Stefan Endres

Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study

BackgroundDegenerative spinal stenosis and instability requiring multilevel spine surgery has been associated with large blood losses. Factors that affect perioperative blood loss include time of surgery, surgical procedure, patient height, combined anterior/posterior approaches, number of levels fused, blood salvage techniques, and the use of anti-fibrinolytic medications. This study was done to evaluate the efficacy of tranexamic acid in reducing blood loss in spine surgery.MethodsThis retrospective case control study includes 97 patients who had to undergo surgery because of degenerative lumbar spinal stenosis and instability. All operations included spinal decompression, interbody fusion and posterior instrumentation (4-5 segments). Forty-six patients received 1 g tranexamic acid intravenous, preoperative and six hours and twelve hours postoperative; 51 patients without tranexamic acid administration were evaluated as a control group. Based on the records, the intra- and postoperative blood losses were measured by evaluating the drainage and cell saver systems 6, 12 and 24 hours post operation. Additionally, hemoglobin concentration and platelet concentration were reviewed. Furthermore, the number of red cell transfusions given and complications associated with tranexamic acid were assessed.ResultsThe postoperative hemoglobin concentration demonstrated a statistically significant difference with a p value of 0.0130 showing superiority for tranexamic acid use (tranexamic acid group: 11.08 g/dl, SD: 1.68; control group: 10.29 g/dl, SD: 1.39). The intraoperative cell saver volume and drainage volume after 24 h demonstrated a significant difference as well, which indicates a less blood loss in the tranexamic acid group than the control group. The postoperative drainage volume at12 hours showed no significant differences; nor did the platelet concentration Allogenic blood transfusion (two red cell units) was needed for eight patients in the tranexamic acid group and nine in the control group because of postoperative anemia. Complications associated with the administration of tranexamic acid, e.g. renal failure, deep vein thrombosis or pulmonary embolism did not occur.ConclusionsThis study suggests a less blood loss when administering tranexamic acid in posterior lumbar spine surgery as demonstrated by the higher postoperative hemoglobin concentration and the less blood loss. But given the relatively small volume of blood loss in the patients of this study it is underpowered to show a difference in transfusion rates.

A 10 year follow-up study after Roux-Elmslie-Trillat treatment for cases of patellar instability

BackgroundA retrospective study concerning patients presenting with patella instability, treated using a Roux-Elmslie-Trillat reconstruction operation and followed up for 10 years following surgery, is presented.MethodsPre-operative and follow-up radiographic evaluation included the weight-bearing anteroposterior and merchant views. Evaluation was carried out using the Insall-Salvati index, sulcus and congruence angle. The Roux-Elmslie-Trillat reconstruction operation was performed on 18 patients. The clinical evaluation at follow-up was performed using the Knee-Society-Score (KSS) and Tegner-Score.ResultsSubjective results of the operation were classed as excellent or good in 16 of the 18 patients ten years after surgery; persistent instability of the patella was recorded in only one of the 18 patients. The majority of patients returned to the same level of sporting activity after surgery as they had participated in before injury.ConclusionsThe Roux-Elmslie-Trillat procedure could be recommended in cases presenting with an increased q-angle, trochlea dysplasia or failed soft tissue surgery. In the present study the majority of patients report a return to previous sporting activity ten years after surgery.

Posterior interbody grafting and instrumentation for spondylodiscitis

Purpose. To report outcomes of 7 patients with bacterial spondylodiscitis treated through a posterior approach. Methods. Five men and 2 women aged 40 to 80 years underwent one–stage posterior interbody debridement and instrumentation for single-segment bacterial spondylodiscitis of lumbar (n=5) or thoracic (n=2) vertebrae. The Oswestry Disability Score, the Frankel classification, the Cobb angle, and the visual analogue scale (VAS) for pain as well as bone union on radiographs were assessed. Results. Patients were followed up for 19 to 36 months. None had relapses or complications. Postoperatively, 5 patients had no pain or used analgesics only occasionally; their VAS scores varied from 0 to 20. The remaining 2 patients had residual symptoms and received regular peripheral pain medication and opiates; their VAS scores ranged from 30 to 50. The mean Oswestry Disability Score improved to 21 (range, 12–38). The mean Cobb angle improved from 13.1° to 11.1°. The segments were probably fused in 5 patients and questionable in 2. Conclusion. Posterior debridement and instrumentation was adequate for single-segment spondylodiscitis and achieved good outcomes.

Fibrous dysplasia - differential diagnosis of cystic lesions in the proximal femur:a case report.

BackgroundWe are reporting about the case of a 22-year old woman, who made a first visit as an outpatient with pain that arose in acute form in the area of the left groin. The patient history did not indicate a preceding trauma, or an inflammatory or malignant disease.Case presentationConventional X-ray showed the image of a cystic lesion in the area of the neck of the thigh [collum femoris] with pathological fracture in the area of the calcar. The MRT produced the diagnosis of an aneurismal bone cyst, in which the presence of juvenile bone cyst or a giant cell tumor could be taken into consideration by differential diagnosis.Owing to the pathological fracture, repair by operation of the lesion was carried out by means of spongioplastic surgery and internal fixation (DHS).ConclusionHistology produced characteristic findings fitting the condition of fibrous dysplasia, which was not included among the primary causes in the considerations offered by differential diagnosis.Therefore, this case is a good example of the fact that fibrous dysplasia must be taken into account when using differential diagnosis as one of the cystic lesions.

Extracorporeal shock-wave therapy in the treatment of pseudoarthrosis: a case report

We describe the case of a of a 23 year old man (european) with a complicated fibular-tibial shaft fracture with subsequent pseudoarthrosis formation, which was unable to be corrected by surgery, but which we were finally able to heal using Extracorporeal shock-wave therapy.

Preoperative marking of thoracic disc herniation

INTRODUCTION The operative therapy for thoracic disc herniations not only presents high demands on the operating surgeon, but also an additional difficulty in the certain identification of intraoperative height localisation. In this retrospective case analysis, we examine the value and practicability of CT-guided percutaneous marking for localisation of the appropriate vertebral segment. METHODS AND RESULTS Between 1986 and 1998, eight patients were treated for a thoracic disc herniation. For these patients, the intraoperative height localisation was determined by a BV system. In two cases, healthy intervertebral discs were accidentally removed due to a faulty height localisation. DISCUSSION At present, the intraoperative use of BV systems for localizing affected intervertebral segments in the operative therapy of a thoracic disc herniation is finding growing application.

Präoperative Markierung thorakaler Bandscheibenvorfälle

INTRODUCTION The operative therapy for thoracic disc herniations not only presents high demands on the operating surgeon, but also an additional difficulty in the certain identification of intraoperative height localisation. In this retrospective case analysis, we examine the value and practicability of CT-guided percutaneous marking for localisation of the appropriate vertebral segment. METHODS AND RESULTS Between 1986 and 1998, eight patients were treated for a thoracic disc herniation. For these patients, the intraoperative height localisation was determined by a BV system. In two cases, healthy intervertebral discs were accidentally removed due to a faulty height localisation. DISCUSSION At present, the intraoperative use of BV systems for localizing affected intervertebral segments in the operative therapy of a thoracic disc herniation is finding growing application.

Comprehensive Biocompatibility Testing of a New Semirigid Titanium Spine Implant in Vitro

AbstractBackground: Titanium spine implants are well established materials in posterior spondylodesis. The biocompatibility of a semirigid tivanium cable suitable for pedicle screws in posterior spinal fusion (DDS-Plus®) was tested by a human bone marrow cell culture. In comparison to the tivanium cable implant (Ti6Al4V; DDS-Plus®), hydroxyapatite (HA), commercially pure titanium (cpTi), glass, chromium-cobalt alloy, (CrCoMo), polyaryletherketon (PAEK) and polyethylene (UHMW-PE) were tested. Materials and Methods: Scanning electron microscopy (SEM), SEM-energy dispersive X-ray analysis (SEM-EDX), fluorescent activated cell sorter (FACS), immunohistochemical techniques, light microscopy (LM) and immunochemical extracellular matrix analysis served to judge the in vitro biocompatibility of the different implants in a human bone marrow cell culture. Results: The datas of this investigation point out that the tivanium cable is equally biocompatible to commercially pure titanium and showed less signs of cytotoxicity than the other tested materials in vitro. Beside the titanium alloys, HA showed a high degree of biocompatibility compated to the polymers and CrCoMo too. Conclusions: In respect to their in vitro biocompatibility, the semirigid tivanium spine cable could be an alternative for other systems for posterior spondylodesis. Biomechanical and clinical studies are necessary to improve these datas.

Is cementing technique the cause of early aseptic loosening of the tibial component in total knee arthroplasty? A report of 22 failed tibial components

Articular cartilage is a specific type of connective tissue composed of hydrated proteoglycans within a matrix of collagen fibrils. In the elderly population, it shows degenerative changes that may results in osteoarthritis. The more severe form of osteoarthritis occasionally demonstrates bone formation within the cartilage, which is designated as a bony protuberance, however, such lesions are rare in children. This report presents the case of a 10-year-old boy with a bony protuberance within the articular cartilage of the knee. The patient initially complained of knee pain and he subsequently developed flexion contracture. Radiological and arthroscopic examinations revealed a bony protuberance in the articular cartilage and degenerative changes of the cartilage above it. He was successfully treated by the removal of the bony protuberance and osteochondral grafting. The bony protuberance may have caused cartilage degradation since the thickness of the cartilage above it was thinner than that around the lesion. The bony protuberance within the articular cartilage formed in the younger population may be a possible cause of osteoarthritis. This case is a noteworthy with regard to the pathogenesis of osteoarthritis.

Early experience with the NexGen® CR-Flex Mobile knee arthroplasty system: results of 2-year follow-up

We evaluated our initial results in 57 patients who received the NexGen® CR-Flex Mobile knee system using the standard anterior approach in a prospective study. The bicondylar surface implant was cemented in position (Palacos®) without posterior patellar resurfacing. The clinical outcome and perioperative and post-operative complications were documented over 24 months of its use. Overall, after two years, good results were obtained for the categories of pain and ROM (range of motion), and for the HSS (knee society score) (pre-operative: 42/57; post-operative: 87/80). No pathological radiological findings were made during this period. Two patients, however, felt that the primary operation had not been successful because of lateral patellar tilt. This was corrected with revision surgery. It was remarkable that our patients achieved greater than 100° flexion within the first 14 days of the immediate post-operative period. Evaluation and comparison of the scores with those of conventional bicondylar surface replacement systems showed no relevant differences.