Operative Techniken zur Skoliosekorrektur haben in den letzten Jahrzehnten eine schnelle Entwickl... more Operative Techniken zur Skoliosekorrektur haben in den letzten Jahrzehnten eine schnelle Entwicklung genommen.
Adequate treatment of scoliosis requires from the managing doctor a detailed knowledge about the ... more Adequate treatment of scoliosis requires from the managing doctor a detailed knowledge about the natural history of the disease for correct indication of the various possibilities for treatment and favourable influence of the spontaneous history. Essential prognostic factors of idiopathic scoliotic forms and congenital or neuromuscular scolioses will be demonstrated.
Archives of Orthopaedic and Trauma Surgery, Jun 17, 2008
Demographic changes create an expansion of the elderly population segment of society. Demands of ... more Demographic changes create an expansion of the elderly population segment of society. Demands of mobility and quality of life have increased in this age group over the last decades. A rising number of elderly patients suffering from degenerative "de novo" lumbar scoliosis (DLS) may be eligible for surgical options to treat their spinal deformities. Therefore, we compared the clinical and radiographic results of conservative and surgical treatment. During 1990-2003, 55 patients with DLS were treated and followed up for a minimum of 24 months. Group 1 patients (n=26) underwent surgery (decompression and spondylodesis), group 2 patients (n=29) declined surgery and received conservative treatment (analgesics, physiotherapy). Clinical data, theatre records and X-rays were analysed. All patients were contacted and 73.1% of group 1 and 75.8% of group 2 patients were clinically re-evaluated and received standing radiographs on average 4.8 and 3.8 years after the initial procedure or consultation, respectively. We found a significantly higher rate of spinal stenosis and degenerative spondylolisthesis in group 1 patients (P<0.01). The procedure corrected the lumbar deformity in the frontal and sagittal planes. Three patients required revision for implant failure. Walking distance improved significantly during the postoperative course. Analgesic requirement decreased in comparison to group 2 patients. No significant difference was evident between the groups in terms of lumbar back pain after 3.8 and 4.8 years, respectively. Operative treatment of DLS with decompression in combination with a longer fusion improved walking ability and quality of life. Reduced need of analgesics can be anticipated. Benefits of surgery and risks of complications have to be considered carefully to avoid disappointment in expectations.
Zeitschrift für Orthopädie und ihre Grenzgebiete, Jun 25, 2002
AIM Long-term anchorage of foreign material in vital bone has proven to be the main problem in hi... more AIM Long-term anchorage of foreign material in vital bone has proven to be the main problem in hip arthroplasty. Bone cement, a material for filling and fitting, allows an excellent solution for older people. Many failures have been blamed on the use of polymethylmethacrylate in younger patients. In our opinion, modelling a stem to the individual anatomic needs of younger patients and to implant it without cement but with a stable press-fit is a good way to transmit stress harmoniously from the prosthesis to the bone and to obtain a long-lasting function. This individual hip stem is now available in the third generation under the name Adaptiva(R). We would like to present our first results. METHOD Between October 1993 and September 1995 150 individual hip prosthesis of the Adaptiva(R) type have been implanted. In the average the patients were 53,2 years old. The average time of follow-up was 19.9 (12 to 44) months. RESULTS The Merle d'Aubigne score showed excellent absolute and relative results for pain, mobility and ability to walk. No aseptic loosening of the stem occurred. CONCLUSION Our early results are promising, but we have to wait for the long-term results, which are part of a current study.
Purpose: Recently, vascular endostapling systems were developed to achieve better sealing at the ... more Purpose: Recently, vascular endostapling systems were developed to achieve better sealing at the proximal neck of the aneurysm and to prevent endograft migration. The purpose of this study was to provide a systematic review about the current state and possible options of vascular endostapling systems. Results: No randomized controlled trials were published. The results showed that the use of an endostaple system considerably reduced the rates of endoleaks type 1a and endograft migration. Regarding the use of endostaples in different types of endografts, only a few results were available.Conclusion: The results are not conclusive. With endostaple systems, patients with difficult anatomic features and high risk can potentially be treated. These systems might reduce the high reintervention rates after endovascular aneurysm repair. Controlled randomized trials with larger number of patients are warranted with endostapling use in primary endograft implantation and for use in reinterventi...
Zusammenfassung Hintergrund Die häufig multimorbiden, geriatrisch-unfallchirurgischen Patienten m... more Zusammenfassung Hintergrund Die häufig multimorbiden, geriatrisch-unfallchirurgischen Patienten mit hüftgelenknaher Femurfraktur bedürfen als Notfallpatienten einer möglichst frühzeitigen operativen und interdisziplinären Behandlung, um Komplikationen (Morbidität, „morbidity“) und die Sterblichkeit (Mortalität, „mortality“) zu reduzieren. Die präoperative Verweildauer ist ein sensibler und multifaktorieller Qualitätsindikator (QI) des Behandlungsgeschehens. Aufgrund von fortbestehenden Auffälligkeiten dieses QI in der externen stationären Qualitätssicherung (esQS) in Deutschland wurde vom Institut für Qualitätssicherung und Transparenz im Gesundheitswesen (IQTIG) und vom Gemeinsamen Bundesausschuss (G-BA) weiterhin „besonderer Handlungsbedarf“ für diesen Indikator konstatiert (IQTIG Qualitätsreport 2019). Ziel der Arbeit Identifizierung von methodisch besonders belastbaren Empfehlungen zu strukturellen und prozessualen Standards zur Sicherstellung einer angemessenen klinischen Verso...
Purpose: Recently, vascular endostapling systems were developed to achieve better sealing at the ... more Purpose: Recently, vascular endostapling systems were developed to achieve better sealing at the proximal neck of the aneurysm and to prevent endograft migration. The purpose of this study was to provide a systematic review about the current state and possible options of vascular endostapling systems. Results: No randomized controlled trials were published. The results showed that the use of an endostaple system considerably reduced the rates of endoleaks type 1a and endograft migration. Regarding the use of endostaples in different types of endografts, only a few results were available. Conclusion: The results are not conclusive. With endostaple systems, patients with difficult anatomic features and high risk can potentially be treated. These systems might reduce the high reintervention rates after endovascular aneurysm repair. Controlled randomized trials with larger number of patients are warranted with endostapling use in primary endograft implantation and for use in reintervent...
Metastatic spine disease is frequent in renal cell carcinoma and 50% of osseous metastases are al... more Metastatic spine disease is frequent in renal cell carcinoma and 50% of osseous metastases are already found at the time of primary diagnosis. Therefore patient mobility and quality of life are threatened early in the course of disease. Surgery is able to relieve pain and to regain or to preserve mobility. Indication and technique of surgery (anterior decompression, vertebral replacement and transpedicular fixation) are explained and treatment results of eleven cases are reported. All patients with paraparesis or cord compression preoperatively were mobile when leaving our hospital after surgery. There were no severe complications, especially no neurological deteriorations or deaths. Postoperative survival time was ten months approximately in cases with multiple osseous lesions and it was several years in cases with solitary metastases. Mobility was preserved for most of the survival time. In conclusion, restabilisation of the spine proved to be a worthwhile treatment option in well...
Zeitschrift für Orthopädie und ihre Grenzgebiete, 2000
Purpose of the study: The aim of the study was to characterize the changes of C-reactive protein,... more Purpose of the study: The aim of the study was to characterize the changes of C-reactive protein, erythrocyte sedimentation rate, white blood count and body temperature by serial measurements after different types of uncomplicated orthopedic surgery. Methods: The uncomplicated coures of 180 patients after elective total hip and knee arthroplasties, ventral and dorsal spinal fusions and diagnostic knee and shoulder arthroscopies were analyzed. Results: The maximal CRP-values were recorded on the second or third day after operation. The peak levels correlated with the extent of the procedures and reached 1.28-17.71 mg/dl. The ESR increased to maximal rates five to six days after surgery and remained elevated during the 14 days of the investigation period. WBC and body temperature showed a slow and uncharacteristic increase followed by a slow and irregular decrease. Conclusion: Awareness of the typical pattern of CRP, ESR, WBC and body temperature may help to evaluate the early postoperative course. The CRP is a sensitive marker. ESR, WBC and body temperature are less costly but a poor diagnostic aid for the early detection of postoperative complications especially infections.
Liebe Kolleginnen und Kollegen! Wenn Sie eine interessante Falldarstellung haben, schicken Sie bi... more Liebe Kolleginnen und Kollegen! Wenn Sie eine interessante Falldarstellung haben, schicken Sie bitte Ihren Vorschlag mit Beschreibung und Bildmaterial an die Redaktion.
We studied prospectively the clinical and radiological course of 36 patients with localised spina... more We studied prospectively the clinical and radiological course of 36 patients with localised spinal instability treated with vertebrectomy. A distractible titanium cage filled with polymethylmethacrylate (PMMA) in combination with transpedicular fixation was used to restore spinal stability. Mean follow-up was 16 (8-55) months. Average correction of the segmental kyphosis was 15.2 (2-29). During follow-up, a loss of correction of 0.9 (2-15) was seen. Segmental height was increased by 7.6 (0-14) mm on average with a mean loss of 1.6 (0-2) mm. Twenty-one patients without preoperative neurological deficits were ambulatory without orthosis at discharge. Patients presenting with neurological deficits were unchanged (n=3) or improved (n=12). RØsumØ Nous avons ØtudiØ prospectivement l'Øvolution clinique et radiologique de 36 malades avec une instabi-litØ vertØbrale localisØe traitØe par vertebrectomie. Une cage en titane distractable remplie de PMMA en combinaison avec une fixation transpØdiculaire a ØtØ utilisØe pour restaurer la stabilitØ vertØbrale. Le suivi moyen Øtait de 16 mois (8-55). La correction moyenne de la cyphose segmentaire Øtait de 15,2 (2-29). Pendant le suivi une perte de correction de 0,9 (2-15) a ØtØ notØe. La hauteur segmentaire a ØtØ augmentØe à 7,6 (0-14) mm en moyenne avec une perte moyenne de 1,6 (0-2) mm. Vingt et un malades sans dØficit neurologique prØopØratoire pouvaient marcher sans orthse. Les malades qui prØsentaient un dØficit neurologique Øtaient inchangØs (n=3) ou amØliorØs (n=12).
This paper reports a retrospective review of 91 patients with idiopathic thoracic scoliosis corre... more This paper reports a retrospective review of 91 patients with idiopathic thoracic scoliosis corrected by Zielke VDS instrumentation. The results were analysed to demonstrate the correction in all three planes. Satisfactory correction was obtained, and was particularly good in the sagittal and horizontal planes. There were no disadvantages from the thoracotomy.
S u m m a r y. The Zielke correction technique (VDS) has two parts, derotation and ventral convex... more S u m m a r y. The Zielke correction technique (VDS) has two parts, derotation and ventral convex-side compression. Both were studied by measurements made during and after the operation. Ventral derotation always creates lordosis. Lordosis can be mainrained during compression by insertion of intervertebral bone blocks, or kyphosis created by omitting them. R~sum~, Le procddd VDS de correction de Zielke comporte deux dtapes: d~rotation c) l' aide d'un matdriel spdcial, puis compression de la convexit6 par vole antdrieure. Les deux composantes ont dtd analysdes par des mesures per-et post-opdratoires afin d'dvaluer comment la technique VDS ¢bnctionne dans tes trois plans. Dans les interventions dorsales et lombaires, aprbs ddrotation isot~e, on constate pendant l" op6ration une tordose notable et l 'amelioration de la courbure atteint d~jh 50% du rdsultat ddfinitif La compression terminale de la convexitd aboutit gt une cyphose clans ie rachis dorsal et ~une lordose au niveau des courbures tombaires oit des greffes intersomatiques sont utilisdes.
Demographic changes create an expansion of the elderly population segment of society. Demands of ... more Demographic changes create an expansion of the elderly population segment of society. Demands of mobility and quality of life have increased in this age group over the last decades. A rising number of elderly patients suffering from degenerative "de novo" lumbar scoliosis (DLS) may be eligible for surgical options to treat their spinal deformities. Therefore, we compared the clinical and radiographic results of conservative and surgical treatment. During 1990-2003, 55 patients with DLS were treated and followed up for a minimum of 24 months. Group 1 patients (n=26) underwent surgery (decompression and spondylodesis), group 2 patients (n=29) declined surgery and received conservative treatment (analgesics, physiotherapy). Clinical data, theatre records and X-rays were analysed. All patients were contacted and 73.1% of group 1 and 75.8% of group 2 patients were clinically re-evaluated and received standing radiographs on average 4.8 and 3.8 years after the initial procedure or consultation, respectively. We found a significantly higher rate of spinal stenosis and degenerative spondylolisthesis in group 1 patients (P<0.01). The procedure corrected the lumbar deformity in the frontal and sagittal planes. Three patients required revision for implant failure. Walking distance improved significantly during the postoperative course. Analgesic requirement decreased in comparison to group 2 patients. No significant difference was evident between the groups in terms of lumbar back pain after 3.8 and 4.8 years, respectively. Operative treatment of DLS with decompression in combination with a longer fusion improved walking ability and quality of life. Reduced need of analgesics can be anticipated. Benefits of surgery and risks of complications have to be considered carefully to avoid disappointment in expectations.
Operative Techniken zur Skoliosekorrektur haben in den letzten Jahrzehnten eine schnelle Entwickl... more Operative Techniken zur Skoliosekorrektur haben in den letzten Jahrzehnten eine schnelle Entwicklung genommen.
Adequate treatment of scoliosis requires from the managing doctor a detailed knowledge about the ... more Adequate treatment of scoliosis requires from the managing doctor a detailed knowledge about the natural history of the disease for correct indication of the various possibilities for treatment and favourable influence of the spontaneous history. Essential prognostic factors of idiopathic scoliotic forms and congenital or neuromuscular scolioses will be demonstrated.
Archives of Orthopaedic and Trauma Surgery, Jun 17, 2008
Demographic changes create an expansion of the elderly population segment of society. Demands of ... more Demographic changes create an expansion of the elderly population segment of society. Demands of mobility and quality of life have increased in this age group over the last decades. A rising number of elderly patients suffering from degenerative "de novo" lumbar scoliosis (DLS) may be eligible for surgical options to treat their spinal deformities. Therefore, we compared the clinical and radiographic results of conservative and surgical treatment. During 1990-2003, 55 patients with DLS were treated and followed up for a minimum of 24 months. Group 1 patients (n=26) underwent surgery (decompression and spondylodesis), group 2 patients (n=29) declined surgery and received conservative treatment (analgesics, physiotherapy). Clinical data, theatre records and X-rays were analysed. All patients were contacted and 73.1% of group 1 and 75.8% of group 2 patients were clinically re-evaluated and received standing radiographs on average 4.8 and 3.8 years after the initial procedure or consultation, respectively. We found a significantly higher rate of spinal stenosis and degenerative spondylolisthesis in group 1 patients (P<0.01). The procedure corrected the lumbar deformity in the frontal and sagittal planes. Three patients required revision for implant failure. Walking distance improved significantly during the postoperative course. Analgesic requirement decreased in comparison to group 2 patients. No significant difference was evident between the groups in terms of lumbar back pain after 3.8 and 4.8 years, respectively. Operative treatment of DLS with decompression in combination with a longer fusion improved walking ability and quality of life. Reduced need of analgesics can be anticipated. Benefits of surgery and risks of complications have to be considered carefully to avoid disappointment in expectations.
Zeitschrift für Orthopädie und ihre Grenzgebiete, Jun 25, 2002
AIM Long-term anchorage of foreign material in vital bone has proven to be the main problem in hi... more AIM Long-term anchorage of foreign material in vital bone has proven to be the main problem in hip arthroplasty. Bone cement, a material for filling and fitting, allows an excellent solution for older people. Many failures have been blamed on the use of polymethylmethacrylate in younger patients. In our opinion, modelling a stem to the individual anatomic needs of younger patients and to implant it without cement but with a stable press-fit is a good way to transmit stress harmoniously from the prosthesis to the bone and to obtain a long-lasting function. This individual hip stem is now available in the third generation under the name Adaptiva(R). We would like to present our first results. METHOD Between October 1993 and September 1995 150 individual hip prosthesis of the Adaptiva(R) type have been implanted. In the average the patients were 53,2 years old. The average time of follow-up was 19.9 (12 to 44) months. RESULTS The Merle d'Aubigne score showed excellent absolute and relative results for pain, mobility and ability to walk. No aseptic loosening of the stem occurred. CONCLUSION Our early results are promising, but we have to wait for the long-term results, which are part of a current study.
Purpose: Recently, vascular endostapling systems were developed to achieve better sealing at the ... more Purpose: Recently, vascular endostapling systems were developed to achieve better sealing at the proximal neck of the aneurysm and to prevent endograft migration. The purpose of this study was to provide a systematic review about the current state and possible options of vascular endostapling systems. Results: No randomized controlled trials were published. The results showed that the use of an endostaple system considerably reduced the rates of endoleaks type 1a and endograft migration. Regarding the use of endostaples in different types of endografts, only a few results were available.Conclusion: The results are not conclusive. With endostaple systems, patients with difficult anatomic features and high risk can potentially be treated. These systems might reduce the high reintervention rates after endovascular aneurysm repair. Controlled randomized trials with larger number of patients are warranted with endostapling use in primary endograft implantation and for use in reinterventi...
Zusammenfassung Hintergrund Die häufig multimorbiden, geriatrisch-unfallchirurgischen Patienten m... more Zusammenfassung Hintergrund Die häufig multimorbiden, geriatrisch-unfallchirurgischen Patienten mit hüftgelenknaher Femurfraktur bedürfen als Notfallpatienten einer möglichst frühzeitigen operativen und interdisziplinären Behandlung, um Komplikationen (Morbidität, „morbidity“) und die Sterblichkeit (Mortalität, „mortality“) zu reduzieren. Die präoperative Verweildauer ist ein sensibler und multifaktorieller Qualitätsindikator (QI) des Behandlungsgeschehens. Aufgrund von fortbestehenden Auffälligkeiten dieses QI in der externen stationären Qualitätssicherung (esQS) in Deutschland wurde vom Institut für Qualitätssicherung und Transparenz im Gesundheitswesen (IQTIG) und vom Gemeinsamen Bundesausschuss (G-BA) weiterhin „besonderer Handlungsbedarf“ für diesen Indikator konstatiert (IQTIG Qualitätsreport 2019). Ziel der Arbeit Identifizierung von methodisch besonders belastbaren Empfehlungen zu strukturellen und prozessualen Standards zur Sicherstellung einer angemessenen klinischen Verso...
Purpose: Recently, vascular endostapling systems were developed to achieve better sealing at the ... more Purpose: Recently, vascular endostapling systems were developed to achieve better sealing at the proximal neck of the aneurysm and to prevent endograft migration. The purpose of this study was to provide a systematic review about the current state and possible options of vascular endostapling systems. Results: No randomized controlled trials were published. The results showed that the use of an endostaple system considerably reduced the rates of endoleaks type 1a and endograft migration. Regarding the use of endostaples in different types of endografts, only a few results were available. Conclusion: The results are not conclusive. With endostaple systems, patients with difficult anatomic features and high risk can potentially be treated. These systems might reduce the high reintervention rates after endovascular aneurysm repair. Controlled randomized trials with larger number of patients are warranted with endostapling use in primary endograft implantation and for use in reintervent...
Metastatic spine disease is frequent in renal cell carcinoma and 50% of osseous metastases are al... more Metastatic spine disease is frequent in renal cell carcinoma and 50% of osseous metastases are already found at the time of primary diagnosis. Therefore patient mobility and quality of life are threatened early in the course of disease. Surgery is able to relieve pain and to regain or to preserve mobility. Indication and technique of surgery (anterior decompression, vertebral replacement and transpedicular fixation) are explained and treatment results of eleven cases are reported. All patients with paraparesis or cord compression preoperatively were mobile when leaving our hospital after surgery. There were no severe complications, especially no neurological deteriorations or deaths. Postoperative survival time was ten months approximately in cases with multiple osseous lesions and it was several years in cases with solitary metastases. Mobility was preserved for most of the survival time. In conclusion, restabilisation of the spine proved to be a worthwhile treatment option in well...
Zeitschrift für Orthopädie und ihre Grenzgebiete, 2000
Purpose of the study: The aim of the study was to characterize the changes of C-reactive protein,... more Purpose of the study: The aim of the study was to characterize the changes of C-reactive protein, erythrocyte sedimentation rate, white blood count and body temperature by serial measurements after different types of uncomplicated orthopedic surgery. Methods: The uncomplicated coures of 180 patients after elective total hip and knee arthroplasties, ventral and dorsal spinal fusions and diagnostic knee and shoulder arthroscopies were analyzed. Results: The maximal CRP-values were recorded on the second or third day after operation. The peak levels correlated with the extent of the procedures and reached 1.28-17.71 mg/dl. The ESR increased to maximal rates five to six days after surgery and remained elevated during the 14 days of the investigation period. WBC and body temperature showed a slow and uncharacteristic increase followed by a slow and irregular decrease. Conclusion: Awareness of the typical pattern of CRP, ESR, WBC and body temperature may help to evaluate the early postoperative course. The CRP is a sensitive marker. ESR, WBC and body temperature are less costly but a poor diagnostic aid for the early detection of postoperative complications especially infections.
Liebe Kolleginnen und Kollegen! Wenn Sie eine interessante Falldarstellung haben, schicken Sie bi... more Liebe Kolleginnen und Kollegen! Wenn Sie eine interessante Falldarstellung haben, schicken Sie bitte Ihren Vorschlag mit Beschreibung und Bildmaterial an die Redaktion.
We studied prospectively the clinical and radiological course of 36 patients with localised spina... more We studied prospectively the clinical and radiological course of 36 patients with localised spinal instability treated with vertebrectomy. A distractible titanium cage filled with polymethylmethacrylate (PMMA) in combination with transpedicular fixation was used to restore spinal stability. Mean follow-up was 16 (8-55) months. Average correction of the segmental kyphosis was 15.2 (2-29). During follow-up, a loss of correction of 0.9 (2-15) was seen. Segmental height was increased by 7.6 (0-14) mm on average with a mean loss of 1.6 (0-2) mm. Twenty-one patients without preoperative neurological deficits were ambulatory without orthosis at discharge. Patients presenting with neurological deficits were unchanged (n=3) or improved (n=12). RØsumØ Nous avons ØtudiØ prospectivement l'Øvolution clinique et radiologique de 36 malades avec une instabi-litØ vertØbrale localisØe traitØe par vertebrectomie. Une cage en titane distractable remplie de PMMA en combinaison avec une fixation transpØdiculaire a ØtØ utilisØe pour restaurer la stabilitØ vertØbrale. Le suivi moyen Øtait de 16 mois (8-55). La correction moyenne de la cyphose segmentaire Øtait de 15,2 (2-29). Pendant le suivi une perte de correction de 0,9 (2-15) a ØtØ notØe. La hauteur segmentaire a ØtØ augmentØe à 7,6 (0-14) mm en moyenne avec une perte moyenne de 1,6 (0-2) mm. Vingt et un malades sans dØficit neurologique prØopØratoire pouvaient marcher sans orthse. Les malades qui prØsentaient un dØficit neurologique Øtaient inchangØs (n=3) ou amØliorØs (n=12).
This paper reports a retrospective review of 91 patients with idiopathic thoracic scoliosis corre... more This paper reports a retrospective review of 91 patients with idiopathic thoracic scoliosis corrected by Zielke VDS instrumentation. The results were analysed to demonstrate the correction in all three planes. Satisfactory correction was obtained, and was particularly good in the sagittal and horizontal planes. There were no disadvantages from the thoracotomy.
S u m m a r y. The Zielke correction technique (VDS) has two parts, derotation and ventral convex... more S u m m a r y. The Zielke correction technique (VDS) has two parts, derotation and ventral convex-side compression. Both were studied by measurements made during and after the operation. Ventral derotation always creates lordosis. Lordosis can be mainrained during compression by insertion of intervertebral bone blocks, or kyphosis created by omitting them. R~sum~, Le procddd VDS de correction de Zielke comporte deux dtapes: d~rotation c) l' aide d'un matdriel spdcial, puis compression de la convexit6 par vole antdrieure. Les deux composantes ont dtd analysdes par des mesures per-et post-opdratoires afin d'dvaluer comment la technique VDS ¢bnctionne dans tes trois plans. Dans les interventions dorsales et lombaires, aprbs ddrotation isot~e, on constate pendant l" op6ration une tordose notable et l 'amelioration de la courbure atteint d~jh 50% du rdsultat ddfinitif La compression terminale de la convexitd aboutit gt une cyphose clans ie rachis dorsal et ~une lordose au niveau des courbures tombaires oit des greffes intersomatiques sont utilisdes.
Demographic changes create an expansion of the elderly population segment of society. Demands of ... more Demographic changes create an expansion of the elderly population segment of society. Demands of mobility and quality of life have increased in this age group over the last decades. A rising number of elderly patients suffering from degenerative "de novo" lumbar scoliosis (DLS) may be eligible for surgical options to treat their spinal deformities. Therefore, we compared the clinical and radiographic results of conservative and surgical treatment. During 1990-2003, 55 patients with DLS were treated and followed up for a minimum of 24 months. Group 1 patients (n=26) underwent surgery (decompression and spondylodesis), group 2 patients (n=29) declined surgery and received conservative treatment (analgesics, physiotherapy). Clinical data, theatre records and X-rays were analysed. All patients were contacted and 73.1% of group 1 and 75.8% of group 2 patients were clinically re-evaluated and received standing radiographs on average 4.8 and 3.8 years after the initial procedure or consultation, respectively. We found a significantly higher rate of spinal stenosis and degenerative spondylolisthesis in group 1 patients (P<0.01). The procedure corrected the lumbar deformity in the frontal and sagittal planes. Three patients required revision for implant failure. Walking distance improved significantly during the postoperative course. Analgesic requirement decreased in comparison to group 2 patients. No significant difference was evident between the groups in terms of lumbar back pain after 3.8 and 4.8 years, respectively. Operative treatment of DLS with decompression in combination with a longer fusion improved walking ability and quality of life. Reduced need of analgesics can be anticipated. Benefits of surgery and risks of complications have to be considered carefully to avoid disappointment in expectations.
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Papers by Johannes Giehl