The surgical treatment of spinal cord compression caused by tumorous metastases. A review of 91 cases.

Spinal cord compressions as a result of metastases are of considerable importance with regard to the quality of life and life expectancy of the cancer patient. Although surgical treatment has contributed to a considerable improvement in the life conditions of these patients, some questions still exist, particularly with regard to the choice of the time to operate. Thus, a total of 91 patients submitted to decompression were studied, taking into consideration different factors such as anatomo-radiographic findings, temporal parameters regarding occurrence of compression, and relative neurologic findings. Compression was incomplete in 44% of cases, complete in 45%, and complete with vertebral collapse in only 11%. Furthermore, it was observed that the group with partial compression included the lowest percentage of patients who resumed walking (57.5%), as compared to those with complete block (65.85%), or complete block associated with vertebral collapse (70%). This contradiction is confirmed by the observation that the resumption of walking was longer in cases with total block as compared to those with partial block. These results, apparently paradoxical ones, may be explained on the basis of the different duration of compression in the two groups. In fact, if we analyze the data relative to the interval of time between the occurrence of neurologic symptoms and surgery, we observed that patients with partial block were those in which surgical indications were made a longer period of time after the onset of symptoms. Surgical indications must be made at the first sign of deficit, regardless of the degree of compression present in the radiologic documentation, in order to avoid the transformation of reversible functional medullary changes into irreversible structural lesions.

Surgery of osteoarticular tuberculosis.

Because of the increasing incidence of tuberculosis consequent on the increasing number of patients with drug-related or HIV-induced immunosuppression, the problems of the invasive or noninvasive treatment of osteoarticular tuberculosis have come up again. While the approach aimed at the elimination of infectious foci with an adequate combination of medical therapy with a conservative treatment or surgery is still valid, the advanced technology of osteosynthesis systems and prosthetic replacement for spinal, hip and knee involvement respectively, with suitable indications, affords new solutions of surgical technique. The objective is to achieve surgical procedures that preserve at best the physiology of locomotor apparatus.