Zeitschrift für Orthopädie und Unfallchirurgie
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Randomized Controlled Trial Comparative Study
[Epidural injection therapy with local anaesthetics versus cortisone in the lumbar spine syndrome: a prospective study].
The prospective randomised double-blind study analyses follow-up data of the therapeutic effects of cortisone versus local anaesthetics using an injection technique close to the nerve root in chronic lumbar spine syndrome. ⋯ The advantage of a combined injection of local anaesthetics and cortisone versus a injection of local anaesthetics alone in epidural-peridural technique in the inpatient treatment of the chronic lumbar spine root compression syndrome could not be detected.
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Several non-fusion technologies have been developed as an alternative to fusion procedures in the past decades, in order to avoid typical problems related to fusion. The Dynesys (Zimmer, USA), which was inaugurated 7 years ago, consists of pedicle screws, flexible spacers and cords and is intended to control segmental motion and to realign the lumbar spine. Since this device is new, it was the goal of this study to analyse the perioperative morbidity of lumbar stabilisation with Dynesys retrospectively. ⋯ The perioperative morbidity of lumbar stabilisation with Dynesys seems to be similar to posterior fusion techniques. However, an additional morbidity due to interbody fusion, which may necessitate also autogenous bone, is avoided.
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With the help of a clinical and radiological follow-up evaluation 8 years after implantation of the femoral neck prosthesis CUT (ESKA Implants, Lübeck Germany), the question of whether this metaphyseal anchoring implant is recommendable in young patients will be answered. ⋯ The analysis of the eight-year follow-up of 82 CUT prostheses shows that the implant does not fulfil our expectations of a femoral neck prosthesis, in spite of the possibility of a less invasive and bone-saving implantation technique. In view of unacceptable survival rates, valgisation changes of the joint geometry and critical changing procedures, from our point of view the femoral neck prosthesis CUT does not represent a recommendable alternative implant in young, active patients.
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Lumbar spinal canal stenosis is a common disease of the elderly patient, with a high prevalence and clinical importance. MRI is the established method of choice for the imaging of spinal canal stenosis. However, there is often a discrepancy between the clinical symptoms and the spinal canal stenosis as shown using MRI in a supine position. In such cases preoperative functional imaging is often warranted. ⋯ Using upright MRI a functional spinal canal stenosis can be shown. The pathomechanisms of the spinal canal stenosis are discussed. The possibilities and limitations of this new imaging modality are presented and analysed.