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Purpose: The aim of this study was to assess retrospectively the safety and efficacy of combined radiofrequency (RF) and kyphoplasty (KP) in managing painful osteolytic metastases to vertebral bodies resistant to conservative treatments., Materials and Methods: Eleven patients (9 women and 2 men; mean age 68 years; age range 58-82) with painful osteolytic vertebral body metastases unresponsive to conservative treatments underwent RF combined with KP under general anaesthesia. Primary neoplasms were kidney carcinoma (n=1), breast carcinoma (n=1), thyroid carcinoma (n=2) and multiple myeloma (n=7). Lesion levels were cervical (n=1), thoracic (n=9) and lumbar (n=1). Combined RF and KP was well-tolerated by all patients. The procedures were performed using fluoroscopic guidance and intraoperative neurophysiology monitoring. Pain relief with the visual analogue scale (VAS) pain score and analgesic consumption were evaluated before and after treatment., Results: No complication occurred. In one case, we observed an asymptomatic cement leakage. Pain significantly decreased after treatment: the mean VAS pain score before treatment was 8 (range 7-10) vs. 1.8 (range 0-3) and 1.9 (range 1-3), respectively, 72 h and 6 weeks after the treatment. Analgesic reduction was achieved in all patients., Conclusions: RF combined with KP represents a potential alternative method for palliation of painful spinal osteolytic metastases in selected patients. The procedures are safe and provide pain relief with bone augmentation and improvement in quality of life.

The author reports the technique and clinical course of patients suffering from metastatic spine tumors, treated by osteosynthesis with the Polster vertebral body implant and bone cement. All tumors were treated by an open ventral procedure: curettage of the tumor, insertion of the tumor device, and correction and stabilization of the lost height. In addition, bone cement was used to strengthen the reconstruction. Subjective and objective clinical improvement was found in 64 per cent, unchanged condition in 23, per cent and new symptoms occurred in 13 per cent. In nearly all cases of clinical improvement, no deterioration recurred. Patients with metastasis died after an average of 10 months, plasmacytomas were found to have an overall survival of about two years.

It is the purpose of this study to report our new surgical technique and the outcome of total en bloc spondylectomy (TES) to resect the primary spinal tumor as a whole in order to ensure oncological curability. TES consisting of en bloc laminectomy and en bloc corporectomy was performed on 7 patients with primary vertebral tumors between 1989 and 1993. There were 2 osteosarcomas, 1 malignant fibrous histiocytoma, 1 chondrosarcoma, 1 undifferentiated sarcoma, 1 solitary plasmocytoma, and 1 giant cell tumor. All of the patients had partial or complete pain relief after TES. None of the patients worsened neurologically after surgery and there was no local recurrence following TES, except for 1 patient who died 3 months postsurgery as a result of a tumor developing in the mediastinum. The advantage of TES is en bloc resection of the affected vertebrae by marginal or wide margin, not piecemeal pattern. This new surgical technique offers the most radical therapy of primary malignant tumors.

62 patients with infected hip joints whose treatment was started between January 1980 and December 1986 were analysed retrospectively in December 1992 with a mean observation period of 7.2 years (range 1-13). The treatments employed were debridement with lavage drainage in 6 cases, one-stage replacement of the prosthesis on 47 occasions and two-stage replacement in 27 cases. On 5 occasions the prosthesis was removed and a Girdlestone procedure was undertaken. In the 47 one-stage replacements primary intervention was successful in 57% (n = 27), in the two-stage replacements in 74% (n = 20). In 42 cemented shafts there was primary healing in 34, i.e. 81%, compared with 13 (65%) in the 20 non-cemented shafts. Successful healing was finally achieved in all 62 infected hips.

Because they show fairly good short- and mid-term results frozen, morselized homologous bone grafts have become very popular in acetabular reconstruction after failed total hip arthroplasty. Graft integration proceeds uneventfully. However, very little is known about its longevity. From 1980 to 1984 we performed 121 acetabular revisions in cases with contained bone defects utilizing homologous bone graft and a cementless non-coated or hydroxyapatite coated HDPE cup. At the end of 1991 (7 to 11 years after the operation), 43 patients (35%) were available for review. 41 patients (34% had died, 19 patients (16%) were lost to follow-up. In 18 patients (15%), the cups had been revised because of aseptic loosening. The Harris Hip Score showed 50% good to excellent results. Cups inserted after grafting of cystic defects showed almost no migration. However when cavity defects were filled with large bone grafts (n = 23), slow continuous cup migration and progressive graft resorption over time was observed. Due to this continuous resorption, we conclude, that morselized bone grafts do not guarantee an ever lasting inert interface. Once the non-coated HDPE cup is in contact with the autogenous host bed, bone osteolysis occurs and loosening proceeds. Cementless porous coated cups with morselized allografts alone may be used in acetabular revision only when cystic defects are present. The surface of the cup has to be brought into contact with a well vascularized autochthonous pelvic bone in order to achieve stable fixation. Segmental and massive cavity defects can only be reconstructed with morselized allografts when protected from loading by supporting rings.(ABSTRACT TRUNCATED AT 250 WORDS)

Resection arthroplasty should nowadays be considered as obsolete for the following reasons: the removal of the implant and adequate antibiotic therapy can clear the infection. From this point of view the reimplantation of an endoprosthesis is possible. "Deficient bone stock" is not a contraindication to the reimplantation since there are surgical means available to replace bone stock. The results of revision arthroplasty (reimplantation) are incomparably better today that they were years ago (cement-free technique, bone replacement, supports of the acetabulum, special revision prostheses etc.

Relation between quadriceps muscle mass and knee extension strength was investigated after resection of malignant bone tumor and endoprosthetic replacement of the distal femur in 19 patients with patellar resurfacing (Group A) and 16 patients without resurfacing (Group B). In all cases, a modular cementless, hinged prosthesis had been used. Age and follow-up period were comparable in the 2 groups. Muscle mass was measured ultrasonographically and strength was evaluated isokinetically. All the data on the operated side are given as percentage of the non-operated side. There was a positive correlation between muscle mass and strength in both groups. By linear regression analysis, a slightly lower value of strength was predicted in the unresurfaced group than in the resurfaced group. Analysis of covariance revealed that the influence of patellar resurfacing on strength was significant. This factor should also be considered in making a decision about patellar resurfacing with a tumor endoprosthesis.

Spinal instability is a loosely used term resulting from a variety of traumatic, developmental, neoplastic, hereditary, and degenerative insults to the axial skeleton. As defined by White and Panjabi, lumbar instability would imply the loss of the spine's ability, under physiological loads, to maintain its patterns of displacement so as to avoid neurologic deficits, incapacitating deformity, and intractable pain. Although from a strict engineering standpoint, the concept of load and deformation is valid, it is not at all known what type of movement or what magnitude of movement is responsible for low back pain. In light of these considerations, the author would define instability as either acute or chronic. Acute mechanical instability would result from those conditions such as fracture, tumor infiltration, infection, postlaminectomy, and certain congenital defects where a small change in loading or deformation could lead to permanent vertebral displacement with fixed deformity and/or neurologic damage. Chronic instability would result from those low back disorders that lead to progressive deformity over a period of years, often producing back pain from degenerative osteoarthritis, and central as well as foraminal stenosis. These disorders would include lumbar scoliosis, kyphosis, and spondylolisthesis, either isthmic or degenerative type. In those situations associated with more chronic instability, the relationship of low back pain is not always discernable even with provocative discography or magnetic resonance imaging. The surgical treatment of low back pain associated with these spinal instabilities depends on the etiology of the conditions defined. Acute traumatic injuries are best managed by posterior segmental instrumentation. At the level of the upper lumbar spine, a combined approach may be desirable to support anterior column deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

The author presents a particular manifestation of the failed back syndrome secondary to previous spondylolisthesis surgery: the flat back syndrome. Surgical treatment of this condition require, in the author experience, combined anterior and posterior surgery.

The success of the cemented arthroplasty is due primarily due to excellent initial stability, intimate contact with the prepared bone and the isoelastic properties provided by the cement. In an experimental in vitro study, the initial stability of both the cemented and uncemented femoral components was measured and it was found that they were both very stable in simulated single limb stance (maximum motion of less than fifty microns). However, in simulated stair climbing, the uncemented components were more unstable than the cemented components (maximum micromotion of 76 microns for cemented and 280 microns for uncemented), and this relative instability of the uncemented femoral components could compromise the bone ingrowth. Studies on femurs retrieved at autopsy from patients who underwent cemented total hip arthroplasty two week sup to seventeen years earlier and were functioning well, have shown that the failure of cemented femoral components is initiated primarily by mechanical factors, consisting of debonding at the cement-prosthesis interface and fractures of the cement rather than lack of bone ingrowth or fibrous tissue formation at the interface. Thus the problems with using cemented femoral components involve the poor strength of the cement-prosthesis interface and the cement, while the problems with cementless components involve the difficulties in precisely machining the femoral canal, and providing rigid stability as well as accurate fit.

The CT findings observed 6 months and 2 years after chemonucleolysis in 50 and 34 patients are reported. Emphasis is placed on the persistence of the hernia image in nearly 70% of the cases, together with an increase in degenerative intradiscal signs and degeneration of the facet joints; however, this did not lead to poor results 2 years after chemonucleolysis.

Between 1976 and 1982, 126 low friction arthroplasties were implanted in primary arthrosis of the hip. The displacement rate or acetabular loosening related to the type osteoblastic response to the disease were studied. The hips were subdivided into three groups based on the radiographical aspect observed prior to implant. The atrophic type revealed a greater incidence for this type of complication (27.3%) whereas cases classified as normotrophic revealed a 5.6% incidence and hypertrophic a 6.1% incidence. The authors conclude that the type of bone response in primary arthrosis plays an important role in the occurrence of acetabular mobilization, and that osteoblastic response may be considered to be of prognostic value together with other well-known factors in the evolution of this type arthroplasty.

Thirty-two patients with therapy-resistant low-back pain and justified indication for fusion were divided into two groups: 16 patients were treated with anterior fusion of the lumbosacral spine, with insertion of tricortical bone grafts of the iliac crest, and 16 patients with insertion of a fibular peg. Additional dorsal fusion of the same segments was performed. Comparison of the two techniques of circumferential fusion of the lumbosacral joint reveals comparable clinical results. A marked difference in roentgenographical criteria such as disk height, retrolisthesis, and anterior osteophytes in the adjacent segment between the two techniques was noted at the time of follow-up evaluation after 89 months and motivated the authors to abandon the fibular-peg technique.