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Experience with three different systems of transpedicular fixation in fusion of the lumbar and thoracic spine over 4 years is reported. The Roy-Camille plates, Louis plates, and the Balgrist turn-buckle arrangement are compared. The Balgrist device allows both extension and compression, and affords better stability. Far better clinical results were obtained with transpedicular fixation in general than with the Harrington method.

In occipito-cervical spondylodesis, performed because of instability in this area, there is quite a high incidence of pseudarthrosis. We tried to achieve a biomechanically stable spondylodesis by anchoring the temporary stabilizing wire-loop with a small osteosynthesis plate in the occiput and with a cortical screw in the spinous processus.

As an alternative to the well-established surgical procedures for the treatment of disk herniation, percutaneous nucleotomy has proved to be very satisfactory. In several cases this approach has brought complete relief to the patient without sacrifice of bone and without causing soft tissue damage as would have been inevitable with the usual surgical methods. Percutaneous nucleotomy is also a true alternative to chemical nucleolysis when leakage of contrast agent into the spinal canal has already been observed during diskography. Furthermore, this method avoids disagreeable complications encountered in chemical nucleotomy, for example, anaphylactic shock or the escape of the nucleolytic agent into the spinal canal. The method basically consists of removing the nucleus pulposus (or a major part of it) by means of a forceps that is introduced to the site through a cannula. In this manner a reduction of volume of the disk is achieved. The procedure can easily be carried out under local anesthesia. This method should be avoided in the case of prolapse within the spinal canal and especially when displacement beyond the level of the disk has occurred. In the period between 1979 and 1985 we carried out percutaneous nucleotomies in 51 patients with herniation mostly combined with a narrow spinal canal orspondylolisthesis. The clinical results from 32 of 51 patients can be assessed as very good, good, or satisfactory. We consider the proportion of patients showing good clinical results to be high, bearing in mind that the indication was not just disk herniation alone but, in most cases, combined with other lumbar pathologies as well.