Scientific Idea of Professor Marian Weiss

This year marks the 100th birth anniversary of Professor Marian Alan Weiss. The following article serves as a reminder of this magnificent man, doctor and scientist and his indisputable multifaceted accomplishments. Prof. Weiss was a brilliant organizer. He proposed and then formed the largest medical rehabilitation centre in Poland, the STOCER Capital Rehabilitation Centre in Konstantin, and established one of the first university departments of rehabilitation in Europe. His medical achievements included Weiss' spring arthroplasty, a me-thod for stabilising the spine after an injury. He also promoted myoplastic amputation and early intraoperative prosthetic support (so-called rapid prosthesis) as well as early comprehensive rehabilitation, which is widely recognized today. Prof. Weiss was a first-rate scientist and lecturer. He published more than 200 articles in Polish and international journals, a few textbooks and monographs. He delivered many lectures and presentations at domestic and international congresses and symposia. As early as 1959, he lectured at international seminars on prosthetics and rehabilitation of amputees. As an expert of the WHO Regional Bureau, he organized international training workshops on rehabilitation, with English and French as languages of instruction. He was an honorary member of the New York Physical Medicine Society, held an honorary doctorate from Rennes University and an honorary membership of the Swedish Orthopaedic Society, and received the Honorary Medal of Vishnevsky Institute in Moscow. He also was Vice-president of the "Paraplegia" International Medical Society. His unexpected death in 1961 put an end to his further organizational, professional, scientific and educational plans.

[Factors effecting frequency of occurrence of back pain syndromes]

Low back pain syndromes are in the group of the commonest diseases observed in recent years and bear serious medical, social and economical burden. According to European data more than 70% of population suffered from back pain at least for a week in the lifetime, and 15-40% of population experiences low back pain every year. There is alarming decrease in the age of first onset described by many authors. Peak morbidity is observed in persons aged between 35 and 55 years, but a recent Japanese study brings evidence that 66.7% of middle-school children has already experienced low back pain lasting for at least 1 week, and relapse rate exceeds 60%. Increase of incidence and morbidity of low back pain is linked to lifestyle alterations including significant limitation of physical activities since young age, changes of hobby preferences, alteration of work habits favoring activities performed in improper body position lasting for hours or even years, to dynamic physical work. Pain may be presented in any phase of spinal overload syndromes. Back pain may result from nocyceptive activation in spinal, paraspinal tissues as well as irritating of nervous structures within vertebral canal, when appears as a neuropathic pain. Pain in spondylolisthesis may be related to ligamentous constrain, particularly when posterior longitudinal ligament (densely supplied with nocyceptive endings) is involved. The paper describes the commonest back pain syndromes and spinal deformities resulting from long-lasting overload with their typical presentation.

Surgery and subsequent rehabilitation for cervical spine tumours compressing neural structures

Bone malignancies account for merely about 1.5% of all cancers, with a small percentage of these tumours developing in the cervical spine. However, the cervical spine is also the site of benign tumours and neoplasms involving not only bony tissue. Benign tumours do not metastasize but pose a threat to the spinal cord when located intrathecally. Even though such tumours do not represent malignancy, they are considered to be locally malignant. The most common cervical spine neoplasms are intradural tumours, usually extramedullary: neurofibromas, meningiomas or gliomas.Indications for surgery depend of the nature and location of the tumour and the consequences of tumour growth. Surgery is obviously necessary for intrathecal tumours compressing the spinal cord. The choice of surgical approach and manner of stabilisation depend primarily on the location of the lesion and the presence of spinal cord compression.Rehabilitation is indicated in all patients, but is particularly important, and at the same time difficult, when the growth of the tumour has resulted in neurological disturbances. The task is all the more difficult when in the presence of a massive and high spinal cord damage. Rehabilitation programmes should be designed individually for each patient and should account for the degree of paresis, stage of the underlying malignant disease, survival prognosis, disturbances in the function of other systems, apart from musculoskeletal apparatus, age of the patient, his or her commitment to treatment and other factors.The treatment of malignant neoplasms is usually associated with an unfavourable outcome. However, combination drug treatments, radiation therapy and surgery with subsequent rehabilitation will often prolong survival, ameliorate suffering and improve patients' quality of life.

[Treatment of post-traumatic instability of the cervical spine--30 years experience]

BACKGROUND

Assessment of the stability of the cervical spine following an injury is an important part of the diagnostic work-up. It is not always easy as the mechanism of injury does not always determine the degree of spinal stability. An actual instability is often confused with increased compensatory instability that is still within physiological limits, i. e. excessive mobility of the segment positioned above the part that has been immobilised as a result of trauma or vertebral block. Spinal injuries with instability are usually an indication for surgery. On the basis of 30 years' experience, the author presents indications for anterior approach surgery, based on the mechanism of injury and the patient's neurological status following an injury to the cervical spine.

MATERIAL AND METHODS

A total of 1,225 patients have been operated on. Indications are defined for surgery using rod or plate implants and compression plates. Radiographic and neurological outcome data are presented for 1138 who had been followed up for at least 6 months.

RESULTS

A good radiographic outcome was obtained in a total of 78% patients, including 84% of the recipients of rod implants and 65% of the recipients of plate implants. Neurological improvement was seen in 68% of patients with neurological symptoms, including substantial improvements in 26% of the patients.

CONCLUSIONS

1. Assessment of spinal stability is an important element of diagnostic work-up. 2. It is essential to distinguish actual instability requiring surgery from a compensatory increase in mobility of the segment lying above the immobilised segment of the spine. 3. An anterior approach procedure, apart from stabilising the spine, serves to decompress the spinal cord and offers a chance of neurological and functional improvement.

Cervico-cephalic syndrome in the course of degenerative disease of the cervical spine

This article contains a synthesis of views concerning cervico-cephalic syndrome, which results from degenerative changes in the cervical spine. The pathophysiology of the syndrome is discussed, along with contemporary methods of diagnosis and therapy, with indications for conservative and surgical treatment.

The possibilities of restoring or improving hand functions in tetraplegic patients

In the immediate aftermath of severe cervical SCI, most patients present with complete loss of functional capacity of the hand. For some of these patients, it is possible during treatment to restore a certain measure of functional capacity in the hand for daily life activities. In the clinical material we analyzed, however, which included 260 patients recovering from such injuries, 45% of those examined presented with no functional abilities in the hand.<br /> Hand function in patients with tetraplegia is vitally important, since this is a decisive factor in determining the degree of the patient's disability and dependence on others. Accordingly, every effort should be made to improve or restore at least the simplest hand functions in tetraplegics.<br /> This report briefly discusses the methods used to improve functioning of the paretic hand (surgery, orthoses), and also the efforts made to restore some measure of function in the paralyzed hand by the use of an autogenic graft of musculocutaneus nerve into median nerve, and also by the application of functional electric stimulation (FES) using electrodes implanted into median and radial nerves.

Principles of management in injuries to the cervical spine

Thorough and prompt diagnostics and selection of the proper course of treatment are often crucial for desirable outcome in patients with cervical spine trauma complicated by SCI. This is indicated by the fact that even among patients with initial presentation of a complete of a complete cord lesion, a certain percentage (ca. 15 percent) of appropriately managed patients can achieve significant improvement in their neurological status. It frequently happens, however, that poor radiological documentation, careless preliminary examination, improper transport from the accident scene, or treatment ill-suited to the actual lesion render neurological improvement impossible, and at times even bring about a deterioration of neurological status in comparison to the initial examination.

[Pulmonary embolism as one cause of death after spinal injury--the role of clexane]

The paper deals with fatal pulmonary embolism in patients treated at STOCER after spinal injuries, frequently with neurological impairment. A group of 417 patients treated between 1988 and 1989 has been compared with another one of 350 patients treated between 1995 and 1996. Antyembolic prophylactics has been employed in both groups: an Aspirin in the first group and Clexane in the second one. Forty-seven fatalities (11% of all patients) occurred in the first group (2 females, 44 males, mean age 55.1 years); 40% of them caused by pulmonary embolism (5% of all patients). Twenty-nine fatalities (8% of all patients) occurred in the second group (1 female, 28 males, mean age 60.2 years) 17% of them caused by pulmonary embolism (1.4% of all patients). A comparison between these groups indicates high efficacy of clexane antyembolic prophylactics in patients treated due to spinal injury especially if complicated neurologically.

[Late results of the Harrington treatment method for posttraumatic injuries of the thoracic and lumbar spine]

At Stołeczne Centrum Rehabilitacji Harrington method along with Weiss spring alloplasty has been introduced for fractured spine stabilization in the early seventies. A modified Bacal-Wierusz (BW) distractor has been mainly used to stabilize the spine after trauma related fracture. The paper presents neurological and radiological results of Harrington method used within thoracic and lumbar spine in 86 patients between 1973 and 1993. There were 36 cases of plegia, 44 paretic patients and 6 cases with no neurological impairment. Thoraco-lumbar spine has been involved in 66% and lumbar spine in 17%. Mean follow-up was 6 years. Loss of the correction achieved at the surgery has been determined after analysis of the final radiographs. In radiological evaluation 66% results were rated good. Neurological improvement occurred in 37% and remarkable improvement in 16% of cases. The authors believe Harrington method does not provide good, triplanar stabilization for the spine.

The use of porous corundum ceramics in spinal surgery

Between 1987 and 1991 the spine was stabilised in 205 patients using corundum ceramic implants. The radiological results were assessed with a follow up of from 6 to 24 months and were graded as good in 81%. Poor results were not due to the implanted material, but were usually caused by failure to obtain full correction of the deformity at operation. Porous ceramic implants produce better radiological results, with a decrease in operating time and a reduced risk of infection.

Factors contributing to the increased threat to life following spinal cord injury

An analysis of the mortality rate of 3486 spinal injured patients treated in the early posttraumatic period in the years 1965-1989 in Konstancin, Poland is presented. The data show that the life of the spinal cord injured is threatened by several factors, the most important of which appear to be: the level and degree of the spinal cord lesion; certain causes of injury predisposing to severe nervous system injury; advanced age; and to some extent, concomitant injuries and methods of treatment. The significance of age is demonstrated by a nearly tenfold increase in mortality in the oldest age group of patients with complete spinal cord lesions as compared to the youngest age group of up to 20 years with the same degree of spinal cord damage.

Application of dexamethasone in the treatment of acute spinal cord injury

This communication evaluates the clinical efficacy of dexamethasone in acute spinal cord injury. The results of treatment in 290 patients given dexamethasone were compared with those of the control group of 330 patients not treated with corticosteroids. Patients with complete injuries and those with incomplete injuries showed greater improvement both quantitatively and qualitatively after treatment with dexamethasone than those without corticosteroids. The slightly increased risk of complications such as gastrointestinal bleeding and delayed wound healing was noted. It is recommended that corticosteroids should be used within the first hours after spinal cord injury.

The causes, sequelae and attempts at prevention of cervical spine injuries in Poland

There are certain differences between the causes of spinal injuries in Poland and in the developed countries of the West. The most common causes of injuries to the cervical spine in Poland are: falls from a horse-cart, diving into shallow water and automobile accidents. This paper presents an analysis of the causes of cervical spine injuries in a series of 1937 patients treated at the Spinal Cord Injury Department of the Metropolitan Rehabilitation Center in Konstancin, Poland, in the years between 1965 and 1991, admitted to hospital within the first hours or days after spinal injury. The relations between the mechanism of injury and the cause of injury, as well as the neurological sequelae of the injuries, are analysed.

Early anterior decompression and fusion for crush fractures of cervical vertebrae

From 1965 to 1991, 273 patients with crush fractures of cervical vertebrae were treated. They were sustained by young people in diving accidents, road accidents, or falls from a height. Spinal cord involvement with a varied degree of tetraplegia was usually present. The results of management by nonoperative or operative means have been compared. There has been neurological improvement in 14% of nonoperative and 44% of operative cases. Early surgical decompression by an anterior approach with stabilization by a bone graft is advocated to improve outcome and reduce the time in hospital.

Neurological outcome from conservative or surgical treatment of cervical spinal cord injured patients

This is an analysis of the results of treatment of 1761 patients with traumatic injury of cervical spinal cord, admitted to hospital within the first hours or days after injury. Analysis of the results of conservative treatment in 798 patients and of surgical treatment in 963 patients has shown that the results are to a large extent dependent on the method of treatment and when specialist treatment was started.

Injuries to the spinal cord in elderly patients

There are certain differences between the mechanism of injury and the course and results of treatment of post-traumatic spinal cord injuries in younger and older victims. Between 1965 and 1990 there were 564 patients over 60 years of age with spinal cord or cauda equina injuries treated at the Spinal Cord Centre in Konstancin, Poland. This article presents the level and degree of the nervous system injury, the methods of treatment and early mortality in the series. Of the patients, 43 per cent were aged between 60 and 65 years, but 31 per cent were patients over 70 years of age. More patients sustained injury to the cervical spine (72 per cent), and 42 per cent of lesions to the spinal cord were neurologically assessed as complete transverse cases. This paper stresses the high mortality rate, amounting to 26 per cent overall and 48 per cent in the groups with complete spinal cord lesions.