Lumbale Spinalkanalstenose

The number of patients with the diagnosis of lumbar spinal stenosis (LSS) is steadily increasing and simultaneously, the patients' expectations are also increasing. Nevertheless, evidence from studies for the appropriate treatment is still lacking. Treatment options mainly result from the practitioner 's experience and the clinical focus. The findings described in magnetic resonance imaging (MRI) often do not correlate with the patient's symptoms. Basically, the treatment should be started with aconservative treatment and preferably with a multimodal approach. Severe pain with extensive neurogenic claudication symptoms and unsuccessful conservative treatment should be treated surgically. Absolute indications for surgery, such as aconus-cauda syndrome are rare. The goal of all surgical procedures is to decompress the spinal canal without compromising the stability of the motion segment. Instability can also make an additional fusion necessary

Therapieresistente Kokzygodynie sollte nicht länger als Mythos angesehen werden

BackgroundCoccygodynia is still often considered amystery, and many patients are not taken seriously with their problems and pain.CaseA51-year-old thin lady presented at our clinic with lifelong, persistent low back pain. The clinical examination indicated suspicion of coccygodynia. A functional X-ray revealed ahypermobile os coccygeum with dorsal tilt. After a total coccygectomy via ay-shaped approach, she was completely pain free at the 12months follow-up examination. No surgical site infection occurred in this period

Injektionstherapie bei Zervikal- und Lumbalsyndromen

In cervical and lumbar pain syndromes special injections are key for effective pain therapy. Depending on the origin of pain injections are placed at the nerve root or the joints. Thus, the vicious cycle can be stopped. A correct technical procedure is of enormous importance. Because pharmacological effects and special complications are possible, monitoring and precautions are mandatory

A novel radiological classification for displaced os coccyx: the Benditz–König classification

Background Treatment of coccygodynia is still a challenging entity. Clear surgical selection criteria are still lacking. The aim of the investigation was to establish a novel radiological classification for surgical decision-making in coccygodynia cases. Material and methods Retrospective analysis of standing and sitting X-rays of coccygodynia patients referred to a single centre from 2018 to 2020. The sacro-coccygeal angle (SCA), the intra-coccygeal angle (ICA) and the difference of the intervertebral disc height ( increment IDH) were measured. All coccyges were distributed in subtypes and correlated with the patients' treatment. Results In total, 138 patients (female/male: 103/35) with a mean age of 45.6 +/- 15.4 years were included in the study. In total, 49 patients underwent coccygectomy. Four different subtypes of displaced coccyges were identified: Type I with a non-segmented coccyx, anterior pivot, increased SCA and ICA from standing to sitting, increment IDH = 1.0 +/- 1.5 mm. Type II with a multisegmented coccyx, anterior pivot, increased SCA and ICA standing/sitting, increment IDH = 1.1 +/- 1.6 mm. Type III showed a posterior pivoted coccyx, negative SCA and ICA, increment IDH = 0.6 +/- 1.6 mm. Type IV is characterized by an anterior-posterior dissociation of the tail bone with a positive SCA, and the ICA shifted from a posterior to an anterior orientation. increment IDH was - 0.6 +/- 1.8 mm. Conclusion The presented radiological classification could help to facilitate the surgical decision-making for patients with displaced os coccyx. In addition, lateral and sitting X-rays were easy to perform and did not need unnecessary ionizing radiation like in CT scans and were more cost-effective than MRI investigations. The subtypes III and especially IV were more likely leading to surgery

Besteht ein Zusammenhang zwischen der degenerativen Bandscheibenveränderung und dem Auftreten von lumbalen Bandscheibenvorfällen?

Background: The correlation between disc prolapse and disc degeneration is important in the evaluation of clinical and occupational disease. The present clinical radiological study investigated whether there is a correlation between disc degeneration (chondrosis) and disc prolapses. Patients and Methods: The present study is a retrospectively trial which was performed with conservatively and surgically treated patients from 2011 till 2013 in our clinic. 100 patients with disc prolapse and chondrosis in current MRI images were recruited. We classified patients into those who exhibited a prolapse and chondrosis in the same segment, those with only disc prolapse and those with only chondrosis. Statistical evaluation for the correlation between chondrosis and disc prolapse was performed with the chi-square test. Odds ratios for prolapse and chondrosis were calculated, as well as interobserver reliability (kappa-value) between the first and second observers of radiological images. Results: In all segments in our 100 patients, 119 radiological findings were made (= 100%). 54 findings (45%) with disc prolapse in combination with chondrosis were identified in the same lumbar segment. 43 findings (36%) exhibited disc prolapse without chondrosis and 22 (19%) chondrosis without prolapse. Inmost cases, thefindings were seen in the last two segments. There was a statistical correlation between disc prolapse and chondrosis, as seen with the chi-squared test. As regards odds ratios, disc prolapse with chondrosis was 1.25-fold more frequent than prolapse without chondrosis; chondrosis with prolapse was 2.37-fold more frequent than chondrosis without prolapse. The interobserver reliability showed a kappa-value of 0.79 with disc prolapses and a kappa-value of 0.85 with chondrosis. Conclusion: For patients with disc prolapse and chondrosis in the same segment, chondrosis was mostly seen in combination with a prolapse. A causal relation was found between prolapse and chondrosis in the same segment. The interobserver reliability showed high correlation for radiological findings with disc prolapse and very high correlations with chondrosis

Anwendung unterschiedlicher Injektionstherapien bei Zervikal- und Lumbalsyndromen

The differentiated consideration of cervical and lumbar pain syndromes leads to a decoding of complaints to assignable pain generators which enables a targeted injection method. Depending on the origin of pain injections are placed at the nerve root or the joints. Thus, the vicious cycle can be stopped. A correct technical procedure is of enormous importance. Because pharmacological effects and special complications are possible, monitoring and precautions are mandatory

Different Kinematics of Knees with Varus and Valgus Deformities

Few data exist of kinematics of knees with varus and valgus deformities combined with osteoarthritis. The purpose of this study was to reveal different (1) tibiofemoral kinematics, (2) medial and lateral gaps, and (3) condylar liftoff of osteoarthritic knees with either varus or valgus deformity before and after total knee arthroplasty (TKA). For this purpose, 40 patients for TKA were included in this study, 23 knees with varus deformity and 17 knees with valgus deformity. All patients underwent computer navigation, and kinematics was assessed before making any cuts or releases and after implantation. Osteoarthritic knees with valgus deformity showed a significant difference in tibia rotation relative to the femur with flexion before and after TKA, whereas knees with varus deformity did not. Knees with a valgus deformity showed femoral external rotation in extension and femoral internal rotation in flexion, whereas knees with a varus deformity revealed femoral internal rotation in extension and femoral external rotation in flexion. In both groups, gaps increased after TKA. Condylar liftoff was not observed in the varus deformity group after TKA. In the valgus deformity group, condylar liftoff was detected after TKA at knee flexion of 50 degrees and more. This study revealed significant differences in tibiofemoral kinematics between osteoarthritic knees with a varus or valgus deformity before and after TKA. Valgus deformities showed a paradoxic movement pattern. These in vivo intraoperative results need to be confirmed using fluoroscopic or radiographic three-dimensional matching before and after TKA

Anwendung Bildwandler-gestützter Injektionen bei Zervikal- und Lumbalsyndromen

The X-ray image-guided injection methods are an important tool for the treatment of cervical and lumbar pain syndromes. For the application of these methods it is necessary to have a differentiated consideration of cervical and lumbar pain syndromes. This leads to a decoding of complaints to assignable pain generators, which enables a targeted injection method. Depending on the origin of pain, injections are placed at the nerve root or the joints. Thus, the vicious cycle of pain can be stopped. A correct technical procedure is of enormous importance. Particular attention must be paid to the pharmacological effects and special complications. A monitoring and precautionary measures are mandatory