Clinical Neuroscience

Die ventrale Fusion im Bereich der Halswirbelsäule bei Bandscheibenschäden

W. Grote, P. Röttgen

APRIL 01, 1967

Clinical Neuroscience - 1967;20(04)

Das so genannte Zervikalsyndrom, dessen häufigste Erscheinungsformen Schulter- und Armschmerzen, Nacken- und Kopfschmerzen, zervikale Migräne, vertebraler Schwindel und zervikale Myelopathie sind, ist wesentlich schwieriger zu diagnostizieren als das Lumbalsyndrom. Bei Vorliegen eines Zervikalsyndroms wurden folgende Operationen durchgeführt: La-Minektomie oder Hemilaminektomie mit oder ohne Entfernung der vorgefallenen Bandscheibe, Radikotomie nach Jackson oder Frykholn. 1962 führten Cloward (Honolulu) und Dereymaeker und Mulier (Belgien) die Operation ein, bei der die vorgefallene Bandscheibe durch ventrale Penetration entfernt und eine knöcherne Fusion zwischen den Wirbelkörpern hergestellt wurde. Nach Lindblom wird die chirurgische Indikation durch eine Diskographie mit 60 % Urographie ergänzt. Seit 1962 wurden 84 Patienten operiert (Tabelle 5). Die Myelographie wurde in 33 Fällen durchgeführt. Bei 37 Patienten wurde eine einzelne und bei 42 Patienten eine multiple Diskusläsion festgestellt. 28 Patienten wurden nicht fusioniert. Bei der Mehrzahl der Patienten wurde die Knochenfusion bei 8 Patienten mit autoplastischem Knochen, bei 42 Patienten mit homoplastischem Knochen und bei 6 Patienten mit heteroplastischem Knochen durchgeführt. Postoperative Ergebnisse (Tabelle 17): Von 29 Brachialgien zeigten 15 eine deutliche Besserung (wg), 10 eine deutliche Besserung (g), 4 hatten unveränderte Beschwerden (u). 17 Brachialgie und Zephalalgie postoperative Ergebnisse Verteilung: 11, 3 und 3. 8 Zephalalgie (C34): 5, 2 und 1. 30 Myelopathie: 7, 7 und 16. Wenige chirurgische Komplikationen: ein Fall von Ösophagusverletzung, ein Fall von Hämatom mit Atemnot, zwei Fälle von Abrutschen des Knochensplitters. Manchmal kann auf eine Knochenversteifung verzichtet werden, aber im Falle einer Versteifung ist das Operationsergebnis besser. Bei Myelopathie ist der Verzicht auf eine Indikation gerechtfertigt, aber auch in diesem Bereich können hervorragende Ergebnisse erzielt werden; ein Patient mit Tetraplegie war nach der Operation arbeitsfähig.

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

[Ehlers-Danlos syndrome associated with neurological symptoms]

KOMÁR József, KRÁNITZ Géza

[The authors diagnosed a 43-year-old woman and her 8-year-old son with classic Ehlers-Danlos syndrome. In the mother, the underlying disease was accompanied by muscular atrophy and symptoms suggestive of spinal cord dorsal cord injury. The authors associate the onset of neurological symptoms with the underlying disease and attribute it to dysplastic vasculature.]

Clinical Neuroscience

[Eozinofil granulocytak a liquorban]

PÉTER Ágnes, KOVÁCS Ferenc

[Eosinophilic cells were detected in a small percentage of CSF in both bacterial and non-bacterial infections. Intense CSF eosinophilia was found only in bacterial processes. In these cases, an allergic pathomechanism was hypothesized. Unique in the literature, liquoreosinophilia accompanied by a leukocytic reaction was observed in our 1 case of meningitis in the setting of collagenosis and in our 3 cases of granulomatous menongoencephalitis. This specific CSF cytological reaction was highlighted in the group of diseases of the nervous system with immune-allergic syndrome. Immuno-allergic CSF syndromes with eosinophilic cell proliferation were divided into three groups according to the involvement of plasma cells. The factors determining the type of reaction response remain to be elucidated. Our patient with periarteritis nodosa with 26% eosinophils in his meningogram complements literature data. Of particular interest is our case No 4, who developed cerebroesinophilia after myelography.]

Clinical Neuroscience

[Data on the psychiatric use of chlormethiazole (Heminevrin)]

KARDOS György

[Author reviews the literature on the pharmacological and clinical effects, side effects and complications of Heminevrin. He reports on 77 cases he has observed and treated. He confirms the excellent efficacy of Heminevrin in delirium tremens, where in 31 patients Heminevrin therapy led to recovery in a few days without mortality and without complications. He has used the drug praeventively in 27 cases of praedelirosus withdrawal syndrome, which he considers to be a beneficial combination for the treatment of endogenous and reactive psychogenic depressions (based on 13 cases). ]

Clinical Neuroscience

[The role of the limbic lobe in incentive production]

FENYVESI Tamás

[Two cases of a midline tumour destroying limbic structures were described. In both cases, the clinical picture was characterized by a high degree of inducibility loss, which was already evident at the onset. We evaluate our cases as recent data on the role of limbic structures in the maintenance of incentin production. ]

Clinical Neuroscience

[Analysis of symptoms and polygraphic data of Elysion psyches]

ZSADÁNYI O., HALÁSZ P., KARÁCSONY A.

[Elysione (phenylcyclohexylpiperidine monohydrochloride) has gained widespread use in anaesthesiology due to its sensory blocking effect. Transient psychotic symptoms after surgery have been described and analysed by several authors as a side effect of the drug. The psychotic picture that develops may also be considered a schizophrenomimetic agent because of certain characteristics.]

All articles in the issue

Related contents

Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Clinical Neuroscience

[Effective therapy in highly active pediatric multiple sclerosis ]

MERÔ Gabriella, MÓSER Judit, LIPTAI Zoltán, DIÓSZEGHY Péter, BESSENYEI Mónika, CSÉPÁNY Tünde

[Multiple sclerosis (MS) is typically a disease of young adults. Childhood MS can be defined in patients under 18 years of age, although some authors set the limit un­der the age of 16 formerly known as “early-onset multiple sclerosis” or “juvenile multiple sclerosis”, seen in 3-5% of all MS patients. Nowadays, owing to ever-evolving, better diagnostic tools and well-traced, strictly defined diagnostic criteria, childhood MS is showing an increasing incidence worldwide (0.05-2.85/100 000). MS is characterized by recurrent episodes of the central nervous system with demyelination separated in space and time. In childhood almost exclusively the relapsing-remitting (RR) type of MS occurs. Based on experience in adults, the goal in the pediatric population is also the early diagnosis, to initiate adequate DMT as soon as possible and to achieve symptom relief and good quality of life. Based on efficacy and safety studies in the adult population, inter­feron β-1a and glatiramer acetate were first approved by the FDA and EMA for the treatment of childhood MS also. The increased relapse rate and rapid progression of childhood MS and unfavorable therapeutic response to nearly 45% of the first DMT necessitated the testing of more effective and second-line drugs in the population under 18 years of age (PARADIGMS, CONNECT). Although natalizumab was reported to be effective and well-tolerated in highly active RRMS in childhood, evidence based studies were not yet available when our patients’ treatment started. In this article, we report on the successful treatment of three active RRMS patients with individually authorized off-label use of natalizumab.]

Lege Artis Medicinae

[Mechanism of mucosal defence and options to reduce virus invasion during the COVID pandemic]

HODINKA László

[The portal of entry for coronavirus is the mucous membrane of the respiratory tract. Severity, organ manifestations and out­come of COVID-19 are determined by the viral load, burdening the attacked organism. Condition of the respiratory tract and gastrointestinal mucosa and the capacity of their defence system are crucial for virus penetration, fusion with epithelial cells and replication. Direct neural spread, penet­ra­tion into the deeper airways and spread through the lymph nodes depend on these functions. Virus binding and engulfment is an active process. The virus penetrates the endosomes of the epithelial cell, by enzymatic transfer where it is recognised by natural defence agents and triggers the first defence responses. These alarm the entire immune system and trigger a whole chain of inflammatory and enzymatic defence processes (cytokine and bradykinin storm) proportional to the viral load. The severity endpoint of COVID-19 pathology is alveolitis, cerebral vasculitis and intestinal da­mage, often with fatal outcome. The airway mucosa defends itself by secreting surface factors and recruiting and activating cells of the adaptive immune system. An important element of the latter is the early ap­pearance of secretory IgA in the mucosa. The viral invasion can be prevented by application of a nasal spray containing carrageenan, which engages the virus and prevents its attachment by the gel-forming property of carrageenan. This effect has worked in previous virus epidemics and the first COVID-19 experiences confirm its pro­tec­tive role. ]

Hypertension and nephrology

[Cerebrovascular diseases in patients with chronic kidney disease]

KISS István, NAGY Judit

[The reason of the unfavourable life expectancy of patients with chronic kidney disease (CKD) is not only the development of end-stage renal failure but the frequent appearance of cardiovascular diseases (CVD). Chronic kidney damage itself is a cardiovascular risk state and the occurrence of CVD/associated diseases is significantly higher in chronic kidney failure. Beside risk stratification and valid treatment of CVD (hypertension, diabetes mellitus, ischemic heart disease e.g.) we and the international nephrological community have left the cerebrovascular diseases of CKD patients out of consideration. However, up to 50% of patients suffering a stroke will die immediately, only 10% of stroke survivors can continue his/her profession, but the others will be permanently disabled. High blood pressure is a strong predictor of stroke and of other CVD in most of the patients. In stroke risk reduction it is particularly important to reach the target blood pressure values. The main object of the “Live under 140/90 mmHg” programme of the Hungarian Society of Hypertension is to familiarize with target blood pressure itself and how to reach target blood pressure. In 2010, prevention, early diagnosis and management of stroke are the most important challenges of this programme (The Brain Control Programme). We think it is advisable to prepare and publish a clinical practice guideline in collaboration with stroke societies which is similar to the guidelines of international societies and of the Hungarian Society of Stroke but specific for CKD patients. This guideline would help to give a uniform, up-to-date treatment for the cerebrovascular diseases of CKD patients.]

Lege Artis Medicinae

[Mephistopheles of the human faced psychiatry. Klára Muhi – András Dér: The crazy circles of freedom]

BENKE Attila