Der Orthopäde
-
Because of its biopsychosocial factors chronic back pain is often resistant to unimodal therapy regimes. Multimodal pain programs are a promising therapy option in the management of chronic pain as they focus on functional restoration. The aim of the study was to evaluate the prevalence of psychopathology in patients with chronic back pain. ⋯ Fisher's exact test was performed to calculate the significance in the different subgroups. The results showed that there was a high prevalence of depression, anxiety disorders and adjustment disorders in patients with chronic back pain. In this cohort the prevalence of depression and anxiety disorders was significantly higher than the estimated prevalence of the normal German population.
-
Kyphoplasty is associated with a low incidence of cement leakage and this usually tends to be clinically asymptomatic. However, there is a potential for life-threatening complications from extraspinal leakage resulting in vascular, cardiac and pulmonary embolisms. A total of eight cases of open surgical thrombectomy for cardiopulmonary cement leakage have been published in the current literature to date. Besides the description of a consecutive series with special reference to extraspinal cement leakage this article presents the results after successful endovascular removal of intravenous cement fragments following kyphoplasty in two patients. ⋯ A computed tomography scan after kyphoplasty is recommended for all cases. If there is involvement of the inferior vena cava or the azygos/hemiazygos vein an additional CT scan of the chest should follow, even in asymptomatic cases. Residual intravasal cement fragments are safely extractable using endovascular techniques.
-
The primary goals of multimodal, interdisciplinary treatment of bone metastases are to achieve mobility, pain relief, and improve quality of life. In cooperation with radiotherapists and oncologists, an individual therapy plan has to be designed. As bone metastases are a sign of a systemic spread of the disease, cure is not possible in nearly all cases. ⋯ The extent of the operation should be based on the 3S principle "save, short & simple". The prognosis of survival should influence the treatment regime. If it is unclear whether a bone metastasis or a primary bone tumor is present, a biopsy is required.
-
The frequency of infectious diseases of the spine and associated spinal cord injury are constantly increasing. Affected are multimorbid and elderly patients, mostly after prolonged medical treatment. An acute spinal cord injury due to infection is an emergency. ⋯ Just as in cases of spondylodiscitis without spinal cord injury inconsistent surgical or insufficient antibiotic treatment worsens the prognosis significantly. If it is possible to remit the infection, the prognosis for recovery of motor and sensory function is better than in cases with traumatic spinal cord injury. In many cases at least partial recovery can be observed.