Der Orthopäde
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The efficacy of intensive interdisciplinary pain management programs for patients with chronic low back pain has been repeatedly demonstrated. A controversial issue in previous studies is the cost-effectiveness of this treatment. Between 2001 and 2006, a total of 575 patients with chronic nonspecific back pain took part in an outpatient pain management program at the German Red Cross Pain Center (DRK Schmerz-Zentrum Mainz) in Mainz, Germany. ⋯ For employed patients, the number of absent days decreased to almost one-quarter. On the basis of the study by Wenig, who calculated pain-related costs as a function of Von Korff pain grades, the treatment resulted in a savings of euro 3,329.50 per year per patient. Intensive multidisciplinary treatment of chronic back pain is highly effective and, at least for patients with high levels of disability, is also cost-effective.
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The number of surgical interventions for spinal diseases has greatly increased due to rapid improvements in surgical techniques. The close anatomical relationship between neural and bony structures and the various anatomical approaches to the spinal column lead to a large variety of possible surgical complications. Therefore, it seems helpful to differentiate the complications with respect to their origin. ⋯ Typical complications can be explained by the anatomical situation, such as the vicinity of the esophagus in the anterior approach to the cervical spine or the great vessels in anterior procedures to the lumbar spine. Complication during the surgical manipulation of the spine can be related to either decompression procedures of neural structures or spinal implants. The correction of spinal deformities can result in very specific complications.
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In all disciplines of operative medicine the number of patients who suffer from diabetes mellitus is increasing dramatically. The reason is that nowadays up to 10% of the population is suffering from this disease. ⋯ Pre-operatively and during the peri-operative course the coordinated efforts of surgeons, anaesthesiologists and diabetes specialists are essential to reach an optimal result. In all hospitals obligatory algorithms must be established for the treatment of these patients.
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Ageing patients reveal an increasing coincidence of orthopaedic disorders and Parkinson's disease (PD). In addition, parkinsonian motor symptoms predispose individuals for orthopaedic diseases. PD patients have a higher risk of perioperative complications than patients without PD; this higher risk is based on motor and autonomous deficits in PD as well as on interactions between antiparkinsonian and anaesthesia medications. The elevated perioperative risk in PD can be reduced by appropriate perioperative management and no longer represents a contraindication to surgery in PD patients.