Reconstruction of septic diaphyseal bone defects with the induced membrane technique.

Septic segmental bone voids of the diaphysis are difficult to manage. The induced membrane technique by Masquelet has been successfully used to reconstruct segmental defects more than 20 cm. Our article describes a series of 13 cases with extensive posttraumatic bone loss of the metatarsal, tibial, femoral and radial bones after septic injuries followed by multiple surgical interventions. Antibiotic-impregnated polymethyl methacrylate (PMMA) cement spacers were implanted after successful eradication of bacterial infections of soft tissue and bones. After a mean of 9.8 weeks, body-induced membranes were established and the cements spacers removed. To fill up the bone void, cancellous bone autografts were implanted into the membranes. The follow-up examination after 24 months revealed bony union in all cases and favorable functional results. The induced membrane technique has shown to be effective in treating bone defects of upper and lower extremity bone defects.

Giant cell tumor of the lumbar spine with intraperitoneal growth: case report and review of literature.

Giant cell tumors of the spine are uncommon. Usually they are benign and solitary, but locally very aggressive. Most of them occur at the sacral spine. There are only 26 reported cases in the literature involving this type of tumor in the lumbar spine, in particular exhibiting an intraperitoneal growth. We present the case of a woman with a primary tumor of the lumbar spine (giant cell tumor) with intraperitoneal growth, the outcome as well as a review of the literature. Furthermore, after reviewing all spinal cases in the literature above the sacral spine, we carefully suggest a management algorithm.

[Computer-assisted surgery (CAS) in transpedicular lumbar fusion. Experiences of the Spinal Neurosurgery Department]. / Die computer-assistierte Chirurgie (CAS) der transpedikulären lumbalen Fusion. Erfahrungen in der Neurochirurgie der Spine Unit.

A well-known problem occurring with lumbar fusion is the incorrect placement of the pedicular screws. Previous studies have shown a rate of incorrect insertion of the screws ranging from 10 to 40%. An incorrectly inserted screw with medial perforation through the pedicle may cause an acute injury of the root passing medially to the pedicle. In case of wrong laterally placed screw the root exiting along the lateral wall of pedicle can be damaged. As a rule, a neurological deficit due to such an injury is irreversible. Vascular lesions are much rarer. Screws malposition, no matter in which direction the insertion should be wrong, leads very often to failed fusion. To reduce the rate of incorrectly placed transpedicular screws, computed tomography based navigation has been introduced. It allows the surgeon multidimensional control of the screw position in virtual reality and real time during insertion. The experience with the first 109 patients in which transpedicular lumbar fusion was performed this way in the Neurosurgical Dpt of the Spine Unit in the Schulthess Clinic in Zurich is described. The computed assisted surgery (CAS) takes slightly more time than the conventional procedure. The significantly increased accuracy of pedicle screw insertion repays this disadvantage generously.