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.

Between March 1994 and June 2003, 80 patients with brachial plexus palsy underwent a trapezius transfer. There were 11 women and 69 men with a mean age of 31 years (18 to 69). Before operation a full evaluation of muscle function in the affected arm was carried out. A completely flail arm was found in 37 patients (46%). Some peripheral function in the elbow and hand was seen in 43 (54%). No patient had full active movement of the elbow in combination with adequate function of the hand. Patients were followed up for a mean of 2.4 years (0.8 to 8). We performed the operations according to Saha’s technique, with a modification in the last 22 cases. We demonstrated a difference in the results according to the pre-operative status of the muscles and the operative technique.

The transfer resulted in an increase of function in all patients and in 74 (95%) a decrease in multidirectional instability of the shoulder. The mean increase in active abduction was from 6° (0 to 45) to 34° (5 to 90) at the last review. The mean forward flexion increased from 12° (0 to 85) to 30° (5 to 90).

Abduction (41°) and especially forward flexion (43°) were greater when some residual function of the pectoralis major remained (n = 32). The best results were achieved in those patients with most pre-operative power of the biceps, coracobrachialis and triceps muscles (n = 7), with a mean of 42° of abduction and 56° of forward flexion. Active abduction (28°) and forward flexion (19°) were much less in completely flail shoulders (n = 34).

Comparison of the 19 patients with the Saha technique and the 15 with the modified procedure, all with complete paralysis, showed the latter operation to be superior in improving shoulder stability. In all cases a decrease in instability was achieved and inferior subluxation was abolished.

The results after trapezius transfer depend on the pre-operative pattern of paralysis and the operative technique. Better results can be achieved in patients who have some function of the biceps, coracobrachialis, pectoralis major and triceps muscles compared with those who have a complete palsy. A simple modification of the operation ensures a decrease in joint instability and an increase in function.

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.

Most brachial plexus palsies are due to trauma, often resulting from motorcycle accidents. When nerve repair and physiotherapy are unsuccessful, muscle transfer may be considered. Paralysis of the deltoid and supraspinatus muscles can be addressed by transfer of the trapezius.

Between March 1994 and June 1997 we treated 38 patients with brachial plexus palsy by trapezius transfer and reviewed 31 of these (7 women, 24 men) after a mean follow-up of 23.8 months (12 to 39), reporting the clinical and radiological results and subjective assessment. The mean age of the patients was 29 years (18 to 46).

The operations had been performed according to the method of Saha described in 1967, involving transfer of the acromion with the insertion of the trapezius to the proximal humerus, and immobilisation in an abduction support for six weeks. Rehabilitation started on the first postoperative day with active exercises for the elbow, hand and fingers, and electrical stimulation of the transferred trapezius.

All 31 patients had improved function with a decrease in multidirectional instability of the shoulder. The average increase in active abduction was from 7.3° (0 to 45) to 39° (25 to 80) at the latest review. The mean forward flexion increased from 20° (0 to 85) to 44° (20 to 90). Twenty-nine of the 31 were satisfied with the improvement in stability and function.

Trapezius transfer for brachial plexus palsy involving the shoulder improves function and stability with clear subjective benefits.