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Article: Surgical Treatment of Spinal Deformities in Pediatric Orthopedic Patients.

Braun, Sebastian / Brenneis, Marco / Schönnagel, Lukas / Caffard, Thomas / Diaremes, Panagiotis

2023 Volume 13, Issue 6

Abstract: Scoliosis and Scheuermann's disease are common spinal deformities that affect a substantial population, particularly adolescents, often impacting their quality of life. This comprehensive review aims to present a detailed understanding of these ... ...

Abstract	Scoliosis and Scheuermann's disease are common spinal deformities that affect a substantial population, particularly adolescents, often impacting their quality of life. This comprehensive review aims to present a detailed understanding of these conditions, their diagnosis, and various treatment strategies. Through an extensive exploration of current literature, the review discusses the etiology of these spinal deformities and the use of diagnostic tools such as X-rays and MRI. It further delves into the range of treatment options available, from conservative approaches such as physiotherapy and bracing to more invasive surgical interventions. The review underscores the necessity of an individualized treatment approach, taking into account factors such as the patient's age, the severity of the curvature, and overall health. This all-encompassing perspective on scoliosis and Scheuermann's disease will aid in evidence-based decision making in their management with the goal of improving patient outcomes.
Language	English
Publishing date	2023-06-07
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life13061341
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Article ; Online: Age and magnitude of acetabular correction impair bone healing after triple pelvic osteotomy.

Dornacher, Daniel / Lutz, Bernd / Sgroi, Mirco / Caffard, Thomas / Reichel, Heiko

Archives of orthopaedic and trauma surgery

2023 Volume 143, Issue 11, Page(s) 6599–6607

Abstract: Introduction: The aim of this examination was to assess, which risk factors impair bone healing after triple pelvic osteotomy (TPO) in the treatment of symptomatic hip dysplasia.: Methods: A consecutive series of 241 TPO was reviewed retrospectively. ...

Abstract	Introduction: The aim of this examination was to assess, which risk factors impair bone healing after triple pelvic osteotomy (TPO) in the treatment of symptomatic hip dysplasia. Methods: A consecutive series of 241 TPO was reviewed retrospectively. Of these, a set of five postoperative radiographs was available, performed in a standardized regimen in the first year after surgery. Two experienced observers had to agree on the existence of a non-union on the radiographs obtained 1 year after TPO. Both observers measured the lateral center edge angle (LCEA) and acetabular index (AI) on all radiographs. Besides patient-specific risk factors, the magnitudes of acetabular correction and the amounts of a detectable slight change in acetabular correction were assessed. Binary logistic regression analysis and chi-squared test were used to detect the impact of the risk factor on bone healing. Results: A total of 222 cases were left for further examination. In 19 of these, at least one osteotomy was not healed completely one year after surgery. Binary logistic regression showed a significant relationship between the risk factors "age" (p < 0.001; odds ratio (OR) 1.109 (95% CI 1.05-1.18)) as well as "magnitude of acetabular correction (LCEA)" (p = 0.01; OR 1.087 (95% CI 1.02-1.16)) and non-union. Pearson's chi-square test showed a relationship between the risk factor "wound healing disorder" and non-union (p < 0.001). LCEA and AI showed a slight increase from the first to the last follow-up (observer 1: 1.6° and 1.3°, resp.), but regression analysis for the risk factor "amount of postoperative change of acetabular correction (LCEA, AI)" did not show statistically significant values. Conclusion: The age at surgery and the magnitude of acetabular correction negatively influenced the healing progress of the osteotomy sites. The amount of a slight postoperative change of LCEA and AI did not correlate with a non-union.
MeSH term(s)	Humans ; Hip Joint/surgery ; Retrospective Studies ; Treatment Outcome ; Acetabulum/surgery ; Hip Dislocation/surgery ; Osteotomy/adverse effects
Language	English
Publishing date	2023-07-08
Publishing country	Germany
Document type	Journal Article
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-023-04966-z
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Article ; Online: Spondylodiszitis.

Braun, Sebastian / Diaremes, Panagiotis / Schönnagel, Lukas / Caffard, Thomas / Brenneis, Marco / Meurer, Andrea

Orthopadie (Heidelberg, Germany)

2023 Volume 52, Issue 8, Page(s) 677–690

Abstract: Spondylodiscitis is a severe infectious disease of the spine that affects the intervertebral discs and adjacent vertebrae. It can lead to nonspecific pain, limited mobility, and destruction of spinal structures. Various pathogens, such as bacteria, fungi, ...

Title translation	Spondylodiscitis.
Abstract	Spondylodiscitis is a severe infectious disease of the spine that affects the intervertebral discs and adjacent vertebrae. It can lead to nonspecific pain, limited mobility, and destruction of spinal structures. Various pathogens, such as bacteria, fungi, or parasites, can trigger the disease. An early diagnosis and targeted treatment are crucial to reduce the risk of serious complications. Magnetic resonance imaging (MRI) with contrast agent and blood tests are essential for the diagnosis and assessing the course of the disease. The treatment includes conservative and surgical approaches. Conservative treatment consists of a minimum 6‑week antibiotic course and immobilization of the affected area. Surgical interventions, along with several weeks of antibiotic therapy, are indicated for instabilities or complications in order to eliminate the infection focus and to restore spinal stability.
MeSH term(s)	Humans ; Discitis/diagnosis ; Intervertebral Disc/diagnostic imaging ; Magnetic Resonance Imaging ; Anti-Bacterial Agents/therapeutic use ; Bacteria
Chemical Substances	Anti-Bacterial Agents
Language	German
Publishing date	2023-07-10
Publishing country	Germany
Document type	English Abstract ; Journal Article
ISSN	2731-7153
ISSN (online)	2731-7153
DOI	10.1007/s00132-023-04403-4
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Conference proceedings: Kein Zusammenhang zwischen TTTG Abstand und femoraler oder tibialer Torsion

Kappe, Thomas / Ludwig, Marius / Caffard, Thomas / Angenendt, Max / Reichel, Heiko

2023 , Page(s) AB74–3062

Event/congress	Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2023); Berlin; ; Berufsverband für Orthopädie und Unfallchirurgie; 2023
Keywords	Medizin, Gesundheit ; TTTG ; tibiale und femorale Torsion ; femorotibiale Rotation
Publishing date	2023-10-23
Publisher	German Medical Science GMS Publishing House; Düsseldorf
Document type	Conference proceedings
DOI	10.3205/23dkou382
Database	German Medical Science

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Conference proceedings: Strukturmorphologische Risikofaktoren bei patellofemoraler Instabilität

Kappe, Thomas / Caffard, Thomas / Reichel, Heiko

2022 , Page(s) AB31–770

Event/congress	Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2022); Berlin; ; Berufsverband für Orthopädie und Unfallchirurgie; 2022
Keywords	Medizin, Gesundheit ; patellofemorale Instabilität ; Trochleadysplasie ; MPFL-Plastik ; Patella alta ; Genu valgum ; tibiale Torsion ; femorale Torsion
Publishing date	2022-10-25
Publisher	German Medical Science GMS Publishing House; Düsseldorf
Document type	Conference proceedings
DOI	10.3205/22dkou186
Database	German Medical Science

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Conference proceedings: Beeinflusst die Morphologie des Akromions die postoperativen klinischen und radiologischen Ergebnisse nach einer Rekonstruktion der Rotatorenmanschette?

Sgroi, Mirco / Caffard, Thomas / Ludwig, Marius / Reichel, Heiko / Kappe, Thomas

2022 , Page(s) AB30–1317

Event/congress	Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2022); Berlin; ; Berufsverband für Orthopädie und Unfallchirurgie; 2022
Keywords	Medizin, Gesundheit
Publishing date	2022-10-25
Publisher	German Medical Science GMS Publishing House; Düsseldorf
Document type	Conference proceedings
DOI	10.3205/22dkou175
Database	German Medical Science

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Conference proceedings: Ist die Morphologie des Akromions mit einem höheren Risiko für eine SSP-Sehnenruptur verbunden?

Sgroi, Mirco / Kappe, Thomas / Dornacher, Daniel / Angenendt, Max / Ludwig, Marius / Caffard, Thomas / Reichel, Heiko

2023 , Page(s) AB94–3328

Event/congress	Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2023); Berlin; ; Berufsverband für Orthopädie und Unfallchirurgie; 2023
Keywords	Medizin, Gesundheit
Publishing date	2023-10-23
Publisher	German Medical Science GMS Publishing House; Düsseldorf
Document type	Conference proceedings
DOI	10.3205/23dkou574
Database	German Medical Science

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Article ; Online: Assessing paraspinal muscle atrophy with electrical impedance myography: Limitations and insights.

Guven, Ali E / Chiapparelli, Erika / Camino-Willhuber, Gaston / Zhu, Jiaqi / Schönnagel, Lukas / Amoroso, Krizia / Caffard, Thomas / Erduran, Ada / Shue, Jennifer / Sama, Andrew A / Girardi, Federico P / Cammisa, Frank P / Hughes, Alexander P

Journal of orthopaedic research : official publication of the Orthopaedic Research Society

2024

Abstract: Paraspinal muscle atrophy is gaining attention in spine surgery due to its link to back pain, spinal degeneration and worse postoperative outcomes. Electrical impedance myography (EIM) is a noninvasive diagnostic tool for muscle quality assessment, ... ...

Abstract	Paraspinal muscle atrophy is gaining attention in spine surgery due to its link to back pain, spinal degeneration and worse postoperative outcomes. Electrical impedance myography (EIM) is a noninvasive diagnostic tool for muscle quality assessment, primarily utilized for patients with neuromuscular diseases. However, EIM's accuracy for paraspinal muscle assessment remains understudied. In this study, we investigated the correlation between EIM readings and MRI-derived muscle parameters, as well as the influence of dermal and subcutaneous parameters on these readings. We retrospectively analyzed patients with lumbar spinal degeneration who underwent paraspinal EIM assessment between May 2023 to July 2023. Paraspinal muscle fatty infiltration (FI) and functional cross-sectional area (fCSA), as well as the subcutaneous thickness were assessed on MRI scans. Skin ultrasound imaging was assessed for dermal thickness and the echogenicities of the dermal and subcutaneous layers. All measurements were performed on the bilaterally. The correlation between EIM readings were compared with ultrasound and MRI parameters using Spearman's correlation analyses. A total of 20 patients (65.0% female) with a median age of 69.5 years (IQR, 61.3-73.8) were analyzed. The fCSA and FI did not significantly correlate with the EIM readings, regardless of frequency. All EIM readings across frequencies correlated with subcutaneous thickness, echogenicity, or dermal thickness. With the current methodology, paraspinal EIM is not a valid alternative to MRI assessment of muscle quality, as it is strongly influenced by the dermal and subcutaneous layers. Further studies are required for refining the methodology and confirming our results.
Language	English
Publishing date	2024-04-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	605542-4
ISSN	1554-527X ; 0736-0266
ISSN (online)	1554-527X
ISSN	0736-0266
DOI	10.1002/jor.25848
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Article ; Online: Spine-specific sarcopenia: distinguishing paraspinal muscle atrophy from generalized sarcopenia.

Schönnagel, Lukas / Chiaparelli, Erika / Camino-Willhuber, Gaston / Zhu, Jiaqi / Caffard, Thomas / Tani, Soji / Burkhard, Marco D / Kelly, Michael / Guven, Ali E / Shue, Jennifer / Sama, Andrew A / Girardi, Federico P / Cammisa, Frank P / Hughes, Alexander P

The spine journal : official journal of the North American Spine Society

2024

Abstract: Background context: Atrophy of the paraspinal musculature (PM) as well as generalized sarcopenia are increasingly reported as important parameters for clinical outcomes in the field of spine surgery. Despite growing awareness and potential similarities ... ...

Abstract	Background context: Atrophy of the paraspinal musculature (PM) as well as generalized sarcopenia are increasingly reported as important parameters for clinical outcomes in the field of spine surgery. Despite growing awareness and potential similarities between both conditions, the relationship between "generalized" and "spine-specific" sarcopenia is unclear. Purpose: To investigate the association between generalized and spine-specific sarcopenia. Study design: Retrospective cross-sectional study. Patient sample: Patients undergoing lumbar spinal fusion surgery for degenerative spinal pathologies. Outcome measures: Generalized sarcopenia was evaluated with the short physical performance battery (SPPB), grip strength, and the psoas index, while spine-specific sarcopenia was evaluated by measuring fatty infiltration (FI) of the PM. Methods: We used custom software written in MATLAB® to calculate the FI of the PM. The correlation between FI of the PM and assessments of generalized sarcopenia was calculated using Spearman's rank correlation coefficient (rho). The strength of the correlation was evaluated according to established cut-offs: negligible: 0-0.3, low: 0.3-0.5, moderate: 0.5-0.7, high: 0.7-0.9, and very high≥0.9. In a Receiver Operating Characteristics (ROC) analysis, the Area Under the Curve (AUC) of sarcopenia assessments to predict severe multifidus atrophy (FI≥50%) was calculated. In a secondary analysis, factors associated with severe multifidus atrophy in non-sarcopenic patients were analyzed. Results: A total of 125 (43% female) patients, with a median age of 63 (IQR 55-73) were included. The most common surgical indication was lumbar spinal stenosis (79.5%). The median FI of the multifidus was 45.5% (IQR 35.6-55.2). Grip strength demonstrated the highest correlation with FI of the multifidus and erector spinae (rho=-0.43 and -0.32, p<.001); the other correlations were significant (p<.05) but lower in strength. In the AUC analysis, the AUC was 0.61 for the SPPB, 0.71 for grip strength, and 0.72 for the psoas index. The latter two were worse in female patients, with an AUC of 0.48 and 0.49. Facet joint arthropathy (OR: 1.26, 95% CI: 1.11-1.47, p=.001) and foraminal stenosis (OR: 1.54, 95% CI: 1.10-2.23, p=.015) were independently associated with severe multifidus atrophy in our secondary analysis. Conclusion: Our study demonstrates a low correlation between generalized and spine-specific sarcopenia. These findings highlight the risk of misdiagnosis when relying on screening tools for general sarcopenia and suggest that general and spine-specific sarcopenia may have distinct etiologies.
Language	English
Publishing date	2024-03-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2037072-6
ISSN	1878-1632 ; 1529-9430
ISSN (online)	1878-1632
ISSN	1529-9430
DOI	10.1016/j.spinee.2024.02.021
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Article ; Online: Association patterns between lumbar paraspinal muscles and sagittal malalignment in preoperative patients undergoing lumbar three-column osteotomy.

Caffard, Thomas / Medina, Samuel J / Arzani, Artine / Chiapparelli, Erika / Schönnagel, Lukas / Tani, Soji / Camino-Willhuber, Gaston / Zhu, Jiaqi / Dalton, David / Zippelius, Timo / Sama, Andrew A / Cammisa, Frank P / Girardi, Federico P / Hughes, Alexander P

Spine deformity

2024 Volume 12, Issue 3, Page(s) 801–809

Abstract: Purpose: We aim to investigate the associations between lumbar paraspinal muscles and sagittal malalignment in patients undergoing lumbar three-column osteotomy.: Methods: Patients undergoing three-column osteotomy between 2016 and 2021 with ... ...

Abstract	Purpose: We aim to investigate the associations between lumbar paraspinal muscles and sagittal malalignment in patients undergoing lumbar three-column osteotomy. Methods: Patients undergoing three-column osteotomy between 2016 and 2021 with preoperative lumbar magnetic resonance imaging (MRI) and whole spine radiographs in the standing position were included. Muscle measurements were obtained using a validated custom software for segmentation and muscle evaluation to calculate the functional cross-sectional area (fCSA) and percent fat infiltration (FI) of the m. psoas major (PM) as well as the m. erector spinae (ES) and m. multifidus (MM). Spinopelvic measurements included pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), L1-S1 lordosis (LL), T4-12 thoracic kyphosis (TK), spino-sacral angle (SSA), C7-S1 sagittal vertical axis (SVA), T1 pelvic angle (TPA) and PI-LL mismatch (PI - LL). Statistics were performed using multivariable linear regressions adjusted for age, sex, and body mass index (BMI). Results: A total of 77 patients (n = 40 female, median age 64 years, median BMI 27.9 kg/m Conclusion: This study included a large patient cohort with sagittal alignment undergoing three-column osteotomy and is the first to demonstrate significant associations between the lumbar paraspinal muscle parameters and global sagittal alignment. Our findings emphasize the importance of the lumbar paraspinal muscles in sagittal malalignment.
MeSH term(s)	Humans ; Female ; Osteotomy/methods ; Osteotomy/adverse effects ; Middle Aged ; Paraspinal Muscles/diagnostic imaging ; Paraspinal Muscles/pathology ; Male ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/surgery ; Aged ; Kyphosis/diagnostic imaging ; Lordosis/diagnostic imaging ; Lordosis/surgery ; Magnetic Resonance Imaging ; Preoperative Period ; Bone Malalignment/diagnostic imaging ; Lumbosacral Region/surgery ; Lumbosacral Region/diagnostic imaging ; Radiography
Language	English
Publishing date	2024-03-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2717704-X
ISSN	2212-1358 ; 2212-134X ; 2212-1358
ISSN (online)	2212-1358 ; 2212-134X
ISSN	2212-1358
DOI	10.1007/s43390-024-00828-9
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