Purpose: To present a series of 49 patients which underwent single or two staged complete spondylectomy, vertebral body reconstruction and segmental spinal stabilization due to spinal tumors.

Materials and Methods: From 1992 to 2002, 49 patients with primary or metastatic spinal tumors were treated. There were 36 females and 13 males with mean age at operation of 53.5 years (19 – 80). The preoperative classification was Frankel E in 17 cases, B – D in 31 cases and A in one case. Five patients had nerve root dysfunction and one, classified as Frankel E, had sphincter inadequacy. The parts of the spine involved were lower cervical in 7 cases, thoracic in 10, thoracolumbar in 15 and lumbar in 17 cases. The operations were two staged in 36 cases and single staged in 13 cases. In the cervical spine, titanium cylinders filled with methylmethacrylate were used. For the rest of the spine, the most commonly used instruments were the Kaneda device, followed by the Miami–MOSS system. Bone graft was used in five benign tumors. Mean follow – up was 62.3 months.

Results: One patient died during the anterior procedure and in another it had to be interrupted, whereupon he died one week later. Two patients died due to their underlying pathology in the 6th post–operative month. Complications included wound healing problems in 9 patients and local recurrence in one patient. There were no neurological deteriorations or instrument failures. The majority of patients experienced improvement in their neurological status, reduction of pain or both. Most patients were functionally improved and spinal alignment was maintained in all.

Conclusion: Spinal tumor resection and spinal reconstruction provide stability, early weight bearing, symptom remission and neurological improvement.

Purpose: To describe the diagnostic planning and treatment modalities of six patients with this rarest of sacral fractures. Due to the low incidence of these injuries, there is no literature evidence concerning their management.

Materials and Methods: Six patients with a transverse fracture of the sacrum with anterior displacement. All patients were admitted with bowel and bladder dysfunction, perineal anesthesia, sensory and motor deficits at the lower extremities. Prompt diagnosis of the sacral fracture was obtained in five of the six patients.

Results: Operative treatment including extensive lumbosacral laminectomies, spine instrumentation and fusion was performed in all cases. Neurological recovery was almost complete in one patient, partial in 4 patients and absent in one patient.

Conclusions: A more favorable clinical outcome can be achieved when operative treatment is implemented using lumbosacral decompression by laminectomy, dural repair and posterolateral instrumented fusion with bone grafting. Although reduction of the fracture was not ideal in many of these patients, long term clinical and radiographic follow – up as well as neurological improvement were rewarding.

The incidence of periprosthetic knee infection is generally low (0.5%–2%) but the economic impact is great. The rates are higher for rheumatoid arthritis and revision knee surgery. Treatment of periprosthetic knee infection takes into account the acuteness of the infection, the overall immune/medical status of the patient, and the local factors at the site of infection.

Evaluate the results of two-phase exchange arthroplasty with the use of articulating spacer in III-A-1 and III-B-1 periprosthetic knee infection.

From 1990–2005, 24 patients with minimum (< 2) systemic and no local compromising factors were treated for chronic periprosthetic knee infection. These patients staged as III-A-1 or III-B-1 according to MSIS staging system. Diagnosis was clinical, radiological, laboratory and from knee aspiration cultures. Two-phase exchange arthroplasty was performed. Initially, there was removal of the prosthesis, surgical debridement and placement of a PMMA spacer impregnated with antibiotic. The spacer was shaped as a knee joint permitting motion. In 6 cases a hybrid spacer was used (PMMA and TECRES® spacer). Intravenous antibiotic therapy according to intraoperative cultures followed for 6–8 weeks. Re-implantation was always done after the completion of the antibiotic therapy and on the ground of normal CRP, ESR and negative aspiration cultures. All patients received antibiotics after the re-implantation.

Staphylococcus aureus was the most common pathogen followed by Staphylococcus epidermidis and Pseudomonas aeruginosa. No infection recurrence was noted over a 2–15 years follow-up. All patients returned to normal everyday activity. A custom-made prosthesis was placed in one patient and there was a rupture of the extensor mechanism in another.

Patients with periprosthetic knee infection, staged as III-A-1 and III-B-1, when treated with two-stage exchange arthroplasty combined with antibiotic impregnated articulating spacer and i.v. antibiotics can have excellent results.