Introduction . Radiofrequency-targeted vertebral augmentation (RF-TVA) is a recognized treatment for painful compression fractures. RF-TVA in a patient with multiple compression fractures due to type I osteogenesis imperfecta (OI) has not been previously reported. Case Presentation . A 54-year-old patient with type I OI is presented with a segmental thoracic hyperkyphosis and 7 recent vertebral compression fractures. Because of persistent severe thoracolumbar back pain despite conservative therapy, RF-TVA was indicated. Nocturnal back pain was almost completely relieved at all postoperative time points evaluated. However, overall pain relief dropped only slightly from 7 to 5 on the numerical rating scale (NRS) at the 6-week follow-up, and there was only a small decrease in the Oswestry Disability Index (ODI) from 72% to 63%. An MRI at the 3-month follow-up revealed hyperintensity at levels T11 and T12, indicating slight recollapsing. At the 6-month follow-up, the ODI improved to 55%, although overall pain had worsened to 6 on the NRS. Pain at rest remained at a very low level. Conclusion . Despite the remaining lumbago, RF-TVA may be a good option for patients with OI who have multiple fractures. However, fractures at multiple levels and segmental thoracic hyperkyphosis may increase the risk for recollapsing and ongoing pain.
The purpose of this study was to assess the radiological and clinical outcome parameters following lumbar hybrid dynamic instrumentation with the focus on the adjacent segment degeneration (ASD) and adjacent segment disease (ASDi). In this prospective trial all patients presenting with degenerative changes to the lumbar spine have been included. Precondition was a stable adjacent level with/without degenerative alteration. The elected patients underwent a standardised fusion procedure with hybrid instrumentation (DTO™, Zimmer Spine Inc., Denver, USA). Patients' demographics have been documented and the follow-up visits were conducted after 6 weeks, and then stepwise after 6 up to 48 months. Each follow-up visit included assessment of quality of life and pain using specific questionnaires (COMI, SF-36, ODI) and the radiological evaluation with focus on the adjacent level alterations. At a mean follow up of 24 months an incidence of ASD with 10.91% and for ASDi with 18.18% has been observed. In 9% a conversion to standardised fusion was needed. There was a high rate of mechanical complication: (1) screw loosening (52.73%), (2) pedicle screw breakage (10.91%), and (3) rod breakage (3.64%) after a follow up of a maximum of 60 months. There were no significant difference of COMI, ODI and SF-36(v2) in comparison to all groups but all 55 patients showed a clinical improvement over the time. The dynamic hybrid DTO™ device is comparable to the long-term results after standardised fusion procedure, while a high rate of mechanical complication decreased the initial benefit. This trial was registered at the ClinicalTrials Register ( #NCT03404232 , 2018/01/18, registered retrospectively).
INTRODUCTION: Due to spinal instability and compressive neurologic deficits surgical management is sometimes necessary in patients with metastatic spinal lesions. However, in some cases open surgery is not possible and minimally invasive procedures, like cryoablation, are needed. The aim of the cur rent study was to investigate whether a miniature cryoprobe provides adequate tissue cooling in vertebrae and to evaluate the direct impact of cryosurgery on vertebral body stability. MATERIALS AND METHODS: Twelve thoracic vertebral bodies were harvested from fresh cadavers. After documenting bone density cryoablation was performed in six vertebral bodies according to a standardized procedure. Afterwards temperature inside the vertebral body and maximum breaking force were measured in the control and experimental groups. RESULTS: Required temperature of -50° was reached in all areas. There was a significant correlation between maximum breaking force and measured bone density (p= 0.001). Mean breaking force within the experimental group was 5047 N (SD = 2955 N) compared to 4458 N (SD = 2554 N) in the control group. There were no observable differences in maximum breaking force between both groups. CONCLUSION: Miniature cryoprobe can deliver adequate tissue cooling to -50°C in vertebral bodies. The procedure does not seem to influence breaking force of the treated bones in-vitro. Therefore, using miniature probes cryosurgery may provide a valuable alternative to conventional surgical resection of neoplastic diseases as well as of benign locally aggressive bone tumors.
Equestrian vaulting is a sport, particularly popular among children and adolescents, in which gymnastic and dance routines are performed on horseback. Current data regarding injuries and thus, the risks of this sport, is meager and based only on retrospective studies.In the current prospective study, 233 active members of a vaulting club were questioned monthly from November 2014 until October 2015. In addition to general information (training, competitions), the questionnaire collected the number of competitions, the competitive class, the discipline (single, team, Pas-de-Deux), and injuries (type, localization, treatment).There were 102 documented events resulting in 125 injuries, yielding an average 31.64 days of training lost. Each vaulter suffered an average 0.44 injuries per year. Frequency of injury was 2.15 injuries per 1000 training hours. Injuries occurred most often to the lower and upper extremities. Most common were bruises and muscle injuries. Injury risk increased with increasing age, number of falls from the horse, increasing competitive level, number of tournament entries and events (P=0.006), and previous injuries (P=0.010).Our study found that vaulting has a low risk of injury comparable to non-contact sports. The best focus for injury prevention strategies is on older vaulters at higher competitive levels performing more complex routines.
Background: Clinical training concepts of medical students differ in the various European countries. The goal of this paper is to study the differences at the beginning of medical practice in specific clinical skills on an international level. Methods: The data were collected by a publically accessible online questionnaire online from February to June 2010. The participants in the study were recruited through the official letter sent by deaneries and student organisations. Two thousand nine hundred and seven medical students participated in the online survey. From study years 1 to 6, 2406 valid data records (67.3 percent female; 32.7 percent male) from four different European countries were sent. The skills in the questionnaire included patient consultation and anamnesis, physical examination, auscultation, gypsum and bandage dressing, suture techniques, venepuncture, and laying of indwelling catheters. Results: One thousand six hundred and twenty-nine data records of medical students in their training years 3 to 6 were assessed. The average age of the students was 24.7 years. On a scale from 1 to 10, the average satisfaction of the students with their medical faculty was 6.47 (±2.07); the assessment of the preparation for the clinical activities was 4.72 (±2.13). By comparison, British students indicated most satisfaction with their training (6.70±1.85). With respect to the clinical skills, the students interviewed felt safest in patient consultation and anamnesis (7.63±2.13) followed by blood sampling (7.46±2.29). The topics of surgical suturing techniques (4.40±2.81) and the gypsum and bandaging techniques (2.63±2.23) were taught worst subjectively. Discussion: The training of medical students in basic clinical skills is an essential part of the studies. This study was able to demonstrate that the subjective trust of medical students in their personal skills positively correlated with the satisfaction with their own university. The results pointed out that future curricula of universities could profit from an increased focus on clinical skills.Hintergrund: Klinische Ausbildungskonzepte von Medizinstudenten unterscheiden sich in den verschiedenen europäischen Ländern. Ziel dieser Studie war es Unterschiede am Beginn der ärztlichen Tätigkeit in spezifischen klinischen Fähigkeiten im internationalen Vergleich zu untersuchen.Methodik: Die Daten wurden im Rahmen eines öffentlich zugänglichen Onlinefragebogens im Zeitraum von Februar bis Juni 2010 erhoben. Die Rekrutierung der Studienteilnehmer erfolgte über das offizielle Anschreiben von Dekanaten und Studentenvereinigungen. 2907 Medizinstudenten nahmen an der Onlinebefragung teil. Aus den Studienjahren 1-6 stammten 2406 gültige Datensätze (67,3% weiblich; 32,7% männlich) aus vier verschiedenen europäischen Ländern. Bei den erfragten Fähigkeiten handelte es sich um Patientengespräche und Anamneseerhebung, körperliche Untersuchung, Auskultation, Gips- und Verbandsversorgung, Wundnahttechniken, Venenpunktion und das Legen von Venenverweilzugängen.Ergebnisse: 1629 Datensätze von Medizinstudenten in den Ausbildungsjahren 3-6 wurden ausgewertet. Das durchschnittliche Alter der Studenten betrug 24,7 Jahre.Die durchschnittliche Zufriedenheit der Studenten mit ihrer medizinischen Fakultät lag auf einer Skala von 1 bis 10 bei 6,47 (±2.07), die Bewertung der Vorbereitung auf die klinische Tätigkeit betrug 4.72 (±2.13). Im Vergleich zeigten britische Studenten die größte Zufriedenheit mit ihrer Ausbildung (6.70±1.85). Von den klinischen Fähigkeiten fühlten sich die befragten Studenten am sichersten bei der Patientengesprächsführung und Anamneseerhebung (7.63±2.13), gefolgt von Blutabnahmen (7.46±2.29). Inhalte der chirurgischen Nahttechniken (4.40±2.81) und Gips- und Verbandstechniken (2.63±2.23) wurden subjektiv in allen Ländern am schlechtesten vermittelt.Diskussion: Die Ausbildung von Medizinstudenten in klinischen Basisfähigkeiten ist ein essenzieller Bestandteil des Studiums. Diese Studie konnte zeigen, dass das subjektive Vertrauen der Medizinstudenten in die persönlichen Fähigkeiten positiv mit der Zufriedenheit in die eigene Universität korreliert. Die Ergebnisse weisen darauf hin, dass zukünftige Lehrpläne der Universitäten von einem vermehrten Fokus auf klinische Fähigkeiten profitieren könnten.
