Introduction and objectives

Intramedullary nailing is indicated to stabilization of tibia shaft fractures. Intramedullary nailing through an infra-patellar incision is commonly the technique of choice. While intramedullary nailing of simple diaphyseal fracture patterns is relatively easy, proximal tibia fractures, extremely comminuted/segmental tibia fractures, politrauma with multiple fractures in both extremities and reconstruction of bone loss segment with stiffness of the knee joint can be very challenging to treat.

A novel technique for intramedullary tibia nailing through the patella-femoral joint is described. This technique allow extension tibia during intervention time and it supplies easier reduction of the pattern of fracture above. The purpose of our investigation was to evaluate the use of this new technique in described above pattern fracture and patient situation; because we have thought that new technique can perform better outcomes in this situations.

Purpose

compare the radiological results in sagittal balance correction obtained with pedicle subtraction osteotomy (PSO) versus anterior-posterior osteotomy (APO) by double approach in adults.

Study Design: A prospective observational study including 43 patients who underwent surgery for degenerative lumbar disease.

Objective: The purpose of this study was to know wich were the expectancies about improvement of patients who underwent a degenerative lumbar disease surgery.

Materials and Methods: Patients with a surgical indication for a degenerative lumbar disease, and followed by spine surgery unit of our insitution, were included. During the day before surgery, Health related quality of life mesures were administrated including SF-36, Oswestry Disability Index (ODI) and a questionnaire adapted to know which ones were our patients preoperative expectancies and the grade of unsatisfaction in case they didn’t accomplish those expectancies after surgery.

Results: 43 patients (22 male, 21 female) were included. Age average was 54 years (rang 22–83), average preoperative ODI value was 48,14 (SD 22’4) and average expected value was 13,14 (SD12,1), with an average of improvement of 72’8% (SD 24’8). Diagnose of estenosis with neurological simptoms was the only parameter associated to improvement in front of isolated low back pain (66,0 SD 29’3; 79’6 SD 17’6 p=0’26%). Previous state, gender, age, SF-36 scores were’nt globaly related to expectancies.

‘Pain’ and ‘to seat’ expectancies were worse in females (r= 0’40 p= 0’023). Age was associated to ‘to lift weight’(r=0’337 p= 0’041), ‘to travel’ (r=0’513 p=0’001) and borderline for ‘sexual activity’ (r=0’315 p= 0’061).

Mental SF-36 score was inversely associated to ‘pain intensity’ (r=−0’449 p= 0’013) and ‘sexual activity’ (r=−0’362 p=0’05). Patients included in our study didn’t expect any improvement for subjects as ‘Personal care’, ‘to sleep’ and ‘to lift weight’ (p=0’9 p=0’2 y p=0’7).

In the group fo workers (16 individuals, 47% of sample), the grade of unsatisfaccion in case of not to be able to return to their occupation, was low. This result was independant to age, gender and diagnose.

Conclusions: Preoperative expectancies of patients before underwent the same surgery are differents. To know about it using a Health related quality of life mesure wich gives the same especific weight to all activities of daily life without knowing which ones are more importants for our patients (according to age, gender, diagnose, social estatus..) could be a bias to evaluate results and the grade of satisfaction of them. More studies are necessary to know if the accomplishment of those expectancies affects the final result of surgery.

Background: Tibial plafond fractures are caused by severe axial compression forces and are associated with soft tissue injuries. These fractures are difficult to treat and the risk of complications is high.

Methods and Materials: A retrospective study of tibial plafond fractures was performed at our hospital between 2003 and 2009 and 51 patients were evaluated (51 fractures). The fracture type was classified according to the OTA classification system. 10 fractures were described as type A fractures (A1 = 3, A2 = 3, A3 = 4) (19.60%), 15 were type B fractures (B1 = 0, B2 = 9, B3 = 6) (29.4%) and 26 were type C fractures (C1= 3, C2=13, C3 = 10) (51%).

Results: The average age was 47.8 years. Cases comprised 25 accidental falls (49%), 13 traffic accidents, (2.5%), 7 autolysis attempts (13.7%), 4 sports accidents (7.8%) and 2 industrial accidents (3.9%). 15 patients were initially treated with external fixators, mainly those who had type C fractures and fractures where the soft tissues were seriously damaged (21.6%). Subsequently the tibia was treated with plate fixation. Mean follow-up period was 87.78 months. Patients were required to fill in 2 quality life questionnaires after the surgical treatment. results obtained with both scales (AOFAS and FFI) were compared.

The complications rate was 14%. The main complications were superficial infections, posttraumatic arthritis and non-union fractures. One case presented a superficial infection (2%) and 6 patients suffered deep infections (11.8%).

Worst scores were observed in both scales with patients treated with type C fractures of the AO classification.

Conclusions:

- Type C fractures have a worse prognosis

Introduction: Femoroacetabular impingement (FAI) has been recently recognized as the main cause of hip pain in sportsmen. We analyse if clinical and functional results of surgical treatment are influenced by preoperative degenerative hip changes.

Materials and Methods: A series of 117 consecutive Ribas mini open procedures (mini open femoroacetabular osteoplasty with labral refixation) were performed in 115 sportsmen with confirmed clinical, radiographic, and MR-arthrography diagnosis of FAI, and were evaluated with a minimum follow up of 4 years (range: 4 – 6,5). According to Tönnis Grade for preoperative radiological degenerative hip stage, the hips were divided into 3 groups: group A/Tönnis 0: 32 hips; group B/Tönnis 1: 61 hips; group C/Tönnis 2: 24 hips. A Combined Clinical Score (CCS), which includes Impingement test, Merle D’Aubigné and WOMAC scores, was used to evaluate the patients before surgery and at 6 weeks, 3 months, 6 months and every year after operation. Satisfactory and unsatisfactory results were obtained and collected. SPSS 10.0 software (SPSS INC, Chicago, Ill) was used for statistical analysis and comparisons were performed by means of chi-squared and Wilcoxon tests; p< 0,05 was considered to be significant.

Results: With CCS method, satisfactory results were obtained in group A (Tönnis 0) in 93,4% of the cases at 12 months, in 96,5% at 24 months, and in 97,8% at the latest follow up of 48 months; in group B (Tönnis 1) satisfactory results were observed in 91,3% of the cases at 12 months, in 91,2% at 24 months, and in 93,6% at 48 months; in group C (Tönnis 2) satisfactory results were obtained in 58,3% of the cases at 12 months, in 55,3% at 24 months, and in 50,1% at 48 months. Differences between groups A and C, as like between groups B and C, were significant (p< 0,001), but not between groups A and B (p> 0,05).

Conclusions: Midterm results of the Ribas mini open procedure for the treatment of femoroacetabular impingement are encouraging, expecially in hips not exceeding Tönnis Grade 1 osteoarthrosis, as results depend directly on degenerative state. If symptomatic patients are treated in early stages, excellent expectancies can be obtained with this procedure already at midterm. In addition, instruction of general physicians and specialists in the diagnosis of FAI is of paramount importance.

Introduction: Optimal management of proximal humeral fractures is still to be defined. The objective of this study is to present the functional and quality of life results of proximal humeral fractures conservatively treated in elderly population

Material and Methods: Prospective study including 74 fractures in patients over 60 and less than 85 years-old. 4 patients lost at final follow-up. Fractures were assessed by X-ray and C.T. exam. There were 14 one-part fractures, 15 two-part greater tuberosity (GT), 17 two-part surgical neck, 10 three-part GT, 6 four-part, 6 two-part GT fracture dislocation, 1 four-part fracture dislocation and 1 impression fracture. Constant Score, EuroQol 5-D and X-Ray study at two-year follow-up. U Mann-Whitney for non parametric and t-student for parametric.

Results: Constant Score: non-displaced fractures mean of 73,58 while displaced fractures 59,41 (p0,003). Significant differences between them in all Constant items except for External rotation (p0,17). Total Constant Score diminished as fracture pattern increased complexity: 2-part GT 72,78, 2-part surgical neck 65,88, 2-part GT fracture dislocation 71, 3-part GT 54,64 and 4-part 33,66. Despite these differences there were no significant differences as far as pain was concerned among all displaced fractures.

Quality of life perception: no significant differences in VAS between displaced and non-displaced fractures (p 0,75). 4 avascular necrosis at final follow-up, 2 in the 4-part group, 1 in 3-part GT and 1 in 4-part fracture dislocation.

Conclusion: Conservative treatment of proximal humeral fractures give reasonable good functional results in 1-part, 2-part GT, 2-part surgical neck and 2-part GT fracture dislocation in specially selected elderly population. 3-part GT and 4-part fractures achieve a limited functional result with conservative treatment. No differences have been observed between non-displaced and displaced fractures conservatively treated as far as quality of life perception is concerned in such elderly population.

Objective: The purpose of this study was to determine how changes in functional shoulder score (Constant Score) affected the values of the SF-36 score, to determine the amount of functional score change to be considered relevant.

Material and Method: 427 patients were included. All of them were assessed with a functional shoulder score (Constant Score) and fulfilled SF-36 score. Mean age was of 50,61(18–85), 200 of them were male and 227 female. 280 were considered to be active while 147 were retired as far as working status is concerned. There were 191 patients with university studies and 236 with primary studies. Primary diagnosis was cuff disorders in 265 patients, old-fracture in 43, degenerative in 72 and instability in 34. Correlations were performed with Spearman’s rho and regression models were evaluated

Results: There was a moderate but significant correlation between the total Constant Score and PF_NORM (0,511) and US standardized physical component (US STPH) (0,491) of the SF-36. For every point of increase in the Constant score the SF-36 increases 0,235 points. Looking into the different items of the Constant Score, Activities of daily living (ADL) and strength presented the stronger correlation with SF-36 (0,428, 0,411). In the regression model, every point of increase of pain, ADL, forward elevation, external rotation and internal rotation means an increase of 0,472, 0,39, 0,84, 0,82 and 0,86 of the US STPH of the SF-36.

Conclusions: Whenever the outcome of any shoulder treatment is analyzed it has to be taken into account that for every point of increase of the Total Constant Score just 0,235 points of the US SPTH of the SF-36 increase. Depending on the mean value of the US SPTH of the SF-36 of the population studied, the relevant increase of Constant Score can be calculated.

Mobility improvements seem to have more influence that pain changes as far as increasing the US SPTH of the SF-36 is concerned.

Introduction: Concern remains in loosening of glenoid component reversed prostheses. This study is to analyze glenoid location of stem and 4 screws of glenoid component.

Material and method: 34 reversed prostheses included. Mean age 74,10, 33 females/1 male. Preoperative CT study : glenoid version; measure of anterior-posterior osteophytes. Postoperative CT study: central stem location and superior, inferior, anterior, posterior screws location. Study of influence of glenoid version and presence of osteophytes in location of glenoid implant.

Results: 27 retroverted glenoids (mean 6,5°); 7 ante-verted (mean 5,3°). 17 cases with anterior osteophyte and 12 of posterior. In 52% the central stem was centered inside glenoid, 33% anterior end was outside glenoid and 14% the posterior end. When central stem was anteriorly outside 85% presented retroverted glenoid (mean 8,33°). When the central stem was posteriorly outside 66% presented anteverted glenoid (mean 9,5°). Inferior screw was fully in place in 38%, ¾ part inside in 19%, 2/4 part in 23%, ¼ part in 19%. Superior screw was fully in place in 47%, ¾ part inside in 23%, 2/4 part in 19%, ¼ part in 9%. Anterior screw was fully in place in 66%, ¾ part in 23% and 2/4 part in 9%. Posterior screw was fully in place in 38%, ¾ part in 42%, 2/4 part in 14%, ¼ part in 4%. The correct positioning of superior screw correlates with less coverture of inferior screw. Anterior and posterior osteophytes did not correlated with stem nor screw positioning.

Conclusions: Positoning of central stem correlates with glenoid version. Anteriorly extruded stems correlate with higher retroverted glenoids and posteriorly extruded stems correlate with higher anteversion.

Positioning the inferior screw fully inside the lateral border of the scapula correlates with lower bony coverture of superior screw.

Introduction: Prostheses radiolucent lines are currently used to evaluate the components fixation. The objective of this study is to determine concordance and reproducibility of humeral stem radiolucent lines evaluation.

Material and method: Five observers evaluated 64 x-ray belonging to 32 pairs (1 antero-posterior view and 1 outlet view) obtained from 16 shoulder prostheses. 16 x-ray pairs were obtained immediately after surgery and 16 one year after surgery. Evaluation in four degrees of radiolucent width for each of the 7 zones that the humeral component was divided for. Evaluation of the component-cement interface and the cement-bone interface. Each observer made two evaluations of the 64 x-ray separated in 6 weeks. Statistics : index kappa with quadratic weighting.

Results: Intra-observer results: mean kappa index for component-cement interface: 0,3274. mean kappa index for cement-bone interface: 0,5269. Inter-observer results: mean kappa index for component-cement interface: 0,1242. mean kappa index for cement-bone interface: 0,2478. Evaluation of 2 pairs of x-ray of the each prostheses taken in a period of 1 year: component-cement interface: mean of 91,67% of plausible results, cement-bone interface: mean of 80,2% of plausible Results:

Conclusions:

- low kappa index of reproducibility (0,3274–0,5269) of humeral component radiolucent lines evaluation for component-cement interface as well as for cement-bone interface.

Introduction and Hypothesis: Genetic studies of osteoporosis have analysed single polymorphisms in individual genes with inconclusive results. An alternative approach may involve haplotypes and gene-gene interactions. The aim of the study was to test the association between COLlAl, ESRl, VDR and TGFBl polymorphisms or haplotypes and BMD in Spanish postmeno-pausal women.

Methods: Sixteen polymorphisms were analysed in 719 postmenopausal women. ANOV A, ANCOV A and Xi2 tests were used to perform the statistical analysis.

Results: COLlAl -1997G> T (p=0.04) and TGFBl Leu10Pro (p=0.02) were found to be associated with adjusted lumbar spine BMD (LS BMD). Interactions were observed between: the C0LlAl -1997 Grr and Sp1 polymorphisms (p< 0.0l for LS BMD); and the COLlAl 1663 indelT and VDR ApaI polymorphisms (p< 0.0l for FN BMD). The COLlAl GDs and ESRl LPX haplotypes were associated with FN BMD (p=0.03 and p=0.03).

Conclusion: Polymorphisms at COLlAl and TGFBl and haplotypes at COLlAl and ESRl were associated with BMD in a cohort of postmenopausal Spanish women. Moreover, COLlAl polymorphisms showed significant interactions among them and with the VDR 3’ pol ymorphisms.

Introduction: Reversed prostheses implantation requires screwing of the glenoid component with prefixed angles. This study is to determine anatomical angles of scapula that take part in reversed prostheses implantation.

Material and method: Seventy-three 3-dimensional computed tomography of the scapula and 108 scapular dry specimens were analyzed. Mean age of the CT-3D serie was of 52.59 years old (ranging from 16 to 84). There were 46 females and 27 males. The following measures were made on each patient: length of the neck of the inferior glenoid, angle between the glenoid surface and the upper posterior column of the scapula, angle between the major craneo-caudal glenoid axis and the base of the coracoid process and angle between the major craneo-caudal glenoid axis and the upper posterior column of the scapula. Measures were performed in the AP view as well as in the posterior view of the scapula.

Results: The length of the neck of the anterior glenoid was classified into two groups named ‘short-neck’ and ‘long-neck’ for both three-dimensional computed tomography and cadaveric scapulas with statistically significant differences between both groups (p< 0,001 for the three-dimensional computed tomography scapulas and p=0,034 for the cadaveric group). The angle between the glenoid surface and the upper posterior column of the scapula was also classified into two different types: type I (52° ranging from 48° to 57°) and type II (64° ranging from 60° to 70°) with statistically significant differences between both groups (p< 0,001 for the three-dimensional computed tomography scapulas and p< 0,001 for the cadaveric group). The angle between the major craneo-caudal glenoid axis and the center of the base of the coracoid process averaged 18,25° (ranging 13° from to 27°). The angle between the major craneo-caudal glenoid axis and the upper posterior column of the scapula averaged 8° (ranging 5° from to 18°).

Conclusions:

- scapulas can be classified into two groups regarding the angle between the glenoid surface and the upper posterior column of the scapula with significant differences between them.

Objective: Analysis of the influence in shoulder function of restoring total humeral length (THL) in proximal humeral fractures (PHF) treated with hemiarthroplasty and comparing the data with a control group of proximal fractures treated with osteosynthesis.

Material and method: Prospective study involving 56 patients, twenty-nine 2 and 3 part PHF treated with osteosynthesis and twenty-seven 3 and 4 part fractures treated with hemiarthroplasty. Clinical assessment through Constant Score and radiological exam of the THL of both humerus as well as CT scans to analyze position of the tuberosities at 1-year follow-up.

Results: Osteosynthesis group: mean Constant Score of 77.37. In all cases greater tuberosity consolidated in good position. When differences in THL were higher than 2 cm Constant Score values significatively decreased to mean of 67, when ranging from 0 to 2 cm did not differ significatively from mean Constant Score.

Hemiarthroplasty group: mean Constant Score of 55.76. In 5 cases THL was increased (mean 0.87 cm) with a mean Constant Score of 63.5 and among them the greater tuberosity consolidated in place in 3 cases and posteriorly in 2. In 20 cases THL was decreased (mean 1.03 cm) with a mean Constant Score of 54.25 and among them if the difference was minor than 1 cm the greater tuberosity consolidated in place in 3 cases, consolidated posteriorly in 4 and absent in 1 case, and if the difference was greater than 1 cm, the greater tuberosity consolidated in place in 4 cases, consolidated posteriorly in 6 and absent in 2 cases . In 2 cases no differences in THL.

Conclusions: In PHF treated either with osteosynthesis or hemiarthroplasty, the greater tuberosity can be properly reattached if THL differences are less than 2 cm.

Constant Score correlates with greater tuberosity position at any difference of THL less than 2 cm.

Objective: The purpose of this study was to evaluate the effectiveness of surgical reconstruction of posttraumatic deformity. Posttraumatic kyphosis (PTK) causes pain, neurological deficit, sagittal imbalance, progressive deformity, cosmetic and functional deterioration. Its treatment is cause of controversy and technically demanding. There are few reviews in the literature about the results of its surgical treatment.

Methods: From 1995 to 2002 twenty-one patients suffering from posttraumatic thoracolumbar kyphosis were operated. The average follow-up was 3.9 years (range 6 – 1 years). The average age was 38 years (range 23–62): 13 female and 8 male. All patients complained about vertebral pain, 16 located at the apex of the deformity, 2 patients in the lumbar area and 3 patients referred also pain above the lesion. Three patients had irradiated circumferential pain and 4 patients mild neurological deficit. Two patients showed sexual dysfunction. In one patient only anterior approach with allograft reconstruction and anterior plate fixation was performed. In 17 patients simultaneous or staged approach with posterior release, anterior discectomy and allograft reconstruction and posterior compressed instrumentation was performed. In three patients a posterior closing wedge osteotomy was performed

Results: Postoperative pain decreased from 7.5 to 2.8 (VAS). Functional status: preoperative 42.3 % and postoperative 13.8% (Oswestry score). There was no hardware failure. All cases showed solid fusion without significant loss of correction. The average corrected kyphosis was 27.3°. All patients were satisfied with their cosmetic result. No cavity drainage was performed in 2 patients with syringomielia. 1 of 4 patients with neurological deficit did not improve. Two patients had thoracic neuropathic postoperative pain; one of them needed pain clinic treatment until remission. One case had superficial infection. One patient showed a Chylous leakage.

Discussion: Only few works analyze the results of surgical treatment of PTK. The controvesrsy between anterior-aposterior surgery versus posterior closing wedge osteotomy depens of classification of posttraumatic spinal deformities based on three criteria: the region involved, the neurological status and the presence of any sagittal or frontal plane deformities outsides the local kyphosis

Conclusions: Our results suggest that the double approach with anterior allograft and posterior instrumentation shows clinical and radiological efficacy for sagittal posttraumatic deformity. In spite of surgical risk, there have been few complications with a high rate of patient satisfaction.

Background: The Inferior Glenohumeral Ligament (IGHL) has a well known mechanical and propioceptive relevance in shoulder stability. The interrelation of the IGHL anatomical disposition and innervation has not actually been described. The studys purpose was to determine the IGHL innervation patterns and relate them to dislocation.

Material & methods: Forty-five embalmed and 16 fresh-frozen human cadaveric shoulders were studied. Massons Trichrome staining was used to detail the intra-ligamentous nerve fibre arrangements. Neural behaviour of the articular nerves was studied dynamically at the apprehension position and while anteroinferior dislocation of the shoulder joint was performed.

Results: The anatomy of the IGHL was clearly defined. However, in 7 out of 61 cases the anterior band was only a slight thickening of the ligament. It averaged 34 mm (range, 28 to 46 mm) in length. The posterior band was only seen in 40.98 % of the cases. The axillary nerve provided IGHL innervation in 95.08 % of the cases. We found two distinct innervation patterns originating in the axillary nerve. In Type 1 (29.5 % of the cases), one or two collaterals later diverged from the main trunk to enter the ligament. Type 2 (65.57%) showed innervation to the ligament provided by the posterior branch for three to four neural branches. In both cases, these branches enter the ligament near the glenoid rim and at 7 oclock position (right shoulder). The shortest distance to the glenohumeral capsule was noted at 5 oclock position. The radial nerve (Type 3 innervation pattern) provided IGHL innervation in 3.28 % (2 specimens). Microscopic analysis revealed wavy intraligamentous neural branches. The articular branches relaxed and separated from the capsule at external rotation and abduction and stayed intact after dislocation.

Conclusions: The current results showed the IGHL to have three different innervation patterns. The special neural anatomy of the IGHL suggested it was designed to avoiding denervation when dislocated. This might contribute to understand why the neural arch remains unaffected after most dislocations. To our knowledge this is the first work that clearly describes specimens in which the main innervation of the IGHL is provided by the radial nerve.

Knowledge of the neural anatomy of the shoulder will clearly help in avoiding its injury in surgical procedures.

Aim: Investigate the influence of various types of allograft (from the tibia, femur, and fibula) through finite element analysis to evaluate the best clinical configuration.

Methods: A non-linear 3D finite element model of a lumbar spine L3–L5 was used as a physiologic model (Noailly, 2003). The model was modified with the insertion of a transpedicular instrumentation (Surgival SA, Spain) and the removal of the L4 body and two adjacent discs. CT scans of a femur, tibia and fibula from the same patient were performed. Fragments of each bone were reconstructed and inserted within the model. Four configurations of allografts were investigated: one femur fragment, one tibial fragment, three fragments of fibula, six fragments of fibula. Four types of loadings were applied: compression (1000N), flexion, extension, and rotation (15Nm). Strain and stresses were calculated in large displacement (MARC, MSC Software).

Results: Von Mises stresses within the internal fixator are well below the Yield stress and the fatigue limit and therefore no fracture of the fixator is foreseen. The use of a fixator to create fusion of the two vertebras makes the lumbar spine much stiffer. The geometry and configuration of the allografts have a large influence on the strain and stresses within the adjacent vertebrae with a reduction of strains and stresses. The use of fragments of fibula gives the most stable configuration. However, this is also the configuration that changes most the maximal principal strains within the vertebrae. Results obtained with the femur or the tibia are very similar between each other. However, due to its ellipsoidal geometry, the allograft in tibia gives more asymmetric deformations than the femur.

Conclusion: Allografts harvested from the femur seems to be more reliable and change least the strain and stress distributions within the lumbar spine compared to allografts from the tibia or fibula.

Aim: Investigate the influence of end-plate preparation in a model of corporectomy to evaluate the best biomechanical configuration.

Methods: A non-linear 3D finite element model of a lumbar spine L3–L5 was used as a physiologic model (Noailly, 2003). The model was modified with the insertion of a transpedicular instrumentation (Surgival SA, Spain) and the removal of the L4 vertebral body and two adjacent discs. A femur allograft was inserted anteriorly. Four configurations were investigated: with allograft supported on the entire end-plate, with allograft supported on the half of cartilage endplate thickness, with allograft supported on the subcondral cortical shell and, finally, with allograft supported on the trabecular bone. Four types of loadings were applied: compression (1000N), flexion, extension, and rotation (15Nm). Strain and stresses were calculated in large displacement (MARC, MSC Software).

Results: Results indicate that the preparation of the end-plates has a minor influence on the strain and stresses within the adjacent vertebrae when rigid transpedicular instrumentation was placed. The use of a fixator to create fusion of the two vertebras makes the lumbar spine much stiffer. The resection of the cartilage and support the allograft in the cortical shell changes most the maximal principal strains in the remaining end-plate, and creates a peak stress in the contact area. On the other hand, complete resection of cartilage and subcondral cortical end-plate is the configuration that changes least the maximal principal strains within the adjacent vertebrae.

Conclusion: Preservation of the cortical end-plate may not offer a significant biomechanical advantage in reconstructing the anterior column when rigid transpedicular instrumentation was used.

Aim: To evaluate the role of selective arterial embolization of Aneurysmal Bone Cyst of the mobile spine (C1-L5). Ten to 35% of aneurysmal bone cyst arises from the mobile spine. The course of the disease depends on the aggressiveness of the tumor, as well as the treatment. No previous series analyses this aspect. Methods: Fourteen cases of Aneurysmal Bone Cyst of the mobile spine were retrospectively reviewed. All charts, radiographs, and images were reviewed allowed for oncologic and surgical staging of these cases. The mean follow-up was 3,5 years (2,5y Ð 11y) and the mean age at diagnosis was 22 years. Lumbar and cervical spine was more frequently involved (5 cases cervical and 5 lumbar). Histologic diagnosis was obtained in all cases. A slow and gradual onset of pain was the constant symptom. In all cases an arterial study was performed and in thirteen cases a selective arterial embolization (SAE) was performed. Six of them were repeated Results:Only two patients shows complete ossiþcation of the cyst without surgery (T10 and T1) and was curative. All the others patients received surgical treatment (curettage or en bloc excision) In three of them a recurrence of disease was diagnosed 6, 8 and 12 months later. Two of the most recent cases shows a little lityc area without symptoms Conclusions: Selective arterial embolization seems NOT be sufþcient to obtain ossiþcation of Aneurysmal Bone Cyst o mobile spine