Traditionally, spinal fusion has been the treatment of choice for individuals who have not found pain relief for chronic back pain through conservative treatment. Premature degeneration at adjacent levels of the spine remains one of the more vexing problems facing spinal surgeons when advising relatively young people to consider lumbar fusion surgery. The use of an artificial disc to replace a damaged intervertebral disc that is generating chronic back pain is currently in various phases of development.

Patients with a primary diagnosis of degenerative lumbar disc disease accompained by low back pain and unilateral leg pain, having failed conservative treatment, were considered for the surgical procedure. Twenty-eight patients were randomized into two groups of 15 and 13, respectively, using a random numbar table. Group 1 had two threaded titanium expanding fusion cages inserted posterior with bilateral medial facetectomy. Group 2 had a disc nucleus replacement device inserted posterior with unilateral medial facetectomy and hemilaminectomy

The artificial disc offers several theoretical benefits over the spinal fusion for chronic back pain including potentially enhanced clinical success rates as pain reduction and potential to avoid premature degeneration at adjacent levels of the spine by maintaining normal spinal motion.

To evaluate the findings of fusion of titanium interbody cages in a sheep lumbar interbody fusion model.

Six sheep underwent lumbar discectomy and fusion at L3-L4 throught transperitoneal approach. An cervical threaded expanding and cylindrical cage packed with bone autografts was placed into intervertebral disc space. The sheeps were killed at 9, 12 and 18 months after surgery. The lumbar spines were excised, trimmed of residual musculature and underwent to plain radiographs and CT scans. The spines were dissected and sectioned using the EXAKT microgrinding device creating parasagittal and coronal sections.

Plain radiographs demonstrated no lucent lines around the implants and no change in disc height. CT scans showed mineralized bone within the cages and bone in growth wit anterior bony bridging outside of the cages. Histologic characterizations indicated the presence of mature lamellar bone with osteonic systems filling the central area of the cage. Bone in growth on the surface of the implant is present near the fenestrations alone. A membrane of fibrous tissue layer is present on the external surface of any cage separating bone from the implant.

Expanding titanium cages have shown mechanical and biological validity to achieve an optimal interbody fusion. Design of the cage showed a decisive role to provide superior endplate-to-endplate contact for unsurpassed strenght and stability and to agree the achievement of the interbody fusion across its fenestrations.

80% of myeloma patients have lytic bone lesions and osteoporosis secondary to corticosteroid therapy with high rate of vertebral compression fractures (VCFs). The consequences include pain and spinal deformity. The treatment ideally should address both the fracture-related pain and associated spinal deformity. Kyphoplasty provides a new tool that may impact bone care entailing the insertion and expansion of an inflatable bone tamps (IBT) in a fractured vertebral body. Bone cement is then deposited into the cavity to correct the deformity and improvement in structural integrity of collapsed vertebra.

Eighteen VCFs were treated during 11 balloon kyphoplasty procedures in 7 multiple myeloma patients. The clinical outcomes were assessed according to visual analogue scale with 0 representing no pain and 10 severe pain. Patients rated their pain before surgery, 1 week after surgery and at 1 year-postoperative period.

Mean improvement in local sagittal alignment was 12.3°. All of the patients who had reached the 1-year postoperative period had reported a high reduction in pain.

Treatment with chemotherapy and/or radiation therapy is very important in the control of bone disease. Patients treated with kyphoplasty in combination with pharmacologic therapy return to higher activity levels, leading to increased independence and quality of life.

Introduction: Trabecular metal associated with monob-lock elliptical design represents a valid surgical solution for orthopaedic acetabular reconstructive procedures and second surgery.

Materials and methods: From 1999 to 2004, 61 patients between 45 and 81 years with osteoathritis underwent total hip primary arthroplasties with porous tantalum elliptical cup. We performed clinical evaluation through Harris Hip Score test. Bone-implant interface was studied through radiography with reference to the three Charnley’s areas. Follow-up were performed preoperatively at six months and yearly thereafter.

Results: Clinical results showed high improvement of Harris Hip Score (average preoperatively score was 46, postoperatively 90). Radiographic evaluation revealed a bone apposition to the porous tantalum without radiolucent lines around the acetabular interface. No local (osteolysis) or general (DVT) complication was seen.

Conclusions: Tantalum monoblock elliptical acetabular cup with high volumetric porosity, flexibility and high biocompatibility associated with particular microstructure permits direct apposition of bone, more extensive osseointegration with the maximum bone contact. The trabecular metal cup increases the initial stability helping in the prevention of osteolysis and loosening in a five years follow up.

Purpose: To compare the clinical and radiographic outcomes of a unilateral transpedicular approach with those of standard bilateral transpedicular vertebroplasty.

Materials and methods: Retrospective review of vertebroplasty yielded 19 vertebrae in 16 patients that were treated with a standard bilateral approach and 24 vertebrae in 21 patients who were treated with unilateral transpedicular approach. Clinical outcomes, including pain relief and change in pain medication requirements, were compared in the two groups by using chi-square test and Fisher’s exact test.

Results: All patients had reported a high reduction in pain in both groups with similar clinical outcomes.

Conclusions: Use of a unilateral approach in percutaneus vertebroplasty allows filling of both vertebral halves from a single puncture site with no statistically significant difference in clinical outcome from that of a bilateral transpeduncolar vertebroplasty; this technique permits a shorter operating time with lower rate of complications.

Corticosteroid-induced osteoporosis is the most common cause of drug-related osteoporosis and appears frequently in the patients affected from rheumatoid arthritis with high rate of pathological vertebral compression fractures (VCFs). The consequences of VCFs include pain related to the fracture and spinal kyphosis. The aim of treatment of osteoporosis is to halt bone loss, to reduce pain and to prevent the occurrence of future fractures through osteoinduction. The treatment of osteoporotic VCFs ideally should address both the fracture-related pain and associated spinal deformity. Balloon kyphoplasty entails the insertion and expansion of an inflatable bone tamps (IBT) in a fractured vertebral body. Bone cement is then deposited into the cavity created by the IBT to reduce the kyphosis and repair the fracture. Twenty-nine corticosteroid-induced osteoporotic VCFs were treated during 21 balloon kyphoplasty procedures in 17 patients. Standing radiographs centered on the treated level/s obtained prekyphoplasty and postkyphoplasty were analysed for improvement in sagittal alignment using the Cobb technique. The clinical outcomes were assessed according to visual analogue scale with 0 representing no pain and 10 severe pain. Patients rated their pain before surgery, 1 week after surgery and at 1 year-postoperative period. Mean improvement in local sagittal alignment was 11.3° (range 0°–32°). All of the patients who had reached the 1-year postoperative period had reported a high reduction in pain, with 11 patients reporting no pain whatsoever. Corticosteroid-induced osteoporotic VCFs present a significant economic burden to society and result in severe clinical consequences leading to impaired function, reduced pulmonary function and overall increase in mortality. Traditional medical option including bed rest, bracing and analgesics have proven to be insufficient. Patients with rheumatoid arthritis treated with kyphoplasty in combination with pharmacologic therapy return to higher activity levels, leading to increased independence and quality of life.

Purpose: Lumbar interbody fusion cages is a valid technique in the treatment of disc diseases. The aim of this study is to evaluate its validity through the analysis of clinical outcomes and radiological findings.

Materials and methods: The paper reports a serie of 52 posterior lumbar interbody fusion cages operations. Clinical outcomes and radiological results were evaluated at a mean of 5 years post-surgery.

Results: Outcome analysis showed a gradual improvement in symptoms. After surgery, the majority of patients returned to their normal activities. Follow-up plain roentgenograms showed no loss of disc height and no signs of implant’s looseness. Computed Tomography (CT) scans showed the presence of mineralized autologous bone grafts inside the interbody cages.

Conclusions: Expandable interbody cages allow the restoration of the disc space height, giving support to the anterior column, opening the neuroforaminal area and providing increased stability. The interpretation of fusion on the basis of roentgenograms is subjected to arguement. Thin CT scan offers more information than X-rays about the fusion process.

Seven patients who had malignant proximal femoral tumours were selected for resection and limb salvage with a modular megaprosthesis. Histopathological diagnosis confirmed one solitary bone metastasis from renal cell carcinoma, one dedifferentiated chondrosarcoma, two primary non-Hodgkin lymphomas non-responsive to adjuvant chemo- and radiotherapy and three low-grade chondrosarcomas. The mean age at the time of surgery was 53.5 years. Post-operative survival averaged 54.5 months. The mean functional status score was satisfactory. There was no local tumour recurrence or dislocation of the prosthesis. There were one superficial wound infection and one post-surgical haematoma. Care must be taken in selecting patients to for resection of the proximal femur and implantation of modular megaprostheses. We reserve such treatment only for tumours that, because of the histopathological diagnosis and spread, chemotherapy or radiotherapy alone is not enough. Modular megaprosthesis is currently the method of choice in the treatment of malignant proximal femoral tumours. With this implant joint function can be restored after wide resection, too, offering a valid alternative to the bony massive allografts that are characterised by a high rate of complications and failure.

This study was conducted to evaluate the clinical and radiographic results on titanium stems that were similar in design but differed with regard to proximal grit-blasted surface texture with and without a hydroxy-apatite (HA) coating. We evaluated 40 patients who had undergone primary total hip replacement by a postero-lateral approach. The stems, all made of titanium alloy, tapered, grit-blasted, collarless, with anterior-posterior fins, did present some differences: in a group of 20 stems a proximal hydroxyapatite coating (thickness: 50 μm) was implanted; in another group of 20 stems the proximal surface was without HA coating. Clinical and radiographic evaluations were performed pre-operatively at 3, 6 and 12 mounths during the first year; than once for the following years.The mean duration of follow-up was 6 years.

At the final follow-up examination the Harris hip scores in the HA-coated group (mean, 96 points) and non-HA coated group (mean, 94 points) were similar. Bone-remodelling patterns were similar in the groups and the fast bone integration of the HA coated group. In both groups only two cases of aseptic loosening of the stems were found.

After 6 years of follow-up, the clinical and radiographic results among grit-blasted titanium tapered stems with or without Ha coating were perfectly similar. The optimum final bone integration was due just to the singular shape of femur (type B Dorr’s) with an excellent proximal bone stock. The micromotion of implants reduced the bony-anchored stems in two cases.

Pain and kyphosis in vertebral body compression fractures (VBCF) impair quality of life. Conservative treatment has been the proposed solution up to now. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps (IBT) into the vertebral body by a trans-pedicle approach. The purpose of IBT is to restore the original height of the vertebral body while creating a cavity that can be filled with highly viscous methylmethacrylate. We prospectively evaluated the safety and efficacy of kyphoplasty in the treatment of pain related to pathological vertebral body compression fractures resulting from osteoporotic collapse, multiple myeloma, primary malignant tumours (lymphoma) and metastatic cancer. Clinical results show immediate and maintained pain relief in all patients who received this treatment and a more rapid improvement in function. Pain relief may be related to spinal realignment by restoring the weight-bearing on the anterior column and to biological factors such as damage of pain-receptors due to the high temperature of cement polymerisation.