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U Liljenqvist

Publications and source records attributed to U Liljenqvist.

At least 19 recordsLinked to original sources
PubMed2006

[Lumbar spinal stenosis].

Lumbal spinal stenosis is gaining more and more clinical relevance because of changing population structure and increasing demand on lifequality in the elderly. Current treatment recommendations are based on clinical experience, expert opinions and single studies rather than on proven evidence. The radiologic degree of stenosis does not correlate with the patients' clinical situation. It is not the main factor indicating surgery but rather the typical history and spinal claudication. Symptomatic patients with light to moderate complaints should undergo multimodal conservative treatment. Epidural injections, delordosating physiotherapy and medication are useful. In patients with severe symptomatic stenosis surgery is indicated after a conservative treatment of 3 months. Relevant pareses or a cauda equina syndrome are absolute indications for surgery. The general aim is to decompress sufficiently while maintaining or restoring segmental stability. A laminectomy is not necessarily required. In patients with accompanying degenerative Meyerding grade I-II spondylolisthesis or instability in functional radiographs, fusion or dynamic stabilisation are recommended in addition to decompression, depending on the patient's age and activity level.

Decompression↗
PubMed2006

[Recommendations on sport activities for patients with idiopathic scoliosis].

The idiopathic scoliosis is a three dimensional spinal deformity mostly occurring in female adolescents. Untreated it can progress and result in back pain, impaired lung capacity and psychosocial disorders due to the cosmetic appearance of the deformed trunk. The treatment depends on the severity of the curve and ranges from physiotherapy and observation, brace treatment to surgical treatment with partial correction and fusion of the primary curve. Patients with an idiopathic scoliosis should be encouraged to actively take part in sports activities. Positive influences on the general fitness including the lung function, on the trunk muscles and on the psyche can be expected. There are no scientific data indicating that any kind of sport activities alter the natural history of idiopathic scoliosis.

Adolescent↗
PubMed2005

[Lumbar disc arthroplasty. Established technique or experimental procedure?].

Lumbar interbody fusion used to be the most common surgical treatment for painful lumbar disc degeneration. With the technical development of total disc prostheses, replacement of the degenerated disc by a motion preserving implant has become a widely discussed alternative. The advantages of such replacement appear to include the prevention of adjacent segment disease as well as less perioperative morbidity. Three types of total disc prostheses are currently in common use. Although numerous studies have been made, a review of the literature reveals only two multicenter randomized studies comparing the outcome of disc prostheses with a control group of fusion patients. After 2 years, the available results show similar improvement after both types of surgery without significant differences. However, there is a trend towards faster recovery and improvement in disc arthroplasty patients. The long-term results of current and future randomized studies, including studies comparing results after disc arthroplasty, with results of standardized conservative therapies will determine the fate of lumbar disc prostheses.

Adolescent↗
PubMed2004

[The natural history of congenital defects and deformities of the spine (I)].

The functional assessment of individuals with congenital defects of the spine requires a differentiated judgement. A lumbalisation or sacralisation of the lumbosacral junction does not seem to be associated with increased lower back pain. However, it remains unclear whether this is the case in individuals with a spina bifida occulta. Defects of segmentation or formation alter the biomechanical loading of the spine, especially in cases of a secondary spinal deformity the functional status can be substantially impaired. Spinal deformities include idiopathic scoliosis, Scheuermanns kyphosis and spondylolisthesis. Depending on the severity of the deformity, they can affect the functional status and may be associated with increased lower back pain.

Adult↗
PubMed2003

Titanium cages in the surgical treatment of severe vertebral osteomyelitis.

The role of spinal implants in the presence of infection is critically discussed. In this study 20 patients with destructive vertebral osteomyelitis were surgically treated with one-stage posterior instrumentation and fusion and anterior debridement, decompression and anterior column reconstruction using an expandable titanium cage filled with morsellised autologous bone graft. The patients' records and radiographs were retrospectively analysed and follow-up clinical and radiographic data obtained. At a mean follow-up of 23 months (range 12-56 months) all cages were radiographically fused and all infections eradicated. There were no cases of cage dislocation, migration or subsidence. Local kyphosis was corrected from 9.2 degrees (range -20 degrees to 64 degrees ) by 9.4 degrees to -0.2 degrees (range -32 degrees to 40 degrees ) postoperatively and lost 0.9 degrees during follow-up. All five patients with preoperative neurological deficits improved to Frankel score D or E. Patient-perceived disability caused by back pain averaged 7.9 (range 0-22) in the Roland-Morris score at follow-up. In cases of vertebral osteomyelitis with severe anterior column destruction the use of titanium cages in combination with posterior instrumentation is effective and safe and offers a good alternative to structural bone grafts. Further follow-up is necessary to confirm these early results.

Aged↗
PubMed2003

Complications of halo treatment for cervical spine injuries in patients with ankylosing spondylitis--report of three cases.

BACKGROUND: Patients suffering from ankylosing spondylitis are prone to injuries of the cervical spine even with minor trauma. Although the fractures are markedly unstable, nonsurgical treatment using a halo-thoracic plaster or jacket is a common approach. METHODS: We present three patients with cervicothoracic fractures of the ankylosed spine to describe problems and complications inherent in this type of treatment. In two, pin track infections and pin protrusion through the skull occurred, leading in one case to an intracerebral hemorrhage. In the third patient, the halo had to be removed after 8 months, just early enough to prevent the pins from cutting through. RESULTS: One patient required craniotomy. The second one could be resolved by local revision. In the third case, the fracture eventually united after using a stiff collar for 2 years. CONCLUSION: Halo treatment for cervical spine fracture in patients with ankylosing spondylitis is a challenging task for orthopedic surgeons and neurosurgeons.

Aged↗
PubMed2002

Comparative analysis of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis.

Posterior correction and fusion with segmental hook instrumentation represent the gold standard in the surgical treatment of progressive idiopathic thoracic scoliosis. However, there is a debate over whether pedicle screws are safe in scoliosis surgery and whether their usage might enable a better curve correction and a shorter fusion length. The details of curve correction, fusion length and complication rate of 99 patients with idiopathic thoracic scoliosis treated with either hook or pedicle screw instrumentation were analyzed. Forty-nine patients had been operated with the Cotrel-Dubousset system using hooks exclusively ("hook group"). Fifty patients had been operated with either a combination of pedicle screws in the lumbar and lower thoracic and hooks in the upper thoracic spine or exclusive pedicle screw instrumentation using the Münster Posterior Double Rod System ("screw group"). The preoperative Cobb angle averaged 61.3 degrees (range 40 degrees-84 degrees ) in the hook group and 62.5 degrees (range 43 degrees-94 degrees ) in the screw group. Average primary curve correction was 51.7% in the hook group and 55.8% in the screw group ( P>0.05). However, at follow-up (2-12 years later) primary curve correction was significantly greater ( P=0.001) in the screw group (at 50.1%) compared to the hook group (at 41.1%). Secondary lumbar curve correction was significantly greater ( P=0.04) in the screw group (54.9%) compared to the hook group (46.9%). Correction of the apical vertebral rotation according to Perdriolle was minimal in both groups. Apical vertebral translation was corrected by 42.0% in the hook group and 55.6% in the screw group ( P=0.008). Correction of the tilt of the lowest instrumented vertebra averaged 48.1% in the hook group and 66.2% in the screw group ( P=0.0004). There were no differences concerning correction of the sagittal plane deformity between the two groups. Fusion length was, on average, 0.6 segments shorter in the screw group compared to the hook group ( P=0.03). With pedicle screws, the lowest instrumented vertebra was usually one below the lower end vertebra, whereas in the hook group it was between one and two vertebrae below the lower end vertebra. Both operative time and intraoperative blood loss were significantly higher in the hook group ( P<0.0001). One pedicle screw at T5 was exchanged due to the direct proximity to the aorta. There were no neurologic complications related to pedicle screw instrumentation. Pedicle screw instrumentation alone or in combination with proximal hook instrumentation offers a significantly better primary and secondary curve correction in idiopathic thoracic scoliosis and enables a significantly shorter fusion length.

Adolescent↗
PubMed2002

Morphometric analysis of thoracic and lumbar vertebrae in idiopathic scoliosis.

The aim of this paper was to analyse the vertebral morphometry in idiopathic scoliosis with respect to pedicle screw instrumentation by means of computed tomography scans. The pedicle morphometry between T5 and L4 was analysed by computed tomography scans in 29 surgically treated patients with idiopathic right thoracic scoliosis. Measurements included chord length, endosteal transverse pedicle diameter and transverse pedicle angle. The endosteal transverse pedicle diameter was significantly smaller (P<0.05) on the concavity in the apical region of the thoracic spine. The chord length was the shortest at the fifth thoracic vertebra with significantly larger dimensions on the concavity of the apical region in the thoracic spine (P<0.05). The transverse pedicle angle varied between 6 degrees in the lower thoracic spine and 12 degrees at the upper thoracic and lower lumbar spine. The morphometry in scoliotic vertebrae is substantially different from those in normal spines with an asymmetrical intra-vertebral deformity. Pedicle screw instrumentation in the middle thoracic spine appears critical due to the small endosteal pedicle diameter, especially on the concave side.

Bone Screws↗
PubMed2001

Occlusion of the left common iliac artery and consecutive thromboembolism of the left popliteal artery following anterior lumbar interbody fusion.

We report on a case of occlusion of the left common iliac artery due to arteriosclerosis and consecutive thrombotic occlusion of the left popliteal artery in a 52-year-old man following anterior retroperitoneal interbody fusion of L4--S1. Initial symptoms included leg pain and numbness of the lateral shank, which were thought to be a result of lumbar nerve root irritation from surgery. Diagnosis was not made until 13 days after surgery, when motor deficits were observed. Angiography showed occlusion of the left common iliac artery and thromboembolism of the left popliteal artery. After thromboendarterectomy of the common iliac artery and thrombectomy of the popliteal artery, motor deficits of the left foot were resolved whereas symptoms of pain and sensory deficits continued. Spine surgeons should be aware of this rare complication in cases of postoperative leg pain or of neurologic deficits in the lower extremity after anterior lumbar interbody fusions.

Angiography↗
PubMed2001

Pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine.

While the biomechanical properties of pedicle screws have proven to be superior in the lumbar spine, little is known concerning pullout strength of pedicle screws in comparison to hooks in the thoracic spine. In vitro biomechanical pullout testing was performed to evaluate the axial pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine with regard to surgical correction techniques in scoliosis. Nine human cadaveric thoracic spines were harvested and disarticulated. To simulate a typical posterior segmental scoliosis instrumentation, standard pedicle hooks were used between T4 and T8 and supralaminar hooks between T9 and T12 and tested against pedicle screws. The pedicle screws were loaded strictly longitudinal to their axis; the hooks were loaded perpendicular to the intended rod direction. In total, 90 pullout tests were performed. Average pullout strength of the pedicle screws was significantly higher than in the hook group (T4-T8: 531 N versus 321 N, T9-T12: 807 N versus 600 N, p < 0.05). Both screw diameter and the bone mineral density (BMD) had significant influence on the pullout strength in the screw group. For scoliosis correction, pedicle screws might be beneficial, especially for rigid thoracic curves, since they are significantly more resistant to axial pullout than both pedicle and laminar hooks.

Aged↗
PubMed2000

[Halm-Zielke instrumentation as primary stable improvement of the Zielke-VDS in idiopathic scoliosis. 1 to 4 year outcome of a prospective study of 29 consecutive patients].

Halm-Zielke Instrumentation (HZI) was developed to eliminate the disadvantage of ventral derotation spondylodesis (VDS)-Zielke in terms of lack of primary stability and in order to simplify sagittal plane control. Within a prospective clinical trial started in 1993, we have studied whether HZI fulfills these demands. HZI is an anterior double-rod system with a two screw per vertebral body fixation. The longitudinal components consist of a threaded VDS rod and a solid rod, which are attached to a hinge-conducted lid plate. Twenty-nine consecutive patients with idiopathic scoliosis and curves ranging from 36 degrees to 92 degrees were treated with HZI. The follow-up period ranged from 1 to 4 years. Correction of the frontal plane within the instrumented levels averaged 71.6% and 70.5% postoperatively and at follow-up, respectively. Derotation averaged 53.7% and mean correction of the tilt of the lowest instrumented vertebra was 69.5% at final follow-up. Thoracolumbar kyphosis was present in eight patients and was always completely corrected from +18.8 degrees to 3.3 degrees on average. One implant-related complication involved a screw breakage 18 months postoperatively without adverse effects. There was no case of pseudoarthrosis. All patients were mobilized without any additional external immobilization in terms of a brace or cast, and were allowed to go swimming for physiotherapeutical purposes immediately after wound healing. This study proves that HZI is a primary stable implant to perform VDS. Implant-related disadvantages typical of VDS are eliminated. Thereby, the period of rehabilitation is shortened by many months due to avoidance of cast and brace treatment.

Adolescent↗
PubMed2000

Segmental pedicle screw instrumentation in idiopathic thoracolumbar and lumbar scoliosis.

The role of posterior correction and fusion in thoracolumbar and lumbar scoliosis as well as pedicle screw instrumentation in scoliosis surgery are matters of debate. Our hypothesis was that in lumbar and thoracolumbar scoliosis, segmental pedicle screw instrumentation is safe and enables a good frontal and sagittal plane correction with a fusion length comparable to anterior instrumentation. In a prospective clinical trial, 12 consecutive patients with idiopathic thoracolumbar or lumbar scolioses of between 40 degrees and 60 degrees Cobb angle underwent segmental pedicle screw instrumentation. Minimum follow-up was 4 years (range 48-60 months). Fusion length was defined according to the rules for Zielke instrumentation, normally ranging between the end vertebrae of the major curve. Radiometric analysis included coronal and sagittal plane correction. Additionally, the accuracy of pedicle screw placement was measured by use of postoperative computed tomographic scans. Major curve correction averaged 64.6%, with a loss of correction of 3 degrees. The tilt angle was corrected by 67.0%, the compensatory thoracic curve corrected spontaneously according to the flexibility on the preoperative bending films, and led to a satisfactory frontal balance in all cases. Average fusion length was the same as that of the major curve. Pathological thoracolumbar kyphosis was completely corrected in all but one case. One patient required surgical revision with extension of the fusion to the midthoracic spine due to a painful junctional kyphosis. Eighty-five of 104 screws were graded "within the pedicle", 10 screws had penetrated laterally, 5 screws bilaterally and 4 screws medially. No neurological complications were noted. In conclusion, despite the limited number of patients, this study shows that segmental pedicle screw instrumentation is a safe and effective procedure in the surgical correction of both frontal and sagittal plane deformity in thoracolumbar and lumbar scoliosis of less than 60 degrees, with a short fusion length, comparable to anterior fusion techniques, and minimal loss of correction.

Adolescent↗
PubMed1998

Simultaneous combined anterior and posterior lumbar fusion with femoral cortical allograft.

The radiographic fusion rates, graft behaviour and clinical outcome of 41 patient with simultaneous combined anterior lumbar interbody fusion and posterior arthrodesis with translaminar screws were reviewed independently. In all patients a femoral cortical allograft (FCA) ring filled with autologous iliac crest cancellous bone was used anteriorly to replace the disc and achieve interbody fusion. The follow-up averaged 30.6 months, with a minimum follow-up of 24 months. All patients had disabling low-back pain with different degrees of radiating leg pain and either discogenic pain (n = 24) or a postdiscectomy syndrome (n = 15) respectively postfusion syndrome (n = 2). The overall fusion rate was 95.2% (59 of 62 segments). Time to radiographic fusion averaged 8.7 months (range 2-34 months), and in 66.1% radiographic fusion occurred without significant subsidence. In 18.6% fusion with subsidence resulted from resorption of the FCA and in 15.3% the FCA had protruded into the vertebral body. The posterior intervertebral disc height (PIVDH) increased postoperatively by 2 mm on average. However, loss of PIVDH was the rule, and occurred within the first 12 postoperative months, resulting in a negligible final gain in height of 0.3 mm on average. The segmental lordosis was increased by 3 degrees; however, loss of lordosis during the first 6 postoperative months led to a final gain in lordosis of 1.3 degrees on average. Graft incorporation occurred in 16 of 62 segments (25.8%) and was observed at an average of 21.9 months postoperatively. Subjectively, 82.4% of the patients were satisfied or highly satisfied with the clinical result of the fusion operation. In conclusion, the described technique has proven to be highly effective in achieving a high fusion rate with a good patient outcome.

Adult↗
PubMed1998

Halm-Zielke instrumentation for primary stable anterior scoliosis surgery: operative technique and 2-year results in ten consecutive adolescent idiopathic scoliosis patients within a prospective clinical trial.

Halm-Zielke instrumentation (HZI) was developed to eliminate the disadvantages of Zielke instrumentation (VDS) in terms of lack of primary stability and a kyphogenic effect. HZI is an anterior double-rod system. The system is composed of a lid-plate, which is fixed at the lateral aspect of the vertebral body with two screws, a sunk screw anteriorly and a VDS screw posteriorly. The lid-plate design provides the lowest possible implant profile. The longitudinal components consist of a threaded VDS rod and a solid, fluted rod. Correction is performed with the threaded rod and the solid rod. The solid rod allows internal derotation and relordosation, eliminates the Zielke three-point lever system and augments the system. The fluted design of the rod provides rotatory stability. This is a report of the first ten consecutive adolescent idiopathic scoliosis patients in a prospective clinical trial using HZI with a minimum follow-up of 2 years. Curves ranged from 36 degrees to 77 degrees. Correction of the frontal plane averaged 77.5% and 72.2% postoperatively and at follow-up, respectively. Thoracolumbar kyphosis was present in three patients and corrected in all from an average of +18 degrees to +1.7 degrees at follow-up. Implant-related complications were not observed. All patients were treated without any additional external immobilization. In our opinion, HZI is a major improvement on the original Zielke VDS. It eliminates the kyphogenic effect and provides primary stability.

Adolescent↗
PubMed1997

Treatment of tumors of the spine.

Thirty-one patients with spinal tumors underwent reconstructive surgery with our spinal instrumentation system (MPDS and MADS), with or without our new vertebral tumor prosthesis. The characteristics of the spinal tumors were analysed statistically and the treatment outcome was evaluated. There were 4 benign tumors, 6 malignant tumors, and 21 metastatic tumors. The malignant tumors involved the sacrum more frequently than the benign tumors (p = 0.0098). Metastatic tumors involved the thoracic spine more frequently than benign or malignant tumors (p = 0.0161). The average number of affected vertebrae was 1.2 in the benign tumors, 1.8 in the malignant tumors, and 2.4 in the metastatic tumors. The metastatic tumors had a tendency to involve the anterior or middle part of the spine more frequently than the benign or malignant tumors (statistically not significant). After surgery, neurological improvement was noted in 8 patients, nochange in 19 patients, and impairment due to resection of the nerve roots in sacral tumors in 4 patients.

Adolescent↗
PubMed1995

Lumbosacral fracture dislocation in a lumberjack.

"Lumberjack fractures" normally occur in the thoracic and upper lumbar spine as a result of hyperextension and shear. This case, however, involves a lumberjack who suffered a lumbosacral fracture dislocation without neurological deficits, which occurred as the result of shear and hyperflexion. Due to the high degree of instability of this lesion, the treatment consisted of dorsoventral fusion with instrumentation.

Adult↗