[Results of a representative inquiry on the use of narcotics by students in Schleswig-Holstein].
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Adolescent↗
Biomedical subjects
K Birnbaum
Publications and source records attributed to K Birnbaum.
[Drug use by secondary school pupils in Schleswig-Holstein (North-Germany)].
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Adolescent↗
[Degenerative changes of the lumbosacral transition after Risser and Harrington spondylodesis].
INTRODUCTION: The long-term results of two operation techniques according to Risser and Harrington were of special interest. As part of this study, secondary changes of the lumbar spine, as well as the lumbosacral junction, were evaluated over time. MATERIAL AND METHODS: Two groups of 20 patients, who underwent one of the above-mentioned operative procedures for idiopathic scoliosis were analyzed (group A: Risser procedure, average age 15 years; group B: Harrington procedure, 17 years of age). The preoperative deformity ranged between 34 degrees and 108 degrees Cobb angle. The patients were evaluated at three different points in time: 1) preoperatively; 2) upon the conclusion of outpatient treatment following the surgery; and 3) between 13 and 15 years postoperatively. RESULTS: Degenerative changes, especially spondylarthrosis of the lumbosacral region, were seen more frequently in the Harrington group due to the higher rigidity of the implant and the ensuing increased loading of the adjacent spinal segments. The comparison of the two procedures revealed that a better primary correction of the deformity was achieved with the Harrington operation. Moreover, the Risser group showed a higher rate of pseudarthrosis and secondary loss of correction. In the Harrington group we found a higher rate of degenerative arthritis. CLINICAL RELEVANCE: A better primary correction of the scoliosis leads to a higher strain of the lumbosacral junction. The resultant secondary changes (spondylarthrosis) in this period of observation were rarely of clinical relevance. Nevertheless, whenever possible presacral segments should remain free in the range of a spondylodesis to reduce the loading of the lumbosacral junction.
Adolescent↗
[Comparative analysis of lumbar spine degeneration documented by x-rays versus large specimen cryomicrotome sections].
AIM OF THE STUDY: The extent of degenerative changes in the lumbar spine as seen on conventional radiographs is interpreted on the basis of visualized osseus structures and indirect signs such as diminution of disc height. In order to analyze the accuracy of these interpretations we compared and correlated different stages of degeneration in conventional radiographs with cuts of large-specimen cryomicrotome sections (LSCS), offering a direct macroscopic vision of the degenerative anatomic features. METHOD: A total of 50 human cadaver lumbar spines with 251 spine segments (Th 12 - S1) was investigated by plain radiograms and LSCS. The degenerative changes were differentiated into 5 stages for both diagnostic measures. Criteria for radiological degeneration were: diminution of disc space, presence of osteophytes and sclerosis of the endplates. Degenerative changes as seen by LSCS were evaluated by the following features: cracks in the endplate, bleeding into the intervertebral disc, alignment of the annulus fibrosus fibres and osseous alterations in the spine segment. RESULTS: Complete matches of the evaluated radiological and macroscopic stages of degeneration were observed in 206 cases. A difference of 1 degree on the degeneration scale was registered in 42 segments, whereas a difference of 2 degrees was seen in 3 cases. The correlation coefficient between the degeneration stages of the two diagnostic measures scored rho = 0.883. CONCLUSION: The comparison of the different degrees of degeneration in the lumbar spine as evaluated by both plain radiographs and LSCS revealed a good correlation.
Adolescent↗
[Kyphoplasty - a new minimally invasive treatment for repositioning and stabilising vertebral bodies].
AIM OF THE STUDY: Osteoporotic vertebral fractures are an ailment of the aging population of increasing incidence and high socioeconomic impact. Intractable pain causing significant morbidity leads to long-term hospitalisation. Kyphoplasty offers a new minimal invasive operative stabilisation procedure for these vertebral compression fractures. This study is conducted to investigate whether this procedure significantly reduces both pain and the duration of hospital stay in comparison to conservative treatment modalities. METHOD: From January until July 2002 a total of 22 patients had undergone kyphoplasty in 37 vertebral bodies. Osteoporotic vertebral fractures were treated in 18 cases, while in another 4 cases prophylactic stabilisation for osteolytic lesions was performed. Both the duration of hospital stay and the reduction of pain symptoms were determined and compared to a conservatively treated control group of 20 patients suffering from 35 fractured vertebral bodies. Pre- and postoperative endplate angles were measured to assess the restoration of the sagittal alignment. The effects on pain symptoms were measured on a self-reported Visual Analogue Score Scale. RESULTS: The mean pain relief for the patients undergoing kyphoplasty was 82 %, which was significantly higher (p < 0.0001) compared to the group of the conservatively treated patients (42 %). Reduction of the kyphotic deformity was achieved in 4 cases (average 8.5 degrees ). The average in-patient treatment duration for the surgical treated patients was 10 days as opposed to a significantly longer mean hospitalisation of 20 days (p = 0.003). Cement extravasation was observed in 5 out of 37 treated vertebral bodies without clinical sequelae. CONCLUSION: Kyphoplasty is a safe minimal invasive procedure for the stabilisation of osteoporotic vertebral fractures leading to a statistically significant reduction both of pain status and duration of hospitalisation.
Aged↗
[Correlation of low back pain and enhanced vascularization in the vertebral endplate].
AIM OF THE STUDY: Degenerative changes of the motion segments are accompanied by an increased vascularization of the endplates. Nerve elements have been demonstrated in the environment of the endplate vessels, which might play a role in pressure related pain sensation. In order to investigate this theory we compared and correlated the extent of memory pain as determined by discography with the amount of vascularization in the endplates on histological examination. METHOD: Discography was performed in 32 Patients (21 female, 11 male), who underwent spinal fusion. The extent of pain sensation was determined on a self reported visual analogue scale ranging from 0-10 Points. Bone chips from the anterior vertebral endplates were obtained during surgery. Decalcified paraffin-embedded samples were then immunostained with the vascular endothelial marker CD 34. The quantification of endothelium as part of the whole cross section area was performed by means of a computerized optical method. RESULTS: The extent of the pain sensation during discography ranged from 0-9 points on the VAS (average: 5.3 points, SD 3.1). On the histological quantification the total endothelial area per observed field varied from 0.04 to 7.39 % (average: 2.19 %, SD 1.62). The comparison of the pain extent on discography and the vascularization of the endplate resulted in a correlation coefficient after Spearman of rho = + 0.64 (p=0.0006). CONCLUSION: The extent of vascularization in the degenerated endplates of a motion segment shows a moderate correlation with the self reported VAS scores after discography. Further investigations will have to clarify, whether neurogenic structures originating from vascular endothelium yield a better correlation to discogenic pain.
Endothelium, Vascular↗
[Primary correction of scoliosis with the Wilmington corset].
QUESTION: As part of our study, the effectiveness and patient's acceptance of the Wilmington-brace is to be evaluated. The effectiveness can be documented with the help of the primary correction achieved, especially in light of the fact, that the primary correction and the long-term results are directly dependant upon one another. MATERIAL AND METHOD: We examined a total of 52 patients with an idiopathic scoliosis treated in a thermoplast brace. The group consisted of 38 female and 14 male patients (average age 11.6 years). The angulation was measured with the help of the Cobb-angle and the rotation with the method described by Nash and Moe. The skeletal age was classified according to Risser's-sign. The angle determinations were carried out at three separate points in time--at first presentation, prior to bracing and four to six weeks following bracing. RESULTS: The patients presented with an average angulation of 31 degrees. The average correction achieved in the Wilmington-brace was 41%. This corresponds to a correction of 13 degrees. The best primary correction (45%) was obtained in the thoracolumbar spine. Those patients with the smallest deformity at the onset of treatment showed the best results. The scoliosis with a large primary deformity and a marked rotation of the vertebral bodies responded poorly to correction. Advanced age or skeletal maturity were also limiting factors. Physical therapy had a positive influence on the amount of primary correction obtained. CLINICAL RELEVANCE: The Wilmington-brace (thermoplast) allows for a good primary correction of idiopathic scoliosis. The simplicity of application and the low production costs are also positive attributes.
Adolescent↗
[Biomechanical design of load simulation in multiple spinal segments].
Multisegmental biomechanical studies on the lumbar spine are steadily increasing in importance. Only in this way can we acquire knowledge about the physiological behaviour of the entire lumbar spine. Furthermore, these studies allow us to analyse in vitro the biomechanics of manipulated lumbar spines after various surgical operations on the spine. A load simulator was developed to investigate multisegmental lumbar spine mobility, and its function was investigated in an initial study on 19 fresh--frozen specimens of human lumbar spine. After x-ray examination and determination of the bone mineral density, the specimens were loaded up to 10 Nm in the automatic electromechanical loading system under flexion/extension, lateral bending and axial rotation. An ultrasound-based motion analysis system was used to measure the displacements of the vertebrae involved.
Biomechanical Phenomena↗