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  • 1
    Electronic Resource
    Electronic Resource
    Lumbar and thoracic spinal fusion with transpedicular fixation (Including a novel distraction and compression device) (1986)
    Springer
    Archives of orthopaedic and trauma surgery 105 (1986), S. 126-129 
    Details
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Experience with three different systems of transpedicular fixation in fusion of the lumbar and thoracic spine over 4 years is reported. The Roy-Camille plates, Louis plates, and the Balgrist turn-buckle arrangement are compared. The Balgrist device allows both extension and compression, and affords better stability. Far better clinical results were obtained with transpedicular fixation in general than with the Harrington method.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00455847
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  • 2
    Electronic Resource
    Electronic Resource
    Percutaneous nucleotomy (1986)
    Springer
    Archives of orthopaedic and trauma surgery 105 (1986), S. 287-295 
    Details
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary As an alternative to the well-established surgical procedures for the treatment of disk herniation, percutaneous nucleotomy has proved to be very satisfactory. In several cases this approach has brought complete relief to the patient without sacrifice of bone and without causing soft tissue damage as would have been inevitable with the usual surgical methods. Percutaneous nucleotomy is also a true alternative to chemical nucleolysis when leakage of contrast agent into the spinal canal has already been observed during diskography. Furthermore, this method avoids disagreeable complications encountered in chemical nucleotomy, for example, anaphylactic shock or the escape of the nucleolytic agent into the spinal canal. The method basically consists of removing the nucleus pulposus (or a major part of it) by means of a forceps that is introduced to the site through a cannula. In this manner a reduction of volume of the disk is achieved. The procedure can easily be carried out under local anesthesia. This method should be avoided in the case of prolapse within the spinal canal and especially when displacement beyond the level of the disk has occurred. In the period between 1979 and 1985 we carried out percutaneous nucleotomies in 51 patients with herniation mostly combined with a narrow spinal canal orspondylolisthesis. The clinical results from 32 of 51 patients can be assessed as very good, good, or satisfactory. We consider the proportion of patients showing good clinical results to be high, bearing in mind that the indication was not just disk herniation alone but, in most cases, combined with other lumbar pathologies as well.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00449928
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  • 3
    Electronic Resource
    Electronic Resource
    The mechanical response of the neural arch of the lumbosacral vertebra and its clinical significance (1980)
    Springer
    International orthopaedics 4 (1980), S. 205-209 
    Details
    ISSN: 1432-5195
    Keywords: Neural arch ; Lumbar vertebra ; Spondylolisthesis ; Spondylolysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Pour apprécier la part des facteurs mécaniques dans l'étiologie du spondylolisthésis les auteurs ont étudié le comportement de la colonne lombaire en charge. Les tests de charge sur le segment lombo-sacré, comportant ou non ses éléments postérieurs, ont montré qu'en général le disque ne transmet que les forces axiales tandis que les forces de cisaillement sont transmises par les éléments postérieurs. Ce n'est qu'après avoir créé artificiellement un Spina bifida, par laminectomie, qu'il a été possible de produire une fracture de l'isthme, en appliquant une force dans une direction transversale. La mesure de la transmission des forces dans l'arc postérieur montre qu'une charge transversale isolée retentit tout autant sur le pédicule que sur la région inter-articulaire. Des mesures pratiquées à l'aide de jauges de contrainte sur une 5ème vertèbre lombaire ont montré qu'une charge verticale sur la charnière lombo-sacrée en hyperextension peut produire une fracture de l'isthme. Des expériences identiques réalisées sur des colonnes lombaires de cadavres frais ont confirmé ces résultats: lorsque la partie interarticulaire de la 5ème lombaire est mise sous tension par le processus articulaire inférieur de la 4ème lombaire, une force verticale de 200 kgs suffit pour provoquer une fracture.
    Notes: Summary To investigate the effect of mechanical stresses in the aetiology of spondylolisthesis a study of the behaviour of the lumbar spine under load has been carried out. The loading tests on the lumbo-sacral segment, both with and without the dorsal elements present, showed that generally the disc only transmitted axial loads whereas transverse loads are resisted by the dorsal processes. Only after simulating a spina bifida, by splitting the lamina, was it possible to initiate a fracture in the isthmus by means of force applied in the transverse direction. Measurement of the stress behaviour in the neural arch shows that with transverse loading alone the pedicle can be just as heavily stressed as the pars interarticularis. Strain gauge measurements were performed on a macerated fifth lumbar vertebra to determine the manner in which loading forces must act to provide the greatest effect upon the region of the pars interarticularis. This was found to occur with vertical loading of the hyperextended spine. The vulnerability of the vertebra under these conditions was confirmed with further tests upon fresh cadaver specimens when it was found that the pars interarticularis of the fifth lumbar vertebra, when impinged upon by the caudal joint edges of the fourth lumbar vertebra, could be fractured with a vertically applied load of about 200 kp.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00268157
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  • 4
    Electronic Resource
    Electronic Resource
    A comparison of the long term results of three types of posterior fusion of the lumbar spine for spondylolisthesis (1982)
    Springer
    International orthopaedics 5 (1982), S. 291-297 
    Details
    ISSN: 1432-5195
    Keywords: Posterior fusion ; Lumbar spine ; Spondylolisthesis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Entre 1923 et 1976 ont été effectuées à la clinique universitaire d'orthopédie Balgrist à Zurich 312 arthrodèses vertèbrales postérieures chez des malades atteints de spondylolisthésis. Les interventions ont été pratiquées selon les techniques d'Albee, Bosworth et Hibbs. Les résultats à long terme ont été estimés bons chez 80% des malades opérés par la technique d'Albee. Par contre, la méthode de Hibbs n'a donné de bons résultats que dans 65% des cas. Un glissement vertèbral progressif post-opératoire a été constaté chez environ 60% des malades ayant été opérés par la méthode d'Albee, surtout dans les cas présentant un glissement vertèbral important. On constate que ce glissement vertèbral cesse dès que l'espace intervertèbral a fusionné tandis que les symptômes subjectifs s'amendent. Ce phénomène n'est que rarement observé après une opération de Hibbs; celle-ci, du fait d'une meilleure stabilité post-opératoire entraîne une sclérose des disques de type dégénératif sans pincement notable de l'espace intervertébral. La plus grande rigidité de l'arthrodèse de Hibbs est mécaniquement plus sollicitée par les mouvements du tronc ce qui peut provoquer un syndrome douloureux persistant et conduire ultérieurement à une fracture de fatigue.
    Notes: Summary Between 1923 and 1976, 312 posterior spinal fusions using the methods of Albee, Bosworth and Hibbs were performed on patients with spondylolisthesis at the Orthopaedic University Hospital Balgrist, Zurich. Long-term clinical results were rated as good in 80% of all patients operated on with the Albee method. The results after the Hibbs procedure on the other hand were good in only 65%. Progressive vertebral slipping after operation was seen in about 60% of all patients operated on by Albee's method, particularly in cases with severe spondylolisthesis. This slipping stops as soon as the intervertebral space had fused. Relief of the subjective symptoms also occured at this time. This phenomenon was only rarely seen after the Hibbs operation, in which the better postoperative stability leads to sclerosis of the discs indicating degenerative changes without a significant decrease in the disc height. The greater stability of the Hibbs's fusion is more easily overstressed by body movements which can cause persistent symptoms and later lead to fatigue fractures.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00271085
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  • 5
    Electronic Resource
    Electronic Resource
    Histomorphological investigations of coxa femoral ends following double-cup arthroplasty according to freeman (1979)
    Springer
    Archives of orthopaedic and trauma surgery 94 (1979), S. 233-240 
    Details
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Von 20 in den Jahren Mitte 1976 bis Ende 1978 in unserer Klinik eingesetzten Schalenprothesen nach Freeman bei frühzeitiger Coxarthrose mußten inzwischen 3 wieder entfernt werden. An den mitentfernten coxalen Femurenden wurden mit verschiedenen histologischen Techniken morphologische Untersuchungen durchgeführt. Anhand makroskopischer und mikroskopischer Strukturanalyse wird das Verhalten des unter dem Zement und der Prothesenschale eingeschlossenen Knochengewebes gegenüber dem Fremdkörper und den biomechanisch gestellten Aufgaben untersucht. Abhängig von dem zeitlichen Verlauf wird die zuerst überall offene Spongiosaoberfläche zu einer dünnen kortikalen Deckschicht umstrukturiert. Unabhängig von zeitlichem Abstand zwischen Einsetzung and Entfernung der Schalenprothese bildet sich zwischen coxalem Femurende und dem Zement ein kontinuierlich breiter, mit zell- und faserreichem Gewebe gefüllter Spaltraum aus, welcher auch nach Ausdifferenzierung einer Kortikalis noch erhalten bleibt.
    Notes: Summary Of 20 shell prostheses inserted in cases of early coxarthrosis in our clinic during the period from mid-1976 to the end of 1978, three had to be removed. Morphological examinations, employing different techniques, were made of the coxa femoral ends which were removed. The foreign body reaction of the bone tissue beneath the cement within the prosthetic shell and the biomechanical response were investigated on the basis of macroscopic and microscopic structural analyses. Dependent upon the time elapsed, the exposed spongiosa surface was observed to have become remodeled to a thin cortical protective layer. Independent of time between insertion and removal of the prosthetic shell, a continuous wide layer, consisting of cellular and fibrous tissue, was formed between the bone and the cement (which remained intact) even after the formation of the above-mentioned cortical bone substrate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00383406
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  • 6
    Electronic Resource
    Electronic Resource
    Biomechanische analyse der lockerung von femurprothesen Biomechanical analysis of the loosening of the femur prostheses (1978)
    Springer
    Archives of orthopaedic and trauma surgery 92 (1978), S. 261-272 
    Details
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Lockerung des einzementierten Prothesenschaftes im Femur wird vom biomechanischen Gesichtspunkt aus untersucht. Die vorliegende experimentelle Spannungsanalyse am Femurmodell läßt Rückschlüsse auf Faktoren zu, welche Ursache von Lockerungsprozessen sein können. Die experimentell erarbeiteten Schlußfolgerungen stimmen mit den klinischen Beobachtungen überein. Die am Femurmodell gewonnenen Mcßergebnisse ließen sich an Hand von Dehnungsmessungen am einzementierten Prothesenschaft beim frisch entnommenen Leichenknochen bestätigen.
    Notes: Summary A comparison of the stresses determined in an epoxy model of the human femur both with and without an intramedullary endoprosthetic replacement indicates how loosening of the implant could occur due to inappropriate mechanical loading of the bone. The stress pattern explains the manner in which the prosthesis stem is loaded and also indicates how hip-joint forces are transmitted from the prosthesis to the bone. The results obtained were verified by strain measurements on prostheses implanted within fresh human cadaver femora.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02341809
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