C. Schulz

Selektive dorsale Dekompression der degenerativen Zervikalstenose

ZusammenfassungHintergrundAuslöser einer therapiebedürftigen zentralen Zervikalstenose kann eine Hypertrophie des dorsalen Bandapparats sein. Für derartige Stenosen stellen selektive Dekompressionsoperationen ohne Stabilisation und Fusion u.xa0U. eine ausreichende Alternative dar.Material und MethodenVorgelegt wird eine Beobachtungsstudie an 17xa0Patienten, die mit einer selektiven Flavektomie und einem „undercutting“ der Laminae und medialen Gelenkportionen behandelt wurden. Verglichen wurden die Parameter Japanese-Orthopedic-Association(JOA)-Score, Neck Pain Disability Index (NPDI) und Arm- sowie Nackenschmerz auf der visuellen Analogskala (VAS) prä- und postoperativ bis zum medianen Nachuntersuchungsintervall von 14xa0Monaten (Minimum 12xa0Monate). Das Ausmaß der Dekompression und der Nachbarsegmentdegeneration wurde mittels MRT bestimmt. Die segmentale und regionale Lordose sowie der Range of Motion (ROM) HWK2–7 prä- und postoperativ wurden mit der Cobb-Methode anhand seitlicher HWS-Röntgenaufnahmen bestimmt.ErgebnisseDie Behandlung verlief in allen 17 Fällen komplikationslos, es mussten keine Revisionen vorgenommen werden. Alle klinischen Parameter besserten sich von präoperativ bis zum letzten Kontrollzeitpunkt signifikant. Bildmorphologisch ergaben sich in allen Fällen eine signifikante Reduktion der Stenose und keine Zunahme der Myelopathie (im T2-MRT). Die sagittalen Parameter blieben ebenso wie der Schweregrad der Nachbarsegmentdegeneration unverändert.DiskussionDie klinischen und radiologischen Ergebnisse dieser Nonfusionstechnik sind für diese spezielle Indikation mindestens konkurrenzfähig zu den publizierten Ergebnissen der Laminektomie und Fusion sowie zur Laminoplastie.AbstractBackgroundHypertrophy of the dorsal ligaments is one reason for central stenosis of the cervical spinal canal. Selective decompression techniques without stabilization and fusion could be a sufficient alternative surgical treatment option.Material and methodsThis article presents the results of an observational study on 17 patients after treatment with selective decompression and undercutting of the cervical laminae and medial joint portion. The Japanese Orthopedic Association (JOA) score, the neck pain disability index (NPDI) and arm and neck pain on a visual analogue scale (VAS) were compared preoperatively and postoperatively (mean follow-up period was 14xa0months, minimum 12xa0months). The reduction of the stenosis and degree of adjacent level disease were measured using presurgical and postsurgical magnetic resonance imaging (MRI). The segmental and regional lordosis and range of motion were determined using the Cobb method on plain standing lateral radiographs.ResultsThere were no complications and no revision surgery was necessary. All clinical parameters improved significantly. The stenosis was significantly decompressed and no progression of myelopathy was observed on MRI. The sagittal parameters and degree of adjacent level degeneration remained unchanged.ConclusionThe clinical and radiological results of this non-fusion technique are convincing. Selective decompression is therefore an alternative to laminectomy and fusion as well as laminoplasty.

[Percutaneous CT-guided destruction versus microsurgical resection of lumbar juxtafacet cysts].

ZusammenfassungHintergrundZur Behandlung lumbaler Juxtafacettzysten ist die mikrochirurgische Resektion etabliert. Perkutane Zystendestruktionen stellen u.xa0U. eine Alternative dar. Die Wertigkeit der CT-gesteuerten Destruktion gegenüber der operativen Therapie ist bislang durch prospektive Untersuchungen nicht bestimmt worden.Material und MethodenEs handelt sich um eine prospektive, nichtrandomisierte Verlaufsstudie an 45xa0Patienten; 25xa0Patienten wurden operiert (Gruppexa0A), 20xa0Patienten perkutan durch Zystendestruktion behandelt (Gruppexa0B).ErgebnisseDie Behandlung verlief in allen 45 Fällen komplikationslos. In Gruppexa0A waren im medianen Nachuntersuchungsintervall von 27xa0Monaten alle Patienten beschwerdefrei. In Gruppexa0B waren im Nachuntersuchungsintervall von 23xa0Monaten 8xa0Patienten beschwerdefrei. Zwölf Patienten wurden wegen persistierender Radikulopathie im weiteren Verlauf operativ behandelt.SchlussfolgerungHinsichtlich der dauerhaften Erfolgsquote stellt die minimalinvasive Zystendestruktion weder in unserer Untersuchung noch im Literaturreview eine Konkurrenz zur mikrochirurgischen Zystenresektion dar.AbstractBackgroundMicrosurgical resection is the standard treatment of lumbar juxtafacet cysts. Percutaneous computed tomography (CT) guided destruction of the cyst could be an alternative modality for inoperable patients. Comparative prospective studies for both treatment strategies do not exist.Materials and methodsThis study involved a non-randomized, prospective trial on 45xa0patients suffering from sciatica or claudication caused by lumbar juxtafacet cysts. Of the patients 25 were operated on microsurgically and 20 patients were primarily treated using percutaneous CT-guided cyst destruction.ResultsThe treatment in both groups was performed without complications in all patients. All patients treated microsurgically were pain-free (mean postoperative interval 27xa0months) but only 8 out of 20xa0patients treated percutaneously recovered completely (mean post-treatment interval 24xa0months). The remaining 12 out of 20xa0patients showed no relevant improvement and were operated on microsurgically.ConclusionMinimally invasive cyst destruction is not a viable alternative to microsurgical resection considering the long-term outcome, neither in this study nor in the reviewed literature.BACKGROUNDnMicrosurgical resection is the standard treatment of lumbar juxtafacet cysts. Percutaneous computed tomography (CT) guided destruction of the cyst could be an alternative modality for inoperable patients. Comparative prospective studies for both treatment strategies do not exist.nnnMATERIALS AND METHODSnThis study involved a non-randomized, prospective trial on 45xa0patients suffering from sciatica or claudication caused by lumbar juxtafacet cysts. Of the patients 25 were operated on microsurgically and 20 patients were primarily treated using percutaneous CT-guided cyst destruction.nnnRESULTSnThe treatment in both groups was performed without complications in all patients. All patients treated microsurgically were pain-free (mean postoperative interval 27xa0months) but only 8 out of 20xa0patients treated percutaneously recovered completely (mean post-treatment interval 24xa0months). The remaining 12 out of 20xa0patients showed no relevant improvement and were operated on microsurgically.nnnCONCLUSIONnMinimally invasive cyst destruction is not a viable alternative to microsurgical resection considering the long-term outcome, neither in this study nor in the reviewed literature.

Perkutane CT-gesteuerte Destruktion vs. mikrochirurgische Resektion lumbaler Juxtafacettzysten

ZusammenfassungHintergrundZur Behandlung lumbaler Juxtafacettzysten ist die mikrochirurgische Resektion etabliert. Perkutane Zystendestruktionen stellen u.xa0U. eine Alternative dar. Die Wertigkeit der CT-gesteuerten Destruktion gegenüber der operativen Therapie ist bislang durch prospektive Untersuchungen nicht bestimmt worden.Material und MethodenEs handelt sich um eine prospektive, nichtrandomisierte Verlaufsstudie an 45xa0Patienten; 25xa0Patienten wurden operiert (Gruppexa0A), 20xa0Patienten perkutan durch Zystendestruktion behandelt (Gruppexa0B).ErgebnisseDie Behandlung verlief in allen 45 Fällen komplikationslos. In Gruppexa0A waren im medianen Nachuntersuchungsintervall von 27xa0Monaten alle Patienten beschwerdefrei. In Gruppexa0B waren im Nachuntersuchungsintervall von 23xa0Monaten 8xa0Patienten beschwerdefrei. Zwölf Patienten wurden wegen persistierender Radikulopathie im weiteren Verlauf operativ behandelt.SchlussfolgerungHinsichtlich der dauerhaften Erfolgsquote stellt die minimalinvasive Zystendestruktion weder in unserer Untersuchung noch im Literaturreview eine Konkurrenz zur mikrochirurgischen Zystenresektion dar.AbstractBackgroundMicrosurgical resection is the standard treatment of lumbar juxtafacet cysts. Percutaneous computed tomography (CT) guided destruction of the cyst could be an alternative modality for inoperable patients. Comparative prospective studies for both treatment strategies do not exist.Materials and methodsThis study involved a non-randomized, prospective trial on 45xa0patients suffering from sciatica or claudication caused by lumbar juxtafacet cysts. Of the patients 25 were operated on microsurgically and 20 patients were primarily treated using percutaneous CT-guided cyst destruction.ResultsThe treatment in both groups was performed without complications in all patients. All patients treated microsurgically were pain-free (mean postoperative interval 27xa0months) but only 8 out of 20xa0patients treated percutaneously recovered completely (mean post-treatment interval 24xa0months). The remaining 12 out of 20xa0patients showed no relevant improvement and were operated on microsurgically.ConclusionMinimally invasive cyst destruction is not a viable alternative to microsurgical resection considering the long-term outcome, neither in this study nor in the reviewed literature.BACKGROUNDnMicrosurgical resection is the standard treatment of lumbar juxtafacet cysts. Percutaneous computed tomography (CT) guided destruction of the cyst could be an alternative modality for inoperable patients. Comparative prospective studies for both treatment strategies do not exist.nnnMATERIALS AND METHODSnThis study involved a non-randomized, prospective trial on 45xa0patients suffering from sciatica or claudication caused by lumbar juxtafacet cysts. Of the patients 25 were operated on microsurgically and 20 patients were primarily treated using percutaneous CT-guided cyst destruction.nnnRESULTSnThe treatment in both groups was performed without complications in all patients. All patients treated microsurgically were pain-free (mean postoperative interval 27xa0months) but only 8 out of 20xa0patients treated percutaneously recovered completely (mean post-treatment interval 24xa0months). The remaining 12 out of 20xa0patients showed no relevant improvement and were operated on microsurgically.nnnCONCLUSIONnMinimally invasive cyst destruction is not a viable alternative to microsurgical resection considering the long-term outcome, neither in this study nor in the reviewed literature.

PEEK-Cage-Fusion nach anteriorer zervikaler Korporektomie

ZusammenfassungHintergrundDie anteriore zervikale Korporektomie und Fusion (ACCF) ist zur Dekompression der mehrsegmentalen Spinalkanalstenose mit spondylotischer Myelopathie etabliert. Neben auto- und heterologen Knochentransplantaten sowie Titanimplantaten kommen zur Fusion der dekomprimierten Segmente in den letzten Jahren zunehmend auch PEEK(Polyetheretherketon)-Cages zur Anwendung. Die Datenlage in der Literatur zur Anwendungssicherheit und den klinischen sowie radiologischen Ergebnissen ist jedoch noch dünn und widersprüchlich. Die vorliegende Studie stellt die größte bislang publizierte Serie von PEEK-Cage-Fusionen nach ACCF dar.Material und MethodenRetrospektive Aufarbeitung eines ACCF-Kollektivs mit plattenaugmentiertem PEEK-Cage bei 101 Patienten mit mehrsegmentaler zervikaler Spinalkanalstenose und zervikaler Myelopathie. Es wurden die Häufigkeiten postoperativer Implantatkomplikationen und implantatbedingter Revisionen innerhalb des 6‑Monats-Intervalls nach Operation bestimmt. Analysiert wurden zudem Sagittalparameter (Sinterung, segmentale und regionale Lordose) sowie die CT-Fusionsrate. Als klinische Ergebnisparameter wurden der Europäische Myelopathie Score (EMS) und der Neck Disability Index (NDI) herangezogen.ErgebnisseIn 8/101 Fällen ist es zu Schraubenkomplikationen (Lockerung, Ausriss oder Bruch) gekommen. In 3/101 Fällen wurden implantatbedingte Revisionseingriffe nötig (allesamt wegen Dislokationen des Cages). Eine relevante Sinterung des Cages (Distraktionsverlust >3xa0mm) fand sich in 12u2009% der Fälle. Die Fusionsrate nach 6xa0Monaten lag bei 82u2009% der Fälle. Die segmentale und regionale (C2–C7) Lordose verbesserte sich signifikant durch den Eingriff. EMS und NDI verbesserten sich ebenfalls signifikant.DiskussionPEEK-Cages sind eine klinisch sowie radiologisch vergleichbar effektive und sichere Alternative zur ACCF gegenüber Titancages und Knochentransplantaten. Die kumulierten Komplikationsraten für PEEK-Cages unterscheiden sich kaum von den publizierten Daten für Knochen- oder Titan-Cage-Fusionen (Pseudarthroserate 13u2009% vs. 5–15u2009%; implantatbedingte Revisionen 4u2009% vs. 5–75u2009%).AbstractBackgroundAnterior cervical corpectomy and fusion (ACCF) has become axa0standard procedure for patients with spondylotic myelopathy due to multisegmental stenosis of the cervical canal. In addition to the fusion technique using autogenous bone grafts and titanium implants, synthetic polyetheretherketone (PEEK) cages have been used increasingly during the last years. However, limited evidence on the clinical and radiological results of PEEK cages for ACCF exists in the literature. The study presented here is the largest series to date reporting clinical and radiological outcome as well as complication rates after one to three-level ACCF using PEEK cages augmented by an anterior plate-screw osteosynthesis.Materials and methodsRetrospective study on 101 patients after stand-alone PEEK cage-ACCF with axa0minimum follow-up of 6xa0months. The number of hardware failures and implant-related surgical revisions were determined. The rate of subsidence and fusion and the course of lordotic alignment were analysed. The neck disability index (NDI) and the European myelopathy score (EMS) were assessed.ResultsScrew complications were detected in 8/101 cases and 3xa0cases of cage dislocation occurred, resulting in ann overall implant related revision rate of 2.9u2009% (all revision cases showed cage dislocation). The rate of cagen subsidence >3xa0mm was 12u2009% and solid fusion was achieved in 82u2009% of the patients. NDI, EMS and lordotic alignment improved significantly.ConclusionsPEEK cages are axa0safe and effective alternative to titanium cages or autogenous bone graft for ACCF. Further randomized evaluation of different fusion techniques in ACCF is still necessary.BACKGROUNDnAnterior cervical corpectomy and fusion (ACCF) has become axa0standard procedure for patients with spondylotic myelopathy due to multisegmental stenosis of the cervical canal. In addition to the fusion technique using autogenous bone grafts and titanium implants, synthetic polyetheretherketone (PEEK) cages have been used increasingly during the last years. However, limited evidence on the clinical and radiological results of PEEK cages for ACCF exists in the literature. The study presented here is the largest series to date reporting clinical and radiological outcome as well as complication rates after one to three-level ACCF using PEEK cages augmented by an anterior plate-screw osteosynthesis.nnnMATERIALS AND METHODSnRetrospective study on 101 patients after stand-alone PEEK cage-ACCF with axa0minimum follow-up of 6xa0months. The number of hardware failures and implant-related surgical revisions were determined. The rate of subsidence and fusion and the course of lordotic alignment were analysed. The neck disability index (NDI) and the European myelopathy score (EMS) were assessed.nnnRESULTSnScrew complications were detected in 8/101 cases and 3xa0cases of cage dislocation occurred, resulting in an overall implant related revision rate of 2.9u2009% (all revision cases showed cage dislocation). The rate of cage subsidence >3xa0mm was 12u2009% and solid fusion was achieved in 82u2009% of the patients. NDI, EMS and lordotic alignment improved significantly.nnnCONCLUSIONSnPEEK cages are axa0safe and effective alternative to titanium cages or autogenous bone graft for ACCF. Further randomized evaluation of different fusion techniques in ACCF is still necessary.

[PEEK cage fusion after anterior cervical corpectomy : Clinical and radiological results in patients with spondylotic myelopathy].

ZusammenfassungHintergrundDie anteriore zervikale Korporektomie und Fusion (ACCF) ist zur Dekompression der mehrsegmentalen Spinalkanalstenose mit spondylotischer Myelopathie etabliert. Neben auto- und heterologen Knochentransplantaten sowie Titanimplantaten kommen zur Fusion der dekomprimierten Segmente in den letzten Jahren zunehmend auch PEEK(Polyetheretherketon)-Cages zur Anwendung. Die Datenlage in der Literatur zur Anwendungssicherheit und den klinischen sowie radiologischen Ergebnissen ist jedoch noch dünn und widersprüchlich. Die vorliegende Studie stellt die größte bislang publizierte Serie von PEEK-Cage-Fusionen nach ACCF dar.Material und MethodenRetrospektive Aufarbeitung eines ACCF-Kollektivs mit plattenaugmentiertem PEEK-Cage bei 101 Patienten mit mehrsegmentaler zervikaler Spinalkanalstenose und zervikaler Myelopathie. Es wurden die Häufigkeiten postoperativer Implantatkomplikationen und implantatbedingter Revisionen innerhalb des 6‑Monats-Intervalls nach Operation bestimmt. Analysiert wurden zudem Sagittalparameter (Sinterung, segmentale und regionale Lordose) sowie die CT-Fusionsrate. Als klinische Ergebnisparameter wurden der Europäische Myelopathie Score (EMS) und der Neck Disability Index (NDI) herangezogen.ErgebnisseIn 8/101 Fällen ist es zu Schraubenkomplikationen (Lockerung, Ausriss oder Bruch) gekommen. In 3/101 Fällen wurden implantatbedingte Revisionseingriffe nötig (allesamt wegen Dislokationen des Cages). Eine relevante Sinterung des Cages (Distraktionsverlust >3xa0mm) fand sich in 12u2009% der Fälle. Die Fusionsrate nach 6xa0Monaten lag bei 82u2009% der Fälle. Die segmentale und regionale (C2–C7) Lordose verbesserte sich signifikant durch den Eingriff. EMS und NDI verbesserten sich ebenfalls signifikant.DiskussionPEEK-Cages sind eine klinisch sowie radiologisch vergleichbar effektive und sichere Alternative zur ACCF gegenüber Titancages und Knochentransplantaten. Die kumulierten Komplikationsraten für PEEK-Cages unterscheiden sich kaum von den publizierten Daten für Knochen- oder Titan-Cage-Fusionen (Pseudarthroserate 13u2009% vs. 5–15u2009%; implantatbedingte Revisionen 4u2009% vs. 5–75u2009%).AbstractBackgroundAnterior cervical corpectomy and fusion (ACCF) has become axa0standard procedure for patients with spondylotic myelopathy due to multisegmental stenosis of the cervical canal. In addition to the fusion technique using autogenous bone grafts and titanium implants, synthetic polyetheretherketone (PEEK) cages have been used increasingly during the last years. However, limited evidence on the clinical and radiological results of PEEK cages for ACCF exists in the literature. The study presented here is the largest series to date reporting clinical and radiological outcome as well as complication rates after one to three-level ACCF using PEEK cages augmented by an anterior plate-screw osteosynthesis.Materials and methodsRetrospective study on 101 patients after stand-alone PEEK cage-ACCF with axa0minimum follow-up of 6xa0months. The number of hardware failures and implant-related surgical revisions were determined. The rate of subsidence and fusion and the course of lordotic alignment were analysed. The neck disability index (NDI) and the European myelopathy score (EMS) were assessed.ResultsScrew complications were detected in 8/101 cases and 3xa0cases of cage dislocation occurred, resulting in ann overall implant related revision rate of 2.9u2009% (all revision cases showed cage dislocation). The rate of cagen subsidence >3xa0mm was 12u2009% and solid fusion was achieved in 82u2009% of the patients. NDI, EMS and lordotic alignment improved significantly.ConclusionsPEEK cages are axa0safe and effective alternative to titanium cages or autogenous bone graft for ACCF. Further randomized evaluation of different fusion techniques in ACCF is still necessary.BACKGROUNDnAnterior cervical corpectomy and fusion (ACCF) has become axa0standard procedure for patients with spondylotic myelopathy due to multisegmental stenosis of the cervical canal. In addition to the fusion technique using autogenous bone grafts and titanium implants, synthetic polyetheretherketone (PEEK) cages have been used increasingly during the last years. However, limited evidence on the clinical and radiological results of PEEK cages for ACCF exists in the literature. The study presented here is the largest series to date reporting clinical and radiological outcome as well as complication rates after one to three-level ACCF using PEEK cages augmented by an anterior plate-screw osteosynthesis.nnnMATERIALS AND METHODSnRetrospective study on 101 patients after stand-alone PEEK cage-ACCF with axa0minimum follow-up of 6xa0months. The number of hardware failures and implant-related surgical revisions were determined. The rate of subsidence and fusion and the course of lordotic alignment were analysed. The neck disability index (NDI) and the European myelopathy score (EMS) were assessed.nnnRESULTSnScrew complications were detected in 8/101 cases and 3xa0cases of cage dislocation occurred, resulting in an overall implant related revision rate of 2.9u2009% (all revision cases showed cage dislocation). The rate of cage subsidence >3xa0mm was 12u2009% and solid fusion was achieved in 82u2009% of the patients. NDI, EMS and lordotic alignment improved significantly.nnnCONCLUSIONSnPEEK cages are axa0safe and effective alternative to titanium cages or autogenous bone graft for ACCF. Further randomized evaluation of different fusion techniques in ACCF is still necessary.

Wirbelsäulenchirurgie unter den Bedingungen eines militärischen Auslandseinsatzes@@@Spine surgery in a combat support hospital

ZusammenfassungHintergrund und ZielSeit 2007 steht im Einsatzlazarett der Internationalen Sicherheitsunterstützungstruppe (ISAF) in Mazar-e-Sharif (MeS) ein kontinuierlicher neurotraumatologischer Bereitschaftsdienst zur Verfügung. Es soll eine Einschätzung über Anzahl und Spektrum der wirbelsäulenchirurgischen Eingriffe über den Einsatzzeitraum 2007–2014 getroffen werden.MethodeHierzu wurden die Operationszahlen dieser Phase retrospektiv ausgewertet. Zudem wurde das ambulante Spektrum spinaler Erkrankungen aus den Jahren 2012 und 2013 ausgewertet.ResultateIm Zeitraum Juli 2007 bis Oktober 2014 wurden insgesamt 341xa0Patienten operiert, dabei erfolgten 188 der Eingriffe (55,1u2009%) an der Wirbelsäule. Eingriffe bei degenerativen Erkrankungen stellten insgesamt die Mehrzahl der Operationen dar (127/188; 67,6u2009%). Der Anteil von Frakturen und Penetrationsverletzungen (61/188; 32,4u2009%) war über den Beobachtungszeitraum ansteigend. Unter den innerhalb von 12xa0h zu operierenden Patienten (nu2009=u200970) machten diese Diagnosen 80u2009% der Fälle aus. Von den spinalen Eingriffen erfolgten 19,8u2009% sofort, 17,3u2009% mit aufgeschobener Dringlichkeit und 62,9u2009% elektiv. Wirbelsäulenchirurgische Fragestellungen betrafen 82u2009% der 1026 ambulanten Konsultationen.DiskussionIm Vergleich zu den publizierten Fallzahlen der wirbelsäulenchirurgischen Eingriffe im übrigen ISAF-Gebiet zeigt sich ein deutlich geringeres gesamtes operatives Aufkommen in MeS. Die Rate an elektiven Operationen und an afghanischen Zivilpatienten ist in MeS jedoch am höchsten. Die Verteilung des operativen Spektrums im Vergleich zu den anderen ISAF-Lazaretten zeigt nirgends sonst einen derart starken Schwerpunkt im Bereich der degenerativen Wirbelsäule wie in MeS. Gleichwohl stellt das veränderte Spektrum an spinalchirurgischen Diagnosen und Therapien in diesem Konflikt eine Herausforderung für zukünftige Ausbildungs- und Materialplanungen in vergleichbaren Einsatzszenarien dar.AbstractBackground and aimFrom July 2007 to October 2014, neurosurgical services have been continuously available in a multinational Role 3 combat support hospital in Mazar-e-Sharif (MeS), Afghanistan. In this paper, we analyze a 7-year operative and outpatient spinal surgery caseload experience.Materials and methodsThe overall annual and monthly caseloads were determined. Additionally, the surgical cases were differentiated relating to the strength of the indication, the location of the surgical site, and the origin of the patients. The outpatient caseload and spectrum of the years 2012 and 2013 were also analyzed.ResultsA total of 341 surgeries were performed and 188 of them were spinal surgeries (55.1u2009%). The vast majority of surgeries were performed for degenerative diseases (127/188; 67.6u2009%). The proportion of fractures and penetrating injuries (61/188; 32.4%) increased over the observation period. Eighty percent of the immediate and urgent surgeries (within 12xa0h; nu2009=u200970) were performed for these indications. 19.8u2009% of the surgeries were done as an emergency, whereas 17.3u2009% had delayed urgency, and 62.9u2009% were elective procedures. Of the 1026 outpatient consultations documented, 82u2009% of them were related to spinal diseases.ConclusionsThe overall caseload in addition to the distribution of location, strength of indication, and patient origin for MeS are significantly lower than that reported by other International Security Assistance Force (ISAF) nations in eastern and southern Afghanistan. In addition, the rate of elective surgeries and those carried out in civilian Afghan patients is highest in MeS. In comparison with MeS, none of the other ISAF military hospitals shows such a strong concentration of degenerative spinal conditions in their surgical spectrum. Nevertheless, the changing pattern of spine-related diagnoses and surgical therapies in the current conflict represents a challenge for future educational and material planning in comparable missions.BACKGROUND AND AIMnFrom July 2007 to October 2014, neurosurgical services have been continuously available in a multinational Role 3 combat support hospital in Mazar-e-Sharif (MeS), Afghanistan. In this paper, we analyze a 7-year operative and outpatient spinal surgery caseload experience.nnnMATERIALS AND METHODSnThe overall annual and monthly caseloads were determined. Additionally, the surgical cases were differentiated relating to the strength of the indication, the location of the surgical site, and the origin of the patients. The outpatient caseload and spectrum of the years 2012 and 2013 were also analyzed.nnnRESULTSnA total of 341 surgeries were performed and 188 of them were spinal surgeries (55.1u2009%). The vast majority of surgeries were performed for degenerative diseases (127/188; 67.6u2009%). The proportion of fractures and penetrating injuries (61/188; 32.4%) increased over the observation period. Eighty percent of the immediate and urgent surgeries (within 12xa0h; nu2009=u200970) were performed for these indications. 19.8u2009% of the surgeries were done as an emergency, whereas 17.3u2009% had delayed urgency, and 62.9u2009% were elective procedures. Of the 1026 outpatient consultations documented, 82u2009% of them were related to spinal diseases.nnnCONCLUSIONSnThe overall caseload in addition to the distribution of location, strength of indication, and patient origin for MeS are significantly lower than that reported by other International Security Assistance Force (ISAF) nations in eastern and southern Afghanistan. In addition, the rate of elective surgeries and those carried out in civilian Afghan patients is highest in MeS. In comparison with MeS, none of the other ISAF military hospitals shows such a strong concentration of degenerative spinal conditions in their surgical spectrum. Nevertheless, the changing pattern of spine-related diagnoses and surgical therapies in the current conflict represents a challenge for future educational and material planning in comparable missions.

Spine surgery in a combat support hospital

ZusammenfassungHintergrund und ZielSeit 2007 steht im Einsatzlazarett der Internationalen Sicherheitsunterstützungstruppe (ISAF) in Mazar-e-Sharif (MeS) ein kontinuierlicher neurotraumatologischer Bereitschaftsdienst zur Verfügung. Es soll eine Einschätzung über Anzahl und Spektrum der wirbelsäulenchirurgischen Eingriffe über den Einsatzzeitraum 2007–2014 getroffen werden.MethodeHierzu wurden die Operationszahlen dieser Phase retrospektiv ausgewertet. Zudem wurde das ambulante Spektrum spinaler Erkrankungen aus den Jahren 2012 und 2013 ausgewertet.ResultateIm Zeitraum Juli 2007 bis Oktober 2014 wurden insgesamt 341xa0Patienten operiert, dabei erfolgten 188 der Eingriffe (55,1u2009%) an der Wirbelsäule. Eingriffe bei degenerativen Erkrankungen stellten insgesamt die Mehrzahl der Operationen dar (127/188; 67,6u2009%). Der Anteil von Frakturen und Penetrationsverletzungen (61/188; 32,4u2009%) war über den Beobachtungszeitraum ansteigend. Unter den innerhalb von 12xa0h zu operierenden Patienten (nu2009=u200970) machten diese Diagnosen 80u2009% der Fälle aus. Von den spinalen Eingriffen erfolgten 19,8u2009% sofort, 17,3u2009% mit aufgeschobener Dringlichkeit und 62,9u2009% elektiv. Wirbelsäulenchirurgische Fragestellungen betrafen 82u2009% der 1026 ambulanten Konsultationen.DiskussionIm Vergleich zu den publizierten Fallzahlen der wirbelsäulenchirurgischen Eingriffe im übrigen ISAF-Gebiet zeigt sich ein deutlich geringeres gesamtes operatives Aufkommen in MeS. Die Rate an elektiven Operationen und an afghanischen Zivilpatienten ist in MeS jedoch am höchsten. Die Verteilung des operativen Spektrums im Vergleich zu den anderen ISAF-Lazaretten zeigt nirgends sonst einen derart starken Schwerpunkt im Bereich der degenerativen Wirbelsäule wie in MeS. Gleichwohl stellt das veränderte Spektrum an spinalchirurgischen Diagnosen und Therapien in diesem Konflikt eine Herausforderung für zukünftige Ausbildungs- und Materialplanungen in vergleichbaren Einsatzszenarien dar.AbstractBackground and aimFrom July 2007 to October 2014, neurosurgical services have been continuously available in a multinational Role 3 combat support hospital in Mazar-e-Sharif (MeS), Afghanistan. In this paper, we analyze a 7-year operative and outpatient spinal surgery caseload experience.Materials and methodsThe overall annual and monthly caseloads were determined. Additionally, the surgical cases were differentiated relating to the strength of the indication, the location of the surgical site, and the origin of the patients. The outpatient caseload and spectrum of the years 2012 and 2013 were also analyzed.ResultsA total of 341 surgeries were performed and 188 of them were spinal surgeries (55.1u2009%). The vast majority of surgeries were performed for degenerative diseases (127/188; 67.6u2009%). The proportion of fractures and penetrating injuries (61/188; 32.4%) increased over the observation period. Eighty percent of the immediate and urgent surgeries (within 12xa0h; nu2009=u200970) were performed for these indications. 19.8u2009% of the surgeries were done as an emergency, whereas 17.3u2009% had delayed urgency, and 62.9u2009% were elective procedures. Of the 1026 outpatient consultations documented, 82u2009% of them were related to spinal diseases.ConclusionsThe overall caseload in addition to the distribution of location, strength of indication, and patient origin for MeS are significantly lower than that reported by other International Security Assistance Force (ISAF) nations in eastern and southern Afghanistan. In addition, the rate of elective surgeries and those carried out in civilian Afghan patients is highest in MeS. In comparison with MeS, none of the other ISAF military hospitals shows such a strong concentration of degenerative spinal conditions in their surgical spectrum. Nevertheless, the changing pattern of spine-related diagnoses and surgical therapies in the current conflict represents a challenge for future educational and material planning in comparable missions.BACKGROUND AND AIMnFrom July 2007 to October 2014, neurosurgical services have been continuously available in a multinational Role 3 combat support hospital in Mazar-e-Sharif (MeS), Afghanistan. In this paper, we analyze a 7-year operative and outpatient spinal surgery caseload experience.nnnMATERIALS AND METHODSnThe overall annual and monthly caseloads were determined. Additionally, the surgical cases were differentiated relating to the strength of the indication, the location of the surgical site, and the origin of the patients. The outpatient caseload and spectrum of the years 2012 and 2013 were also analyzed.nnnRESULTSnA total of 341 surgeries were performed and 188 of them were spinal surgeries (55.1u2009%). The vast majority of surgeries were performed for degenerative diseases (127/188; 67.6u2009%). The proportion of fractures and penetrating injuries (61/188; 32.4%) increased over the observation period. Eighty percent of the immediate and urgent surgeries (within 12xa0h; nu2009=u200970) were performed for these indications. 19.8u2009% of the surgeries were done as an emergency, whereas 17.3u2009% had delayed urgency, and 62.9u2009% were elective procedures. Of the 1026 outpatient consultations documented, 82u2009% of them were related to spinal diseases.nnnCONCLUSIONSnThe overall caseload in addition to the distribution of location, strength of indication, and patient origin for MeS are significantly lower than that reported by other International Security Assistance Force (ISAF) nations in eastern and southern Afghanistan. In addition, the rate of elective surgeries and those carried out in civilian Afghan patients is highest in MeS. In comparison with MeS, none of the other ISAF military hospitals shows such a strong concentration of degenerative spinal conditions in their surgical spectrum. Nevertheless, the changing pattern of spine-related diagnoses and surgical therapies in the current conflict represents a challenge for future educational and material planning in comparable missions.

Wirbelsäulenchirurgie unter den Bedingungen eines militärischen Auslandseinsatzes

ZusammenfassungHintergrund und ZielSeit 2007 steht im Einsatzlazarett der Internationalen Sicherheitsunterstützungstruppe (ISAF) in Mazar-e-Sharif (MeS) ein kontinuierlicher neurotraumatologischer Bereitschaftsdienst zur Verfügung. Es soll eine Einschätzung über Anzahl und Spektrum der wirbelsäulenchirurgischen Eingriffe über den Einsatzzeitraum 2007–2014 getroffen werden.MethodeHierzu wurden die Operationszahlen dieser Phase retrospektiv ausgewertet. Zudem wurde das ambulante Spektrum spinaler Erkrankungen aus den Jahren 2012 und 2013 ausgewertet.ResultateIm Zeitraum Juli 2007 bis Oktober 2014 wurden insgesamt 341xa0Patienten operiert, dabei erfolgten 188 der Eingriffe (55,1u2009%) an der Wirbelsäule. Eingriffe bei degenerativen Erkrankungen stellten insgesamt die Mehrzahl der Operationen dar (127/188; 67,6u2009%). Der Anteil von Frakturen und Penetrationsverletzungen (61/188; 32,4u2009%) war über den Beobachtungszeitraum ansteigend. Unter den innerhalb von 12xa0h zu operierenden Patienten (nu2009=u200970) machten diese Diagnosen 80u2009% der Fälle aus. Von den spinalen Eingriffen erfolgten 19,8u2009% sofort, 17,3u2009% mit aufgeschobener Dringlichkeit und 62,9u2009% elektiv. Wirbelsäulenchirurgische Fragestellungen betrafen 82u2009% der 1026 ambulanten Konsultationen.DiskussionIm Vergleich zu den publizierten Fallzahlen der wirbelsäulenchirurgischen Eingriffe im übrigen ISAF-Gebiet zeigt sich ein deutlich geringeres gesamtes operatives Aufkommen in MeS. Die Rate an elektiven Operationen und an afghanischen Zivilpatienten ist in MeS jedoch am höchsten. Die Verteilung des operativen Spektrums im Vergleich zu den anderen ISAF-Lazaretten zeigt nirgends sonst einen derart starken Schwerpunkt im Bereich der degenerativen Wirbelsäule wie in MeS. Gleichwohl stellt das veränderte Spektrum an spinalchirurgischen Diagnosen und Therapien in diesem Konflikt eine Herausforderung für zukünftige Ausbildungs- und Materialplanungen in vergleichbaren Einsatzszenarien dar.AbstractBackground and aimFrom July 2007 to October 2014, neurosurgical services have been continuously available in a multinational Role 3 combat support hospital in Mazar-e-Sharif (MeS), Afghanistan. In this paper, we analyze a 7-year operative and outpatient spinal surgery caseload experience.Materials and methodsThe overall annual and monthly caseloads were determined. Additionally, the surgical cases were differentiated relating to the strength of the indication, the location of the surgical site, and the origin of the patients. The outpatient caseload and spectrum of the years 2012 and 2013 were also analyzed.ResultsA total of 341 surgeries were performed and 188 of them were spinal surgeries (55.1u2009%). The vast majority of surgeries were performed for degenerative diseases (127/188; 67.6u2009%). The proportion of fractures and penetrating injuries (61/188; 32.4%) increased over the observation period. Eighty percent of the immediate and urgent surgeries (within 12xa0h; nu2009=u200970) were performed for these indications. 19.8u2009% of the surgeries were done as an emergency, whereas 17.3u2009% had delayed urgency, and 62.9u2009% were elective procedures. Of the 1026 outpatient consultations documented, 82u2009% of them were related to spinal diseases.ConclusionsThe overall caseload in addition to the distribution of location, strength of indication, and patient origin for MeS are significantly lower than that reported by other International Security Assistance Force (ISAF) nations in eastern and southern Afghanistan. In addition, the rate of elective surgeries and those carried out in civilian Afghan patients is highest in MeS. In comparison with MeS, none of the other ISAF military hospitals shows such a strong concentration of degenerative spinal conditions in their surgical spectrum. Nevertheless, the changing pattern of spine-related diagnoses and surgical therapies in the current conflict represents a challenge for future educational and material planning in comparable missions.BACKGROUND AND AIMnFrom July 2007 to October 2014, neurosurgical services have been continuously available in a multinational Role 3 combat support hospital in Mazar-e-Sharif (MeS), Afghanistan. In this paper, we analyze a 7-year operative and outpatient spinal surgery caseload experience.nnnMATERIALS AND METHODSnThe overall annual and monthly caseloads were determined. Additionally, the surgical cases were differentiated relating to the strength of the indication, the location of the surgical site, and the origin of the patients. The outpatient caseload and spectrum of the years 2012 and 2013 were also analyzed.nnnRESULTSnA total of 341 surgeries were performed and 188 of them were spinal surgeries (55.1u2009%). The vast majority of surgeries were performed for degenerative diseases (127/188; 67.6u2009%). The proportion of fractures and penetrating injuries (61/188; 32.4%) increased over the observation period. Eighty percent of the immediate and urgent surgeries (within 12xa0h; nu2009=u200970) were performed for these indications. 19.8u2009% of the surgeries were done as an emergency, whereas 17.3u2009% had delayed urgency, and 62.9u2009% were elective procedures. Of the 1026 outpatient consultations documented, 82u2009% of them were related to spinal diseases.nnnCONCLUSIONSnThe overall caseload in addition to the distribution of location, strength of indication, and patient origin for MeS are significantly lower than that reported by other International Security Assistance Force (ISAF) nations in eastern and southern Afghanistan. In addition, the rate of elective surgeries and those carried out in civilian Afghan patients is highest in MeS. In comparison with MeS, none of the other ISAF military hospitals shows such a strong concentration of degenerative spinal conditions in their surgical spectrum. Nevertheless, the changing pattern of spine-related diagnoses and surgical therapies in the current conflict represents a challenge for future educational and material planning in comparable missions.

Selektive dorsale Dekompression der degenerativen Zervikalstenose@@@Selective dorsal decompression of degenerative cervical canal stenosis

ZusammenfassungHintergrundAuslöser einer therapiebedürftigen zentralen Zervikalstenose kann eine Hypertrophie des dorsalen Bandapparats sein. Für derartige Stenosen stellen selektive Dekompressionsoperationen ohne Stabilisation und Fusion u.xa0U. eine ausreichende Alternative dar.Material und MethodenVorgelegt wird eine Beobachtungsstudie an 17xa0Patienten, die mit einer selektiven Flavektomie und einem „undercutting“ der Laminae und medialen Gelenkportionen behandelt wurden. Verglichen wurden die Parameter Japanese-Orthopedic-Association(JOA)-Score, Neck Pain Disability Index (NPDI) und Arm- sowie Nackenschmerz auf der visuellen Analogskala (VAS) prä- und postoperativ bis zum medianen Nachuntersuchungsintervall von 14xa0Monaten (Minimum 12xa0Monate). Das Ausmaß der Dekompression und der Nachbarsegmentdegeneration wurde mittels MRT bestimmt. Die segmentale und regionale Lordose sowie der Range of Motion (ROM) HWK2–7 prä- und postoperativ wurden mit der Cobb-Methode anhand seitlicher HWS-Röntgenaufnahmen bestimmt.ErgebnisseDie Behandlung verlief in allen 17 Fällen komplikationslos, es mussten keine Revisionen vorgenommen werden. Alle klinischen Parameter besserten sich von präoperativ bis zum letzten Kontrollzeitpunkt signifikant. Bildmorphologisch ergaben sich in allen Fällen eine signifikante Reduktion der Stenose und keine Zunahme der Myelopathie (im T2-MRT). Die sagittalen Parameter blieben ebenso wie der Schweregrad der Nachbarsegmentdegeneration unverändert.DiskussionDie klinischen und radiologischen Ergebnisse dieser Nonfusionstechnik sind für diese spezielle Indikation mindestens konkurrenzfähig zu den publizierten Ergebnissen der Laminektomie und Fusion sowie zur Laminoplastie.AbstractBackgroundHypertrophy of the dorsal ligaments is one reason for central stenosis of the cervical spinal canal. Selective decompression techniques without stabilization and fusion could be a sufficient alternative surgical treatment option.Material and methodsThis article presents the results of an observational study on 17 patients after treatment with selective decompression and undercutting of the cervical laminae and medial joint portion. The Japanese Orthopedic Association (JOA) score, the neck pain disability index (NPDI) and arm and neck pain on a visual analogue scale (VAS) were compared preoperatively and postoperatively (mean follow-up period was 14xa0months, minimum 12xa0months). The reduction of the stenosis and degree of adjacent level disease were measured using presurgical and postsurgical magnetic resonance imaging (MRI). The segmental and regional lordosis and range of motion were determined using the Cobb method on plain standing lateral radiographs.ResultsThere were no complications and no revision surgery was necessary. All clinical parameters improved significantly. The stenosis was significantly decompressed and no progression of myelopathy was observed on MRI. The sagittal parameters and degree of adjacent level degeneration remained unchanged.ConclusionThe clinical and radiological results of this non-fusion technique are convincing. Selective decompression is therefore an alternative to laminectomy and fusion as well as laminoplasty.

Selective dorsal decompression of degenerative cervical canal stenosis

ZusammenfassungHintergrundAuslöser einer therapiebedürftigen zentralen Zervikalstenose kann eine Hypertrophie des dorsalen Bandapparats sein. Für derartige Stenosen stellen selektive Dekompressionsoperationen ohne Stabilisation und Fusion u.xa0U. eine ausreichende Alternative dar.Material und MethodenVorgelegt wird eine Beobachtungsstudie an 17xa0Patienten, die mit einer selektiven Flavektomie und einem „undercutting“ der Laminae und medialen Gelenkportionen behandelt wurden. Verglichen wurden die Parameter Japanese-Orthopedic-Association(JOA)-Score, Neck Pain Disability Index (NPDI) und Arm- sowie Nackenschmerz auf der visuellen Analogskala (VAS) prä- und postoperativ bis zum medianen Nachuntersuchungsintervall von 14xa0Monaten (Minimum 12xa0Monate). Das Ausmaß der Dekompression und der Nachbarsegmentdegeneration wurde mittels MRT bestimmt. Die segmentale und regionale Lordose sowie der Range of Motion (ROM) HWK2–7 prä- und postoperativ wurden mit der Cobb-Methode anhand seitlicher HWS-Röntgenaufnahmen bestimmt.ErgebnisseDie Behandlung verlief in allen 17 Fällen komplikationslos, es mussten keine Revisionen vorgenommen werden. Alle klinischen Parameter besserten sich von präoperativ bis zum letzten Kontrollzeitpunkt signifikant. Bildmorphologisch ergaben sich in allen Fällen eine signifikante Reduktion der Stenose und keine Zunahme der Myelopathie (im T2-MRT). Die sagittalen Parameter blieben ebenso wie der Schweregrad der Nachbarsegmentdegeneration unverändert.DiskussionDie klinischen und radiologischen Ergebnisse dieser Nonfusionstechnik sind für diese spezielle Indikation mindestens konkurrenzfähig zu den publizierten Ergebnissen der Laminektomie und Fusion sowie zur Laminoplastie.AbstractBackgroundHypertrophy of the dorsal ligaments is one reason for central stenosis of the cervical spinal canal. Selective decompression techniques without stabilization and fusion could be a sufficient alternative surgical treatment option.Material and methodsThis article presents the results of an observational study on 17 patients after treatment with selective decompression and undercutting of the cervical laminae and medial joint portion. The Japanese Orthopedic Association (JOA) score, the neck pain disability index (NPDI) and arm and neck pain on a visual analogue scale (VAS) were compared preoperatively and postoperatively (mean follow-up period was 14xa0months, minimum 12xa0months). The reduction of the stenosis and degree of adjacent level disease were measured using presurgical and postsurgical magnetic resonance imaging (MRI). The segmental and regional lordosis and range of motion were determined using the Cobb method on plain standing lateral radiographs.ResultsThere were no complications and no revision surgery was necessary. All clinical parameters improved significantly. The stenosis was significantly decompressed and no progression of myelopathy was observed on MRI. The sagittal parameters and degree of adjacent level degeneration remained unchanged.ConclusionThe clinical and radiological results of this non-fusion technique are convincing. Selective decompression is therefore an alternative to laminectomy and fusion as well as laminoplasty.