Kindliche Verletzungen im Bereich der Halswirbelsäule sind selten. Wesentlich sind eine frühzeitige Diagnosestellung und die rasche, konsequente Therapie. Dies ist die wahrscheinlich beste Ausgangssituation, um Spätfolgen zu vermeiden, denn diese würden das Kind ein Leben lang behindern. Entsprechend behandelt dieser Beitrag die Akutversorgung und Spätfolgen bei kindlichen Verletzungen der Halswirbelsäule.

Spinale Hämangiome sind meist gutartige vaskuläre Tumore mit einem Anteil von 11% der benignen Tumore der Wirbelsäule. In 0.9 – 1.2% können sogenannte aggressive Hämangiome große Anteile des Wirbelkörpers aushöhlen und durch Frakturen und intraspinales Wachstum symptomatisch werden. Aufgrund starker Blutungsneigung gilt die Embolisation mit nachfolgender Radiatio als kurativer Therapieansatz, ebenso die Vertebroplastie zur Behandlung frakturgefährdeter Hämangiome auch in Kombination mit Radiatio und Fixation. Allerdings sehen wir unter dieser Therapie eine relevante Anzahl von lokalen Rezidiven, ebenso primär lokal aggressiv wachsende Tumore mit Invasion des Spinalkanas. Durch intraspinales Wachstum kommt es zur Kompression von Rückenmark oder Nervenwurzeln. Wir präsentieren unsere Erfahrungen mit der Subpopulation der aggressiv wachsenden Hämangiome.

Die bewegungserhaltende Chirurgie im Bereich der Halswirbelsäule ist möglich durch den Einsatz spezieller Implantate (cTDR) oder durch Anwendung von Operationsverfahren ohne Instrumentation (dorsale Dekompression der zervikalen Wurzeln). Daneben haben aber auch fusionierende Verfahren ihren Stellenwert. In diesem Artikel werden die Indikationen und Kontraindikationen zur Anwendung bewegungserhaltender Verfahren und die Indikationen für fusionierende Verfahren besprochen. Ein cTDR ist dann sinnvoll, wenn ein weicher Vorfall mit radikulärer Klinik bei jungen Patienten vorliegt. Die dorsale Dekompression nach Frykholm ist an der HWS dann zweckmäßig, wenn ein weicher, lateraler BSV vorliegt und es Gründe gibt, nicht ventral zu operieren. In Fällen weit fortgeschrittener Degeneration, bei zervikaler Kyphose, schwerer Raumforderung durch Spondylose, erheblicher Instabilität und vor allem bei mäßiger oder schwerer Myelopathie sind fusionierende Verfahren der bessere Weg.

Soft-tissue sarcomas of the genitourinary tract account for only 1-2% of urological malignancies and 2.10% of soft-tissue sarcomas in general. A 69-year-old male complained of a 4 month history of a painless right groin swelling during routine urological review for prostate cancer follow-up. Clinical examination revealed a non-tender, firm right inguino-scrotal mass. There was no discernible cough impulse. Computed tomography of abdomen and pelvis showed a non-obstructed right inguinal hernia. During elective hernia repair a solid mass involving the spermatic cord and extending into the proximal scrotum was seen. The mass was widely resected and a right orchidectomy was performed. Pathology revealed a paratesticular sarcoma. He proceeded to receive adjuvant radiotherapy. Only around 110 cases of leiomyosarcoma of the spermatic cord have been described in the literature. They commonly present as painless swellings in the groin. The majority of diagnoses are made on histology.

The human cervical spine is a unique structure that differs dramatically from the thoracic and lumbar spine. The main differences concern the topographic anatomy of the spinal cord, anatomy and physiology of the occipito-atlanto-axial joint complex, the close course of the vertebral artery to the cervical spine and the very close relationship of the esophagus, vessels, peripheral and cranial nerves to the spine. To avoid serious complications during surgical treatment of spondylodiscitis within the cervical spine, these aspects must be kept in mind. They will be explained in detail in this article.

Bei der Therapieplanung einer Spondylodiszitis an der Halswirbelsäule sollten im Vergleich zur Brust- und Lendenwirbelsäule folgende Gesichtspunkte berücksichtigt werden: Die topographische Anatomie des Rückenmarks, die Anatomie und Physiologie des okzipitoatlantoaxialen Gelenkkomplexes, die Nähe der A. vertebralis zur Halswirbelsäule und die Nähe der Halseingeweide, die insgesamt die Operation erheblich komplizieren können.

Soft-tissue sarcomas of the genitourinary tract account for only 1-2% of urological malignancies and 2.1% of soft-tissue sarcomas in general. A 69-year-old male complained of a 4 month history of a painless right groin swelling during routine urological review for prostate cancer follow-up. Clinical examination revealed a non-tender, firm right inguinoscrotal mass. There was no discernible cough impulse. Computed tomography of abdomen and pelvis showed a non-obstructed right inguinal hernia. During elective hernia repair a solid mass involving the spermatic cord and extending into the proximal scrotum was seen. The mass was widely resected and a right orchidectomy was performed. Pathology revealed a paratesticular sarcoma. He proceeded to receive adjuvant radiotherapy. Only around 110 cases of leiomyosarcoma of the spermatic cord have been described in the literature. They commonly present as painless swellings in the groin. The majority of diagnoses are made on histology.

Purpose: The aim was to characterize different types of slings such as autologous rectus fascia (ARF), porcine dermis (PD) and tension-free vaginal tape (TVT) in the early postoperative period with regard to its visibility and location by using magnetic resonance imaging (MRI). Materials and Methods: Between October 2003 and June 2007, total of 60 patients underwent MRI after a sling procedure. Thirty-six patients had ARF slings. Twelve patients had a PD sling and 12 had a TVT. All patients had pelvic MRI 6-8 hr postoperatively. Six patients in the ARF sling group had both preoperative and postoperative images at 6 hr and 3 months. MRI images were analyzed with regard to visibility and location. All data were collected prospectively. Results: ARF slings were clearly visible in both T1W and T2W images. ARF appeared as low signal intensity area with surrounding high signal intensity due to fat attached to the rectus fascia in the MRI images obtained 6 hr after the procedure. Although the fatty component of the sling was diminished but was still visible on MRI scan 3 months postoperatively. On the other hand PD and TVT sling materials were not visible by MRI. Most of the ARF slings were located just below the bladder neck. Conclusions: The ARF sling is easily identifiable on MRI in the early postoperative period primarily because of the fat attached to the autologous rectus fascia. However, depiction of the PD and TVT slings in the early postoperative period is very poor. Neurourol. Urodynam. 30: 108-112, 2011. (C) 2010 Wiley-Liss, Inc.

Interspinous spacers are commonly used to treat lumbar spinal stenosis or facet joint arthritis. The aims of implanting interspinous devices are to unload the facet joints, restore foraminal height, and provide stability especially in extension but still allow motion. This paper summarizes several in vitro studies, which compared four different interspinous implants - Coflex, Wallis, DIAM, and X-STOP - in terms of their three-dimensional primary stability, the intradiscal pressure, and stability after cyclic loading. 24 human lumbar spine specimens were divided into four equal groups and tested with pure moments in flexion/extension, lateral bending, and axial rotation: intact, after decompression with hemifacetectomy, and after implantation. Implantation had similar biomechanical effects with all four implants. In extension, they overcompensated the instability caused by the defect and restricted extension to about 50% compared to the intact state. In contrast, in flexion, lateral bending, and axial rotation the values of the range of motion stayed similar compared to the defective state. Intradiscal pressure after implantation was similar to that of the intact specimens in flexion, lateral bending, and axial rotation but much smaller during extension; 50,000 load cycles increased the range of motion in all motion planes by no more than 20%, but in extension motion this was still less than in the intact state.

Lumbar spinal stenosis in most cases is due to progressive degeneration of the spine, resulting in thickening of facet joints and flaval ligament. Thus the diameter of the lumbar spinal canal is reduced to less than 12 mm in the AP direction. Typically complaints consist in neurogenic claudication. Patients usually experience improvement of pain when bending their back or walking up a hill. Diagnosis of lumbar spinal stenosis is confirmed by MRI. CT myelography may help detect where compression is most pronounced. Surgical treatment should be based on the clinical symptoms of the mostly elderly people and should be performed as microsurgical decompression or in cases of clinical instability as TLIF.

Interspinöse Platzhalter werden häufig implantiert, um eine lumbale Spinalkanalstenose oder eine Gelenkfacettenarthrose zu behandeln. Ziel ist es; mit deren Hilfe die Extension in den betroffenen Segmenten einzuschränken, die Gelenkfacetten zu entlasten, die Höhe des Foramens wiederherzustellen, gleichzeitig aber die Bewegung im physiologischen Bereich zu erhalten. In dieser Arbeit werden mehrere In-vitro-Studien zusammengefasst, in denen die vier verschiedenen interspinösen Implantate – Coflex™, DIAM™, Wallis und X-STOP – bezüglich der Primärstabilität, des Bandscheibendrucks und der Stabilität nach zyklischer Belastung untersucht wurden.

BACKGROUND:While laparoscopic appendectomy (LA) has become established in the diagnosis and treatment of acute appendicitis, its utilisation compared to open appendectomy (OA) is variable.AIM:To compare the utilisation and outcome of laparoscopic (LA) versus OA in an Irish regional hospital setting.METHOD:Retrospective review of OA and LA performed from 2003 to 2005.RESULTS:Intention-to-treat analysis of 787 patients in this study revealed that 149 patients (19%) had LA and 638 patients (81%) had OA. Consultants were significantly more likely than trainees to undertake a LA (P < 0.0001). Twenty-two complications (2.8%) were recorded in the post-operative period. The overall negative appendectomy rate by histopathology was 17% with no significant difference between the rate in the LA group (19%) and the OA (17%) group.CONCLUSION:Mean length of stay and complication rate were comparable between the LA and OA groups.

We evaluate the reliability of hand-held Doppler (HHD) in the management of acute scrotal pain of 24 h or less duration. Between October 2003 and December 2004, patients presenting with acute scrotal pain were enrolled in this prospective study. After clinical examination, all patients had a HHD assessment. Presence or absence of Doppler arterial signals and its intensity were recorded. A blinded assessor corroborated HHD findings with the clinical, ultrasound, operative findings and final diagnosis. Primary outcome measured were sensitivity and specificity of HHD in the diagnosis of testicular torsion. Twenty-five patients presented during the study period with acute scrotal pain. The final diagnosis was testicular torsion in nine, epididymitis in 13, twisted cyst of Morgagni in two and Henoch–Schoenlein purpura in one patient. The HHD predicted all patients of testicular torsion correctly, preoperatively. HHD is a reliable diagnostic tool in the management of patients with acute scrotal pain.

Interspinous implants are used to treat lumbar spinal stenosis or facet joint arthritis. The aims of implanting interspinous devices are to unload the facet joints, restore foraminal height and provide stability especially in extension but still allow motion. The aim of this in vitro study was to compare four different interspinous implants-Colfex, Wallis, Diam and X-Stop-in terms of their three-dimensional flexibility and the intradiscal pressure. Twenty-four human lumbar spine specimens were divided into four equal groups and tested with pure moments in flexion/extension, lateral bending and axial rotation: (1) intact, (2) defect, (3) after implantation. Range of motion and the intradiscal pressure were determined.In each implant-group the defect caused an increase in range of motion by about 8% in lateral bending to 18% in axial rotation. Implantation had similar effects with all four implants. In extension, Coflex, Wallis, Diam, and X-Stop all overcompensated the instability caused by the defect and allowed about 50% of the range of motion of the intact state. In contrast, in flexion, lateral bending and axial rotation the values of the range of motion stayed about the values of the defect state. Similarly the intradiscal pressure after implantation was similar to that of the intact specimens in flexion, lateral bending and axial rotation but much smaller during extension. All tested interspinous implants had a similar effect on the flexibility: they strongly stabilized and reduced the intradiscal pressure in extension, but had almost no effect in flexion, lateral bending and axial rotation.