To evaluate our results of treatment of kyphosis following osteoporotic fractures of the last 3 years.

28 women with a mean age of 63,2 years were treated for a painful kyphotic deformity of a mean Cobb angle 76,1°. They all had posterior fusion with pedicular screws and rods enhanced with autologous bone graft as well as allografts. Cement augmentation was used in a number of screws. A cell saver for auto transfusion and continuous neurophysiological monitoring was used intraoperatively in all cases. All patients fitted with a thoracolumbar brace for 3 months.

The postoperative mean Cobb angle was 45,2° (40,6% improvement). Pain questionnaires at a mean postoperative follow up of 16 months showed excellent results in 10 patients (35,71%), good in 8 patients (28,57%), satisfactory in 6 patients (21,42%) and poor results in 4 patients (14,28%). All patients were satisfied with the cosmetic result. 2 patients presented a postoperative infection that was treated with debridement and antibiotics.

Kyphotic deformity following osteoporotic fractures may treated satisfactory with rods and pedicular screws with cement augmentation

The documentation of the results of combined anterior -posterior approach in the treatment of spinal tumors in our department.

A total of 28 patients (16 men – 12 women) aged 15 to 75 year old (mean age = 54 years) were treated. Of those 7 presented with a benign primary tumor and 21 with malignancies of which 15 were metastatic. 16 patients had a neurologic deficit but met the international criteria for surgical intervention. The staging of the tumors and their postoperative care was undertaken by a tumor centre. All patients underwent posterior decompression with laminectomy, resection of all posterior elements including part of the pedicle, excision of the tumor and posterior stabilization. This was followed at the same operative session by an anterior approach (transthoracic, transperitoneal or anterior cervical) corpectomy of the affected vertebrae and implantation of interbody cages secured with an anterior plate and screws in the healthy vertebrae.

7 patients improved neurologically following the operation while 9 had no change of their clinical condition. Perioperative complications were recorded in 5 patients. In 3 cases a dural tear was dealt with direct closure and 3 infections had to have surgical debridement at another stage and antimicrobial therapy.

The treatment of spinal tumors with combined anterior-posterior approach in one session for a radical excision of the tumor is a demanding procedure

Background and Objectives: It has been extensively discussed that there is a lowering effect of Replacement Therapy on lipids and lipoproteins. Recent hypotheses relate the lipids and osteoporosis. Thus, there is a possibility that hormone therapy improves osteoporosis not only via direct effect of estrogens on bone tissue, but also via lowering the lipids that may have detrimental effect on bone tissue. The aim of this study was to assess the effect of various regimens of hormone therapy on lipids and osteoporosis and the correlation between lipids and osteoporosis under given hormone treatment.

Methods: Three hundred and thirty five women (n=335) participated in this open study and were assigned to receive orally (a) CEE (n=29), (b) Tibolone (n=75), (c) CEE/MPA (n=57), (d) E2/NETA (n=72), (e) raloxifene (n=64) and (f) no therapy (control) (n=68) for at least 12 months. At baseline and 12 months blood samples were taken and analyzed for lipids and lipoproteins (total cholesterol, triglycerides, HDL, LDL, Lipoprotein (a), Apolipoprotein-A1, Apolipoprotein–B). At baseline and 12 months DEXA was also performed for the measurement of BMD of the lumbar spine.

Results: In the unopposed estrogen group (CEE) most of the variables were negatively connected with osteoporosis and BMD, but none of them were statistically significant. In the raloxifene group similar features were observed, but only LDL reached statistical significance (p=0.0031). In the tibolone group almost all variables were negatively correlated with osteoporosis and BMD, but again only LDL reached statistical significance (p=0.038). In the E2/NETA group most variables were negatively correlated with osteoporosis and BMD, but none reached statistical significance. In the CEE/MPA group all of the variables were negatively correlated with BMD and osteoporosis, but statistical significance was reached by total cholesterol, LDL and Lp(a) (p=0.008, 0.007, 0.047 respectively).

Conclusion: In this study it has been observed that there is a trend in almost every medication group towards an inverse correlation between lipids and BMD. The effect is more prominent in the tibolone, raloxifene and, mainly, in the CEE/MPA group. The greater effect was observed from the point of the lipids, in the LDL variable group. It is very important to clarify whether these findings could be extrapolated at orthopaedic trauma research providing thus a novel explanation for the aetiology of atrophic non unions in patients with compromised vascular function either locally or systematically.

The aim of this paper is to study patients who have had surgery for spinal tumors. Indications for surgical treatment are pain(not resolving with analgesics), impending as well as manifested neurologic symptomatology or spinal instability, compression of neighboring structures and failure of radiotherapy or chemotherapy. In this study we present 50 patients, 30 women and 20 men, aged 15 to 75, suffering from benign(10 pts), malignant(15 pts)and metastatic(25 pts) spinal tumors. All were treated surgically by wide excision during a four-year period (1997–2002) using an anterior, posterior, posterolateral or combined approach to the spine. Most of the 30 pts who presented with neurologic compromise improved to a significant degree postoperatively with the exception of 5 whose condition did not change. One patient, whose preoperative neurologic status was Frankel D, deteriorated postoperatively and underwent a second operation to no avail. One patient died on day 12 p.op. CT-assisted biopsy was not successful in half the patients with metastatic cancer. 18 patients suffering from malignancy(primary or metastatic) underwent angiography and selective embolism of the feeding vessels. All patients were evaluated preoperatively by CT-scan, MRI, bone scan and in most cases myelography as well. Complications that were observed were wound infection(3 pts), intraoperative meningeal trauma and CSF leak(2 pts) and lymfatic duct trauma and lymph leak(1 pt).

Purpose: the study of the correction of scoliotic deformity in young adults 18–21 years of age, compared to that of older adults with adult idiopathic scoliosis.

Materials and methods: in this retrospective study, 65 patients (7 male, 58 female), with a mean age of 25,3 years (range, 18–68) suffering from adult idiopathic scoliosis, who underwent posterior instrumentation with fixation systems utilizing transpedicular screws and hooks between January 1999 and May 2003, were included. Patients with scoliosis of another etiology were not included. Patients were divided in two age groups: the first group included patients 18–21 years old and the second group included patients over 21 years old. The preoperative and postoperative Cobb angle was measured and the percentage of correction of the deformity was compared between the two groups.

Results: The first group (18–21y) included 41 patients (5 male, 36 female). The mean Cobb angle was 44° pre-operatively and 15,9° postoperatively, with a mean correction of deformity of 64%. The second group (over 21y) included 24 patients (2 male, 22 female). The mean Cobb angle was 49° preoperatively and 26,1° postoperatively, with a mean correction of deformity of 47%. Comparing the correction of deformity between the two age groups resulted in statistically significant difference (p< 0,05).

Conclusion: The percentage of correction of the scoliotic deformity after posterior instrumentation with fixation systems utilizing transpedicular screws and hooks is significantly greater in young adults between 18 and 21 years of age, compared to older adult patients over 21 years of age, although a significant percentage of correction can also be achieved in the latter group of patients.

Purpose: The presentation of our experience in the operative treatment of adult idiopathic scoliosis (AIS) with different posterior instrumentation systems.

Materials and methods: 195 patients with AIS, who underwent posterior instrumentation between January 1989 and December 2002 were included. Patients with degenerative scoliosis were not included in this study. 151 patients were female (77%) and 44 male (23%), with a mean age of 29 years (range, 18–68). The distribution of the lesions according to type was: 48 Th (25%), 67 Th/L (34%), 28 ThL (14%), 50 L (26%) and 2 Th/Th (1,0%). The mean preoperative Cobb angle was 52° (range, 32°–90°). The main indication for surgical treatment in older patients was unremitting pain after 15 months of conservative treatment. Preoperatively, 57% of the patients complained about pain (75% axial back pain, 25% radicular pain) and 43% about deterioration of deformity. Correction of the deformity in pre-operative lateral bending films was 43%. The systems for posterior instrumentation used were: Harrington:15, Hartshill: 26, Isola:38, Colorado:1, TSRH:35, CD-Horizon:21, Synergy:26, Moss-Miami:30, Spine evolution:1, Isobar-Isolock:2.

Results: postoperative correction of the Cobb angle was 48% and subjective improvement of pain was reported by 71,2% of symptomatic patients. Postoperative complications occurred in14 patients (7%): 4 had deep wound infection, 2 had transient worsening of radicular symptoms, 1 had postoperative icterus, 1 had transient postoperative thoracic pain, 3 had implant failure that was symptomatic in 2 of them and were revised, 2 had CSF leak and 1 had postoperative back pain and had the implants removed after fusion had been achieved.

Conclusion: The operative treatment of adult idiopathic scoliosis with posterior instrumentation is a safe method that provides a great amount of correction of deformity and diminishes pain in symptomatic patients.

Introduction: It is very common in spine surgery to transfuse substantial amounts of homologous blood. The danger of spreading infectious diseases (HIV, HBV etc.) as well as possible side- effects of multiple transfusions (haemolysis, anaphylaxia, etc.) has created the necessity of finding methods to minimize the amount of homologous blood transfusions. One of these methods is the use of systems for autotransfusion of the patient’s drained blood.

Purpose: Evaluation of the advantages of the use of postoperative autotransfusion systems is spine surgery.

Methods: 26 patients were evaluated, from November 2002 until May 2003, who underwent posterior spinal fusion and to whom postoperative autotransfusion was used. The patients’ group consisted of 19 women and 7 men aged from 14–75 years old (aver.23.8 years of age). We recorded the preoperative haematocrit value, the amount of homologous blood transfused intra- and postoperatively, the amount of autologous blood transfused as well as the haematocrit values at the 1st, 2nd, and 5th postoperative day. Moreover all the patients were observed postoperatively for possible complications relevant to autotransfusion.

Results: 70% of the patients did not require postoperative transfusion with homologous blood. We observed allergic reactions in 4 patients and fever in 3 patients. These findings were not directly correlated to autotrans-fusion, however the autotransfusion was interrupted. There were no major complications. The above mentioned results are considered to be encouraging for further us and study of postoperative autotransfusion systems in spine surgery.