Posterior segmental fixation of the cervical spine facilitates fixation in sub-optimal bone, abnormal anatomy, and complex deformity. Compared to lateral mass plates a screw rod construct provides a stable construct in osteoporotic bone or in cases where the lateral masses are fractured or missing.

To investigate whether a posterior cervical screw- rod construct is an effective, stable and safe means of posterior cervical fixation.

Retrospective evaluation of consecutive patients undergoing a posterior cervical stabilization with a screw- rod construct with clinical and radiographic evaluation.

Clinical variables included age, gender, neurologic status, surgical indication, number of levels stabilized, and number of screws. Note was made as to whether a laminectomy was performed and concomitant anterior surgery. Clinical and radiographic assessments were carried out immediately after surgery and at six weeks, three, six, twelve months and annually after surgery.

Eighty-three patients had five hundred and seventy-three screws placed from October 1998 to December 2003. Mean patient age was fifty-seven. Mean follow-up was twenty-three months, (one to sixty months). The underlying diagnoses were inflammatory arthritis thirty-three, spondylotic myelopathy twenty-nine and trauma in twenty-one patients. Forty-four patients (53% had motor deficit, forty-seven patients (57%) had sensory deficit. Fixation was carried out over an average of five levels (range – two to eight). Mean number of screws per construct was seven (range – four to fourteen). The instrumentation was successfully implanted in all despite lateral mass deficiencies (fracture, poor bone) and coronal and sagittal plane deformities. Late occipital fixation failure was encountered in one patient. There was no loss of alignment or surgical correction on follow-up radiographs.

A posterior screw-rod system allows for treatment of traumatic and degenerative and inflammatory conditions. Crossing the occipitocervical or cervicothoracic junctions is easily afforded. We have had excellent success without complications from screw placement or pseudoarthrosis.

Aims: In order to reduce the waiting list, the Spanish National Institute of Health sent a large number of patients from Badajoz to other private hospitals, from October 1996 to December 2000, to undergo knee replacement. No medium or long-term follow-up was arranged. Our aims were to compare revision operations in those patients with the ones performed locally.

Material and methods: In that period of time 791 knee arthroplasties were sent to distant centres and 620 were performed in our institution. All revision surgery was performed in our hospital after two months of the index operation in the distant hospitals. We stopped entry of patients in this study in December 2003.

Results: 82 (10.3%) knees have so far required revision surgery in the distant centres group. Of these, 45 have been for deep infection, 26 for aseptic loosening, 5 failed unicompartmental, 3 stiffness, 2 painful non-replaced patellas, 1 non-union of the tibial tuberosity

In the local group 17 (2.6%) knees have so far been revised in the same period of time. Of these 10 have been for deep infection, 3 for aseptic loosening, 3 for instability, and 1 for soft tissue impingement.

Conclusion: The causes for such a difference in revision rates were analysed and include implant selection, surgical technique and absence of follow-up. A constant and angry complaint of all patients sent to other hospitals and subsequently revised was the lack of follow-up.