Strategy in the diagnostics and therapy of tumours of the spine.

The authors present the diagnostic methods and basic surgical procedures used in treatment of spinal neoplasms. Both metastatic and primary spinal tumours lead to instability and loss of the protective function. Spinal cord can be damaged by compression or increased mobility of the vertebral column. Pain is reported as common symptom. Investigations include: plain X-ray films, myelography, radioisotope bone scan, CT, MRI and needle biopsy. The goal of surgery is to improve the quality of life with preservation of neurological function, reduction of pain and assured spinal stability. Indications for surgery are related with patient's general condition, grade of neoplasmatic disease, neurological symptoms and spinal involvement. Curative surgery include total removal of the tumour with affected vertebral body, followed by spinal stabilization. Palliative surgery as partial tumour removal, partial removal of the vertebral body or laminectomy are performed for spinal decompression. In the majority of cases surgery is combined with radiotheraphy, chemiotheraphy and treatment of pain.
Main goal of surgery in the treatment of spinal metastatic lesions are: tumor removal (cytoreduction), protection of the spinal cord and spinal stabilization. The choice of surgical treatment depends on spinal involvement and neurological status.

[Problems in the selection of surgical approach for the treatment of non-traumatic deformities of the craniocervical junction]. / Problemy zwiazane z wyborem dojscia operacyjnego w leczeniu nieurazowych przemieszczen pogranicza czaszkowo-kregoslupowego.

Developmental abnormalities or inflammatory disorders provoke deformations and instability of the craniocervical junction. The most dangerous results of these lesions are: sudden brainstem compression or cervical myelopathy. The authors propose the guidelines for surgical management of non-traumatic deformities caused by: a) rheumatoid arthritis of the spine, b) congenital anatomic changes of the occipit and odontoid. Main goals of surgical treatment are decompression and stabilization. The choice of surgical approach and method depends on pathology. It is very important to estimate individual anatomic changes and mobility--possibility of reduction. The authors discuss surgical methods actually used for fusion and decompression of the occipitocervical junction.