Purpose of the study: Pott’s disease of the cervical spine is exceptional. We collected 27 cases over a period of 30 years.

Material and methods: Mean patient age was 21 years. Male gender predominated. Most patients consulted because of cervical pain and 50% presented neurological disorders. Mean duration of symptoms was 14 months. A peri-spinal abscess was found in ten patients. The posterior cervical spine was affected in most patients and four presented suboccipital involvement. There was associated lung disease in two-thirds of the patients. Standard anti-tuberculosis chemotherapy was given associated with traction alignment in twelve patients to correct for kyphosis or associated spinal dislocation. Surgery was reserved for major bone destruction leading to instability or neurological disorders resistant to medical treatment.

Results: Mean follow-up was five years. The anatomic result after medical or surgical treatment was characterized by vertebral fusion in all patients. There were three serious neurological complications after surgery. Improvement was achieved in eleven of the twelve patients with inaugural neurological complications.

Purpose: Aneurysmal bone cyst is a benign osteodystrophic pseudotumor. It can occur as a primary lesion or develop on a pre-existing lesion. The etiopathogenesis, diagnosis and treatment remain subjects of interest.

Material and methods: For this retrospective analysis, we collected 48 peripheral aneurysmal bone cysts over a 27-year period. Most cysts occurred in children, adolescents, or young adults, with a slight female predominance. Imaging included standard x-rays, computed tomography, and for the more recent cases magnetic resonance imaging (MRI). MRI provided new imaging features increasing diagnostic accuracy. Second readings of histology slides enabled establishment of the correct diagnosis in certain cases but differential diagnosis was established only with benign tumours. Surgical treatment predominated. Other treatments included curettage-filling with cancellous bone, resection, resection-reconstruction,curettage-filling with cement. Adjuvant treatments mainly involved use of calcitonin. Therapeutic abstention with surveillance confirmed the possibility of spontaneous regression after biopsy. Curettage-filling with cancellous bone was performed in 58% of cases, giving an Enneking function score of 95.7%.

Results: We reviewed outcome at mean 7 years follow-up. There were four recurrent cysts and the mean global Enneking score was 95%. Our series showed the several methods can be used for the treatment of aneurysmal bone cysts, the indication taking into consideration the patient’s age, the location of the lesion and is progression. We propose a therapeutic schema. The role of calcitonin remains to be determined.

Conclusion: The diagnosis of bone cysts requires a close collaboration between the surgeon, the radiologist, and the pathologist. The indication for surgery must be made case by case to achieve cure without sequelae.

Purpose: Surgery is generally proposed for the treatment of giant-cell bone tumours but other options are discussed. The problem is to decide between curettagefilling and enucleation, using or not local adjuvant treatment with curettage, and filling with an autograft, an allograft, or cement. The purpose of this work was to provide a new perspective to the treatment of giant-cell tumours based on the tumour pathophysiology and calcitonin infiltration.

Material and methods: We report 25 cases of benign giant-cell tumours treated by calcitonin. Mean patient age was 31 years. Female gender clearly predominated (75%). All of the tumours were located at the extremity of long bones. We grouped the tumours as quiescent benign tumours, and active or aggressive tumours according to the Enneking classification. Our treatment protocol included four stages after histological confirmation of the diagnosis on the biopsy specimen. The first stage was aggressive curettage, followed by intramuscular injection of calcitonin until cutaneous healing. The third stage involved daily washing of the tumour cavity with saline solution for one month. The final stage lasted two months with intramuscular injections of calcitonin.

Results: We analysed outcome at mean three years (range 2 – 20 years). Progressive filling of the tumour cavity was observed in the majority of patients starting with the first month of treatment even for the aggressive forms where tumour resection was tempting. Using the Enneking scale, our rates were near 90%, largely above the rates obtained with other conventional techniques. There were no complications. We did however have eight cases of recurrence including three which were treated again with the same protocol with good outcome.

Discussion and conclusion: Giant-cell bone tumours are clearly hormone sensitive. Calcitonin would appear to arrest the osteolytic process by attacking the osteoclast-like cell which bears calcitonin-receptors. Daily washing of the tumour cavity is designed to modify the microenvironment and eliminate tumour growth factors and cytokines expressed by giant-cells. More detailed studies of the cell membrane might reveal an explanation of certain calcitonin escape phenomena which are the cause of more or less long-term recurrence.