Degenerative lumbar scoliosis with lateral deviation of the spine is frequently seen in elderly. Clinical presentation varies. The deformity is often associated with loss of lordosis, axial rotation and spinal stenosis. The operative treatment is a challenge to achieve the greatest benefit with least amount of intervention. Therefore the potential benefit to be obtainened by means of spinal fusion must be measured against the operative risks. A retrospective study was performed to investigate patient outcomes after fusion for degenerative lumbar scoliosis using XIA-Instrumentation. Functional outcome was assessed 2 to 9 years later using the Roland Morris score, a visual analogue scale and the Short Form 36 Health survey. The aim was to determine the effectiveness of the surgical procedure in terms of patient satisfaction, outcome scores and radiological aspects. There is an accepted deficiency of this form of outcomes assessment in the literature

Methods: Final evaluation was possible in 28 patients at a mean period of observation of 48 months. Inclusion criteria were: age ≥60 years, Cobb angle preop. greater than 15degrees, degenerative deformity, no prior surgery (spine), and complete records. Each patient completed the standard Short Form-36 (SF-36) questionnaire. Radiographic and clinical data were evaluated. The measures of outcomes assessment included patient satisfaction, pain scores, low back outcome, medication use and social status.

Results: Questionnaire data indicated good satisfactory and bad surgical results in 9 (32%), 12 (43%) and 7 (25%) patient. Scoliosis was converted from a mean preoperative Cobb angle of 17 degrees to 10 degrees. On an average of 5 spinal segments were instrumented and fused. In the first two years after spinal fusion the patient satisfaction was about 90%. In the following years until final evaluation the satisfaction rate decrease continuously by all patients often caused by adjacent instability of neighbouring unfixed motion segments. No pseudarthrosis were seen in final evaluation.

Conclusion: Proper preoperative planning, a sufficient fusion length and a good biomechanical properties of the used implants, such as XIA, are prior to prevent adjacent instability and can achieve satisfactory results with less operative risks.

Introduction: The today’s applied osteotomy techniques in surgical orthopaedics have to adapt on the requirements on modern operationprocedures. The application of abrasive water jets offers the possibility to realize a self-defined, athermic precise cut in biological hard tissues. The small process forces indicate the application of modern handling systems. Process engineering and visions of a clinical conversion were demonstrated. Methods: With biocompatible crystalline abrasives freely defined separation cuts and open space geometries, which correspond to the contour of a knee endoprosthesis, were realized at human bones for the first time. The used abrasives (sucrose, xylitol) and can be added in mass flows of 10–20% and the physiological osmolarity is not exceeded after material removal and following dissolution. The necessary pressure level was 75MPa, which only corresponds to a fraction of the necessary pressure of pure water jet. The analysis about quality of the cut-surfaces was done laser-optical. Results: The transect performances of the used abrasives are similar. The arithmetic roughness Ra was 5μm with a pressure level of 75MPa. The value was found by surface detection 3mm under the point of entrance of the water jet in the bones. The flow mass of the abrasives showed only a small influence on the roughness. Conclusion: The results concerning angle deviation and surface seems to be were very promising.

Aims: The purpose of the study was to determine the distribution and speciþcation of nerve þbers in the infrapatellar fat pad especially concerning nociceptive substance-P þbres. Methods: The infrapatellar fat pad was taken as a fresh specimen out of 21 patients (4 male, 17 female, mean age 69 years) during total knee arthroplasty. It was dissected in þve deþned parts, þxed and embedded in parafþn. Immunohistochemical techniques using antibodies against S-100 protein and substance-P were employed to determine and specify the nerve þbres. Results: Studying all the detectable nerves present in 50 þelds (x200 objective) we found an average of 6,4 substance-P- (25%) of a total of 24,7 nerve þbres in the infrapatellar fat pad. There was a significantly (p< 0,01) higher number of substance-P-þbers (24,4 (28%) of 105,7) in the surfacing synovial tissue. The number of S-100-þbers was signiþcantly (p< 0,05) higher in the central and lateral part of the fat pad. Conclusions: The occurance and distribution of nerve þbres in the infrapatellar fat pad suggests a nociceptive function. A neurohistological role in the anterior knee pain syndrome is assumed.