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Purpose There is no data that shows if it is possible to determine if a curve is structural or non-structural or to assess flexibility of an adolescent idiopathic scoliosis (AIS) by magnetic resonance imaging (MRI) instead of bending radiographs (BR). We investigated if the results of BR may be compared to those of MRI. Methods We retrospectively analyzed prospectively collected data of patients with AIS in whom a selective spinal fusion was performed and in whom a MRI, BR and full-spine X-rays were obtained preoperatively. We measured the Cobb angles of the main and of the minor curve in full-spine X-ray (FSR), BR and MRI and analyzed the degree of the intervertebral disk degeneration in the MRI. Results After applying inclusion and exclusion criteria, 25 patients were included. We found a significant correlation (p p Conclusion Spinal curves showed a significant correlation between bending radiographs and recumbent images (MRI). In our group of patients, a Cobb angle of the minor curve of less than 30° in the MRI indicated that this minor curve was non-structural according to the classification of Lenke.

Objective To evaluate radiological outcomes following the use of xenogeneic bone graft substitute (BGS) in patients undergoing multisegmental spinal fusion. Summery of Background Data Data exists for single level and short segment fusions, there presently is a paucity of data on fusion rate after bone augmentation with BGS in multisegmental posterior spinal fusion (PSF). The leading concern is pseudarthrosis, which often leads to a loss of correction after PSF. Therefore, the bone graft is an essential aspect of PSF. Methods We retrospectively analysed the radiological data of a consecutive cohort of patients who had been treated for adolescent idiopathic scoliosis (AIS) via multisegmental spinal fusion, in whom a bovine derived BGS had been used and had a complete dataset of 24 months follow-up. The Cobb angle of the main curve was measured pre-operatively and then at 6, 12 and 24 months post-operatively. Loosening of the screws was recorded at the same post-operative time points. Results After applying inclusion and exclusion criteria, 28 patients were included. We found no significant change of the cobb angle from the main curve as well as the cobb angle from the thoracic kyphosis during the 24 months of follow up. No patient showed a lack of bony fusion. There was 1 revision surgery, which was due to trauma. Conclusion In this cohort, all patients showed successful bone fusion during a 24-month follow-up. Additionally, there was no change in the Cobb angle during the 2-year post-operative period. Our data indicates that the use of bovine-derived BGS supports bone fusion after multisegmental posterior instrumented fusion of the spine.

BACKGROUND: It is presently unknown if lumbar lordosis (LL) might be applied to monitor low back pain (LBP) in patients with lumbar disc herniation (LDH). There is presently only conflicting data that does not show a correlation of LL with LBP: Previous studies do either include chronic LBP or do not consider that each patient has an individual value of LL that cannot be compared to other patients. METHODS: Power analysis: At least 32 patients had to be enrolled in the study. Out of 84 consecutive patients with acute onset of pain (

Retrospective data analysis.The primary objective of this investigation was to analyze if treatment of Postoperative surgical site infections (PSSI) after posterior stabilization of the spine (PS) without radiological signs of screw loosening (RSL) shows a sufficient success rate without implant removal and if there was any difference between early and late PSSI.PSSI after PS are usually treated by implant removal and reinstrumentation if loosening of one of more screws is detected. There is presently no conclusive data that shows the success rate of the treatment of PSSI after PS without implant removal if no RSL are perceived.All patients who were treated for a PSSI after PS without RSL in a single spine center from 12/2009 to 03/2020 were enrolled in a retrospective analysis. Patients were treated by revision surgery with debridement and irrigation and subsequent antibiotic therapy. Implant removal was performed if the initial treatment did not lead to an improvement in wound healing and normalization of laboratory values. Statistical analysis was performed by Statistical Package for the Social Sciences 25. Descriptive data are given as mean and standard error of mean, a χ2 test was performed.Of the 32 enrolled patients, 17 had an early PSSI, 15 a late PSSI. In 71.9% (23/32), the PSSI was treated without implant removal: 12/17 in early PSSI, 11/15 in late PSSI. The difference was not significant (P0.05). One patient died, all other patients were discharged from the hospital with no remaining laboratory signs of the infection and with closed soft tissues.In our group of patients, the success rate of irrigation and debridement without implant removal was 71.9%. In the light of this data, performing at least two irrigations and debridement before implant removal seems to be a valid treatment option in PSSI after PS if there are no RSL in early and late PSSI.

Background There is presently insufficient data on small groups of patients, without focus on time since herniation occurred and without establishing a valid method of measurement for signal intensity (SI) of a lumbar disc herniation (LDH) in a standard magnetic resonance imaging (MRI). SI could be reported in relation to SI of nucleus pulposus of herniated intervertebral disc, nucleus pulposus of a healthy “control” intervertebral disc, cerebral spinal fluid, or anterior anulus fibrosus. It is not known which signal intensity ratio (SIR) shows the highest correlation with time since onset of pain and how SIR of different Combined Task Forces (CTF)-types of herniation develop over time. Methods Out of 1053 patients, we enrolled 151 patients to a retrospective single-center analysis of standard MRIs of consecutive patients treated for LDH from February 2008 to December 2017 with confirmed (surgery, injection, or electrophysiologic testing) radicular pain by LDH and known exact date of onset of pain. We excluded patients 70 years, with chronical pain syndrome, spinal deformity, and history of prior spinal surgery on the affected spinal level. Because data did not show normal distribution, we assessed correlation by Spearman rank correlation coefficient. Correlation (R) and coefficient of correlation (CC) are reported. Results SI of LDH referenced by SI of nucleus pulposus of the affected intervertebral disc and CTF type “extrusion” showed the highest correlations with time since onset of pain (R: −0.893; CC: 79.7), followed by CTF-type “sequestration” (R: −0.356; CC: 12.7). Conclusions SIR of extrusion referenced by nucleus pulposus of the affected intervertebral disc does show a high correlation with days since onset of herniation and may be applied to monitor changes of SI of LDH after herniation in standard MRIs of the lumbar spine.

• Molecular intervertebral disc damage was associated with LBP and radiculopathy. • Patients with radiculopathy and LBP demonstrated a depletion of gagCEST values compared with healthy controls. • GagCEST imaging may be a non-invasive tool for investigation of degeneration processes of lumbar intervertebral discs (IVDs). GagCEST imaging may be an imaging biomarker for biochemical IVD alterations.

Objective: To assess glycosaminoglycan (GAG) content of lumbar intervertebral discs (IVDs) in patients with radiculopathy compared with healthy volunteers with glycosaminoglycan chemical exchange saturation transfer (gagCEST). Methods: The lumbar spines of 15 patients with radiculopathy (9 women, 6 men; mean age 45 years; range: 19 - 80 years) and 13 healthy controls (10 women, 3 men; mean age 29 years; range: 19 - 38 years) without lumbar back pain or previous spine surgery were examined at a 3 Tesla (T) magnetic resonance imaging (MRI) scanner in this prospective study. The MRI protocol included standard morphological, sagittal, and transverse T2-weighted (T2w) images of the five lumbar IVDs (L1-S1) to assess Pfirrmann score and to detect disc disorders according to the Combined Task Force classification. To analyze biochemically the lumbar IVDs, a gagCEST sequence was applied to measure the GAG content of the nucleus pulposus (NP) and annulus fibrosus (AF). Results: Patients with radiculopathy indicated significantly lower gagCEST values in NP than healthy volunteers (2.82% ± 3.12% vs. 4.09% ± 2.25%, P = 0.017). The GAG content of AF showed no significant difference between volunteers and patients (2.66% ± 2.01% vs. 1.92% ± 2.56%; P = 0.175). Conclusions. Patients with radiculopathy presented with lower GAG values than healthy volunteers in NP, indicating an association between pain and IVD degeneration. gagCEST of lumbar IVDs is a powerful, non-invasive tool to investigate early disc degeneration, which we could demonstrate in the NP in our study collective.

Purpose There is no data that show if it is possible to determine if a curve is structural or non-structural or to assess flexibility of an adolescent idiopathic scoliosis (AIS) by recumbent images like a CT scan (CTS) instead of bending radiographs (BR). We investigated if the results of BR may be compared to those of CTS. Methods We retrospectively analyzed prospectively collected data of patients with AIS in whom a selective spinal fusion was performed and in whom a CTS, BR, and full spine x-rays were made preoperatively. We measured the Cobb angles of the main and the minor curve in full spine x-ray, BR, and CTS. Results After applying inclusion and exclusion criteria, 39 patients were included. We found a strong correlation (r = 0.806, p r = 0.601, p Conclusion Spinal curves showed a significant correlation between bending radiographs and recumbent images (CTS). In our group of patients, a Cobb angle of the minor curve of less than 35 degrees in the CTS indicated that this minor curve was non-structural.

Purpose In the present study, a systematic histological analysis of the glenohumeral joint capsule was conducted. Materials and methods 12 cadaveric shoulders were examined. Inclusion criteria were: 1) intact joint capsule and 2) fixation in neutral position. The tissue samples were Elastica Hematoxylin-van-Gieson-(ElHvG) stained and diameter, quantity, and distribution patterns were analyzed. Results We detected a new layer (elastic boundary layer, EBL) between the synovial and fibrous membrane. The elastic fibres of the EBL differ considerably in diameter, quantity, and distribution pattern. Conclusions A previously undescribed layer was noticed, which we named elastic boundary layer for now.

Objective To evaluate the position of the acromioclavicular joint (ACJ) and relation to the critical shoulder angle (CSA) in shoulders with rotator cuff tears (RCT). Methods In a matched pair study including 75 shoulders with arthroscopically validated RCT and 75 controls (mean age 59.4 ± 7.9 years) the position of the ACJ in relation to the glenoid and the CSA were measured on true ap radiographs. Results The CSA is larger (p = 0.0018) and the position of the ACJ is more lateral (p = 0.0016) in shoulders with RCT in comparison to matched controls. Conclusion The more lateral position of the ACJ in shoulders with a large CSA might be an additional component in the multifactorial pathogenesis of RCT.

We investigated if applying the Transition system (® Globus Medical) as topping off can prevent Adjacent Segment Degeneration (ASD) and if rate of ASD is increased if instrumentation stopped at the apex of the Lumbar Lordosis (LL). We enrolled 99 consecutive patients in a retrospective study who have been operated by instrumented fusion of the lumbar spine. Thirty patients were treated by topping of (Group 1), 69 patients received the standard procedure (Group 2). 18 patients of group 1 (60%) and 38 patients of group 2 (55%) developed ASD. The difference was not significant (p>0.05). In 17 patients (17%) instrumentation stopped at apex of LL. 14/17 patients (82%) developed an ASD. This influence was significant (p

This study was a retrospective radiographic analysis of consecutive patients.To analyze exposure to radiation of the surgeon and-separately-of patients in minimally invasive surgery (MIS) of multilevel posterior stabilization by percutaneous pedicle screw insertion guided by navigation (PIN) versus percutaneous pedicle screw insertion guided by fluoroscopy (PIF).Spine surgeons are exposed to a 12-fold higher dose of radiation than other nonspinal musculoskeletal surgeons and PIF in MIS leads to a 2-fold higher dose of radiation than in open surgery. PIN might reduce the dose of radiation for the surgeon and the patient, especially in multilevel MIS surgery. To the best of our knowledge, there are only rare data of short-segment fusions that do not focus on exposure to radiation of surgeons.After power analysis, we included 205 consecutive screws (22 patients). We monitored dose of radiation (recorded separately for patient and surgeon), accuracy of screw placement, time of operation, and approach-related complications.In PIN, only 58.7% of dose area product (cGy×cm) per screw of PIF was determined for patients (P0.01). The surgeon was only exposed to 19.9% of radiation per screw in PIN compared with dosage in PIF (P0.01). Four of 205 screws (2.0%) were classified as being incorrectly positioned: 2 of 87 screws (2.3%) in PIF and 2 of 118 screws (1.7%) in PIN (P0.05). We did not observe any wound infections.PIN in MIS is a safe procedure and does, compared with PIF, lead to significant reduction of radiation dose for patients and-even more-for spine surgeons.

In this prospective study, we sought to establish normative data for T2* analysis of lumbar intervertebral discs (IVDs). Further, potential diurnal effects regarding T2* relaxometry of the lower spine were examined. Lumbar IVDs of young, healthy, adult men (n = 20) and women (n = 20; mean age = 24.5 ± 2.9 years) were assessed. Magnetic resonance imaging including T2* mapping was performed on a 3-T scanner. Mid-sagittal T2* values were obtained in five regions: anterior annulus fibrosus (AF), anterior nucleus pulposus (NP), central NP, posterior NP, and posterior AF. Zonal and segmental differences, as well as diurnal variations between the T2* analysis in the morning and the evening and effects of unloading, were analyzed. Discs with signs of degeneration on morphological images or imaging artifacts were excluded. We noted a zonal and segmental T2* distribution with high values in the NP, low T2* values in the AF and a T2* increase towards the caudal NP. We observed no diurnal differences between the mean T2* values in the morning and in the evening (p = 0.748). The effect of unloading the spine was low (maximum T2* difference between four measurements = 13.6 ms; significant difference noted only between the 0 and 15-min measurement). The T2* values obtained in this study will serve as normative values for future T2* measurements. There are no diurnal influences, and we suggest that unloading of the spine has no demonstrable effect after 30 min on the T2* results. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1956-1962, 2019.

Brace treatment for adolescent idiopathic scoliosis (AIS) is generally prescribed for 18-23 hours per day, but the minimal time of brace wear per day to stop progression of AIS is still unclear. Compliance of patients with AIS with brace treatment is reported to be between 27% and 47% of the prescribed time, brace wear especially at school is often described as embarrassing by adolescent patients. It has been reported that a higher rate of compliance leads to a significantly lower rate of curve progression. Theoretically, prescribing brace treatment 16 hours instead of 23 hours per day (patients are allowed to attend school free of their brace) could lead to a higher rate of compliance, and subsequently reduce progression rate of patients with AIS.To investigate if brace treatment 16 hours per day is noninferior to16 hours with regard to curve progression, and if other clinical and demographic factors that might influence incidence and progression (apart from time of brace wear) of AIS can be identified.In a retrospective study, we investigated patients with AIS who had been admitted to our outpatient clinic and enrolled them in one of three groups: group 1 brace12 hours per day, group 2 brace 12-16 hours per day, and group 3 brace16 hours per day.Seventy-two patients met our inclusion criteria and were enrolled in our study, 61 female and 11 male patients. Twenty-eight were allocated in group 1, 13 in group 2, and 25 in group 3.Progression of Cobb angle with regard to brace wear per day was the main outcome measure.Skeletally immature patients who presented from October 2010 to June 2013 with an AIS and a Cobb angle20° were enrolled in our study and have been prescribed a Chêneau orthesis. Demographic parameters, progression of Cobb angle, and time of brace wear have been recorded. Groups 1, 2, and 3 of brace wear were analyzed for differences.The overall difference between the groups referring to increase of Cobb angle was significant (p.05). Further analysis of groups 2 and 3 showed that the difference between these groups was not significant (p.05). Apart from time of brace wear, no other factor showed any influence on curve progression. Smoking status of parents of our patients was significantly more often positive than in the general local population (p.05).Twelve to 16 hours of brace wear per day did not lead to a higher progression rate of AIS compared with more than 16 hours in our study group. Our analysis showed that smoking status of parents possibly contributes to the risk of developing AIS; however, we did not find an impact on progression of scoliosis.