Erol Gercek

Kyphoplasty as an alternative treatment of traumatic thoracolumbar burst fractures Magerl type A3.

INTRODUCTION Traumatic thoracolumbar spine fractures are frequently classified as burst fractures Magerl type A3. There still are many controversies regarding the treatment of this fracture. The therapeutic spectrum ranges from conservative to invasive operative methods with attendant morbidities. The minimal-invasive technique of kyphoplasty has established itself as a common treatment of osteoporotic vertebral compression fractures and is associated with a low complication rate. The aim of this study is to evaluate the functional and radiological results after kyphoplasty of traumatic thoracolumbar burst fractures. PATIENTS AND METHODS Patients with traumatic thoracolumbar fractures type A3.1, A3.2 and A3.3, who were treated with kyphoplasty, were included in this study. The clinical outcome was measured at follow up with a neurological assessment, the visual analogue pain scale (VAS), the Oswestry Disability Score (ODI) and the SF-36 Health Survey. The radiological measurements, performed on preoperative, postoperative and follow up radiographs, included the sagittal index, the wedge angle and the modified Cobb angle of Daniaux. RESULTS 26 patients with 23 A3.1, one A3.2 and five A3.3 fractures were treated between 2004 and 2007, including five patients with multiple vertebral fractures. At follow up the Oswestry Disability Score (26.2%) and the SF-36 score (60.1%) assessed a moderately limitation of functional outcome and quality of life without any neurological deficits. Radiological measurements showed a postoperative height restoration and reduction of kyphosis, but at follow up a secondary loss of correction except in five cases. Six minor ventrocranial cement leakages without further clinical consequence were observed. CONCLUSIONS The present study showed that kyphoplasty is a safe and feasible method for the treatment of burst fractures. It allowed the correction of the kyphosis, stabilisation of the facture, pain reduction and early mobilisation.

Therapieempfehlungen zur Versorgung von Verletzungen der Brust- und Lendenwirbelsäule

ZusammenfassungIn dieser Arbeit werden Empfehlungen zur Versorgung von Frakturen der Brust- (BWS) und der Lendenwirbelsäule (LWS) gegeben. Die Empfehlungen beruhen auf der Erfahrung der beteiligten Wirbelsäulenchirurgen der Arbeitsgemeinschaft „Wirbelsäule“ der Deutschen Gesellschaft für Unfallchirurgie unter Berücksichtigung der aktuellen Literatur. Grundlagen der Diagnostik, der konservativen und operativen Therapie werden dargestellt. Die Frakturen werden Anhand von morphologischen Kriterien, wie der Zerstörung des Wirbelkörpers, der Fragmentdislokation, der Einengung des Spinalkanals, der Achsabweichungen und der Abweichung vom individuellen sagittalen Profil beurteilt. Die Abweichung von dem individuellen sagittalen Profil wird anhand der Änderung des monosegmentalen oder bisegmentalen Grund-Deckplatten-Winkels bestimmt. Es werden die Therapieoptionen für den knochengesunden Patienten aufgezeigt.AbstractThis paper gives recommendations for treatment of thoracolumbar and lumbar spine injuries. The recommendations are based on the experience of the involved spine surgeons, who are part of a study group of the “Deutsche Gesellschaft für Unfallchirurgie” and a review of the current literature. Basics of diagnostic, conservative, and operative therapy are demonstrated. Fractures are evaluated by using morphologic criteria like destruction of the vertebral body, fragment dislocation, narrowing of the spinal canal, and deviation from the individual physiologic profile. Deviations from the individual sagittal profile are described by using the monosegmental or bisegmental end plate angle. The recommendations are developed for acute traumatic fractures in patients without severe osteoporotic disease.

Recommendations for the treatment of thoracolumbar and lumbar spine injuries

ZusammenfassungIn dieser Arbeit werden Empfehlungen zur Versorgung von Frakturen der Brust- (BWS) und der Lendenwirbelsäule (LWS) gegeben. Die Empfehlungen beruhen auf der Erfahrung der beteiligten Wirbelsäulenchirurgen der Arbeitsgemeinschaft „Wirbelsäule“ der Deutschen Gesellschaft für Unfallchirurgie unter Berücksichtigung der aktuellen Literatur. Grundlagen der Diagnostik, der konservativen und operativen Therapie werden dargestellt. Die Frakturen werden Anhand von morphologischen Kriterien, wie der Zerstörung des Wirbelkörpers, der Fragmentdislokation, der Einengung des Spinalkanals, der Achsabweichungen und der Abweichung vom individuellen sagittalen Profil beurteilt. Die Abweichung von dem individuellen sagittalen Profil wird anhand der Änderung des monosegmentalen oder bisegmentalen Grund-Deckplatten-Winkels bestimmt. Es werden die Therapieoptionen für den knochengesunden Patienten aufgezeigt.AbstractThis paper gives recommendations for treatment of thoracolumbar and lumbar spine injuries. The recommendations are based on the experience of the involved spine surgeons, who are part of a study group of the “Deutsche Gesellschaft für Unfallchirurgie” and a review of the current literature. Basics of diagnostic, conservative, and operative therapy are demonstrated. Fractures are evaluated by using morphologic criteria like destruction of the vertebral body, fragment dislocation, narrowing of the spinal canal, and deviation from the individual physiologic profile. Deviations from the individual sagittal profile are described by using the monosegmental or bisegmental end plate angle. The recommendations are developed for acute traumatic fractures in patients without severe osteoporotic disease.

How does spinal canal decompression and dorsal stabilization affect segmental mobility? A biomechanical study

IntroductionWhen decompression of the lumbar spinal canal is performed, segmental stability might be affected. Exactly which anatomical structures can thereby be resected without interfering with stability, and when, respectively how, additional stabilization is essential, has not been adequately investigated so far. The present investigation describes kinetic changes in a surgically treated motion segment as well as in its adjacent segments.Material and methodsSegmental biomechanical examination of nine human lumbar cadaver spines (L1 to L5) was performed without preload in a spine-testing apparatus by means of a precise, ultrasound-guided measuring system. Thus, samples consisting of four free motion segments were made available. Besides measurements in the native (untreated) spine specimen further measurements were done after progressive resection of dorsal elements like lig. flavum, hemilaminectomy, laminectomy and facetectomy. The segment was then stabilised by means of a rigid system (ART®) and by means of a dynamic, transpedicularly fixed system (Dynesys®).ResultsFor the analysis, range of motion (ROM) values and separately viewed data of the respective direction of motion were considered in equal measure. A very high reproducibility of the individual measurements could be verified. In the sagittal and frontal plane, flavectomy and hemilaminectomy did not achieve any relevant change in the ROM in both directions. This applies to the segment operated on as well as to the adjacent segments examined. Resection of the facet likewise does not lead to any distinct increase of mobility in the operated segment as far as flexion and right/left bending is concerned. In extension a striking increase in mobility of more than 1° compared to the native value can be perceived in the operated segment. Stabilization with the rigid and dynamic system effect an almost equal reduction of flexion/extension and right/left bending. In the adjacent segments, a slightly higher mobility is to be noted for rigid stabilization than for dynamic stabilisation. A linear regression analysis shows that in flexion/extension monosegmental rigid stabilisation is compensated predominantly in the first cranial adjacent segment. In case of a dynamic stabilisation the compensation is distributed among the first and second cranial, and by 20% in the caudal adjacent segment.SummaryMonosegmental decompression of the lumbar spinal canal does not essentially destabilise the motion segment during in vitro conditions. Regarding rigid or dynamic stabilisation, the ROM does not differ within the operated segment, but the distribution of the compensatory movement is different.

Dynamic angular three-dimensional measurement of multisegmental thoracolumbar motion in vivo.

Study Design. Method validation and in vivo motion segment study. Objective. To determine in healthy subjects in vivo intervertebral segmental kinematics and coupled motion behavior in all 3 planes simultaneously for 3 segments and to evaluate whether these results differ from those in the normal population according to the literature. Summary of Background Data. Few studies have provided a direct invasive approach to investigate segmental kinematics in vivo. Dynamic recordings of 3-dimensional segmental motion patterns of adjacent segments have rarely been reported. To date, no studies have examined the 3-dimensional segmental movements of the thoracolumbar junction in vivo in detail. Methods. K-wires were inserted into the Th11, Th12, L1, and L2 spinous processes of 21 healthy subjects. Ultrasound markers and sensors were attached to the k-wires. Real-time motion data were recorded during standardized ranging exercises. Errors caused by the k-wires, and the static and dynamic accuracy of the system, were considered. Results. Large intersubject variation was found in all of the exercises. The average ranges of motion from Th11 to L2 were 18.7° for flexion-extension, 13.5° for one-sided lateral bending, and 1.8° for one-sided axial rotation. Coupled-motion patterns among the subjects showed a coupled flexion in active lateral bending and a coupled extension in active rotation, but the results were inconsistent for active extension and flexion. Conclusion. This method offered accurate multisegmental dynamic-recording facilities. The dynamic exercises showed high reproducibility. The ranges of motion for extension/flexion and lateral bending differed from those reported in previous studies. The coupling patterns were only partly consistent because of large interindividual variation. The measurement error was comparable with that of other invasive methods.

Long-term outcome after operative treatment of traumatic patellar dislocation in adolescents.

Objectives: Retrospective evaluation of the long-term outcomes after surgical treatment of traumatic patellar dislocations in adolescents and identification of possible predictive factors of poor outcomes. Design: Retrospective clinical study. Setting: University Clinic, Level I Trauma Center. Patients: All 33 adolescents, with a mean age of 14.8 years, who were treated surgically after traumatic patellar dislocation between 1994 and 2006, were involved in this study. Intervention: Mini-open medial reefing and arthroscopic lateral release. Main Outcome Measurements: The clinical outcome was evaluated with the visual analogue scale, the Lysholm score, the Kujala score, and the Tegner activity level scale. On preoperative radiographs and magnetic resonance imaging scans, trochlear dysplasia and patella alta were assessed. The variables analyzed were sex, associated osteochondral injuries, the number of redislocations before surgery, and the number of redislocations after surgery. Results: At the mean follow-up of 9.8 years, the mean Lysholm score was 82.6, the mean Kujala score was 84.4, the mean Tegner activity level was 4.8, and the mean visual analogue scale was 0.2. We found no significant differences in the subgroups regarding functional outcomes. Fifteen patients with patella alta and 4 patients with trochlear dysplasia were assessed radiologically. Redislocations after surgery were observed in 4 patients, 2 of them were female patients who exhibited quadriceps angles requiring tibial tubercle osteotomy to be performed after maturation. Conclusions: The techniques of mini-open medial reefing and lateral release demonstrate a good functional long-term outcome and effectively prevent recurrent instability. The major predictive factor for poor outcomes and redislocations is an inadequately addressed pathology. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

[The distally based sural neurocutaneous island flap for coverage of soft-tissue defects on the distal lower leg, ankle and heel].

ZusammenfassungOperationszielFunktionell suffiziente Deckung von Weichteildefekten in der Problemregion des distalen Unterschenkels, Sprunggelenks und der Ferse unter Vermeidung einer freien, mikrovaskulär reanastomosierten Lappenplastik.IndikationenPosttraumatische, ggf. nach Komplikationen, wie z.B. Infekt oder Hautnekrosen, entstandene Weichteilschäden ≤ 10 cm Durchmesser an distalem Unterschenkel, Sprunggelenk und Ferse mit freiliegenden Knochen-, Sehnen- oder Gelenkstrukturen unter Einbeziehung von Risikopatienten (Diabetes mellitus Typ 1 oder 2 und/oder nicht verbesserungsfähige arterielle Verschlusskrankheit [AVK] bis einschließlich Stadium IIb).KontraindikationenRelativ: Defektdurchmesser > 10 cm.Absolut: Kritische Ischämie (AVK Stadien III und IV).OperationstechnikZentrieren des Suralislappens über der Vena saphena parva. Fasziokutane Lappenhebung von proximal nach distal. Präparation des 3 cm breiten und bis 15 cm langen adipofaszialen Lappenstiels in lipofaszialer Technik über eine gerade Hautinzision vom distalen Lappenpol aus nach distal. Stielrotationspunkt 5 cm kranial des Außenknöchels. Lappenpassage in den Defekt über subkutanen Tunnel oder durchtrennte Gewebsbrücke. Verschluss der Hautinzision (Stielpräparation), Spalthautdeckung des Hebedefekts.WeiterbehandlungRuhigstellung im gut gepolsterten Unterschenkelliegegipsverband für etwa 10 Tage.ErgebnisseIm Rahmen einer retrospektiven Studie wurden elf von zwölf Patienten mit einer Arteria-suralis-Lappenplastik, darunter sechs Risikopatienten, durchschnittlich 3,7 Jahre postoperativ nachuntersucht. Das Durchschnittsalter lag bei 54,9 Jahren (28–80 Jahre).Das Ziel der Defektdeckung gelang in allen zwölf Fällen. Zehn der zwölf Lappenplastiken heilten primär reizlos im Defekt ein, bei zwei Patienten wurden Zusatzmaßnahmen erforderlich (Spalthauttransplantation, Nekrosenabtragung). Alle nachuntersuchten Patienten waren mit dem Resultat des primären Operationsziels, der Wiederherstellung des Weichteilmantels, zufrieden. Als Kritikpunkte wurden Gefühlsabschwächung im Versorgungsgebiet des Nervus suralis (viermal), ästhetische Beeinträchtigung (zweimal) und Neuromschmerzen proximal des Hebedefekts (einmal) angegeben.AbstractObjectiveStable coverage of soft-tissue defects in the critical regions of the distal lower leg, ankle and heel by avoidance of a microsurgically transplanted free flap.IndicationsSoft-tissue defects ≤ 10 cm in diameter – either by trauma or complications (skin necrosis, infection) – on the distal lower leg, ankle or heel with exposed osseous, tendinous or articular structures including high-risk patients (diabetes mellitus type 1/2 and/or arterial vascular disease including stage IIb, not capable of improvement).ContraindicationsRelative: diameter of defect > 10 cm.Absolute: critical ischemia (arterial vascular disease stages III and IV).Surgical TechniqueOutlining of the sural island flap directly over the small saphenous vein. Fasciocutaneous flap elevation proceeding in a proximal-distal direction. Lipofascial dissection of the 3 cm wide and up to 15 cm long neurovascular pedicle after longitudinal skin incision starting at the distal border of the island flap and running distally. Point of pedicle rotation 5 cm above the tip of the fibula. Flap passage into the defect through subcutaneous tunnel or after incision of the soft tissue between defect and donor site. Skin closure over region of pedicle dissection, meshed skin grafting of donor site.Postoperative ManagementImmobilization of the lower leg in a well-padded cast over a period of about 10 days.ResultsIn a retrospective study, eleven out of twelve patients (including six high-risk patients) with a distally based sural neurocutaneous flap were examined on average 3.7 years postoperatively. The mean age was 54.9 years (28–80 years).A stable coverage of the defect was achieved in all twelve patients. In ten of twelve sural flaps the defect site was closed by primary wound healing, additional procedures were necessary in two cases (meshed skin grafting of flap border, excision of skin necrosis). All patients examined were satisfied with the result of the primary operative target, the stable coverage of the defect. Stated disadvantages were loss of sensation in the area of sural nerve function (four times), aesthetic impairment (twice), and pain resulting from sural nerve neuroma above donor site (once).OBJECTIVE Stable coverage of soft-tissue defects in the critical regions of the distal lower leg, ankle and heel by avoidance of a microsurgically transplanted free flap. INDICATIONS Soft-tissue defects < or = 10 cm in diameter--either by trauma or complications (skin necrosis, infection)--on the distal lower leg, ankle or heel with exposed osseous, tendinous or articular structures including high-risk patients (diabetes mellitus type 1/2 and/or arterial vascular disease including stage IIb, not capable of improvement). CONTRAINDICATIONS Relative: diameter of defect > 10 cm. Absolute: critical ischemia (arterial vascular disease stages III and IV). SURGICAL TECHNIQUE Outlining of the sural island flap directly over the small saphenous vein. Fasciocutaneous flap elevation proceeding in a proximal-distal direction. Lipofascial dissection of the 3 cm wide and up to 15 cm long neurovascular pedicle after longitudinal skin incision starting at the distal border of the island flap and running distally. Point of pedicle rotation 5 cm above the tip of the fibula. Flap passage into the defect through subcutaneous tunnel or after incision of the soft tissue between defect and donor site. Skin closure over region of pedicle dissection, meshed skin grafting of donor site. POSTOPERATIVE MANAGEMENT Immobilization of the lower leg in a well-padded cast over a period of about 10 days. RESULTS In a retrospective study, eleven out of twelve patients (including six high-risk patients) with a distally based sural neurocutaneous flap were examined on average 3.7 years postoperatively. The mean age was 54.9 years (28-80 years). A stable coverage of the defect was achieved in all twelve patients. In ten of twelve sural flaps the defect site was closed by primary wound healing, additional procedures were necessary in two cases (meshed skin grafting of flap border, excision of skin necrosis). All patients examined were satisfied with the result of the primary operative target, the stable coverage of the defect. Stated disadvantages were loss of sensation in the area of sural nerve function (four times), aesthetic impairment (twice), and pain resulting from sural nerve neuroma above donor site (once).

Die distal gestielte Arteria-suralis-Insellappenplastik zur Deckung posttraumatischer Defekte an distalem Unterschenkel, Sprunggelenk und Ferse

ZusammenfassungOperationszielFunktionell suffiziente Deckung von Weichteildefekten in der Problemregion des distalen Unterschenkels, Sprunggelenks und der Ferse unter Vermeidung einer freien, mikrovaskulär reanastomosierten Lappenplastik.IndikationenPosttraumatische, ggf. nach Komplikationen, wie z.B. Infekt oder Hautnekrosen, entstandene Weichteilschäden ≤ 10 cm Durchmesser an distalem Unterschenkel, Sprunggelenk und Ferse mit freiliegenden Knochen-, Sehnen- oder Gelenkstrukturen unter Einbeziehung von Risikopatienten (Diabetes mellitus Typ 1 oder 2 und/oder nicht verbesserungsfähige arterielle Verschlusskrankheit [AVK] bis einschließlich Stadium IIb).KontraindikationenRelativ: Defektdurchmesser > 10 cm.Absolut: Kritische Ischämie (AVK Stadien III und IV).OperationstechnikZentrieren des Suralislappens über der Vena saphena parva. Fasziokutane Lappenhebung von proximal nach distal. Präparation des 3 cm breiten und bis 15 cm langen adipofaszialen Lappenstiels in lipofaszialer Technik über eine gerade Hautinzision vom distalen Lappenpol aus nach distal. Stielrotationspunkt 5 cm kranial des Außenknöchels. Lappenpassage in den Defekt über subkutanen Tunnel oder durchtrennte Gewebsbrücke. Verschluss der Hautinzision (Stielpräparation), Spalthautdeckung des Hebedefekts.WeiterbehandlungRuhigstellung im gut gepolsterten Unterschenkelliegegipsverband für etwa 10 Tage.ErgebnisseIm Rahmen einer retrospektiven Studie wurden elf von zwölf Patienten mit einer Arteria-suralis-Lappenplastik, darunter sechs Risikopatienten, durchschnittlich 3,7 Jahre postoperativ nachuntersucht. Das Durchschnittsalter lag bei 54,9 Jahren (28–80 Jahre).Das Ziel der Defektdeckung gelang in allen zwölf Fällen. Zehn der zwölf Lappenplastiken heilten primär reizlos im Defekt ein, bei zwei Patienten wurden Zusatzmaßnahmen erforderlich (Spalthauttransplantation, Nekrosenabtragung). Alle nachuntersuchten Patienten waren mit dem Resultat des primären Operationsziels, der Wiederherstellung des Weichteilmantels, zufrieden. Als Kritikpunkte wurden Gefühlsabschwächung im Versorgungsgebiet des Nervus suralis (viermal), ästhetische Beeinträchtigung (zweimal) und Neuromschmerzen proximal des Hebedefekts (einmal) angegeben.AbstractObjectiveStable coverage of soft-tissue defects in the critical regions of the distal lower leg, ankle and heel by avoidance of a microsurgically transplanted free flap.IndicationsSoft-tissue defects ≤ 10 cm in diameter – either by trauma or complications (skin necrosis, infection) – on the distal lower leg, ankle or heel with exposed osseous, tendinous or articular structures including high-risk patients (diabetes mellitus type 1/2 and/or arterial vascular disease including stage IIb, not capable of improvement).ContraindicationsRelative: diameter of defect > 10 cm.Absolute: critical ischemia (arterial vascular disease stages III and IV).Surgical TechniqueOutlining of the sural island flap directly over the small saphenous vein. Fasciocutaneous flap elevation proceeding in a proximal-distal direction. Lipofascial dissection of the 3 cm wide and up to 15 cm long neurovascular pedicle after longitudinal skin incision starting at the distal border of the island flap and running distally. Point of pedicle rotation 5 cm above the tip of the fibula. Flap passage into the defect through subcutaneous tunnel or after incision of the soft tissue between defect and donor site. Skin closure over region of pedicle dissection, meshed skin grafting of donor site.Postoperative ManagementImmobilization of the lower leg in a well-padded cast over a period of about 10 days.ResultsIn a retrospective study, eleven out of twelve patients (including six high-risk patients) with a distally based sural neurocutaneous flap were examined on average 3.7 years postoperatively. The mean age was 54.9 years (28–80 years).A stable coverage of the defect was achieved in all twelve patients. In ten of twelve sural flaps the defect site was closed by primary wound healing, additional procedures were necessary in two cases (meshed skin grafting of flap border, excision of skin necrosis). All patients examined were satisfied with the result of the primary operative target, the stable coverage of the defect. Stated disadvantages were loss of sensation in the area of sural nerve function (four times), aesthetic impairment (twice), and pain resulting from sural nerve neuroma above donor site (once).OBJECTIVE Stable coverage of soft-tissue defects in the critical regions of the distal lower leg, ankle and heel by avoidance of a microsurgically transplanted free flap. INDICATIONS Soft-tissue defects < or = 10 cm in diameter--either by trauma or complications (skin necrosis, infection)--on the distal lower leg, ankle or heel with exposed osseous, tendinous or articular structures including high-risk patients (diabetes mellitus type 1/2 and/or arterial vascular disease including stage IIb, not capable of improvement). CONTRAINDICATIONS Relative: diameter of defect > 10 cm. Absolute: critical ischemia (arterial vascular disease stages III and IV). SURGICAL TECHNIQUE Outlining of the sural island flap directly over the small saphenous vein. Fasciocutaneous flap elevation proceeding in a proximal-distal direction. Lipofascial dissection of the 3 cm wide and up to 15 cm long neurovascular pedicle after longitudinal skin incision starting at the distal border of the island flap and running distally. Point of pedicle rotation 5 cm above the tip of the fibula. Flap passage into the defect through subcutaneous tunnel or after incision of the soft tissue between defect and donor site. Skin closure over region of pedicle dissection, meshed skin grafting of donor site. POSTOPERATIVE MANAGEMENT Immobilization of the lower leg in a well-padded cast over a period of about 10 days. RESULTS In a retrospective study, eleven out of twelve patients (including six high-risk patients) with a distally based sural neurocutaneous flap were examined on average 3.7 years postoperatively. The mean age was 54.9 years (28-80 years). A stable coverage of the defect was achieved in all twelve patients. In ten of twelve sural flaps the defect site was closed by primary wound healing, additional procedures were necessary in two cases (meshed skin grafting of flap border, excision of skin necrosis). All patients examined were satisfied with the result of the primary operative target, the stable coverage of the defect. Stated disadvantages were loss of sensation in the area of sural nerve function (four times), aesthetic impairment (twice), and pain resulting from sural nerve neuroma above donor site (once).

Two-year results of vertebral body stenting for the treatment of traumatic incomplete burst fractures

Abstract Purpose: Vertebral body stenting (VBS) was developed to prevent loss of reduction after balloon deflation during kyphoplasty. The aim of this study is the radiological and clinical mid-term evaluation of traumatic incomplete burst fractures treated by vertebral body stenting. Material and methods: This retrospective study included patients with traumatic thoracolumbar incomplete burst fractures treated with VBS between 2009 and 2010. The outcome was evaluated with the visual analogue pain scale (VAS), the Oswestry Disability Score (ODI), the SF-36 Health Survey and radiologically assessed. Results: Eighteen patients with an average age of 74.8 years were treated with VBS. Twelve were female and six were male. Two years after the operation the ODI and SF-36 showed a moderate limitation of daily activities and quality of life without neurological deficits. VBS restored the vertebral kyphosis by 3.2° and segmental kyphosis by 5°. A minor sintering was observed at follow-up losing 0.8° vertebral kyphosis and 2.1° segmental kyphosis correction. Two asymptomatic cement leakages were detected. Conclusion: VBS provides clinical outcomes comparable with BKP. The stent allows a reconstruction of the anterior column with reduced subsequent loss of correction.

Der enge Spinalkanal aus traumatologischer Sicht

ZusammenfassungVerletzungen der Wirbelsäule sind auch heute noch eine große Herausforderung für die behandelnden Unfallchirurgen.Vom Konzept der überwiegend konservativen Behandlung ist man im letzten Jahrhundert infolge einer differenzierteren Diagnostik gerade bei den sog. instabilen Verletzungen abgekommen. Diskrepanzen bestehen nach wie vor in der Stabilitätsbeurteilung. In den letzten Jahren haben sich sowohl dorsale als auch ventrale oder kombinierte Versorgungen etabliert. Verengte Spinalkanäle und neurologische Defizite sind dabei wichtige Faktoren. Anhand der Literatur werden die verschiedenen Vorgehensweisen und Beurteilungen diskutiert und abschließend unserer eigenes Konzept vorgestellt.AbstractEven today, injuries of the spinal column still pose a large challenge for the treating trauma surgeons. In the last century due to more differentiated diagnostics, the concept of predominantly conservative treatment changed to interventional procedures especially in the so-called unstable injuries.Discrepancies still exist in the evaluation of stability. In the last few years, dorsal, ventral, or combined interventional procedures have become established. The narrow spinal canal and neurological deficits represent important factors. Based on the literature, the different procedures and evaluations are discussed and finally we introduce our own concept.