Wolfgang Sterzinger

Radiographic Abnormalities in the Thoracolumbar Spine of Young Elite Skiers

An increased frequency of radiologic abnormalities in the thoracolumbar spine has been reported among young athletes in various sports, but there are no data concerning ski sports. To evaluate the incidence of these abnormalities in young elite skiers, we compared 120 skiers younger than 17 years old (alpine skiers, ski jumpers, and Nordic cross-country skiers) with a random sample of 39 control subjects of the same age who had no history of high-performance sports participation. Standardized anteroposterior and lateral radiographs of the entire lumbar spine, the lower thoracic spine, and the upper part of the sacrum were obtained from each athlete and each control subject. Radiographs were evaluated by two independent observers for the presence and size of anterior and posterior endplate lesions and Schmorls nodes. The elite alpine skiers and ski jumpers demonstrated a significantly higher rate of anterior endplate lesions than did the control subjects. This finding might be attributable to excessive loading and repetitive trauma of the immature spine under high velocity, especially in the forward bent posture.

Radiologic abnormalities and low back pain in elite skiers.

Lumbar radiographs of 120 adolescent elite skiers were evaluated for radiologic abnormalities by two independent observers. All athletes had no symptoms before the study. Radiographs were taken before enrollment of the students in elite level training. To determine the clinical significance of these abnormalities, all athletes were observed prospectively during the subsequent 2-year period for development of low back pain under high performance training. Anterior end plate lesions, Schmorl’s nodes, posterior end plate lesions, spondylolysis, scoliosis, and spina bifida occulta were found. The depth of anterior end plate lesions showed a two-peak distribution, with peaks at 11% and 22% and a valley at 18% vertebral body height. The overall low back pain incidence was 12.5%. Students with severe anterior lesions (greater than 18% vertebral body height, n = 25) had significantly more low back pain (incidence, 32%) than did students without severe anterior lesions (incidence, 7.4%). Accordingly, students with severe anterior lesions had a significantly higher risk of having low back pain develop. Moderate end plate lesions and other abnormalities were not related to an increased incidence of low back pain. Adolescent students of elite sports with severe lumbar anterior end plate lesions have an increased risk of having low back pain develop under high performance training.

Suprascapular nerve entrapment at the spinoglenoid notch caused by a ganglion cyst

A 34-year-old man had right infraspinatus muscle palsy and posterior aching of the shoulder caused by electromyographically confirmed suprascapular nerve entrapment. Sonography and magnetic resonance imaging revealed a cystic lesion at the spinoglenoid notch; this lesion was diagnosed as a ganglion. Operative removal led to immediate pain relief and incomplete recovery of the compressed branches of the suprascapular nerve.

Glenohumeral osteoarthrosis after the Eden-Hybbinette procedure.

Thirty-six patients (36 shoulders) who underwent the Eden-Hybbinette procedure for recurrent anterior dislocation of the shoulder with an average followup of 15 years were evaluated. Evaluation consisted of radiographic assessment in a true anteroposterior view and an axillary lateral view of both shoulders, physical examination, and a questionnaire. Mild glenohumeral osteoarthrosis was present in 1/3 of the patients, and moderate and severe osteoarthrosis was evident in 1/2. There were no signs of osteoarthrosis in four shoulders. Function, as assessed by the Rowe score as modified by Young and Rockwood, was excellent or good in 27 shoulders and fair or poor in nine shoulders. The extent of osteoarthrosis was related to restriction of external rotation, length of followup, and function.

Minimally invasive approaches and surgical procedures in the lumbar spine

SummaryThe history of minimally invasive lumbar spine surgery began in 1963 with the introduction of chemonucleolysis. Like this technique, the later development of mechanical nucleotomy and lasernucleotomy aimed primarily at reduction of the disc pressure. Miniature optical systems offered the opportunity for more specific decompression by discoscopy or, more recently, by transforaminal epiduroscopy. Initially, nucleotomy was the only feasible minimally invasive procedure. In recent years, however, minimally invasive spinal fusion became possible due to the development of new devices (Cages) and advanced transperitoneal (laparoscopic) and retroperitoneal approaches.ZusammenfassungDie minimal-invasiven Operationen an der lumbalen Wirbelsäule begannen 1963 mit Einführung der Chemonukleolyse. Wie diese hatte auch die später entwickelte perkutane mechanische Nukleotomie und die Lasernukleotomie zunächst nur die intradiskale Drucksenkung zum Ziel. Kleine Optiken machten eine gezieltere Dekompression mittels Diskoskopie oder zuletzt via transforaminalem Zugang mittels Epiduroskopie möglich. Während zunächst nahezu ausschließlich bandscheibenbedingte Syndrome behandelt werden konnten, ist in den letzten Jahren auch die Behandlung degenerativer Veränderungen und von Instabilitäten möglich geworden. Die Entwicklung neuer Implantate (Cages) und neuer, minimal-invasiver transperitonealer (laparoskopisch) und retroperitonealer Zugänge hat hierzu beigetragen.

Lumbar fusion in adults – dorsal or combined arterior/posterior?

SummaryA retrospective study was conducted to compare the results of posterior with combined anterior/posterior lumbar fusion in adults. Seventy-six consecutive posterior cases fused with pedicle screws and 46 combined cases were included and followed for at least 2 years. Subjective assessment was based on the Visual Analogue Scales, Waddel Disability and Impairment Score and the GBB for objective quantification of complaints. Furthermore, a thorough clinical examination was done and X-rays including flexion/extension radiographs, were taken. Questions were asked about the occupational status as well. Pain decreased significantly more in the combined cases than in the posterior fusion cases. In one case a lesion of the common iliac vein occurred during a retroperitoneal approach. Only about half the patients working preoperatively returned to work again. In conclusion, the benefit of better pain relief after combined fusion must be regarded in relation to a higher complication rate due to a second approach.ZusammenfassungIn einer retrospektiven Studie wurden die Ergebnisse nach dorsaler und kombiniert ventral/dorsaler Fusion bei Erwachsenen verglichen; 76 konsekutive dorsale Fälle, fusioniert mit Pedikelschrauben, wurden mit 46 kombinierten Fällen verglichen und nach mindestens 2 Jahren nachuntersucht. Die subjektive Bewertung beruhte auf einer visuellen Analogskala, „Waddel-disability-Index“ und Impairment-Score, und dem GBB als Maß der Klagsamkeit. Außerdem wurde eine genaue klinische Untersuchung durchgeführt, Röntgen auch in Flexion und Extension angefertigt und die Arbeitssituation erfragt. In den kombinierten Fällen konnte eine signifikant größere Schmerzbesserung beobachtet werden. In einem Fall wurde von ventral bei einem retroperitonealen Zugang die V. iliaca communis verletzt. Nur rund die Hälfte der präoperativ Arbeitenden ging auch bei der Nachuntersuchung einer Beschäftigung nach. Zusammenfassend muß der Vorteil der besseren Schmerzlinderung bei den kombinierten Fällen in Relation zu einer höheren Komplikationsrate gesehen werden.