Der Orthopäde
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Kyphosis is the typical deformity of untreated spine fractures. In the majority of all injuries, destruction of the anterior part of the spine occurs. Biomechanical aspects require reconstruction of the anterior column. ⋯ In the case of anterior cage implantation, the risk of graft failure can be avoided. With anterior minimally invasive approaches, traumatization can be reduced by using the same biomechanical principles. In the case of a type A fracture with intact posterior elements, use of an anterior primary stable implant with bone graft represents an alternative method.
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A case of spontaneous occipitocervical fusion is discussed. The authors believe that fusion at the occipitocervical junction will occasionally occur in rheumatoid arthritis in the adult population. As a result of fusion, the dens axis is unable to exert compression on the spinal cord with increased neck flexion.
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Spondyloptoses, but also high-grade spondylolistheses, usually only develop at the lumbosacral junction and are nearly always classed among dysplastic spondylolistheses. Kyphosis of the lumbosacral junction leads to compensation mechanisms with increased lumbar lordosis and straightening of the pelvic tilt with involvement of the hip and knee joints. Reconstructing a physiological sagittal profile by more or less complete repositioning with permanent fusion of only the lumbosacral motion segment is thus of primary importance in the surgical management of high-grade spondylolisthesis and spondyloptosis. ⋯ In ten cases complete or nearly complete reposition was achieved. Firm bone consolidation was seen in all patients. Complaints were markedly reduced in all patients compared to the preoperative status.
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In spite of extensive, conservative methods for treating spondylitis, more or less distinct kyphotic deformities are common. Pain usually plays a minor role as an indication for surgery either as local instability or as impairment of the large hip or knee joints. Much more common are the loss of social contact and the lack of visual contact with the surroundings, both of which the patients find unacceptable. ⋯ The possible complications no longer include the disturbance of the spinal cord but are rather to be found in the poor general condition of the patient. The restoration of a largely normal equilibrium of the backbone relieves the musculature and is therefore a definitive pain therapy for muscle tension problems. Straightening the backbone also relieves the hip joints and therefore it is possible in many cases to delay the implantation of a hip prosthesis.