1. In 120 of 740 European patients found to be suffering from spinal tuberculosis the disease was complicated by paraplegia. These 120 patients have been studied.

2. The patients could be divided into two groups: those receiving chemotherapy and those not receiving specific drugs. Chemotherapy improves the patient's general condition and makes operation safer, but does not have any significant effect in preventing paraplegia or in promoting recovery from it.

3. Only twenty-four of the fifty patients treated by closed method made full recovery.

4. The recovery rate after decompression was only 60 per cent. The reasons for this relatively low rate are discussed and the advantages of the postero-lateral approach to the cord, combined with focal operation on the lesion, are stressed.

5. Experience has shown that a policy of early and adequate focal operation can eliminate the risk of this serious complication of spinal tuberculosis.

6. The behaviour of spinal tuberculosis in the European is contrasted with that in the African and Asian.

1. The long-term results of 740 European patients suffering from spinal tuberculosis and treated without and with specific anti-tuberculous drugs have been surveyed.

2. The results of treatment by conservative methods and by conventional surgical methods have been compared in the two periods. The attainment of spinal stability as judged by serial examination of radiographs was the main criterion in assessing healing.

3. Although the results of conventional treatment have improved since the advent of chemotherapy, the credit is mainly due to the influence of more frequently and more expertly applied operations.

4. With chemotherapy the well tried medical and surgical procedures produce stable spines in three-quarters of cases. With early operation on the lesion the results are better and more quickly obtained. Of eighty spines on which focal surgery was performed during the past twelve years before the lesions had become extensive, seventy-seven (9·62 per cent) healed by bone. The average duration of hospitalisation after such operation was four and a half months. No patient has had to be readmitted.

5. The difficulties and possible dangers of these methods must be emphasised. The operations are difficult and dangerous when the lesions have been allowed to get out of hand and become unduly extensive. They are contra-indicated in cases where there is very marked deformity.

6. Training in special techniques of operation is necessary. Duplicated drainage of the hemithorax after thoracotomy is essential, and skilled after-care is important if good results are to be obtained.

1. A review of nineteen cases of malignant spinal tumour treated surgically is presented.

2. Four cases are presented in detail.

3. The results in terms of survival are not assessed, because the effect of operation on survival cannot be estimated in a small series without controls. However, if the patient does survive for a considerable time, the value of operation can be assessed in terms of its contribution to the quality of survival, in relieving pain or improving or protecting neurological function.

4. The limitations of laminectomy are compared with the possible advantages of anterior approaches.

1. After almost seventeen years the three metal prostheses remain in approximately the original position in which they were inserted.

2. All three patients are ambulatory and two of them pleased with the result.

3. The youngest patient, now fifty-six, has a solid ankylosis of the hip and leads an active life free of pain.

4. In view of the attritional changes which have been seen to occur as a result of the reaction of bone to metal, it is suggested that resection replacement operations should be reserved for the primary treatment of certain fractures in the elderly and in those patients who are expected to be mostly inactive for the rest of their life. As a rough guide, it is considered that the operation should not be carried out under the age of seventy.