Zusammenfassung: Ziel Darstellung von Studien zur psychischen Belastung von medizinischem Personal unter Bedingungen der COVID-19-Pandemie. Methodik PubMed-gestützte Suche mit den Stichworten COVID 19“, „stress“, „mental health“, „healthcare worker“, „staff“, „psychiatry“. Eingeschlossen wurden quantitative Studien, (inkl. „Letter to the editor“) zur Belastung des medizinischen Personals im Zeitraum von Januar bis März 2020. Ergebnisse Es wurden 14 Studien mit Klinikpersonal aus Infektionsabteilungen, Abteilungen für Fieberkranke, Abteilungen der Inneren Medizin inklusive Intensivstationen sowie der Chirurgie und Psychiatrie identifiziert. Am häufigsten wurden der Patient Health Questionnaire-9 (PHQ-9), die Self-rating-Anxiety Scale (SAS) und die Impact of Event Scale (IES-R) verwendet. Die Stichprobengröße schwankte zwischen 37 und 1257 Personen des überwiegend pflegerischen und ärztlichen Personals. Der Anteil an COVID-19-nahen Tätigkeiten schwankte zwischen 7,5 % und 100 %. Es wurde eine erhebliche Belastung durch Stresserleben, depressive und ängstliche Symptome berichtet. Schwere Ausprägungsgrade fanden sich bei 2,2–14,5 % der Befragten. Die Ausprägung der psychischen Symptomatik wurde beeinflusst durch Alter, Geschlecht, Berufsgruppe, Fachrichtung, Art der Tätigkeit und die Nähe zu COVID-19-Patienten. Als Mediatorvariablen wurden das Personalmanagement, die präventive Intervention, die Resilienz und vorhandene soziale Unterstützung angesehen. Schlussfolgerung Angesichts der Häufigkeit psychischer Symptome bei medizinischem Personal erscheinen begleitende psychiatrisch-psychotherapeutisch informierte Interventionen notwendig, um eine Bewältigung zu unterstützen. Eine schnell einsetzende Forschung ist in diesem Bereich wünschenswert.

Over the past several decades, there has been an upward trend in the total number of spinal fusion procedures worldwide. Advanced spinal fusion techniques with or without internal fixation, additional innovations in surgical approaches, innovative implants including a wide variety of interbody devices, and new alternatives in bone grafting materials are some reasons for the increasing number of spine fusion procedures. Moreover, the indications for spinal fusion have broadened over time. Initially developed for the treatment of instability and deformity due to tuberculosis, scoliosis, and traumatic injury, spinal fusion surgery has now a wide range of indications like spondylolisthesis, congenital or degenerative deformity, spinal tumors, and pseudarthrosis, with degenerative disorders as the most common indication. This review emphasizes current lumbar fusion techniques and their development in the past decades.

Background: Cervical radiculopathy is defined as a syndrome of pain and/or sensorimotor deficits due to compression of a cervical nerve root. Understanding of this disease is vital for rapid diagnosis and treatment of patients with this condition, facilitating their recovery and return to regular activity. Purpose: This review is designed to clarify (1) the pathophysiology that leads to nerve root compression; (2) the diagnosis of the disease guided by history, physical exam, imaging, and electrophysiology; and (3) operative and non-operative options for treatment and how these should be applied. Methods: The PubMed database was searched for relevant articles and these articles were reviewed by independent authors. The conclusions are presented in this manuscript. Results: Facet joint spondylosis and herniation of the intervertebral disc are the most common causes of nerve root compression. The clinical consequence of radiculopathy is arm pain or paresthesias in the dermatomal distribution of the affected nerve and may or may not be associated with neck pain and motor weakness. Patient history and clinical examination are important for diagnosis. Further imaging modalities, such as x-ray, computed tomography, magnetic resonance imaging, and electrophysiologic testing, are of importance. Most patients will significantly improve from non-surgical active and passive therapies. Indicated for surgery are patients with clinically significant motor deficits, debilitating pain that is resistant to conservative modalities and/or time, or instability in the setting of disabling radiculopathy. Surgical treatment options include anterior cervical decompression with fusion and posterior cervical laminoforaminotomy. Conclusion: Understanding the pathophysiology, diagnosis, treatment indications, and treatment techniques is essential for rapid diagnosis and care of patients with cervical radiculopathy.

Degenerative lumbar scoliosis is a coronal deviation of the spine that is prevalent in the elderly population. Although the etiology is unclear, it is associated with progressive and asymmetric degeneration of the disc, facet joints, and other structural spinal elements typically leading to neural element compression. Clinical presentation varies and is frequently associated with axial back pain and neurogenic claudication. Indications for treatment include pain, neurogenic symptoms, and progressive cosmetic deformity. Non-operative treatment includes physical conditioning and exercise, pharmacological agents for pain control, and use of orthotics and invasive modalities like epidural and facet injections. Operative treatment should be contemplated after multi-factorial and multidisciplinary evaluation of the risks and the benefits. Options include decompression, instrumented stabilization with posterior or anterior fusion, correction of deformity, or a combination of these that are tailored to each patient. Incidence of perioperative complications is substantial and must be considered when deciding appropriate operative treatment. The primary goal of surgical treatment is to provide pain relief and to improve the quality of life with minimum risk of complications.