Background: Vertebral compression fractures can affect both sexes and constitute a major health care problem, due to negative impact on the patient’s function, quality of life and the costs to the health care system. Patients can be treated conservatively or by conventional vertebroplasty. Conventional vertebroplasty imposes technical challenges with possible complications including cement extravasations, nerve root compression, breaching the walls of the pedicle by the osteoplasty needle and prolonged fluoroscopic radiation exposure of the surgeon and the medical team at large.

Methods: Retrospective comparative study of 20 cases of thoraco-lumbar vertebral compression fracture, treated with robotic assisted vertebroplasty (research group) versus 30 cases of fractures treated by conventional fluoroscopic vertebroplasty (compared group). All patients were diagnosed as suffering from acute vertebral compression fractures (up to 3 weeks from the traumatic event) and were scored 7 and above in the VAS.

Results: The mean overall operation time of the fluoroscopic assisted vertebroplasty was 35 minutes compared to a mean operation time of 45 minutes at the robotic assisted vertebroplasty. There was a significant difference in the fluoroscopic time and subsequent exposure time to radiation between the groups: in the research group we used only an average of 3 seconds of fluoroscopic exposure (an average of 5 fluoroscopic images) compared to an average of 7 seconds of exposure (an average of 12 fluoroscopic images). No difference was found between the groups in regard with overall admission time or with the time between the operation and physiotherapy.

Conclusions: Robotic assisted vertebroplasty is a new and safe approach aiming to shorten the duration of fluoroscopic exposure and radiogenic dose of the patient and surgeon. This novel procedure, promotes better accuracy with regard to the cement injected thus reducing the potential complication of the operation.

Vertebral compression fractures can affect both sexes and constitute a major health care problem, due to negative impact on the patient’s function, quality of life and the costs to the health care system. Patients can be treated conservatively or by conventional fluoroscopic assisted vertebroplasty – injection of polymethylmethacrylate PMMA into the fractured vertebral body. Conventional vertebroplasty imposes technical challenges with possible complications including cement extravasations, nerve root compression, the possibility of breaching the walls of the pedicle by the osteoplasty needle and prolonged fluoroscopic radiation exposure of the surgeon and the medical team at large.

We present here a comparative study of 20 cases of thoraco-lumbar vertebral compression fracture, treated with robotic assisted vertebroplasty (research group) versus 30 cases of fractures treated by conventional fluoroscopic vertebroplasty (compared group). All patients were diagnosed as suffering from acute vertebral compression fractures (up to 3 weeks from the traumatic event) and were scored 7 and above in the VAS. The mean overall operation time of the fluoroscopic assisted vertebroplasty was 35 minutes compared to a mean operation time of 45 minutes at the robotic assisted vertebroplasty. There was a significant difference in the fluoroscopic time and subsequent exposure time to radiation between the groups: in the research group we used only an average of 3 seconds of fluoroscopic exposure (an average of 5 fluoroscopic images) compared to an average of 7 seconds of exposure (an average of 12 fluoroscopic images). No difference was found between the groups in regard with overall admission time or with the time between the operation and physiotherapy.

Conclusion: robotic assisted vertebroplasty is a new and safe approach aiming to shorten the duration of fluoroscopic exposure of the patient and surgeon thus reducing the exposure to radiogenic dose. This novel procedure, promotes better accuracy with regard to the cement injected thus reducing the potential complication of the operation.

Anterior decompression and adequate spine fixation in patients with cervical radiculopathy and myelopathy are essential for functional restoration of cervical spine. In this study, we performed evaluation and comparative radiological assessment of several types of spinal implants in terms of bone block formation, sagittal alignment and effectiveness as a structural support.

Materials and Methods: From 1993 to 2003, 165 patients with radiculopathy and myelopathy due to degenerative disease of cervical spine were operated on. The age of patients was 32–74 years (mean age 57, 8). The interbody fusion was performed by several methods.

Group1. Autograft – 91 patients

Group 2. TiNi alloy cages – 74 patients.

Group 3. Varilift expandable cages without plate fixation – 22 patients

Group 4. Verilift cages with plate fixation – 8 patients

Group 5. Bone substitute spacer and plate fixation – 3 patients.

Results: In groups 1 and 2, the bone and bone-metal block was formed during the first 3–4 months after surgery in all patients. There were no cases of bone resorbtion around the TiNi cages or loosening of the device. In patients with one-level (15 patients) interbody fusion by Varilift cages (group 3); formation of the bone block during the same time period was observed in 14 out of 15 patients. In cases with two-level fusion (7 patients), the bone block at the second level was not formed for longer than 6 months. There were 7 cases of subsiding and segmental kyphosis. In group 4, we did not detect any cases of loosening, subsiding or segmental kyphosis. In group 5, no bone block formation was observed after 6 months despite plate fixation.

Conclusions: A high fusion rate was achieved after a single or multi-level discectomy and interbody fusion by autograft and TiNi cages, which did not subside due to their design and superelasticity and can therefore be used without plate fixation. Varilift cages were also very effective, but if used without plate fixation may be associated with subsiding effect. The use of the bone substitute spacer is questionable in cervical spine surgery. Cervical plate fixation is effective as a prophylactic measure against segmental kyphosis in all types of interbody fusion.

Background: Quantitative sensory testing (QST) conventionally identifies threshold elevation as reflecting sensory deficit. A major disadvantage of the technique is its inability to distinguish organic from feigned sensory deficit, as both are characterized by an elevated threshold.

Aim: To distinguish organic from feigned sensory deficit.

Method: Vibratory thresholds and their variances were measured, at foot L4, L5 and S1 sites, in 14 patients with low back pain (LBP) suspected of non-organic sensory loss by clinical criteria of Waddell, 14 patient controls with abnormal neurological examination and CT of the low back, and 20 healthy controls.

Results: Thresholds of non-organic patients and of patient controls were elevated to a similar extent compared to those of healthy controls. Variances, however, were higher for non-organic patients (6.7–10.5 for the various test sites) than for either patient controls (0.39–0.80, p: 0.001–0.05) or for healthy controls (0.20–0.54, p: 0.001–0.02). Of non-organic patients with high thresholds who would otherwise be identified as pathological, 30–67% were ‘spared’ the misdiagnosis and correctly identified as non-organic because of the inclusion of the variance criterion.

Conclusion: Variance evaluation is therefore suggested for inclusion into QST methodology, together with threshold itself, as a quality assurance parameter.

Aim: To evaluate the clinical and radiological results of hydroxyapatite stem in primary total hip replacement.

Method: A prospective review was performed on 22 osteoporotic patients (Singh index 1–3) with hydroxyapatite-coated total hip replacements. These results were compared with a control group (Singh index 4–6) of 45 patients (48 hips) with respect to clinical and radiographic data. Surgery was performed over a six year period (1991–1996) and the time to follow-up evaluation averaged 5 years (range 2–7 years). Clinical evaluation was based on the Harris Hip score and radiographic evaluations using Engh’s criteria.

Results: There was no significant difference between the final average Harris hip score in the osteoporotic bone group which was 87 points and that for the control group which was 91 points (p> 0.05). Radiographic evaluation demonstrated confirmed bone ingrowths in all patients except for one patient in each group, each with suspected bone ingrowth. There were no stems revised for aseptic loosening and no endosteal lysis was found. Progressive bone formation was seen around the femoral stem proximally. The acetabular components demonstrated no sign of mechanical loosening or osteolysis. Bone formation was found in most patients in zone I, and less in zone III.

Conclusion: The basis of the results of this study, it is believed that osteoporotic bone as a factor by itself should not compromise the early results of hydroxyapatite total hip arthroplasty and hopefully give as good results n the long term.

Nuclear magnetic resonance imaging (MRI) was used to study the normal knee. As well as revealing bone quality, MRI provided useful information on intra-articular and extra-articular soft tissues. Midsagittal views gave clear images of the cruciate ligaments, and of the patellar and quadriceps tendons. Parasagittal views were the best for delineating the menisci which, like ligaments and tendons, are of low intensity; the semimembranosus tendon and its insertion to the proximal tibia were also seen clearly in these views. The cruciate ligaments and menisci, though visible in the coronal view also, were better seen in the sagittal view. Axial views provided information on the structure of the patella, its cartilage, the patellofemoral joint and posterior soft-tissue structures.