Aim: Presentation of the application of the transcervical system of posterior spinal fusion Varigrip in spinal infections showing its rapid and safe application and also its stability to the spinal level where it is applied to.

Patients and Methods: 22 patients (13 men / 9 women) with mean age 50, 6 years (18–79) and mean follow up time is 34,6 months (9–62) were included in our study. In 10 patients the level was in lumbar spine and in 12 in thoracic spine. In their admission 16 patients had neurological deficit and 22 mean pain score according to VAS 8, 4 (6–10). ESR was increased in 14 patients, CRP in 20 and 7 patients had also increased WBC. All 22 patients had increased signal of Tc” and 69Ga in the level of the lesion and also pathological signal in MRI (Tl, T2 and Tl with Gadolinium). All the patients underwent posterior spinal fusion using Varigrip system and 17 of these underwent in the same time somatectomy and anterior fusion.

Results: Pathologic organism was isolated to all the patients. In 20 patients the tissue culture of the lesion isolated the pathologic organism and the other 2 patients came to us with positive blood cultures from other hospitals. 6 months postoperatively 21 patients referred pain score according to VAS 2,4 (1–4) and 1 patient had no improvement (5–7). 1 patient died of PE, another of chest infection and one of head injury. 1 patient had recurrence of the infection in another level, 1 had herpeszoster and 1 had infection of the surgical wound. All the patients had neurological improvement postoperatively.

Conclusions: The method is characterized as safe because of avoidance of the neurological structures. It can be applied also safely to patients with osteoporosis. Its application is rapid so the surgical time is minimum and also it doesn’t need image intensifier during the surgical procedure. It can be applied easily either in thoracic or lumbar spine and it provides stability of the spine.

Aim: The evaluation of the results of the posterior application of the combination of the implants Varifix (transcervical screws)/Varigrip (new generation under compression hook with middle line pedicle fixation) to the imstable thoracic and lumbar vertebral fractures.

Patients and Methods: During the years 1999–2001, 30 patients have been operated on with the combination of the implants Varifix/Varigrip to the unstable thoracic (T3–T10: 4), thoracolumbar (T11–L2:21) and lumbar (L3–L5:5) vertebral fractures. Mean age was 33, 5 years and sex variation was 22 men and 8 women. Road traffic accidents were the most common cause and the thoracic and lower limp injuries were the most common (17%) accompanied injuries. For the fracture type and the treatment indications the combination of Gertzbein & Gaines classification was used.

Results: The evaluation of the results was with radiological and clinical examination. Mean surgical time was 170 min (120–240) and the mean blood loss was 500ml (350–800). According to special questionnaire, 25 of the 30 patients (83, 5%) were free of pain and able to return to their previous activities. There was no deterioration in the 24 patients who were in Frankel E neurological condition and the mean post surgical improvement according to Frankel classification was 1, 4 points. In the radiological evaluation (compression percentage, Gardner ankle, conquest of the spinal canal) there was statistical significant difference (p < 0, 05, p < 0, 01, p < 0, 05) between pro and post surgical values. Two patients with acute infection were dealt with surgical cleaning, washing and closing of the wound in second time surgery. One failure of the hook in one patient with osteoporosis was dealt with removal of it.

Conclusions: TheVarifix/Varigrip combination has nearly the same surgical results with traditional partial implants. The satisfactory reduction during the operation in the 30 patients was preserved during the follow up time. The posterior Varigrip system acts with cross link splinting and provides multidirectional spinal stability when it is used alone or supporting the system Varifix for avoiding the detachment or break of the transcervical screws. We suggest the use of these systems for all the unstable thoracic and lumbar injuries because of their safe fixation and easy application.

Aim: Of Calveston (USA) and Crete (HELLAS). We studied immediate and long-term outcome of 50 patients who underwent subaxial lateral mass fixation of the cervical spine between January 1997 and March 2001.

Patients and Methods: Intraopeartive fluoroscopy and somatosensory evoked potential monitoring were employed in all patients. Immediate postoperative CT scans were performed to determine screw trajectory and placement. Follow up ranged from 1 to 5 years.

Results: Postoperative CT scans showed that 113 of 210 screws (54%) had unicorticate and 46% had bicorticate purchase. Forty-five screws (31 %) had suboptimal trajectory, but only 7 of these screws minimally penetrated the foramen transversarium without resultant vascular or neurological sequelae.

The overall fusion success rate in our series was 90%, while pseudoarthrosis occurred in 5 patients (10%), with screw breakage in 1 patient (2%). Two of these patients had bone graft supplementation and in other 2 patients was done anterior fusion.

Conclusions: Results of this study show that the recommended drilling technique and trajectory (15–25 degrees postal to the sagital plane, 20–30 degrees lateral I the axial plane), supplemented bone grafting and intraoperative SEP monitoring are all associated to good screw placement, fusion and neurological outcome and are recommended for all lateral mass fusion procedures.