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O Vlach

Publications and source records attributed to O Vlach.

At least 19 recordsLinked to original sources
PubMed2003

[An unusual case of non-structural scoliosis (case report)].

The case of a female patient with conversion scoliosis is described. At 24 years, the patient underwent surgery for herniated disks in the L4-L5 and L5-S1 regions and a short-time relief was achieved. At age 28, she was admitted to our department because of severe pain and antalgic posture. Because radiographs of her spine showed no findings corresponding to her symptoms, psychological examination was indicated. This revealed traumatic emotional experience in her family of origin and later also in her foster family, which unfavorably affected her married life. Psychotherapy, including cognitive behavioral treatment, hypnotherapy and audiovisual stimulation, markedly improved the patient's mental and somatic state during two periods of hospitalization. The effects of psychotherapy, physical therapy and adaptation of her physical activity regimen were still evident at 1 year after her therapy was commenced.

Adult↗
PubMed2002

[Infections in surgery of idiopathic scoliosis].

PURPOSE OF THE STUDY: In this retrospective study, we evaluated infectious complications in the patients undergoing surgical treatment for idiopathic scolions in order to identify risk factors for postoperative infections. MATERIAL: A total of 786 patients with idiopathic scoliosis were operated on during 24 years. In 754 (96%) cases, we used the posterior approach, involving posterior fusion and internal fixation, and subsequent immobilization in a brace. During that period, we recorded 15 (1.9%) deep wound infections in the area of fusion. Early infections were treated by debridement and lavage, with targeted administration of antibiotics, while instrumentation was kept in place. In late und recurrent infections, instrumentation was always removed. METHODS: We investigated a relationship between the infectious agent and the device used, the length of period between surgery and the onset of infection, the effect of device removal on curve progression, the agent causing infection and the effect of allergy to metal or infectious lesions at other body sites on the outbreak of infection. RESULTS: Early infections (within 6 weeks) were observed in six, late in nine patients. Repeat operations were necessary on average after 487 days. Staphylococcus aureus, the most frequent infectious agent, was isolated from four patients; on four occasions, cultivation was negative. Allergy to nickel was found in four patients. Infection was most often associated with the most frequently used Harrington Instrumentation (six cases, 1.1%). However, in relation to the number of patients treated, infection frequency was highest in TSRH (5.0%) and Isola (4.8%) devices. When Miami Moss fixation or the anterior approach was used, no infection was recorded. In comparison with the non-infected cases, the patients with infectious complications showed the same average values for the curve before and after surgery. At a check up, however, the loss of correction increased to 6 degrees and, after instrumentation removal, to 10 degrees as against 3 degrees in the non-infected patients. Pseudoarthrosis developed in two cases. DISCUSSION: The incidence of deep wound infections in patients who had surgery for idiopathic scoliosis was comparable with the data in the relevant literature. A higher number of infections, particularly late ones, in patients treated with the use of modern instrumentation is probably related to a higher volume of these implants. Early infections are a rare feature and their cause is known (allergy, sepsis). Treatment involves surgical intervention; in early infections, instrumentation is retained but is removed in late infections. CONCLUSIONS: Even though our group included a low number of patients with infections, we can conclude that risk factors for the development of infectious complications associated with surgical treatment of idiopathic scoliosis are as follows: allergy, higher age, large volume of metal used for stabilization and the presence of another infectious lesion.

Adolescent↗
PubMed2000

Conservative treatment versus surgery in spondylotic cervical myelopathy: a prospective randomised study.

A prospective randomised 2-year study was performed to compare the conservative and operative treatment of mild and moderate forms of spondylotic cervical myelopathy (SCM). Forty-eight patients presenting with the clinical syndrome of SCM, with a modified Japanese Orthopaedic Association (mJOA) score of 12 points or more, were randomised into two groups. Group A, treated conservatively, consisted of 27 patients, mean age 55.6 +/- 8.6 years, while group B was treated surgically (21 patients, mean age 52.7 +/- 8.1 years). The clinical outcome was measured by the mJOA score, recovery rate (RR), timed 10 m walk, score of daily activities (recorded by video and evaluated by two observers blinded to the therapy), and by the subjective assessment of the patients at 6, 12, and 24 months of the follow-up. There was, on average, no significant deterioration in mJOA score, recovery ratio, or timed 10 m walk within either group during the 2 years of follow-up. In the surgery group there was a slight decline in the scores for daily activities and subjective evaluation. A comparison of the two groups showed no significant differences in changes over time in mJOA score or quantified gait, but there were significant differences in the score of daily activities recorded by video at 24 months, which was a little lower in the surgical group, and also in RR and subjective evaluation, which were both worse in the surgical group at months 12 and 24. However, at month 6, this last parameter was significantly better in the surgical than in conservative group. Surgical treatment of mild and moderate forms of SCM in the present study design, comprising the patients with no or very slow, insidious progression and a relatively long duration of symptoms, did not show better results than conservative treatment over the 2-year follow-up.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1999

The value of somatosensory- and motor-evoked potentials in predicting and monitoring the effect of therapy in spondylotic cervical myelopathy. Prospective randomized study.

STUDY DESIGN: A 2-year follow-up prospective randomized electrophysiologic and clinical study of patients with spondylotic cervical myelopathy. OBJECTIVE: To assess the value of somatosensory- and motor-evoked potentials in the evaluation and prediction of the effect of therapy. SUMMARY OF BACKGROUND DATA: Previous studies have yielded conflicting data concerning the correlation between the changes in evoked potential parameters and the clinical postsurgical outcome in spondylotic cervical myelopathy. METHODS: Sixty-one patients with magnetic resonance images suggesting spondylotic cervical cord compression and clinical signs of cervical myelopathy were divided into two groups according to the degree of clinical cervical cord involvement. The 49 patients with mild and moderate spondylotic cervical myelopathy were randomized into groups that underwent either surgical or conservative therapy. Patients were evaluated clinically and by the means of somatosensory- and motor-evoked potentials. RESULTS: The clinical and evoked potential changes showed good correlation on the group level, but poor correlation intraindividually. There were no significant evoked potential and clinical group changes after 6 months and 2 years in the mild myelopathy group treated either surgically and conservatively, whereas patients with severe myelopathy displayed significant improvement in clinical and evoked potential parameters after surgery. In a subgroup of patients, the isolated segmental medullar N13 abnormality could potentially predict favorable postsurgical clinical outcome. CONCLUSIONS: Longitudinal evoked potentials showed limited use for evaluating the results of therapy in an individual patient. They could be useful in the group assessment of therapy results and in labeling a subgroup of patients with potentially favorable postsurgical outcome.

Cervical Vertebrae↗
PubMed1996

[Surgical treatment of cervical spondylotic myelopathy in the Czech and Slovak Republic in 1994].

The authors investigated the state of surgery on account of cervical spondylosis and in particular spondylogenic cervical myelopathy in the Czech and Slovak Republic in 1994. They assessed the number of operated patients, surgical methods, indication criteria and the diagnostic strategy of different departments. The total number of patients operated on account of cervical spondylosis in 1994 was 347, incl. 113 on account of cervical spondylogenic myelopathy. As to surgical techniques in the majority the anterior approach was selected (Smith-Robinson's method). Laminectomy was performed in 14 and laminoplasty in 22 cases. The number of operated patients is, as compared with the frequency of similar operations in the United States, six times lower. As all departments where enquiries were made operate every cervical compression regardless of the degree of functional deficiency, this may reflect inadequate diagnosis of the disease.

Cervical Vertebrae↗
PubMed1993

[Initial experience with peroperative autotransfusion in spinal surgery].

The authors describe combinations of anaesthesiological methods which enabled them during extensive spondylosurgical operations in 66 patients to reduce the consumption of homologous blood during operation to 90 ml, on the first day after operation to 300 ml and on the second day after operation to 120 ml. In six patients they used preoperative collection of the patient's own blood, in 45 patients acute normovolaemic haemodilution, in all patients controlled hypotension with sodium nitroprusside to a mean arterial pressure of 8-9 kPa and peroperative collection of blood by means of an autotransfusion apparatus Dideco Stat with a standard programme and yield higher than 50%. During and after peroperative collection they did not record any complications. Lower haemoglobin and haematocrit values and a reduced number of erythrocytes, lower than the lower normal range, during and after operation did not threaten the postoperative course in these patients. The authors draw, however, attention to the rise of the number of leucocytes immediately after operation to 19.7 x 10(9). 1(-1) which is due to their shift into the final product. Solution of this phenomenon which can produce ARDS is according to the authors the use of a programme different from the standard one.

Blood Loss, Surgical↗
PubMed1991

Enthesopathy in the vertebral disc region.

In view of the increased numbers of vertebrogenic complaints in society today, the authors investigated the clinical and morphological relations involved in these conditions. Histological techniques and the scanning electron microscope were used to examine the different structures of the spine under conditions of tensile overload. Chief attention was paid to the structures most exposed to mechanical stress, such as the interface between the vertebral body and the intervertebral disc. The authors found that the insertion of collagen fibres in cartilage or bone in the regions overloaded by tensile forces is identical to that found in epicondylitis in other locations. Such enthesopathies in the spinal region may form a major component of back pain states, and special therapy should be employed for them.

Adolescent↗
PubMed1991

[Surgical treatment of sequelae of injuries of the thoracolumbar spine].

The authors describe surgical techniques used in 48 patients with sequelae of injuries of the thoracolumbar spine and the achieved results. Twenty-one patients were treated by an anterior operation, 14 by posterior operation and 13 a combination of both. The anterior operation involved 1) simple stabilization by autografts or 2) release, correction of the kyphosis and fusion and 3) elimination of the affected body of the vertebra and replacement by a massive allograft. If reliable stability was not achieved, instrumentation was added. In posterior operation they always stabilized the spine by instrumentation and added fusion. In the remaining patients they combined the posterior and anterior operation. The anterior operations were, if necessary, supplemented by decompression, when using the posterior approach they decompressed by the posterolateral route. As to complications which called for re-operation, instrumentation failed once and twice a pseudoarthrosis was repaired. Pain disappeared or receded substantially in 86%. Of 30 patients with a partial nervous lesion 14 (47%) improved, in two slight deterioration occurred.

Adolescent↗
PubMed1991

[Sequelae of injuries of the thoracolumbar spine and indications for surgery].

Inadequate treatment of a fresh injury of the thoracolumbar spine of failure or surgical treatment may lead to substantial restriction of the physical activity of the patient. This is due to posttraumatic kyphosis, possibly its progression, instability, painfulness and a persisting or progressing neurological finding. Forty-eight patients with unstable fracture of the thoracolumbar spine were, except one operated patient, treated originally by conservative methods, 15 of them were moreover subjected to isolated laminectomy. In 30 patients a partial nervous lesion was involved. The majority of patients in the group subjected to laminectomy had a more severe kyphotic deformity which more frequently was progressive. The authors indicated surgery in 18 patients (37%) on account of pain, in 14 (29%) on account of instability, in 12 (25%) on account of progressing kyphosis and in 4 (8%) on account of an increasing nervous deficit. They included 26 patients with persisting partial nervous affections in the group with instability and progressing kyphosis, as anterior compression of the dural sac was revealed and they indicated release of nervous structures as part of the surgical operation. In the remaining partial neurological lesions with a patient spinal canal decompression was not indicated.

Adolescent↗
PubMed1990

[The effect of controlled hypotension on kidney function in spinal surgery].

The authors investigated the influence of controlled hypotension on renal function in patients operated on account of idiopathic scoliosis of the spine. The deformity was corrected by posterior fusion with Harrington instrumentation under general anaesthesia during controlled hypotension induced by sodium nitroprusside (n = 20). The control group was formed by 20 patients with the same deformity and the same surgical procedure without hypotension. The renal function was assessed before operation, during operation and continuously for 102 hours after operation. In the group of patients with controlled hypotension (median arterial pressure 8.0 kPa) during operation a significant decline of the creatinine clearance occurred (0.7 ml/s), as compared with the control group (1.3 ml/s), as well as compared with the value before operation (1.7 ml/s). After terminated hypotension the mean value of creatinine clearance rose to 2.0-2.2 ml/s for a period of 42 hours. In the control group the creatinine clearance persisted at a slightly reduced level, recorded during operation, for another 30 hours. Sodium retention as a manifestation of hyperaldosteronism was less marked in patients with controlled hypotension. During the investigation period no biochemical signs of retention of nitrogenous substances were recorded.

Adolescent↗
PubMed1990

Zinc status in patients with idiopathic scoliosis.

The zinc content in m. sacrospinalis, hair, leukocytes of peripheral blood, and in serum was examined in 50 patients with idiopathic scoliosis treated by Harrington instrumentation. A control group included 20 patients treated for spinal column injury. A significant decrease of zinc content in back muscles was observed in patients with scoliosis. The value of zinc in hair, leukocytes, and serum did not differ compared with the control group. Similarly, the potassium and magnesium content in muscle was the same in both groups. These results do not suggest that there is a primary zinc deficiency in patients with idiopathic scoliosis. The authors consider the decreased zinc content in back muscle of patients with idiopathic scoliosis to be a secondary disturbance associated with primary deformation of the spinal column.

Adolescent↗
PubMed1990

[The esthetic effect of surgical treatment of idiopathic scoliosis].

Idiopathic scoliosis has a negative impact on the heart and lungs in the deformed chest, its creates a cosmetic defect, i.e. asymmetry of the paravertebral prominence, shortening of the trunk, asymmetry of the shoulders and protruding scapulae. Later it may cause pain and nervous disorders. In a group of 46 patients aged 15.5 years with thoracic right-sided idiopathic scoliosis the effect of operation by Harrington's instrumentation and spondylodesis on improvement of the curvature and the cosmetic effect were investigated. Preoperative curvature of 69 degrees according to Cobb improved to 35 degrees (by 50%) and the prominence from 38 mm before operation to 23 mm after operation (by 32%). The operation had also a positive effect from the cosmetic aspect which is of great psychological importance for the patients, in particular girls.

Adolescent↗
PubMed1990

[Spondylothoracic dysplasia].

The authors describe 4 cases of spondylothoracal dysplasia. In two of them the severity of scoliotic deformity necessitated surgical treatment, the other two cases are under observation, as numerous malformations are at present compensating each other. All of them fall into the type II with a good life prognosis. The analysis of patients and survey of findings from the available literature facilitates a better familiarization with this syndrome.

Child↗
PubMed1990

[Tuberculosis of the upper cervical spine].

The authors present a case report on a 25-year-old female patient with the tuberculous spondylitis of 2nd cervical vertebra. For the treatment they choose a two-stage surgical procedure. Within the first stage they removed transorally the focus and filled in the defect in the body of the vertebra with autospongy bone grafts. In the second stage they stabilized the spine from the dorsal approach. Postoperative treatment in the plaster of Paris collar lasted three months. Thus the disease was quickly eliminated.

Adult↗
PubMed1990

[The preoperative radiographic image in traction and of the postural angle in relation to postoperative correction of the scoliotic curvature].

The authors evaluated a group of 297 patients after the surgical correction and stabilization of the spine, out of which there were 171 idiopathic, 98 congenital, 14 neuromuscular deformities and 14 deformities were connected with neurofibromatosis. By the statistical comparison of the values of curvature when the patient is standing prior to operation, lying in distraction of 200N and lying in side-bend to the convex of the curve with the value of correction after operation the authors have proved that it is sufficient to carry out only the examination in the maximum voluntary side-bend with the exception of the deformities of neuromuscular origin where it is necessary to perform also x-ray examination in the distraction of 200N when the patient is lying.

Female↗
PubMed1990

[The present occurrence of scoliosis and spondylolisthesis].

On the basis of the clinical material of 319 individuals suffering from spondylolysis and spondylolisthesis the authors examined the current occurrence of scoliosis and spondylolisthesis. After eliminating the curves up to 20 degrees and all disruptions of isthmus without slide they found only 18 patients. The slide was on the average 35 per cent (8 per cent to 100 per cent), scoliotic curve 35 degrees (21-71 degrees). The scoliotic curve was idiopathic in 13 cases and once it occurred in case of Marfan syndrome. Only 2 curves were of spastic and 2 of olisthetic type with the maximum of 41 degrees. The analysis has shown that in the selection of more pronounced deformities the number substantially falls of spastic and olisthetic scolioses which are mostly very slight and there prevail idiopathic curves. Operation was performed in one case of idiopathic curve and in one case of Marfan syndrome and in 3 patients suffering from spondylolisthesis.

Adolescent↗
PubMed1990

[The effect of controlled hypotension during spinal surgery on kidney function].

The effect of controlled hypotension on renal function in patients operated on for idiopathic scoliosis of the spine was examined (n = 20). The deformity was corrected under general anesthesia by posterior fusion using Harrington's instrumentation during controlled hypotension induced by sodium nitroprusside. The control group included 20 patients suffering the same deformity and operated on in the same way but without hypotension. Renal function tests were performed before and during the operation and continuously for 102 h after surgery. In the group with controlled hypotension (medium arterial pressure 8.0 kPa) there was a significant decrease in creatinine clearance during the operation (0.70 ml/s) compared with that in the control group (1.30 ml/s) and with the value before surgery (1.70 ml/s). At the end of hypotension, the average clearance value of creatinine increased up to 2.0-2.2 ml/s within 42 h. In the group of control patients (medium arterial pressure 11.5 kPa) the creatinine clearance persisted at a mildly decreased level (1.3 ml/s) during surgery and for a further 30 h after. The sodium retention characteristic of hyperaldosteronism was less marked in the patients with controlled hypotension. We did not observe any biochemical findings indicating retention of nitro substances. Controlled hypotension induced by sodium nitroprusside at surgical treatment of the vertebral column does not cause any impairment of the renal function either during surgery or as a late sequela.

Adolescent↗