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Light-chain deposition disease (LCDD), a rare type of monoclonal immunoglobulin deposition disease, can be presented as systemic or localized, very rarely affecting central nervous system (CNS). Only 10 cases of CNS-LCDD have been described so far. We present an eleventh case of cerebral tumour-like LCDD, called aggregoma, and compare it with previously reported cases. A 49-year-old patient was admitted to the hospital due to a first generalized epileptic seizure. Magnetic resonance imaging (MRI) showed focal lesion in the right occipital lobe. Abundant parenchymal aggregates of pale eosinophilic material were observed, Congo red negative, Thioflavin T moderately positive, and l-light chain positive, but k negative in immunofluorescence with mild perivascular lymphoplasmacytic infiltrates in the intervening brain tissue. Clonality testing by next-generation sequencing showed the monoclonal nature of B-lymphocytes. Electron microscopy showed a finely granular ultrastructure of the aggregates without deposition in the vessel walls. A whole-body workup did not show any extra-cerebral immune dyscrasias.

Background: Degenerative disc disease is a progressive and chronic disorder with many open questions regarding its pathomorphological mechanisms. In related studies, in vitro organ culture systems are becoming increasingly essential as a replacement option for laboratory animals. Live disc cells are highly appealing to study the possible mechanisms of intervertebral disc (IVD) degeneration. To study the degenerative processes of the endplate chondrocytes in vitro, we established a relatively quick and easy protocol for isolating human chondrocytes from the vertebral endplates. Methods: The fragments of human lumbar endplates following lumbar fusion were collected, cut, ground and partially digested with collagenase I in Advanced DMEM/F12 with 5% foetal bovine serum. The sediment was harvested, and cells were seeded in suspension, supplemented with special media containing high nutrient levels. Morphology was determined with phalloidin staining and the characterisation for collagen I, collagen II and aggrecan with immunostaining. Results: The isolated cells retained viability in appropriate laboratory conditions and proliferated quickly. The confluent culture was obtained after 14 days. Six to 8 h after seeding, attachments were observed, and proliferation of the isolated cells followed after 12 h. The cartilaginous endplate chondrocytes were stable with a viability of up to 95%. Pheno- and geno-typic analysis showed chondrocyte-specific expression, which decreased with passages. Conclusions: The reported cell isolation process is simple, economical and quick, allowing establishment of a viable long-term cell culture. The availability of a vertebral endplate cell model will permit the study of cell properties, biochemical aspects, the potential of therapeutic candidates for the treatment of disc degeneration, and toxicology studies in a well-controlled environment.

Spondylodiscitis with or without epidural abscess is a rare, although serious, complication after sacrocolpopexy. We present a case of an 81-year-old patient who developed anaerobic Bacteroides fragilis sacral spondylodiscitis with epidural abscess 18 weeks after laparoscopic sacrocolpopexy. Because of the patient’s old age, comorbidities, and further complications during hospitalization, she was treated conservatively with an early switch to oral antimicrobial therapy with good oral bioavailability. Because of retention of titanium bone anchors in the first sacral vertebra, oral antimicrobial treatment with biofilm-active clindamycin was prolonged to 6 months. This conservative approach was successful. One year after discontinuation of antimicrobial therapy, the patient had no signs of recurrence of infection or other complications. With retention of implanted material, we preserved good pelvic support with a good effect on the patient’s quality of life. A combined surgical and antimicrobial therapy with mesh removal is the treatment of choice in most cases of spinal infectious complications. However, we would like to emphasize the need for an individualized therapeutic approach in the growing population of frail and polymorbid, older patients, where a conservative approach can have important effects on the quality of life. Infectious complications can have devastating consequences in these patients.

Background Modern style of living and the aging of the population increase the number of the patients with the degenerative diseases of the lumbar spine, especially in the active part of the population. Methods For the surgical treatment, different types of fusion were used in order to achieve the rigid stability of the affected motion segment. These techniques often lead to adjacent segments degeneration, therefore the development of the new dynamic systems, needing no fusion, occurred. With careful patient selection, the new operative techniques and instrumentation provide better results in these diseases. Results The results in the major centers, treating this pathology are encouraging, however being a new system, enough long-term results have to be available for proper evaluation of the method. In our department we treated 15 patients in one year, 11 of them were evaluated eight months after surgery with appropriate scales, so far with good results. Discussion Cosmic is a posterior nonfusion dynamic implant system, featuring hinged screws that provide a sufficient degree of dynamization and load sharing between the system and the vertebral column. The hinged screws are coated with bioactive calcium phosphate and connected adjacently with the rod, providing stability. The system provides a good rotational stability. The main indication for the Cosmic is symptomatic spinal stenosis accompanied by the spondylolisthesis. Conclusions Cosmic is a posterior dynamic nonfusion pedicle screw-rod system for the stabilization of the lumbar vertebral column. It represents the new step in the development of the spinal instrumentation and can efficiently replace the spondylodesis in the treatment of painful degenerative diseases of the lumbar spine.

BACKGROUND Tumors of the spine where spinal part of the tumor spreads trough the intervertebralforamen are so-called hourglass or dumbbell tumors. Malignant tumors of this kind arerare and most frequently neurogenic in origin. The extraspinal part of the tumor could beextremely large; however, the symptoms and signs are most commonly attributable to thespinal part. METHODS Three patients with malignant dumbbell tumors with an extensive exstraspinal part arepresented. Two patients had malignant peripheral nerve sheet tumor and one patient hadsynovial sarcoma. RESULTS In two patients operation was performed in several steps and the spinal part of the tumorwas operated first. The third patient was first operated for the extraspinal part butdied after the operation due to the general postoperative complications. Corpectomy andadequate stabilization was performed in one patient. Two patients received adjuvantoncological treatment. The longest survival was achieved in a patient who had the mostradical surgery. CONCLUSIONS Patients with rare tumors are presented where surgical and postoperative treatment ischallenging, experiences with the treatment are few, individual and multidisciplinaryapproach is mandatory, postoperative course is demanding and the prognosis is lessfavorable