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.

Purpose: To check the accuracy of the Internet-derived medical information.

Materials and Method: We tested the validity of randomly chosen Internet-derived statements concerning four common orthopaedics problems. Two-hundred statements were gleaned by two nonmedical persons from 30 chosen websites, after employing a common search engine. Fifty statements were derived on each of four separate topics (knee osteoarthritis, hip osteoarthritis, low back pain, and osteoporosis). Five residents in orthopaedic surgery were then asked, to independently rank the accuracy of these statements using a five point rating scale with 1 being strongly disagree to 5 being strongly agree with the statement. Means were then obtained for each question and ranked on validity with > 4 being very valid, > 3 being somewhat valid and < 3 being invalid.

Results: Overall score for the 200 statements was 3.81 with 61% deemed very valid, 20% deemed somewhat valid and 19% deemed invalid. For knee osteoarthritis, the overall score was 3.63 with 63% being very valid, 18% being somewhat valid and 19% being deemed invalid. For hip osteoarthritis, the overall score was 3.75 with 58% being very valid, 21% being somewhat valid and 19% deemed invalid. For low back pain, the overall score was 3.91 with 48% being very valid, 36% being somewhat valid and 16% deemed invalid. For osteoporosis, the overall score was 3.96 with 59% being very valid, 18% being somewhat valid and 23% deemed invalid.

Conclusion: Approximately 20% of medical information found on the Internet is misleading and, invalid. Patients and physicians who use the Internet to access health information, should be aware of these inaccuracies and better seek advice from reliable medical web sites of universities.

Purpose: To evaluate the modification of the hump in patients with idiopathic scoliosis after the use of Boston brace and to compare this with the change of the Cobb angle.

Material – Methods: Prospective study of 60 female patients with idiopathic scoliosis who were treated with the application of Boston brace. The average age was 12,8 years ( 9–15 years ) and the average Kisser sign was 1,5. According to King classification 14 (23.5%) patients met the criteria for type I, 21 (35%) for type II, 13 (21.5%) for type III and 12 (20%) for type IV .No patients with type V curves were included. The average Cobb angle was 22°. The patients were reviewed every six months with clinical examination, plain x-rays at erect position and twelve hours after the removal of the brace The patient’s hump was evaluated with the use of a special equipment (formulator), it was imprinted on a chart and the hump gradient was measured. The time of brace application was recorded.

A small group of 15 patient with scoliosis less than 15°, was used as control group. A Boston brace was notn applied to this patients.

T -test and x square test were used for statistical analysis.

Results: The follow-up period was on average 25 months. The brace was applied for 18–20 hours in 24-hours with the tendency of gradual decrease of the time of the application as the patient was getting older. An average decrease of 13,5% of the hump gradient was found after using the Boston brace. This was 17% for King type I, 22.29%, for King type 1lo 9.73% for King type III and 1.19% for King type IV. The average increase of the Cobb ankle was 2, 6 .

Conclusion: The application of the Boston brace in patients with idiopathic scoliosis seems to improve the pattern of the hump, mainly in type II and III patterns and less in type IV.

Purpose: This is a prospective study to examine the post-operative self-satisfaction of the patients and the stability of the lumbar spine.

Material and Method: Twenty patients (11 female and 9 male), mean age 40 years old (range 35–58 years) were operated on for: central disc protrusion-sequestration (14 cases), lumbar Stenosis (3 cases) and lumbar instability (3 cases). For the stabilization of the lumbar spine, the Dynesis system (Sulzer-Medica) was applied. In 9 cases a one-motion segment was included in the stabilization, in 8 cases a two-motion and finally in 3 cases a three-motion segment were included. The pre and post-operative examination included a) the self assessment evaluation included the Oswesrty and Roland-Morris questionnaires and b) the radiological parameters related to the type of spinal problem and to the lumbar stability.

Results: The mean follow up was 12 months (range 9 to 24 months).There was statistically significant improvement of both the self assessment tests. The radiological examination demonstrated stable lumbar spines and no implant loosening or hardware failure.

Conclusion: In spite of the short follow-up the overall results prove that the dynamic stabilization of the lumbar spine with the Dynesis system, in cases of wide laminotomy (ies) for disc excision, and Stenosis as well as for stabilization of depenerative type lumbar instability, is able to provide satisfactory early results.