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Degenerative de novo scoliosis is commonly present in older adult patients. The degenerative process including disc bulging, facet arthritis, and ligamentum flavum hypertrophy contributes to the appearance of symptoms of spinal stenosis. Idiopathic scoliosis has also degenerative changes that can lead to spinal stenosis. The aetiology, prevalence, biomechanics, classification, symptomatology, and treatment of idiopathic and degenerative lumbar scoliosis in association with spinal stenosis are reviewed. Review study is based on a review of pertinent but non-exhaustive literature of the last 20 years in PubMed in English language. Retrospective analysis of studies focused on all parameters concerning scoliosis associated with stenosis. Very few publications have focused specifically on idiopathic scoliosis and stenosis, and this was before the advent of modern segmental instrumentation. On the other hand, many papers were found for degenerative scoliosis and stenosis with treatment methods based on aetiology of spinal canal stenosis and analysis of global sagittal and frontal parameters. Satisfactory clinical results after operative treatment range from 83 to 96 % but with increased percentage of complications. Recent literature analysed the importance of stabilizing or not the spine after decompression in such situation knowing the increasing risk of instability after facet resection. No prospective randomized studies were found to support short instrumentation. Long instrumentation and fusion to prevent distabilization after decompression were always associated with higher complication rates. Imbalance patients with unsatisfactory compensation capacities were at risk of complications. Operative treatment using newly proposed classification system of lumbar scoliosis with associated canal stenosis is useful. Sagittal balance and rotatory dislocation are the main parameters to analyse to determine the length of fusion.

Since their discovery 40 years ago by Urist M., several studies have been done on the bone morphogenetic proteins (BMP). They belong to the superfamily of TGF β (Transforming Growth Factor) and are the only osteo-inductive growth factors known until now. They are nowadays up to 20. After the fixation of these molecules on their receptors, intracellular cell reactions occur, inducing bone formation by the activation of genes responsible for cartilaginous formation and osteogenesis. In experimental studies on animal species, BMP showed their efficiency on the recovery of bone defects, on the acceleration of fractures consolidation or spine arthrodesis fusion or on pseudarthrodesis treatment. To be efficient, BMP must be used at the proper dose and delivered locally for a sufficient period by a biocompatible and biodegradable matrix, whose tridimensional structure allows its invasion by new bone and vascular cells. According to these data, clinical trials have been conducted on the human. Only rhBMP-2 and rhBMP-7 uses are validated for definite clinical applications (vertebral fusion, tibial pseudarthrosis and open leg fracture) by the results of randomized multicentric studies. Other clinical applications have been reported in the literature but large-scale studies are still necessary to confirm their results. Even if the clinical results are sometimes spectacular, and if the use of BMP, currently reserved because of their cost, in difficult situations give rise to big hopes, many questions remain unsolved. These questions will probably be dealt with in the future: stability of the new bone formation, eventual long-term adverse effects.

The aim of this work was to assess the clinical results in 13 snapping scapulas treated between 1990 and 1996. This is an infrequent source of shoulder discomfort characterized by painful, audible and palpable abnormal scapulothoracic motion. It may or may not have a demonstrable mechanical etiology, but often no obvious cause can be identified with imaging techniques. We report a series of 13 cases, of whom 8 were operated. The mean age was 23 years; there were 4 women and 9 men. All patients underwent a CT-scan and X-ray imaging. Initial treatment was conservative in 10 cases without obvious etiology, and surgical in three osteochondromas. Five patients who did not improve by a nonoperative approach were operated. After a mean follow-up of 24 months, pain and snapping were completely relieved. Surgery was the appropriate treatment in the cases of failure of conservative treatment and allowed patients to return to normal activities and work.

Bone graft substitute success depends on the formation of healing bone tissue that will bring about the incorporation of the implant, in a sequence of discrete phases. Each of these phases may be influenced by the nature of the implant used. The biological, biochemical, and physicochemical parameters involved may be measured, quantified, and checked. All those involved in the manufacture or the use of these substitutes must thoroughly understand these aspects in order to be able to control them. Tricalcium phosphate, Hydroxyapatite and the biphasic compounds are currently the most widely used materials. TCP, whether used by itself, or as one of the constituents of the biphasic calcium phosphates, will eventually disappear, leaving the bone graft substitute to be gradually osseointegrated. This osseointegration will ensure the biocompatibility of the implant, since resorption occurs without the interposition of a fibrous tissue layer.

Bipolar lesion of the clavicle is rare. Only few cases have been reported. We report two cases treated surgically with success. In case of bipolar dislocation, surgical treatment guarantees better stability than conservative treatment. In case of fracture associated with sterno-clavicular dislocation, it is possible to stabilize both with the same Kirschner wire. Surgical treatment is recommended in young patients.