Biomedical subjects

Michael Putzier

Publications and source records attributed to Michael Putzier.

9 recordsLinked to original sources

PubMed2006

Mechanical concepts for disc regeneration.

Different strategies exist to treat intervertebral disc degeneration. Biological attempts to regenerate the disc are promising. However, degeneration of the disc is always accompanied by alterations of disc height, intradiscal pressure, load distribution, and motion patterns, respectively. Since those preconditions are independent factors for disc degeneration, it is unlikely that regeneration may occur without firstly restoring the physiological status of the affected spinal segment. In vitro and in vivo animal studies demonstrate that disc distraction normalizes intradiscal height and pressure. Furthermore, histological and radiological examinations provided some evidence for regenerative processes in the disc. Only dynamic stabilization systems currently offer the potential of a mechanical approach to intervertebral disc regeneration. Dynamic stabilization systems either using pedicle screws or with an interspinous device, demonstrate restabilization of spinal segments and reduction of intradiscal pressure. Clinical reports of patients with degenerative disc disease who underwent dynamic stabilization are promising. However, there is no evidence that those implants will lead to disc regeneration. Future treatment concepts should combine intradiscal cell based therapy together with dynamic restoration of the affected spinal segment.

Biomechanical Phenomena↗

PubMed2006

Postoperative analgesia after major spine surgery: patient-controlled epidural analgesia versus patient-controlled intravenous analgesia.

BACKGROUND: Spinal fusion surgery causes severe postoperative pain, hampering reconvalescense. We investigated the efficacy of patient-controlled epidural analgesia (PCEA) in a prospective, double-blind, randomized, controlled comparison with patient-controlled IV analgesia (PCIA). METHODS: After lumbar anterior-posterior fusion receiving an epidural catheter intraoperatively, 72 patients were given either PCEA (ropivacaine 0.125% and sufentanil 1.0 microg/mL at 14 mL/h; bolus: 5 mL; lockout time: 15 min) and IV placebo or PCIA (morphine 2.0 mg/mL; bolus: 3 mg; lockout time: 15 min) and epidural placebo. Pain levels (visual analog scale 0-10), functional capabilities (turning in bed, standing, and walking), analgesic consumption, and side effects were evaluated until 72 h after surgery. RESULTS: Fourteen patients were excluded by predetermined criteria, leaving 58 patients for data analysis. Pain levels at rest and during mobilization were significantly lower in the PCEA when compared with that in the PCIA group throughout the study period (P < 0.0001 in all cases). Time until able to turn in bed was achieved earlier in the PCEA group (P < 0.05). Patients in the PCEA group were significantly more satisfied with pain therapy (P < 0.01). CONCLUSION: We conclude that PCEA with ropivacaine and sufentanil, using intraoperatively placed epidural catheters, provides superior analgesia and higher patient satisfaction when compared with PCIA after spinal fusion surgery.

Adult↗

PubMed2005

Percutaneous discography: comparison of low-dose CT, fluoroscopy and MRI in the diagnosis of lumbar disc disruption.

AIM: To compare the diagnostic accuracy of low-dose computed tomography (CT), magnetic resonance imaging (MRI) and fluoroscopy in percutaneous discography in patients scheduled for lumbar spondylodesis. MATERIAL AND METHODS: Within a prospective pilot study, 18 disc segments of 11 patients with radicular or pseudoradicular pain prior to anteroposterior spondylodesis were evaluated. After injection of a mixture of non-ionic iodine-containing contrast agent and gadolinium-based contrast medium into the disc spaces, all patients underwent conventional fluoroscopy, as well as low-dose CT and MRI. The occurrence of memory pain during contrast injection was recorded. CT, MRI and fluoroscopic images were analyzed independently by two readers blinded to the clinical findings. RESULTS: There was 100% agreement between CT and MRI discography in the detection, localization and grading of degenerative changes. In contrast, conventional fluoroscopy identified only 9 of the 12 abnormal segments. Memory pain following puncture was identified in 3 of the 12 affected segments. SUMMARY: Low-dose CT and MRI discography have a similar accuracy in the assessment of disc disruption and they are superior to fluoroscopic discography.

Adult↗

PubMed2005

Charité total disc replacement--clinical and radiographical results after an average follow-up of 17 years.

A retrospective clinical-radiological study to evaluate the long-term outcome after artificial disc replacement was performed. The objective is to investigate long-term results after implantation of a modular type artificial disc prosthesis in patients with degenerative disc disease (DDD). Total disc replacement (TDR) is a surgical procedure intended to save segmental spinal function, and thus replace spondylodesis. Short-term results are promising, whereas long-term results are scarce. The Charité TDR is the oldest existing implant, therefore, the longest possible follow-up is presented here. Seventy-one patients were treated with 84 Charité TDRs types I-III. Indication for TDR was moderate to severe DDD. Fifty-three patients (63 TDRs) were available for long-term follow-up of 17 years. Evaluation included Oswestry disability index, visual analog scale, overall outcome score, plain and extension/flexion radiographs. Implantation of Charité TDR resulted in a 60% rate of spontaneous ankylosis after 17 years. No significant difference between the three types of prostheses was found concerning clinical outcome. Reoperation was necessary in 11% of patients. Although no adjacent segment degeneration was observed in the functional implants (17%), these patients were significantly less satisfied than those with spontaneous ankylosis. TDR, nowadays, is an approved procedure. Proof that long-term results of TDR implantation in DDD are at least as good as fusion results is still missing.

Adult↗

PubMed2005

The surgical treatment of the lumbar disc prolapse: nucleotomy with additional transpedicular dynamic stabilization versus nucleotomy alone.

STUDY DESIGN: Clinical and radiologic study evaluating the outcome after nucleotomy with dynamic stabilization compared with nucleotomy alone. OBJECTIVES: To investigate the effect of dynamic stabilization on the progression of segmental degeneration after nucleotomy. SUMMARY OF BACKGROUND DATA: Nucleotomy as treatment for lumbar disc prolapse in combination with initial segment degeneration may lead to segmental instability. Dynamic stabilization systems restrict segmental motion and thus prevent further degeneration of the lumbar spine. They are designed to avoid the disadvantages of rigid fixation, such as pseudarthrosis and adjacent segment degeneration. METHODS: Eighty-four patients underwent nucleotomy of the lumbar spine for the treatment of symptomatic disc prolapse. Additional dynamic stabilization (DYNESYS) was performed in 35 of those cases. All patients showed signs of initial disc degeneration (MODIC I). They underwent evaluation before surgery, 3 months after surgery, and at follow-up. The mean duration of follow-up was 34 months. Examinations included radiographs, magnetic resonance imaging (MRI), physical examination, and subjective patient evaluation using Oswestry score and visual analog scale (VAS). RESULTS: Clinical symptoms, Oswestry score, and VAS improved significantly in both groups after 3 months. At follow-up, a significant increase in the Oswestry score and in the VAS was seen only in the nonstabilized group. In the dynamically stabilized group, no progression of disc degeneration was noted at follow-up, whereas radiologic signs of accelerated segmental degeneration existed in the solely nucleotomized group. There were no implant-associated complications. CONCLUSIONS: The applied dynamic stabilization system is useful to prevent progression of initial degenerative disc disease of lumbar spinal segments after nucleotomy.

Adult↗

PubMed2005

Treatment of traumatic cervical spine instability with interbody fusion cages: a prospective controlled study with a 2-year follow-up.

INTRODUCTION: The purpose of this prospective cohort study was to define indications and analyze the clinical and radiographic results of using interbody cages to surgically treat traumatic cervical spine instability. PATIENTS AND METHODS: 53 patients were treated by monosegmental anterior discectomy and interbody fusion using either autologous tricortical iliac crest bone graft and CSLP (cervical spine locking plate) (bone graft group, n=26) or Syncage-C filled with autologous cancellous bone grafts and CSLP (cage group n=27). Indications for surgery were traumatic cervical spine instability classified according to the AO classification as B1, B2, B3, C2, or C3. Intraoperative parameters such as blood loss and operation time were assessed. Prior to surgery and at follow-up (6,12, and 24 months), evaluation included measurement of neck pain, shoulder/arm pain, muscle strength, Neck Pain Disability Index (NPDI), and Cervical Spine Functional Score (CSFS). Neurological and overall outcome was assessed using the ASIA impairment scale and Odom's criteria, respectively. In addition, radiographic evaluation, including plain x-rays, flexion-extension views, and CT scans was performed. Fusion, segmental mobility, segmental lordosis/kyphosis and disc space height were determined. RESULTS: Operation time and hospital stay were significantly shorter (p<0.05) in the cage group than in the bone graft group. After 6,12, and 24 months there was no difference between either group in pain, muscle strength, NPDI, CSFS, neurological and overall outcome. Although the cage group showed a trend for prolonged fusion process, there was no statistically significant difference between the groups for all radiographic parameters. CONCLUSION: Under strict indications, cages offer a valid alternative to a tricortical iliac crest bone graft in the surgical treatment of monosegmental traumatic cervical spine instability. Although there was no significant difference between the cage and the bone graft group in the functional and radiographic outcome, less donor site morbidity, a shorter operating time, and a reduced hospital stay might result in cost-effectiveness of cages.

Adolescent↗

PubMed2005

Posterior stabilization of subaxial cervical spine trauma: indications and techniques.

The use of instrumentation for stabilization following cervical trauma has evolved rapidly in the past few decades. Nonoperative maneuvers, including traction, extended bed rest, and cast immobilization, have given way to wiring or screw rod constructs that allow immediate fixation and early mobilization of the patient. These procedures can be performed soon after trauma and with a minimum of surgical risk. They offer immediate stability of the injured spine, and can prevent the sequelae of acute cervical spinal cord injury that may accompany prolonged bed rest, thus allowing early rehabilitation and the potential for improved recovery. Current techniques for posterior cervical spine stabilization following trauma include spinous process or facet wiring [1-9], lateral mass plating [10-18], and cervical pedicle screws [19-27]. Several radiological tools, including MRI [28] and reformatted CT, yield precise details of the injured spine and allow the treating physician to determine which, if any, fixation technique offers the best chance of recovery with the least amount of risk. The goals of surgery following acute cervical spine injury include decompressing the injured spinal cord or nerve root, maintaining alignment, providing stability to the spine, promoting healing and fusion, and allowing early mobilization. This article will review indications for posterior cervical spine surgery, as well as the techniques that are currently available to help achieve the above-noted goals. We also report a recent retrospective review of 5-year data in treating posterior cervical trauma with lateral mass and pedicle screw fixation.

Adolescent↗

PubMed2004

Postoperative epidural anesthesia preserves lymphocyte, but not monocyte, immune function after major spine surgery.

UNLABELLED: Extensive spine surgery is associated with postsurgical pain. Epidural pain therapy may reduce postoperative stress responses and thereby influence immune functions. In a randomized, controlled, double-blinded prospective trial, 54 patients received either conventional patient-controlled IV analgesia (PCIA; morphine 3 mg/15 min) or patient-controlled epidural analgesia (PCEA; 0.125% ropivacaine plus sufentanil 1 microg/mL at a base rate of 12 mL/h and bolus application of 5 mL/15 min). Circulating cytokines, C-reactive protein (CRP), cortisol, and cell-surface receptor expression of immune cells (cluster of differentiation [CD]14, human leukocyte antigen-DR, CD86, CD71, CD3, CD4, CD8, CD16, and CD19) were measured perioperatively to characterize immunological functions. PCEA, compared with PCIA, had no influence on altered levels of circulating cytokines (interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-alpha, monocyte chemoattractant protein-1, and macrophage inhibitory factor) or indicators of the stress response (CRP and cortisol). Also, no significant difference was found in monocyte numbers or their human leukocyte antigen-DR, CD86, or CD71 expression. In contrast, the postoperative decrease in B lymphocytes and T-helper cells was significant in the PCEA group. Natural killer cells decreased significantly in patients receiving PCEA compared with PCIA. Therefore, postoperative epidural pain therapy has no influence on monocyte functions but reduces natural killer cells and preserves B-cell and T-helper cell populations. Epidural analgesia thus influences the specific rather than the innate immune system and potentially blunts the postsurgical lymphocyte depression, which is relevant for infectious resistance. IMPLICATIONS: Epidural analgesia affects the immune system. Postoperative epidural analgesia, compared with conventional IV opioid therapy, preserves lymphocyte rather than monocyte functions. An improvement of postoperative immune function by epidural analgesia therefore may improve postoperative resistance to infectious complications or to chronic pain states.

Adult↗

PubMed2002

Primary leptomeningeal melanoma.

STUDY DESIGN: A retrospective review of a case of primary leptomeningeal melanoma. OBJECTIVES: To present a previously undescribed tumor of the lumbar meninges. BACKGROUND: The case described the first report of lumbar localization and of bony metastasis of this tumor. METHODS: The authors present a case of a 65-year-old man with a destruction of the fifth lumbar vertebra and an exacerbation of lumbar pain and acute sensorimotor radiculopathy. RESULTS: The histologic examination of the resected tissue after the transpedicular stabilization suggested the presence of metastatic melanoma. After the development of progressive paraplegia and a second operation, subsequent histologic examination of the resected tissue showed the lesion to be a primary leptomeningeal melanoma. The patient's condition deteriorated progressively, and 31 days after confirmation of the diagnosis, he died of meningeal melanomatosis. CONCLUSION: By indicating the possibility of hitherto unreported sites of occurrence, routes of metastatic spread, and manifestations of this malignant tumor, this case report may contribute to the further elucidation of this disease.

Aged↗