. The aim of our prospective study was to analyze the treatment effect in a homogeneous group of patients and to develop prognostic factors. Forty-three consecutive patients were included in this study. All patients had been operated on for trauma or undergone selective osteotomy and had developed pseudarthrosis that persisted for 9 months. All patients received high-energy ESWT (0.6 mJ/mm2) with 3000 impulses (Siemens Osteostar) in one session under regional anesthesia. To differentiate active from inactive pseudarthrosis, a bone scintigraphy was compulsory. Clinical and radiological follow-ups were done at 4-week intervals starting 8 weeks after ESWT for 9 months. Cortical bridging was found in 31 of 43 (72.1%) pseudarthroses at 4.0 +/- 0.6 months after ESWT. Of 31 (80.6%) successfully treated patients, 25 had a positive scintigraphy compared to 4 of 12 (33.3%) treatment failures. Of 35 (82.9%) patients with a positive bone scintigraphy, 29 had bony healing compared to 2 of 8 (25%) patients with a negative bone scintigraphy. Six of these eight patients smoked more than 20 cigarettes a day. ESWT is still a clinically experimental treatment method. The absence of complications justifies its use for pseudarthrosis treatment. Further controlled studies are mandatory.

Adolescent↗
PubMed2002

[Basic research of applying extracorporeal shockwaves on the musculoskeletal system. An assessment of current status].

Detailed knowledge concerning the action of extracorporeal shock waves on the locomotor system as well as concerning possible side effects of extracorporeal shock wave therapy (ESWT) are crucial to optimize the clinical use of ESWT for the treatment of illnesses such as calcific tendinitis of the shoulder, tennis elbow, plantar fasciitis, aseptic pseudarthrosis, and aseptic hip necrosis. This study presents the current knowledge gained from animal experiments, which have yielded important findings, in particular concerning possible side effects of ESWT. Very recent studies have also provided valuable insights into the molecular actions of extracorporeal shock waves on the locomotor system. Further intensified experimental animal research will greatly improve the scientific basis for the clinical use of ESWT in the near future.

Animals↗
PubMed2002

[Undercutting decompression versus laminectomy. Clinical and radiological results of a prospective controlled trial].

The aim of the current study was to evaluate the clinical outcome after laminectomy or undercutting decompression in patients with lumbar spinal stenosis (LSS) without apparent signs of instability. In a prospective controlled, nonrandomized trial 1 year after operation, two groups of patients were compared. Out of 85 consecutive patients, treated from 1998 to 1999 in an orthopedic university clinic for symptomatic LSS, decompression without simultaneous fusion was performed in 40 cases. In group I ( n=13) a laminectomy was done and in group II ( n=27) an undercutting of the vertebral arch and facet joints. The main outcome measure was the Oswestry Low Back Disability Score. Subjective complaints, visual analog scale (VAS), claudication distance, analgesic demands, and radiomorphometric parameters following the procedure of Dupuis and Nash/Moe at 6 and at 12 months after the operation were secondary objective criteria. One year postoperatively the main outcome measure showed no significant difference between the two groups, although group II had shown better results ( p=0.0195) 6 months postoperatively. The required analgesics could be significantly lowered in group II compared with group I at 12 months ( p=0.0011). The remaining secondary outcome measures showed no statistically significant differences. The extent of decompression in LSS without apparent instability did not influence the outcome. If there is any doubt intraoperatively about the adequate amount of decompression of the lumbar spinal canal, undercutting decompression should be extended to laminectomy without fear of consecutive segmental instability.

Aged↗
PubMed2001

Health-related quality of life and somatization in patients with long-term low back pain: a prospective study with 109 patients.

STUDY DESIGN: For this study, a prospective cohort of 109 patients was recruited consecutively at an orthopedic inpatient unit of a university hospital. Three self-report instruments were administered to patients with sciatica believed to be caused by a herniated lumbar disc to examine their quality of life and psychic stress at baseline and at the 1-year follow-up visit. OBJECTIVES: To investigate whether patients who have undergone a previous discectomy experience greater psychic stress than patients with no surgery, and to determine whether the groups differed regarding their health-related quality of life at the follow-up visit. SUMMARY OF BACKGROUND DATA: Previous studies have described psychic abnormalities in patients with long-term back pain, particularly patients with severe chronicity (i.e., history of surgeries and persistent problems) or those who underwent a previous discectomy. Additionally, a series of studies has shown that psychic and psychosocial parameters exert a significantly greater influence on the success of treatment than do clinical and imaging findings or the extent of disc abnormality. METHODS: The Short Form Health Survey 36, the Symptom Checklist 90, and Screening for Somatoform Disorders were administered to 109 patients consecutively treated in the authors' orthopedic university clinic, at baseline and at the 1-year follow-up visit. RESULTS: In all the patients examined, the physical and mental quality of life improved regardless of their group classification. The psychological distress, according to the Symptom Checklist 90, was clearly reduced in both groups at the follow-up visit, with the exception of somatization, as indicated by Symptom Checklist 90 and Screening for Somatoform Disorders. Whereas the patients who had undergone surgery remained nearly unchanged with regard to their somatization, the patients with no previous surgery improved significantly, as indicated by Screening for Somatoform Disorders and Symptom Checklist 90. Somatization, particularly that surveyed by the comprehensive Screening for Somatoform Disorders, proved to be quite a stabile factor over time in both groups. The extent of the physical impairment before treatment was nearly the same in both groups, as indicated by Short Form Health Survey 36. Despite a markedly higher chronicity of reported problems, patients who had undergone surgery were hardly more greatly impaired in terms of their mental quality of life and psychological distress, as indicated by Symptom Checklist 90, than those without a history of surgery. At the follow-up visit, the differences tended to be minimal as well. As compared with those who had no previous surgeries, the patients who had undergone surgery were significantly more heavily impaired in their physical quality of life despite significant improvements. CONCLUSIONS: Patients with sciatica demonstrated less abnormality in terms of the psychopathologic markers investigated than described in previous studies. Nevertheless, the predisposition to somatize influences health-related quality of life to a high degree.

Adult↗
PubMed2001

Chronic lateral epicondylitis of the elbow: A prospective study of low-energy shockwave therapy and low-energy shockwave therapy plus manual therapy of the cervical spine.

OBJECTIVE: To compare the effects of extracorporeal shockwave therapy (ESWT) alone with a combination of ESWT and manual therapy of the cervical spine in treating chronic tennis elbow. DESIGN: Prospective, matched single-blind control trial. SETTING: University hospital clinic. PATIENTS: Thirty patients with unilateral chronic tennis elbow, an unsuccessful conservative therapy during the 6 months before referral, and clinical signs of cervical dysfunction (eg, pressure pain at the C4-5 and/or C5-6 level, protraction of the head). INTERVENTIONS: Three times at weekly intervals all patients received 1000 shockwave impulses of an energy flux density of.16mJ/mm(2) at the lateral elbow. Additionally, they underwent manual therapy of the cervical spine and the cervicothoracic junction 10 times (group I). For each patient, a control matched by age (3-yr range) and gender at first conservative treatment was drawn at random from 127 patients who had undergone low-energy shockwave therapy in the same unit in the past 3 years (group II). Follow-up examinations took place at 12 weeks and at 12 months. MAIN OUTCOME MEASURES: The Roles and Maudsley outcome score at 12 months, defining an excellent or good result with no or only occasional discomfort without limitation of activity and range of motion. RESULTS: Neither group differed statistically before the study, with a poor rating for all patients (p >.05). At 12 months, there was still no significant difference, with the outcome being excellent or good in 56% in group I, and in 60% in group II (p >.05). Each group showed significant improvement compared with the respective prestudy evaluation (p <.0001). CONCLUSION: ESWT may be an effective conservative treatment method for unilateral chronic tennis elbow. The efficacy of additional cervical manual therapy for lateral epicondylitis remains questionable.

Adult↗
PubMed2001

[MRI in chronic epicondylitis humeri radialis using 1.0 T equipment--contrast medium administration necessary?].

PURPOSE: Evaluation of the diagnostic value and confidence of contrast-enhanced MR imaging in patients with lateral epicondylitis in comparison to clinical diagnosis. MATERIAL AND METHODS: 42 consecutive patients with clinically proven chronic lateral epicondylitis and 10 elbow joints of healthy controls have been examined on a 1.0 T MR-unit. Criteria for inclusion in the prospective study were: persistent pain and a failed conservative therapy. The MR protocol included STIR sequence, a native, T2-weighted, fat-suppressed TSE sequence, and a Flash-2-D sequence. Also, fat-suppressed, T1-weighted SE sequences before and after administration of Gd-DTPA contrast media have been recorded. RESULTS: In 39/42 patients the STIR sequence showed an increased SI of the common extensor tendon. Increased MR signal of the lateral collateral ligament combined with a thickening and a partial rupture or a full thickness tear have been observed in 15/42 cases. A bone marrow edema at the lateral epicondilus was noticed in 6 of the studied patients and a joint effusion in 18/42 patients. After administration of contrast media we noticed an average increase of SI by about 150%. However, enhanced MR imaging did not provide additional information. CONCLUSION: In MR imaging of chronic epicondylitis administration of gadolinium-DTPA does not provide additional information.

Adult↗
PubMed2001

Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder.

A prospective quasirandomized study was performed to compare the effects of surgical extirpation (Group I, 29 patients) with the outcome after high-energy extracorporeal shock wave therapy (Group II, 50 patients; 3,000 impulses of an energy flux density of 0.6 mJ/mm2) in patients with a chronic calcifying tendinitis in the supraspinatus tendon. Symptoms and demographic data of the two groups were comparable. According to the University of California Los Angeles Rating System, the mean score in Group I was 30 points with 75% good or excellent results after 12 months, and 32 points with 90% good or excellent results after 24 months. Radiologically, there was no calcific deposit in 85% of the patients after 1 year. In Group II, the mean score was 28 points with 60% good or excellent results after 12 months, and 29 points with 64% good or excellent results after 2 years. Radiologically, complete elimination of the deposit was observed in 47% of the patients after 1 year. Clinically, according to the University of California Los Angeles score, there was no significant difference between both groups at 1 year. At 2 years, there was a significantly better result in Group II. Both groups then were subdivided into patients who had a homogenous deposit as seen on radiographs and patients who had an inhomogenous deposit before treatment. Surgery was superior compared with high-energy shock wave therapy for patients with homogenous deposits. For patients with inhomogenous deposits, high-energy extracorporeal shock wave therapy was equivalent to surgery and should be given priority because of its noninvasiveness.

Adult↗
PubMed2001

High-energy extracorporeal shock wave treatment of nonunions.

Forty-three consecutive patients who did not have healing of tibial or femoral diaphyseal and metaphyseal fractures and osteotomies for at least 9 months after injury or surgery were examined prospectively for use of high-energy extracorporeal shock waves. Former treatment modalities (cast, external fixator, plate osteosynthesis, limitation of weightbearing) remained unchanged. In all cases a 99mTechnetium dicarboxyphosphonate regional two-phase bone scintigraphy was performed before one treatment with 3,000 impulses of an energy flux density of 0.6 mJ/mm2. Radiologic and clinical followups were done at 4-week intervals starting 8 weeks after shock wave treatment. The success criterion was bridging of all four cortices in the anteroposterior and lateral radiographic views, in oblique views, or by conventional tomography. An independent observer described bony consolidation in 31 of 43 cases (72%) after an average of 4 months (range, 2-7 months). Twenty-nine of 35 (82.9%) patients with a positive bone scan had healing of the pseudarthrosis compared with two of eight (25%) patients with a negative bone scan. Six of these eight patients with negative scans were heavy smokers. No complications were observed. High-energy shock wave therapy seemed to be an effective noninvasive tool for stimulation of bone healing in properly selected patients with a diaphyseal or metaphyseal nonunion of the femur or tibia. Additional controlled studies are mandatory.

Adolescent↗
PubMed2000

[Initial instability of different cages for fusion of the cervical spine].

Purpose of the present investigation is to determine the biomechanical behaviour of different cages for monosegmental fusion of the cervical spine. Three commercially available cages (BAK, NOVUS, WING) representing the different principles of intercorporal implants and a combination of intercorporal bone graft together with anterior plating were tested for their resistance and sintering patterns under axial compression conditions. Therefore, FSU (functional spine-units) of 5-months old calfs were used. After preparation, the anterior fusion was performed by an orthopaedic surgeon. Specimen were mounted in a testing machine Zwick 1425 and axial load from 100 N up to 2000 N was applied. The compressed distance was measured and put into relation to the applied load. After that, the device was unloaded and the test was repeated another 2 times to determine the plastic deformation of implant and specimen. There was no significant difference to all of the constructs in the first compression. After repeated compression, the WING-cage, the NOVUS-cage and the plate-construct showed a constant compression pattern as expression of resting stable on the vertebral endplates, whereas the cylindrical BAK-cage had a decrease in compression distance, but increase in sintering into the vertebral body. Intercorporal implants that require the destruction of the vertebral endplates as described in the Cloward dowel-technique may have a higher risk of sintering into the vertebral body and therefore of developing progressive kyphosis. By attaching lateral supporting areas this risk can be reduced and the advantage of sponges contact for fusion is preserved.

Biomechanical Phenomena↗
PubMed1999

Outcome after palliative posterior surgery for metastatic disease of the spine--evaluation of 106 consecutive patients after decompression and stabilisation with the Cotrel-Dubousset instrumentation.

From 1987 to 1996, 106 consecutive patients with metastatic disease of the spine who underwent palliative decompression from a dorsal approach and subsequent stabilisation with Cotrel-Dubousset instrumentation (CDI) were followed prospectively, and independent of the surgeons. Parameters evaluated were neurological function, perioperative complications, survival and rehabilitation. Following the Frankel system for the assessment of neurological disorder, 33 patients had a major deficit (grade A, B or C), 23 a minor deficit (grade D) and 50 no deficit. If there was no neurological dysfunction, the only patients who underwent operation were those graded as class IV according to Harrington. Our surgical strategy combined posterior decompression of the spinal cord followed by CD stabilisation without bone grafting. Of 56 patients who had a neurological deficit preoperatively, 35 enjoyed complete or partial recovery within the first 3 months after the operation. Of the 50 patients without neurological dysfunction, 3 developed an incomplete transient paresis. The rate of survival was 72% (76 of 106) at 6 months and 50% (53 of 106) at 12 months. At 12 months 42 of the 53 patients who were alive were still able to walk. All but 13 patients were able to return home. Overall survival time was 19.2 months, with 5 patients still alive. Six patients required re-operation for tumour recurrence at the same or at a new level. The results of this study show that neurological function, pain level and mobility can be enhanced by decompression and stabilisation through a posterior approach.

Adult↗
PubMed1999

Shock-wave therapy for tennis and golfer's elbow--1 year follow-up.

Thirty patients with chronic medial epicondylitis were treated with low-energy shock waves. They received 500 impulses of 0.08 mJ/mm2 three times at weekly intervals. At 1 year follow-up examinations were performed. According to the Verhaar criteria, only seven patients reached excellent or good results. In eight cases a fair outcome was recorded, and in 14 patients the outcome was poor. Only six patients were satisfied with the treatment. The average relief of pain was 32%. These data were significantly worse than for identically treated patients with chronic tennis elbow. Thus, the question arises as to whether extracorporal shock-wave therapy is indicated in medial epicondylitis.

Adult↗
PubMed1999

Prognostic criteria for work resumption after standard lumbar discectomy.

The purpose of this study was to determine prognostic criteria for return to work 9-12 years after standard nucleotomy for herniated nucleus pulposus confirmed by CT. From 1985 until 1988, 182 patients (102 male, 80 female, mean age 45 years) with a single-level herniated nucleus pulposus were operated on for the first time. In summer 1997, an average of 10.2 years after the operation, 101 of 182 patients (55.5%) returned a standardised questionnaire. Eighteen patients (9.8%) had died during the intervening years, while 63 patients (34.6%) were lost to follow-up because of moving to other cities. Two groups could then be distinguished: group I worked full time in their usual job; group II did not. The influence of the degree of the paresis, time elapsed since the occurrence, intraoperative findings, age, sex, weight, type of work and re-operations were analysed statistically. Group I consisted of 44 patients who still worked full time in their usual job. Group II contained 57 patients, of whom 18 worked only part of the time, 9 had changed to a lighter full-time job, 23 had taken early retirement, and 7 were receiving a pension. Patients in group I were significantly younger (38 vs. 51 years), had a smaller proportion of patients with more than 20% overweight (27% vs. 44%), had a smaller proportion of severe, grade 0 and 1, motor dysfunction (0% vs. 16.3%), had been operated sooner (within 3 days: 52.3% vs. 19.3%), had undergone fewer re-operations for recurrence of the herniation (4.5% vs. 21.1%), and had worked less frequently in physically demanding jobs (6.7% vs. 22.8%). We concluded that when there is a relative indication for herniated nucleus pulposus surgery, it should be limited to patients aged below 40 years, with slight motor dysfunction, who work in physically undemanding jobs, so as to make a satisfactory long-term result more likely.

Adult↗