Carolin Meyer

[Type 2 dens fracture in the elderly and therapy-linked mortality : Conservative or operative treatment].

BACKGROUND Type II fractures of the odontoid process of the axis are the most common injury of the cervical spine in elderly patients. Only little evidence exists on whether elderly patients should be treated conservatively or surgically. MATERIAL AND METHODS The mortality and survival probability of 51 patients were determined in a retrospective study. The range of motion, pain and the neck disability index were clinically investigated. RESULTS Of the 51 patients 37 were treated surgically and 14 conservatively. The conservatively treated group showed a higher mortality (64 % vs. 32 %). Kaplan-Meier analysis revealed a median survival of the conservatively treated group of 29 months, whereby during the first 3 months of treatment this group showed a higher survival probability and afterwards the surgically treated group showed a higher survival probability. The clinical examination of 20 patients revealed limited range of motion of the cervical spine. Additionally, moderate levels of pain and complaints were recorded using the neck disability index. CONCLUSION Fractures of the odontoid process pose a far-reaching danger for elderly patients. A balanced assessment of the general condition should be carried out at the beginning of treatment of these patients. In the early phase following trauma no differences were found with respect to survival rates but for long-term survival the operatively treated group showed advantages; however, these advantages cannot be causally attributed to the choice of therapy.

Whole body vibration (WBV) following spinal cord injury (SCI) in rats: Timing of intervention

BACKGROUND Following spinal cord injury (SCI), exercise training provides a wide range of benefits and promotes activity-dependent synaptic plasticity. Whole body vibration (WBV) in SCI patients improves walking and spasticity as well as bone and muscle mass. However, little is known about the effects of timing or frequency of intervention. OBJECTIVE To determine which WBV-onset improves locomotor and bladder functions and influences synaptic plasticity beneficially. METHODS SCI was followed by WBV starting 1, 7, 14, 28 days after injury (WBV1, WBV7, etc.) and continued for 12 weeks. Intact animals and those receiving SCI but no WBV (No WBV), SCI plus WBV twice daily (2×WBV) and SCI followed by passive hindlimb flexion-extension (PFE) served as controls. Locomotor [BBB rating, foot stepping angle (FSA) and rump-height index (RHI)] as well as bladder function were determined at 1, 3, 6, 9, and 12 weeks. Following perfusion fixation at 12 weeks, lesion volume and immunofluorescence for astrogliosis (GFAP), microglia (IBA1) and synaptic vesicles (synaptophysin, SYN) were determined. RESULTS Compared to the No WBV group, the WB7 and WBV14 groups showed significantly faster speeds of BBB score recovery though this effect was temporary. Considering RHI we detected a sustained improvement in the WBV14 and PFE groups. Bladder function was better in the WBV14, WBV28, 2×WBV and PFE groups. Synaptophysin levels improved in response to WBV7 and WBV14, but worsened after WBV28 in parallel to an increased IBA1 expression. Correlation- and principal components analysis revealed complex relationships between behavioural (BBB, FSA, RHI) and morphological (GFAP, IBA1, SYN) measurements. CONCLUSIONS WBV started 14 days after SCI provides the most benefit (RHI, bladder); starting at 1day after SCI provides no benefit and starting at 28 days may be detrimental. Increasing the intensity of WBV to twice daily did not provide additional benefit.

Typ-II-Densfrakturen des alten Menschen und therapiebedingte Mortalität

BACKGROUND Type II fractures of the odontoid process of the axis are the most common injury of the cervical spine in elderly patients. Only little evidence exists on whether elderly patients should be treated conservatively or surgically. MATERIAL AND METHODS The mortality and survival probability of 51 patients were determined in a retrospective study. The range of motion, pain and the neck disability index were clinically investigated. RESULTS Of the 51 patients 37 were treated surgically and 14 conservatively. The conservatively treated group showed a higher mortality (64 % vs. 32 %). Kaplan-Meier analysis revealed a median survival of the conservatively treated group of 29 months, whereby during the first 3 months of treatment this group showed a higher survival probability and afterwards the surgically treated group showed a higher survival probability. The clinical examination of 20 patients revealed limited range of motion of the cervical spine. Additionally, moderate levels of pain and complaints were recorded using the neck disability index. CONCLUSION Fractures of the odontoid process pose a far-reaching danger for elderly patients. A balanced assessment of the general condition should be carried out at the beginning of treatment of these patients. In the early phase following trauma no differences were found with respect to survival rates but for long-term survival the operatively treated group showed advantages; however, these advantages cannot be causally attributed to the choice of therapy.

The effect of myelotomy following low thoracic spinal cord compression injury in rats

ABSTRACT Myelotomy is a surgical procedure allowing removal of extravasated blood and necrotic tissue that is thought to attenuate secondary injury as well as promote recovery in experimental spinal cord injury (SCI) models and humans. Here we examined in rat whether myelotomy at 48h after low‐thoracic compressive SCI provided any benefit over a 12week period. Compared to animals receiving SCI alone, myelotomy worsened BBB scores (p<0.05) and also did not improve plantar stepping, ladder climbing, urinary bladder voiding or sensory function (thermal latency) during the 12‐week period. Quantitative analyses of tissue sections at 12weeks showed that myelotomy also did not reduce lesion volume nor alter immunohistochemical markers of axons in spared white matter bridges, microglia, astrocytes or serotinergic fibres. However, myelotomy reduced synaptophysin expression, a marker of synaptic plasticity. We conclude that further studies are required to evaluate myelotomy after SCI. (142 words).

Einfluss osteoligamentärer Verletzungen auf die Stabilität des atlantoaxialen Komplexes

Background The odontoid process and the transverse ligament are the most important structures stabilising the atlantoaxial complex. It has not been fully elucidated how injuries of these structures contribute towards instability and a potential narrowing of the spinal canal. Therefore, our investigation aimed to perform a biomechanical analysis of spinal width and dislocation of the odontoid process depending on injuries of the aforementioned structures. Methods In 10 fresh human cadaveric specimens, physiologic flexion and extension were simulated under fluoroscopy in intact specimens and after application of an odontoid process fracture and transverse ligament rupture in a crossover design. The width of the spinal canal and the dislocation of fragments were measured. Results In the intact condition, values of 19.8/19.5/19.8 mm (neutral/flexion/extension) were observed regarding spinal width. After an isolated fracture, values were 18.5/18.9/17.9 mm. With additional ligamentous injury, values changed to 20.3/19.4/22.6 mm. In the second group, values after initial ligament injury were 18.6/16.2/17.3 mm and 16.6/14.1/18.7 mm after fracture. Dislocation of fragments after an isolated fracture averaged 2.2/2.5/2.5 mm; an additional ligamentous injury led to 2.6/2.2/2.2 mm. In the second group, where a ligamentous injury preceded the fracture, a dislocation of 1.5/1.9/3.5 mm was detected after the fracture. Conclusion Neurological disorders have been observed starting at a spinal canal constriction of 2.0 mm. Our results demonstrate that a relevant constriction of the spinal canal may be due to isolated or combined injuries of the bone and the transverse ligament. Furthermore, our results show the importance of posttraumatic immobilisation of the spine with a view to the role of the transverse ligament for stabilisation of the atlantoaxial complex.

The impact of obesity measured by outer abdominal fat on instability of the adjacent segments after rigid pedicle screw fixation

Previous studies have shown coherence between obesity and higher rates of complications following spinal surgery. However, there is a lack of information about the influence of obesity and the mass of outer abdominal fat (OAF) on adjacent segment instability after spinal fusion surgery. Radiographs of 194 patients with spinal fusion surgery were assessed retrospectively. Radiographs were performed after surgery during two years’ follow-up and signs of adjacent segment instability were documented. Patients were classified regarding their BMI and extent of OAF was assessed using CT at the umbilical level. In 20 patients (10.3%) instability of adjacent segments occurred during followup. In this cohort mean OAF was significantly thicker (28.07 mm) compared to the patients without instability (22.39) (P=0.038). A total of 45% of patients with instability showed OAF of more than 30 mm at time of intervention compared to 10% in those without signs of instability. There exists significant correlation between the extent of OAF and development of adjacent segment instability postoperatively. Thus, weight reduction before spinal surgery could potentially decrease risk of adjacent segment instability.

Recovery after spinal cord injury by modulation of the proteoglycan receptor PTPσ

&NA; SCI is followed by dramatic upregulation of chondroitin sulfate proteoglycans (CSPGs) which limit axonal regeneration, oligodendrocyte replacement and remyelination. The recent discovery of the specific CSPGs signaling receptor protein tyrosine phosphatase sigma (RPTP&sgr;) provided an opportunity to refine the therapeutic approach to overcome CSPGs inhibitory actions. In previously published work, subcutaneous (s.c.) delivery of 44 &mgr;g/day of a peptide mimetic of PTP&sgr; called intracellular sigma peptide (ISP), which binds to PTP&sgr; and blocks CSPG‐mediated inhibition, facilitated recovery after contusive SCI. Since this result could be of great interest for clinical trials, we independently repeated this study, but modified the method of injury as well as peptide application and the dosage. Following SCI at the Th10‐segment, 40 rats were distributed in 3 groups. Animals in group 1 (20 rats) were subjected to SCI, but received no treatment. Rats in group 2 were treated with intraperitoneal (i.p.) injections of 44 &mgr;g/day ISP (SCI + ISP44) and animals of group 3 with s.c. injections of 500 &mgr;g/day ISP (SCI + ISP500) for 7 weeks after lesioning. Recovery was analyzed at 1, 3, 6, 9 and 12 weeks after SCI by determining (i) BBB‐score, (ii) foot‐stepping angle, (iii) rump‐height index, (iv) number of correct ladder steps, (v) bladder score and (vi) sensitivity (withdrawal latency after thermal stimulus). Finally, we determined the amount of serotonergic fibers in the preserved neural tissue bridges (PNTB) around the lesion site. Our results show that, systemic therapy with ISP improved locomotor, sensory and vegetative recovery which correlated with more spared serotonergic fibers in PNTB. HighlightsISP was applied two modes: 44 &mgr;g/day i.p. and 500 &mgr;g/day s.c for 7 weeks after SCI.Recovery was analyzed at 1, 3, 6, 9 and 12 weeks after SCI.We determined the spared serotonergic axons in preserved neural tissue bridges (PNTB).Systemic therapy with ISP improved locomotor, sensory and vegetative recovery.This correlated with more spared serotonergic fibers in PNTB

Typ-II-Densfrakturen des alten Menschen und therapiebedingte Mortalität@@@Type 2 dens fracture in the elderly and therapy-linked mortality: Konservative oder operative Behandlung@@@Conservative or operative treatment

BACKGROUND Type II fractures of the odontoid process of the axis are the most common injury of the cervical spine in elderly patients. Only little evidence exists on whether elderly patients should be treated conservatively or surgically. MATERIAL AND METHODS The mortality and survival probability of 51 patients were determined in a retrospective study. The range of motion, pain and the neck disability index were clinically investigated. RESULTS Of the 51 patients 37 were treated surgically and 14 conservatively. The conservatively treated group showed a higher mortality (64 % vs. 32 %). Kaplan-Meier analysis revealed a median survival of the conservatively treated group of 29 months, whereby during the first 3 months of treatment this group showed a higher survival probability and afterwards the surgically treated group showed a higher survival probability. The clinical examination of 20 patients revealed limited range of motion of the cervical spine. Additionally, moderate levels of pain and complaints were recorded using the neck disability index. CONCLUSION Fractures of the odontoid process pose a far-reaching danger for elderly patients. A balanced assessment of the general condition should be carried out at the beginning of treatment of these patients. In the early phase following trauma no differences were found with respect to survival rates but for long-term survival the operatively treated group showed advantages; however, these advantages cannot be causally attributed to the choice of therapy.

Folgen der Affektion der Halswirbelsäule bei rheumatoider Arthritis- eine biomechanische Untersuchung der Bandstrukturen des atlantoaxialen Komplexes

Fragestellung: Der Durchmesser von anteriorem und posteriorem antlantoaxialem Interval ist diagnostisch und prognostisch relevant im Hinblick auf mogliche neurologische Storungen bei Patienten mit rheumatoider Arthritis. Im Rahmen des Follow-ups werden zumeist Rontgen- und MRT-Untersuchungen[zum vollstandigen Text gelangen Sie uber die oben angegebene URL]