Paradoxien der Geschichte. Anmerkungen zu den Fotografien von Gerhard Gäbler

PURPOSE: Surgical treatment of early-onset scoliosis (EOS) requires a balance between maintained curve correction and the capacity for spinal and thoracic growth. Spinal fusion creates irreversible conditions that prevent the implementation of further treatment methods. Our hypothesis was that non-fused anchors in growth guidance show a comparable outcome as the technique described in the literature, which involves spondylodesis of the anchoring segments. METHODS: This retrospective study analysed 148 surgeries in 22 EOS patients (11 female, 11 male) over a 15-year period. Patients underwent surgery with non-fused anchors and growth guidance techniques. Scoliosis, kyphosis, growth and anchoring segments were measured. For the latter, a new measuring technique was developed. Complications were recorded and classified. RESULTS: The mean Cobb angle reduced from 73.5 ± 24.4° to 28.4 ± 16.2° (60.2 ± 22.9%, p < 0.001) at the last follow-up. Spinal growth T1-S1 and T1-T12 were 41.1 ± 23.3 mm and 24.9 ± 16.6 mm (p < 0.001), respectively. Growth at the cranial and caudal anchoring segment was 1.5 mm/segment/year and 1.9 mm/segment/year, respectively. A total of 63 complications were documented in 20 patients, with 40 requiring unplanned revision surgery. Definitive spondylodesis was performed in three patients. CONCLUSION: Patients demonstrated a significant spinal growth including the anchoring segments. A comparable correction in Cobb angle and the type of complications was noted, although the rate of device-related complications was higher. No permanent impairment was reported. The rate of device-related complications is acceptable and outweighed by the significant degree of growth preservation and more flexible and individualised treatment strategy for patients with EOS. These slides can be retrieved under Electronic Supplementary Material

Correction to: Surgical growth guidance with non-fused anchoring segments in early-onset scoliosis

The preoperative X-ray presented in Figure 1 of the original publication erroneously was not the latest radiographic image taken before the index surgery at the age of 3 years

Peculiarities of organomineral fertilizer granulation by the pelletizing method

Актуальность. Использование органоминеральных удобрений позволяет существенно повысить плодородие почвы и восстановить ее агрохимические и физические свойства. Исследование позволит решить некоторые проблемы, связанные с применением удобрения в необработанном виде, а полученный продукт в виде сферических гранул размером от 2,0 до 5,5 мм будет иметь высокую статическую прочность и может быть легко использован в сельском хозяйстве в условиях сплошного внесения удобрений в почву с использованием агротехники. Цель: изучение процесса гранулирования органоминерального удобрения методом окатывания с предварительной подформовкой и определение оптимальных технологических параметров; исследование вероятности образования труднорастворимых соединений при взаимодействии растворов связующих с компонентами, входящими в состав органоминеральных удобрений. Объект: органоминеральное удобрение биогумус с влажностью 55–60 %. Методы: электронная сканирующая микроскопия (Hitachi «S-3400N»), позволяющая определить элементный состав биогумуса и оценить поверхность частиц удобрения и готового гранулированного продукта; рентгеноспектральный анализ, используемый для установления элементного состава; термодинамический анализ, необходимый для оценки вероятности протекания реакций и возможности образования труднорастворимых соединений в гранулированном удобрении, способствующих увеличению прочности гранул; ситовой анализ, используемый для определения гранулометрического состава, и метод определения статической прочности гранул на приборе ИПГ-1М. Результаты. С помощью электронно-сканирующего микроскопа была изучена и описана поверхность частиц органоминерального удобрения – биогумус. Установлен элементный состав органоминерального удобрения: C, N, P, K, O, Fe, Al, Ca, Mg, Na, Cl, S, Ti. Определены оптимальные параметры технологии гранулирования органоминерального удобрения с предварительным формованием через ячейки диаметром 4,0 мм: продолжительность 180 с, температура окатывания 25 °С, сушка при 110 °С в течение 60 мин и величина ретура 3 %. Определен вид связующего раствора и его содержание в тукосмеси, благодаря которому можно получить продукт с наилучшими товарными характеристиками (статическая прочность, выход товарной фракции от 2,0 до 5,5 мм). На основании термодинамического анализа установлена возможность протекания химических реакций между связующим раствором и компонентами биогумуса, в результате которых образуются труднорастворимые соединения (Mg3(PO4)2, Ca3(PO4)2, Fe3(PO4)2), способствующие увеличению прочности гранул. Применяемый в качестве связующего вещества водный раствор фосфата натрия позволяет получить гранулы, обладающие высокой статической прочностью (51,1 Н/гранула). С помощью электронно-сканирующей микроскопии изучена и описана структура получаемого гранулированного удобрения.The relevance. The use of organomineral fertilizers makes it possible to substantially increase the fertility of soil and restore its agrochemical and physical properties. Research allows you to solve some problems associated with fertilizer application in untreated form, and the resulting product in the form of spherical granules measuring of 2,0 to 5,5 mm will have a high static strength and can be easily used in agriculture in conditions of continuous application of fertilizers to the soil with the use of agrotechnics. The main aim of the research is to study the organomineral fertilizer granulation by pelletizing with preliminary subforming and determination of optimal technological parameters; to investigate the probability of formation of sparingly soluble compounds in interaction of solutions of binders with components that are part of organomineral fertilizers. Objects: organomineral fertilizer biohumus with a moisture content of 55-60 %. Methods: electronic scanning microscopy (Hitachi «S-3400N»), which allows determining the elemental composition of biohumus and evaluating the surface of fertilizer particles and the finished granular product; X-ray spectral analysis used to establish the elemental composition; the thermodynamic analysis necessary for estimation of probability of proceeding the reactions and possibility of formation of difficult-to-constructible compounds in the granular fertilizer, promoting increase in strength of granules; sieve analysis, used to determine the particle size distribution, and a method for determining the static strength of granules on an IPG-1M instrument. Results. Using the electron-scanning microscope, the surface of organic-mineral fertilizer particles - biohumus - was studied and described. The elemental composition of organomineral fertilizer is determined: C, N, P, K, O, Fe, Al, Ca, Mg, Na, Cl, S, Ti. Optimum parameters of the technology of organomineral fertilizer granulation with preliminary molding through cells with a diameter of 4,0 mm were determined: duration of 180 s, rolling temperature of 25 °C, drying at 110 °C for 60 min, and retention value of 3 %. The type and content of the binder solution in the fertilizer mixture is determined, which makes it possible to obtain the product with the best commercial characteristics (static strength, output of product fraction of 2,0 to 5,5 mm). Based on the thermodynamic analysis, the possibility of chemical reactions between the binder solution and biohumus components was established, resulting in formation of sparingly soluble compounds (Mg3(PO4)2, Ca3(PO4)2, Fe3(PO4)2), which increase the strength of the granules. The sodium phosphate aqueous solution used as a binder allows obtaining pellets having a high static strength (51,1 N/pellet). With the help of electron-scanning micros- copy, the structure of the obtained granular fertilizer was studied

Multimodal intraoperative monitoring (MIOM) during 409 lumbosacral surgical procedures in 409 patients

A prospective study on 409 patients who received multimodel intraoperative monitoring (MIOM) during lumbosacral surgical procedures between March 2000 and December 2005 was carried out. The objective of this study was to determine the sensitivity and specificity of MIOM techniques used to monitor conus medullaris, cauda equina and nerve root function during lumbosacral decompression surgery. MIOM has increasingly become important to monitor ascending and descending pathways, giving immediate feedback information regarding any neurological deficit during the decompression and stabilisation procedure in the lumbosacral region. Intraoperative spinal- and cortical-evoked potentials, combined with continuous EMG- and motor-evoked potentials of the muscles, were evaluated and compared with postoperative clinical neurological changes. A total of 409 consecutive patients with lumbosacral spinal stenosis with or without instability were monitored by MIOM during the entire surgical procedure. A total of 388 patients presented true-negative findings while two patients presented false negative and 1 patient false-positive findings. Eighteen patients presented true-positive findings where neurological deficit after the operation was intraoperatively predicted. Of the 18 true-positive findings, 12 patients recovered completely; however, 6 patients recovered only partially. The sensitivity of MIOM applied during decompression and fusion surgery of the lumbosacral region was calculated as 90%, and the specificity was calculated as 99.7%. On the basis of the results of this study, MIOM is an effective method of monitoring the conus medullaris, cauda equina and nerve root function during surgery at the lumbosacral junctions and might reduce postoperative surgical-related complications and therefore improve the long-term results

Multimodal intraoperative monitoring (MIOM) during cervical spine surgical procedures in 246 patients

A prospective study of 246 patients who received multimodal intraoperative monitoring during cervical spine surgery between March 2000 and December 2005. To determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve root function during cervical spine surgery. It is appreciated that complication rate of cervical spine surgery is low, however, there is a significant risk of neurological injury. The combination of monitoring of ascending and descending pathways may provide more sensitive and specific results giving immediate feedback information and/or alert regarding any neurological changes during the operation to the surgeon. Intraoperative somatosensory spinal and cerebral evoked potentials combined with continuous EMG and motor-evoked potentials of the spinal cord and muscles were evaluated and compared with postoperative clinical neurological changes. A total of 246 consecutive patients with cervical pathologies, majority spinal stenosis due to degenerative changes of cervical spine were monitored by means of MIOM during the surgical procedure. About 232 patients presented true negative while 2 patients false negative responses. About ten patients presented true positive responses where neurological deficit after the operation was predicted and two patients presented false positive findings. The sensitivity of MIOM applied during cervical spine procedure (anterior and/or posterior) was 83.3% and specificity of 99.2%. MIOM is an effective method of monitoring the spinal cord functional integrity during cervical spine surgery and can help to reduce the risk of neurological deficit by alerting the surgeon when monitoring changes are observed

Outcome of L5 radiculopathy after reduction and instrumented transforaminal lumbar interbody fusion of high-grade L5-S1 isthmic spondylolisthesis and the role of intraoperative neurophysiological monitoring.

PURPOSE To evaluate the incidence and course of iatrogenic L5 radiculopathy after reduction and instrumented fusion of high-grade L5-S1 isthmic spondylolisthesis and the role of intraoperative neurophysiological monitoring (IONM). METHODS Consecutive patients treated for high-grade spondylolisthesis with IONM from 2005 to 2013 were screened for eligibility. Prospectively collected clinical and surgical data as well as radiographic outcomes were analyzed retrospectively. Patients completed the multidimensional Core Outcome Measures Index (COMI) before and at 3, 12, and 24 months after surgery. RESULTS Seventeen patients were included, with a mean age of 26.3 (±9.5) years. Mean preoperative L5-S1 slip was 72% (±21%) and was reduced to 19% (±13%) postoperatively. Mean loss of reduction at last follow-up [mean 19 months (±14, range 3-48 months)] was 3% (±4.3%). Rate of new L5 radiculopathy with motor deficit (L5MD) after surgery was 29% (five patients). Four patients fully recovered after 3 months, one patient was lost to neurologic follow-up. IONM sensitivity and specificity for postoperative L5MD was 20 and 100%, respectively. COMI, back pain and leg pain scores showed significant (p < 0.001) improvements at 3 months postoperatively, which were retained up to 24 months postoperatively. CONCLUSIONS Transient L5 radiculopathy after reduction and instrumented fusion of high-grade spondylolisthesis is frequent. With IONM the risk of irreversible L5 radiculopathy is minimal. If IONM signal changes recover, full clinical recovery is expected within 3 months. Overall, patient-reported outcome of reduction and instrumented fusion of high-grade spondylolisthesis showed clinically important improvement

Revision surgery for incomplete resection or recurrence of cervical spine chordoma: a consecutive case series of 24 patients

Purpose!#!Chordomas are rare tumors with an annual incidence of approximately one per million. Chordomas rarely metastasize but show a high local recurrence rate. Therefore, these patients present a major clinical challenge, and there is a paucity of the literature regarding the outcome after revision surgery of cervical spine chordomas. Available studies suggest a significantly worse outcome in revision scenarios. The purpose of this study is to analyze the survival rate, and complications of patients that underwent revision surgery for local recurrence or incomplete resection of chordoma at the craniocervical junction or at the cervical spine.!##!Methods!#!24 consecutive patients that underwent revision surgery for cervical spine chordoma remnants or recurrence at a single center were reviewed retrospectively. We analyzed patient-specific surgical treatment strategies, complications, and outcome. Kaplan-Meier estimator was used to analyze five-year overall survival.!##!Results!#!Gross total resection was achieved in 17 cases. Seven patients developed dehiscence of the pharyngeal wall, being the most common long-term complication. No instability was observed. Postoperatively, four patients received proton beam radiotherapy and 12 patients had combined photon and proton beam radiotherapy. The five-year overall survival rate was 72.6%.!##!Conclusion!#!With thorough preoperative planning, appropriate surgical techniques, and the addition of adjuvant radiotherapy, results similar to those in primary surgery can be achieved

Development of the "Core Yellow Flags Index" (CYFI) as a brief instrument for the assessment of key psychological factors in patients undergoing spine surgery

Background: Depression, anxiety, catastrophising, and fear-avoidance beliefs are key "yellow flags" (YFs) that predict a poor outcome in back patients. Most surgeons acknowledge the importance of YFs but have difficulty assessing them due to the complexity of the instruments used for their measurement and time constraints during consultations. We performed a secondary analysis of existing questionnaire data to develop a brief tool to enable the systematic evaluation of YFs and then tested it in clinical practice. Methods: The following questionnaire datasets were available from a total of 932 secondary/tertiary care patients (61 ± 16 years; 51% female): pain catastrophising (N = 347); ZUNG depression (N = 453); Hospital Anxiety and Depression Scale (anxiety subscale) (N = 308); fear-avoidance beliefs (N = 761). The single item that best represented the full-scale score was identified, to form the 4-item "Core Yellow Flags Index" (CYFI). 2422 patients (64 ± 16 years; 54% female) completed CYFI and a Core Outcome Measures Index (COMI) before lumbar spine surgery, and a COMI 3 and 12 months later (FU). Results: The item-total correlation for each item with its full-length questionnaire was: 0.77 (catastrophising), 0.67 (depression), 0.69 (anxiety), 0.68 (fear-avoidance beliefs). Cronbach's α for the CYFI was 0.79. Structural equation modelling showed CYFI uniquely explained variance (p < 0.001) in COMI at both the 3- and 12-month FUs (β = 0.11 (women), 0.24 (men); and β = 0.13 (women), β = 0.14 (men), respectively). Conclusion: The 4-item CYFI proved to be a simple, practicable tool for routinely assessing key psychological attributes in spine surgery patients and made a relevant contribution in predicting postoperative outcome. CYFI's items were similar to those in the "STarT Back screening tool" used in primary care to triage patients into treatment pathways, further substantiating its validity. Wider use of CYFI may help improve the accuracy of predictive models derived using spine registry data. Keywords: Core Yellow Flags Index (CYFI); Outcome; Registry data; SPINE surgery; Yellow flags

The influence of cervical plate fixation with either autologous bone or cage insertion on radiographic and patient-rated outcomes after two-level anterior cervical discectomy and fusion

PURPOSE We aimed to identify technique-related factors influencing radiographic and patient-rated outcomes after two-level anterior cervical discectomy with fusion (ACDF) using either cage or autologous bone, with or without anterior plate fixation (APF). METHODS This single center study was nested within the Eurospine Spine Tango data acquisition system. INCLUSION CRITERIA consecutive two-level ACDF patients (2004-2012) presenting with signs of degenerative cervical radiculopathy or myelopathy. Before and 12 month postoperatively, patients completed the multidimensional Core Outcome Measures Index (COMI); at 12 months postoperatively they also rated the global treatment outcome (GTO) and their satisfaction with care. Cervical lordosis and segmental height were assessed radiographically preoperatively, immediately postoperatively, and at the last follow-up (LFU) (18.2 ± 13.3 months). RESULTS One hundred and forty-four consecutive patients (113 with APF) were included. The use of APF versus stand-alone methods was associated with significantly increased segmental height (by 2.6 ± 2.6 versus 1.5 ± 2.4 mm, p = 0.04) and preservation of lordosis (by 2.7 ± 4.4° versus -1.7 ± 5°, p < 0.0001) at LFU, with comparable clinical outcome (COMI score reduction ≥3.1-point). Multiple regression controlling for potential confounders revealed that APF (p = 0.0004) and cage (p = 0.001) were associated with greater segmental height at LFU; APF was associated with a greater lordosis angle at LFU (p < 0.0001). Greater increase in segmental height at LFU (p = 0.02) was associated with a better GTO. CONCLUSIONS Adding APF was associated with greater segmental height and preservation of lordosis in two-level ACDF, especially using bone autograft, but also for cage. Clinical outcome was comparable for all groups. Though the surgical technique per se did not determine clinical outcome, patients achieving a greater segmental height difference showed a significantly better GTO