Purpose of the study: We report a series of 12 patients who underwent surgery in 2003 or 2004 for spinal shortening as treatment for thoracic or lumbar metastasis.

Material and method: This series included seven females and five males, mean age 56.5 years (range 34–80 years). The operation was a resection of the vertebral body in a one-stage procedure. A simple posterior approach was used for two patients and a wider costotransversectomy approach was required for ten. Posterior fixation was installed with pedicle screws in the two vertebrae above and two below the resection. Mean operative time was 343 minutes (range 260–420 min). Mean blood loss was 2380 cc (range 600–5000). There were few surgery-related complications: one dural breach and one pulmonary breach.

Results: The decision to undertake surgery was made on the basis of neurological problems in seven patients. All patients were Frankel class C, unable to walk. Among these patients, five died in less than six months. For the two survivors, they were scored 7 on the Tokuhashi scale. The remainder scored 5. For the two survivors, one recovered walking capacity (Frankel D) and the other achieved a normal status (Frankel E). The five other patients underwent surgery for pain related to a kyphosis callus threatening the cord. We used the Karnofsky and the Oswestry score to analyze outcome. The score did not regress in any of the patients after surgery. Three patients improved their score significantly. The three others had an unchanged score. The best correction of the kyphosis callus was obtained when the vertebral collapse was greater than 50%. The preoperative regional deformity was measured at 23.2° (range 15–35°) which postoperatively reached 0.5° (range 20 to −17°).

Conclusion: This technique for spinal shortening appears to be a better alternative to anterior reconstruction, especially when the vertebral collapse is greater than 50%. In this context, this palliative surgery enables improved quality-of-life for a patient with often advanced disease.

Purpose of the study: We report the results of a series of seven cases of non-tuberculos infectious lumbar spondylodiscitis treated by posterior instrumentation and secondary anterior curettage of the infectious focus with bone grafting. This particular osteosynthesis method produces a short monosegmentary fixation limited to the space of the infected disc.

Material and methods: The series included six men and one woman (mean age 61.7 years, age range 37–82 years). The causal germ was identified in all cases: Staphylococcus aureus in five, and in one each, Staphylococcus epidermidis and Pseudomonas aeruginosa. Levels were L1L2 in one, L2L3 in two, L3L4 in three and L5S1 in one. Predisposing factors were history of prostatic cancer in two patients, coronary heart disease in one and chronic renal failure in one. One patient had received corticosteroid injections and two had no recognized co-morbid conditions. The surgical procedure was undertaken due to persistent pain in three patients (one with quadriceps amyotrophy and weakness), spinal instability with risk of neurological injury in two, and after failure of medical treatment in two patients who had persistent abscesses.

Results: Excepting one patient who died from renal failure four months after the surgical procedure, mean follow-up was 31.5 months (range six months to six years). Outcome was excellent in four patients, good in one, and a failure in one patient who was operated on because of instability. Failure of the instrumentation required surgical revision to extend the initial assembly. At last follow-up, all patients had achieved fusion of the instrumented zone and were considered to be cured of their infection.

Discussion: Classically, it is advisable to avoid instrumenting close to an infectious area in order to avoid the vicious circle of infection. Configurations described in the literature are usually extensive, blocking healthy levels beyond the infected area and compromising spinal mobility. However, a short instrumentation limited to one segment can be proposed when the end plates at the outer limits of the infectious focus are theoretically healthy. Careful analysis of the imaging data is required to carefully select patients who can benefit from this short configuration. Magnetic resonance imaging is most helpful.