Spinal cord decompression and stabilization in malignant lesions of the spine.

20 patients with neurologic deficit and pain from malignant spinal tumors (7 primary) underwent 28 decompression and stabilization procedures. Their mean age was 57 (30-74) years and 11 were women. Indications for stabilization were pathological spine fractures or a previous spinal decompression procedure. An anterior procedure was used in 2 patients with disease limited to 1 or 2 levels. A posterior procedure was used in 10 patients with widespread disease and unsatisfactory condition. Anteroposterior procedures in 1 or 2 stages were performed on 8 patients in satisfactory general condition with a malignant lesion at 1 or 2 levels and an unstable spine. Patients were submitted to radio- and/or chemotherapy postoperatively. Survival of patients treated for primary malignant tumors averaged 30 months and was 11 months for metastatic disease. 16 of the patients, especially those with nonmetastatic disease, had substantial relief of pain. Neurologic recovery was achieved in all of the anterior and combined anterior-posterior procedures and in 60% of the posterior decompressions. Complications included failure of the instrumentation in 2 cases, skin breakdown in another 2 and dislodgment of the autograft in 1.

Anteriorly displaced transverse fractures of the sacrum in adolescents: report of two cases.

A fracture of the sacrum at the level of the first and second segments, with forward displacement of the first segment, is a very rare injury in adolescents. The cases of two patients, who both suffered a displaced transverse fracture of the sacrum with resulting neural disturbance, are reported here. We consider that these unstable fractures may be treated surgically, by extensive laminectomies of the lumbosacral area and posterolateral fusion. Stabilization of the displaced fracture is possibly preferable, because it provides the prerequisites for early mobilization and reduces pain.

Thoracolumbar burst fractures: correlation between post-traumatic spinal canal stenosis and initial neurological deficit.

Forty five patients (27 males and 18 females) aged 18 to 62 years, with thoracolumbar burst fracture treated between 1980 to 1994 were studied retrospectively. The purpose of the study was the identification of the existing correlation between the posttraumatic spinal canal stenosis and the initial neurological deficit. The presence of Dall and Stauffer type II fracture statistically constitutes an important factor, with negative involvement, in the diagnosis of the initial neurological status. In thoracolumbar spine, there is an inversely proportional relation with statistical importance between the level of injury and the post-traumatic spinal stenosis-as the burst fracture is sited higher, smaller canal encroachments by fragments will produce the same neurological deficit.

Radiological parameters associated with the evolution of degenerative scoliosis.

The risk factors related to the evolution of the degenerative adult scoliosis are investigated. A review was conducted of the the radiographs of 162 women (mean age 65 years) with degenerative scoliosis who were examined at the Research Center for Diseases of the Musculoskeletal System "Th. Garofalidis" Orthopaedic Department, at the Medical School of Athens University, during the period of 1985 through 1994. Only patients with degenerative lumbar curves greater than 10 degrees and only patients with no previous history of scoliosis were included in the study. The mean follow-up was 8 years (range 5-30 years) and for 30 patients the follow-up period was more than 10 years. The research demonstrated that the degenerative changes of the spine may relate to appearance and evolution of scoliotic curves in adults. Additionally, it was found that the risk factors that are associated with the evolution of the degenerative adult scoliosis are: curves over 30 degrees; curves having Grade II and III rotation; curves that are imbalanced and have a secondary compensatory curve that is sharp and angular at the L4-S1 level; curves in which the apex is at the L2-L3 and L3-L4 area; an intercrest line through the L5 vertebra; and vertebral translation equivalent to or more than 6 mm.

Correlation of spinal canal post-traumatic encroachment and neurological deficit in burst fractures of the lower cervical spine (C3-7).

Burst fractures of the lower cervical spine (C3-7) are often associated with severe neurological injury. During the last 5 years (1987-1992) we operated on 11 patients who had sustained burst fractures together with neurological deficit. The operations were performed through an anterior approach. The burst vertebra was excised, and the defect was filled with bone graft. Implants (plates and screws) were used in 10 cases. The preoperative examination was conducted by computed tomography and revealed that in 4 patients with complete tetraplegia (Frankel grade A) there was more than 50% spinal canal narrowing, whilst in the remaining 7 patients, with various levels of incomplete tetraplegia, there was less than 50% spinal canal narrowing, resulting in considerable improvement. The above results support the hypothesis that a correlation exists between the magnitude of the spinal canal encroachment, the initial neurological deficit and the final outcome.