Biomedical subjects

Ulrich Berlemann

Publications and source records attributed to Ulrich Berlemann.

4 recordsLinked to original sources

PubMed2005

Posterior dynamic stabilization systems: DYNESYS.

Posterior dynamic stabilization systems have to neutralize injurious forces and restore painless function of the spine segments and protect the adjacent segments. Because degenerative disc disease has many clinical manifestations, pedicular screw systems and interspinous implants have their indications. A dynamic stabilization device has to provide stability throughout its lifetime, unless it activates or allows reparative processes with a reversal of the degenerative changes. Anchorage to the bone is crucial, at least for pedicular systems. This is a great demand on spinal implants and assumes rest and motion going together. Our experience with DYNESYS has shown that this method has limitations in elderly patients with osteoporotic bone or in patients with a severe segmental macro-instability combined with degenerative olisthesis and advanced disc degeneration. Such cases have an increased risk of failure. Only future randomized evaluations will be able to address the potential reduction of accelerated adjacent segment degeneration. The few posterior dynamic stabilization systems that have had clinical applications so far have produced clinical outcomes comparable with fusion. No severe adverse events caused by these implants have been reported. Long-term follow-up data and controlled prospective randomized studies are not available for most of the cited implants but are essential to prove the safety, efficacy, appropriateness, and economic viability of these methods.

Adult↗

PubMed2005

Kyphoplasty: chances and limits.

Kyphoplasty provides a minimal-invasive surgical technique for the cement augmentation of vertebral bodies following osteoprotic compression fractures or malignant processes. Kyphoplasty has been developed as an advancement of vertebroplasty. Both procedures feature high-success rates in terms of reliable and lasting reduction of pain. Advantages of kyphoplasty over vertebroplasty are to be seen in the possibility of deformity correction as well as in a decreased risk of cement leakage, which represents the most important source for clinical complications. Long-term experiences with the effect of cementing vertebral bodies are sparse. Thus indications and possibilities have to be judged realistically. Conditions, which have to be considered before performing kyphoplasty or vertebroplasty include age of the patient, age of the fracture, degree of deformation and additional degenerative changes of the spine. This article summarizes the present research and literature as well as indications and contraindications and is thought to provide guidelines for the aforementioned decision-making processes.

Contraindications↗

PubMed2004

Kyphoplasty for treatment of osteoporotic vertebral fractures: a prospective non-randomized study.

BACKGROUND: Minimally invasive augmentation techniques of vertebral bodies have been advocated to treat osteoporotic vertebral body compression fractures (VBCFs). Kyphoplasty is designed to address both fracture-related pain as well as kyphotic deformity usually associated with fracture. Previous studies have indicated the potential of this technique for reduction of vertebral body height, but there has been little investigation into whether this has a lasting effect. The current study reports on our experience and the one-year results in 27 kyphoplasty procedures (24 patients) for osteoporotic VBCFs. RESULTS: All but one patient experienced pain relief following the procedure (on VAS 1-10)--with a lasting effect over the follow-up period in 25 cases. An average vertebral kyphosis reduction of 47.7% was achieved with no loss of reduction after one year. The potential for reduction was statistically related to the pre-operative amount of kyphosis, the level treated, and the age of the fracture, but not to the age of the patient. During follow-up, one fracture adjacent to a treated level was observed. Pain relief was not related to the amount of reduction. CONCLUSION: Kyphoplasty is an effective treatment of VBCFs in terms of pain relief and durable reduction of deformity. Whether spinal realignment results in an improved long-term clinical outcome remains to be investigated.

Adult↗

PubMed2002

Degeneration of the atlanto-axial joints: a histological study of 9 cases.

Degeneration of the lateral atlanto-axial joints (AAJ) has been described as a potential cause of severe neck pain. However, hardly any data are available on its incidence, especially in comparison to the lower cervical spine. In this histological study, we examined the AAJs in 9 specimens from elderly patients, graded the findings and compared them to those in the facet joints of the lower cervical spine. Most histological changes in the AAJs were mild, but the changes in the lower cervical spine were severer. Previous mechanical studies have described the AAJ as a very mobile joint with large neutral zones, which may explain the mild degree of osteoarthrosis found in these specimens.

Aged↗