Wirbelsäulenverletzung im Sport

Merkel, P.; Hauck, Stefan; Zentz, Florian; Bühren, V.; Beisse, Rudolf

doi:10.1007/s00113-008-1456-2

Cited by 11 publications

(4 citation statements)

References 18 publications

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“…Postoperative chest tube output can be lower using VATS 9 , similar 16 or higher compared to OTC 20,25 . Minor complications directly attributed to VATS include pleural effusions indicating puncture or prolonged chest tube drainage (that might be due to the inability of suture closing the pleura), pneumothorax formation, and an increased rate of atelectasis and mucoid plug formation during collapsed lung surgery 10,16,19,[37][38][39] . Serious complications previously reported include lung injuries, the development of tension pneumothorax, neurologic injury and serious arterial bleeding indicating urgent conversion to OTC 12,20,23,38,[40][41][42] .…”

Section: Discussionmentioning

confidence: 99%

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Approach-related morbidity in transthoracic anterior spine surgery: a clinical study and review of literature

et al. 2010

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BACKGROUND: Anterior access to the thoracic spine is done by open thoracotomy (OTC) or video-assisted thoracoscopic surgery (VATS). VATS is known as the method which results in lower morbidity rates, but there is little evidence of its less invasiveness. Objective: The current study yielded for outcome data concerning patients' perception of approach-related morbidity (ArM) following OTC for spinal surgery and that of a control group having a chest tube thoracotomy (CTT). METHODS: We performed a questionnaire assessment of ArM after OTC and CTT. Applying strict inclusion criteria, we compared outcomes in terms of percentage morbidity (Morbidity %) of 43 patients that underwent OTC for instrumented scoliosis correction to 30 patients that had CTT for minor thoracic pathologies (e.g., pneumothorax). RESULTS: Mean age in CTT and OTC Group was 50.2 and 16.5 years old, follow-up was of 32.2 and 58.4 months, and mean incision length was 2.5 and 25.5 cm, respectively. Mean number of levels fused in the OTC Group was 5.8. Mean morbidity (0% delineating no cases, 100% delineating highest morbidity) for the CTT Group was 10.8±15.4% (0-59.5%), 42% of patients had no morbidity. Signs of intercostal neuralgia (ICN) were present in 16.7%. A total of 35.5% had a morbidity >10% (mean: 27.5%), and 10% of morbidity cases were defined as having a chronic post-thoracotomy pain (CPP). In the OTC Group, mean morbidity was 7.0±12.7% (0-52.1%), 44% had no morbidity. Out of the sample, 18.6% had morbidity >10% (mean: 28.6%). Signs of ICN were present in 14%. In both groups, the presence of ICN had a significant impact on and showed correlation with morbidity (p<0.0001). In terms of clinical judgement, the severity of the ArM after a CTT or OTC was generally mild except for one patient in each group. Age and follow-up were significantly different between groups (p<0.0001, p=0.02), but the intergroup difference in morbidity was not significant (p=0.08). CONCLUSIONS: ArM after open thoracic spinal surgery or VATS procedures can be assessed using the questionnaire. To put ArM of OTC into perspective, a Control Group with simple CTT was selected, demonstrating that morbidity was not different between the OTC and CTT groups. Patients with increased signs of ICN do worse which was reflected by increased morbidity in both groups. The study demonstrates that not only the cosmesis is not a concern for patients undergoing OTC, but neither is the ArM a concern, equalling that of a simple CTT.

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Section: Discussionmentioning

confidence: 99%

“…The study showed a significant follow-up-dependant drop in the prevalence of sequels following VATS. Recently, a German group 39 presented the results of VATS for anterior reconstruction in 60 spinal fractures. Assessment included a physicians' judgement on the perceived ArM in four grades (grade 4 resembles disabling pain).…”

Section: Discussionmentioning

confidence: 99%

Approach-related morbidity in transthoracic anterior spine surgery: a clinical study and review of literature

et al. 2010

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“…Fractures in the region of the thoracic and lumbar spine are common entities representing 80% of all vertebral fractures [ 1 ]. Almost half (49.6%) of vertebral body fractures are reported to be burst or incomplete burst fractures [ 2 , 3 ]. Thereof, the majority (68%) of these fractures occur at the thoracolumbar junction (Th11-L2) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Improvement of vertebral body fracture reduction utilizing a posterior reduction tool: a single-center experience

et al. 2023

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Background Extensive research regarding instabilities and prevention of kyphotic malalignment in the thoracolumbar spine exists. Keystones of this treatment are posterior instrumentation and anterior vertebral height restoration. Anterior column reduction via a single-stage procedure seems to be advantageous regarding complication, blood loss, and OR-time. Mechanical elevation of the anterior cortex of the vertebra may prevent the necessity of additional anterior stabilization or vertebral body replacement. The purpose of this study was to examine (1) if increased bony reduction in the anterior vertebral cortex could be achieved by utilization of an additional reduction tool, (2) if postoperative loss of vertebral height could be reduced, and (3) if anterior column reduction is related to clinical outcome. Methods From one level I trauma center, 173 patients underwent posterior stabilization for fractures of the thoracolumbar region between 2015 and 2020. Reduction in the vertebral body was performed via intraoperative lordotic positioning or by utilization of an additional reduction tool (Nforce, Medtronic). The reduction tool was mounted onto the pedicle screws and removed after tightening of the locking screws. To assess bony reduction, the sagittal index (SI) and vertebral kyphosis angle (VKA) were measured on X-rays and CT images at different time points ((1) preoperative, (2) postoperative, (3) ≥ 3 months postoperative). Clinical outcome was assessed utilizing the Ostwestry Disability Index (ODI). Results Bisegmental stabilization of AO/OTA type A3/A4 vertebral fractures was performed in 77 patients. Thereof, reduction was performed in 44 patients (females 34%) via intraoperative positioning alone (control group), whereas 33 patients (females 33%) underwent additional reduction utilizing a mechanical reduction tool (instrumentation group). Mean age was 41 ± 13 years in the instrumentation group (IG) and 52 ± 12 years in the control group (CG) (p < 0.001). No differences in terms of gender and comorbidities were found between the two groups. Preoperatively, the sagittal index (SI) was 0.69 in IG compared to 0.74 in CG (p = 0.039), resulting in a vertebral kyphosis angle (VKA) of 15.0° vs. 11.7° (p = 0.004). Intraoperatively, a significantly greater correction of the kyphotic deformity was achieved in the IG (p < 0.001), resulting in a compensation of the initially more severe kyphotic malalignment. The SI was corrected by 0.20–0.88 postoperatively, resulting in an improvement of the VKA by 8.7°–6.3°. In the CG, the SI could be corrected by 0.12–0.86 and the VKA by 5.1°–6.6°. The amount of correction was influenced by the initial deformity (p < 0.001). Postoperatively, both groups showed a loss of correction, resulting in a gain of 0.08 for the SI and 4.1° in IG and 0.03 and 2.0°, respectively. The best results were observed in younger patients with initially severe kyphotic deformity. Considering various influencing factors, clinical outcome determined by the ODI showed no significant differences between both groups. Conclusion Utilization of the investigated reduction tool during posterior stabilization of vertebral body fractures in a suitable collective of young patients with good bone quality and severe fracture deformity may lead to better reduction in the ventral column of the fractured vertebral body and angle correction. Therefore, additional anterior stabilization or vertebral body replacement may be prevented.

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“…Auch Könings und Böhmer (2000) sehen in der dorsalen Vorgehensweise ein relativ "komplikationsarmes, effektives und etabliertes Stabilisierungsverfahren". Sie Eine aktuellen Studie über "Wirbelsäulenverletzungen im Sport" (Merkel et al 2008) konnte zeigen, dass eine dorso-ventrale Versorgung den geringsten postoperativen Korrekturverlust aufweist, wobei hier noch keine Langzeitergebnisse vorlagen. Auch wenn der Korrekturverlust bei dem kombinierten Verfahren geringer war, gab es hinsichtlich der Rückenfunktion der Patienten, die anhand des VAS klassifiziert wurden, keine signifikanten Unterschiede zwischen dem rein dorsalen und dem kombinierten dorso-ventralen Verfahren (Merkel et al 2008).…”

Section: Behandlungsstrategien Von Thorakolumbalen Frakturenunclassified

Versorgungsstrategien von Wirbelfrakturen des thorakolumbalen Übergangs

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Wirbelsäulenverletzung im Sport

Abstract: The current management of injuries of the spine effectuates a high rate of resumption of sports activity following conservative or operative treatment.

Cited by 11 publications

References 18 publications

Approach-related morbidity in transthoracic anterior spine surgery: a clinical study and review of literature

Approach-related morbidity in transthoracic anterior spine surgery: a clinical study and review of literature

Improvement of vertebral body fracture reduction utilizing a posterior reduction tool: a single-center experience

Versorgungsstrategien von Wirbelfrakturen des thorakolumbalen Übergangs

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