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Purpose: To conduct a retrospective analysis of the clinical case of metastatic vertebral lesion in prostate cancer and the algorithm for the use of instrumental diagnostic methods.Material and methods: Patient 67 years old. History of prostatectomy for prostate cancer. Suspected metastatic lesion of the left transverse process of the 7th thoracic vertebra based on PET/CT. For clarification, MRI, Skeletal scintigraphy, SPECT/CT were performed.Conclusion: Access to a wide range of instrumental methods does not guarantee correct diagnosis. Modality, research methodology, time between the first and clarifying methods — all these factors affect the correct diagnosis, the choice of the treatment method, the timeliness of the start of treatment and, as a result, the fate of the patient.

Granulomatosis with polyangiitis is a systemic, small vessel vasculitis associated with the anti-neutrophil cytoplasmic antibody. We herein report a case of granulomatosis with polyangiitis with paravertebral lesions. A 69-year-old man presented to our hospital with fever, back pain, and myalgia. A computed tomography scan showed multiple lung nodules, while magnetic resonance imaging revealed soft tissue shadows around a thoracic vertebral lesion. A laboratory examination revealed positive myeloperoxidase anti-neutrophil cytoplasmic antibody. He was diagnosed with granulomatosis with polyangiitis. He was treated with oral glucocorticoid and intravenous cyclophosphamide, and the shadows resolved. Physicians should consider granulomatosis with polyangiitis in cases with paravertebral lesions.

Isolated osseous Rosai-Dorfman disease is rare. We describe FDG PET/CT findings of solitary thoracic vertebral Rosai-Dorfman disease without extraosseous involvement. The vertebral lesion caused osteolytic destruction of the vertebral body and showed intense FDG uptake.

Purpose:Spinal lesion differential diagnosis remains challenging even in MRI. Radiomics and machine learning (ML) have proven useful even in absence of a standardized data mining pipeline. We aimed to assess ML diagnostic performance in spinal lesion differential diagnosis, employing radiomic data extracted by different software. Methods:Patients undergoing MRI for a vertebral lesion were retrospectively analyzed (n = 146, 67 males, 79 females; mean age 63 ± 16 years, range 8-89 years) and constituted the train (n = 100) and internal test cohorts (n = 46). Part of the latter had additional prior exams which constituted a multi-scanner, external test cohort (n = 35). Lesions were labeled as benign or malignant (2-label classification), and benign, primary malignant or metastases (3-label classification) for classification analyses. Features extracted via 3D Slicer heterogeneityCAD module (hCAD) and PyRadiomics were independently used to compare different combinations of feature selection methods and ML classifiers (n = 19). Results:In total, 90 and 1548 features were extracted by hCAD and PyRadiomics, respectively. The best feature selection method-ML algorithm combination was selected by 10 iterations of 10-fold cross-validation in the training data. For the 2-label classification ML obtained 94% accuracy in the internal test cohort, using hCAD data, and 86% in the external one. For the 3-label classification, PyRadiomics data allowed for 80% and 69% accuracy in the internal and external test sets, respectively. Conclusions:MRI radiomics combined with ML may be useful in spinal lesion assessment. More robust pre-processing led to better consistency despite scanner and protocol heterogeneity.

OBJECTIVE This study aims to evaluate the added value of hybrid SPECT-CT in differential diagnosis of indeterminate solitary vertebral lesion (SVL) on planar scintigraphy in patients with non-small cell lung cancer (NSCLC). METHODS Sixty-three NSCLC patients with indeterminate "hot spot" SVL on planar scintigraphy were retrospectively included in this study. Pathological confirmation and followup by whole body scintigraphy and SPECT-CT were used as golden standard for the evaluation of diagnostic performance of planar scintigraphy, SPECT, and SPECT-CT. Receiver operating characteristic (ROC) analyses were performed and compared among the three imaging modalities. For subgroup analysis, the performance of each imaging modality in different NSCLC subgroups including age, gender, histology of primary tumor and nature, site and location of SVL were analyzed, respectively. The impact of SPECT-CT on the management of NSCLC patient with SVL was also analyzed. RESULTS The sensitivity and specificity of planar scintigraphy, SPECT, and SPECT-CT in differentiating SVL were 41.9 % and 81.2 %, 83.9 % and 71.9 %, and 90.3 % and 90.6 %, respectively. SPECT-CT performed significantly better than both planar scintigraphy (P < 0.0001) and SPECT (P = 0.0027). The sensitivity for planar scintigraphy in nonlytic SVL was significantly higher than in lytic SVL (88.5 % vs. 50.0 %, P = 0.0008). The sensitivity for the planar scintigraphy and SPECT-CT in dorsal SVL was significantly higher than in non-dorsal SVL (55.0 % vs. 18.2 %, P = 0.0029 and 100 % vs. 85.7 %, P = 0.0236, respectively). SPECT-CT had an impact on the clinical management of 52.6 % (20/38) of patients compared to planar scintigraphy and 23.6 % (9/38) of patients compared to SPECT. CONCLUSION Compared to planar scintigraphy and SPECT, hybrid SPECT-CT shows excellent performance in differentiating indeterminate SVL in NSCLC patients, the application of which will significantly impact patient management. ZIEL: : Ziel dieser Studie ist es, den Mehrwert der hybriden SPECT-CT in der Differenzialdiagnose der unbestimmten solitaren Knochenlasionen der Wirbelsaule (SVL) auf der planaren Szintigraphie bei Patienten mit nichtkleinzelligem Lungenkarzinom (NSCLC) zu untersuchen. METHODE Retrospektiv wurden 63 NSCLC-Patienten mit unbestimmten solitaren "hot spot" Knochenlasionen der Wirbelsaule unter planarer Szintigraphie eingeschlossen. Pathologische Bestatigung und Follow-up durch Ganzkorper-Szintigraphie und SPECTCT wurden als Goldstandard fur die Bewertung der diagnostischen Leistung der Planar- Szintigraphie, SPECT und SPECT-CT verwendet. ROC-Analysen (Receiver Operating Characteristic, Beobachterkennlinie) wurden erstellt und zwischen den drei Bildgebungsmodalitaten verglichen. Fur die Subgruppenanalyse wurde die Leistung jeder Bildgebungsmodalitat in verschiedenen NSCLC-Untergruppen einschlieslich Alter, Geschlecht, Histologie des Primartumors und der Art, Lage und Ort der SVL analysiert. Der Einfluss von SPECT-CT auf das Management von NSCLC-Patienten mit SVL wurde ebenfalls analysiert. ERGEBNISSE Die Sensitivitat und Spezifitat der planaren Szintigraphie, SPECT und SPECT-CT bei der Differenzierung von SVL waren 41,9 % und 81,2 %, 83,9 % und 71,9 % bzw. 90,3 % und 90,6 %. Die SPECT-CT zeigte eine signifikant bessere Leistung als die planare Szintigraphie (P < 0,0001) und die SPECT (P = 0,0027). Die Sensitivitat fur die planare Szintigraphie bei nicht-lytischer SVL war signifikant hoher als bei der lytischen SVL (88,5 % vs. 50,0 %, p = 0,0008). Die Sensitivitat fur die planare Szintigraphie und SPECT-CT in der dorsalen SVL war signifikant hoher als in nicht-dorsalen SVL (55,0 % gegenuber 18,2 %, P = 0,0029 und 100 % gegenuber 85,7 %, P = 0,0236). SPECT-CT beeinflusste das klinische Management von 52,6 % (20/38) der Patienten im Vergleich zur planaren Szintigraphie und 23,6 % (9/38) der Patienten im Vergleich zur SPECT. SCHLUSSFOLGERUNG Im Vergleich zur Planar-Szintigraphie und SPECT zeigt die hybride SPECT-CT eine hervorragende Leistung bei der Differenzierung unbestimmter SVL bei NSCLC-Patienten, deren Anwendung das Patientenmanagement signifikant beeinflussen wird.

One of the well-known complications in advanced ankylosing spondylitis (AS) is the development of Andersson lesion (AL)1. Subsequently, various reports with conflicting terminology appeared in the literature. Spondylodiskitis , which implies inflammatory etiology, was used by some authors2,3,4. Others have used the terms destructive vertebral lesion 5,6,7,8 or spinal pseudarthrosis 9,10. The terminological diversity alludes to the varied purported etiologies surrounding AL. The etiologies of extensive AL have been well documented in literature. Various etiologies for the development of AL in patients with AS have been postulated, including infection, inflammation, and trauma. Current consensus is that infection is no longer considered a cause of the AL, because of the lack of positive culture results. Subsequently, etiology of the AL has been open to an ongoing debate between inflammation and trauma. AS is characterized by spinal inflammation, and it is not surprising that many authors have focused on the inflammatory etiology of AL. Anterior spondylitis such as Romanus lesion comprised marginal erosion of the anterior vertebral corners related to inflammation of the attachment sites of anterior annulus fibrosus (AF) and anterior longitudinal ligament (ALL) in patients with AS8. The erosion becomes enclosed by a sclerotic rim and further healing results in the formation of syndesmophytes, finally resulting in a complete ankylosed segment. It has been postulated that AL might be exceptional extensions of this inflammatory process3,8,11,12. … Address correspondence to Dr. S. Lee, Department of Radiology, Hanyang University Hospital for Rheumatic Diseases, 17 Haengdang-Dong, Seongdong-Gu, Seoul 133-792, Republic of Korea. E-mail: radsh{at}hanyang.ac.kr

Primary bone tumors of the spine are less common than metastases or multiple myeloma. Based on the patient's age and the radiologic pattern and topography of the tumor, a very approximate differential diagnosis can be established for an osseous vertebral lesion. This article shows the radiologic manifestations of the principal primary bone tumors of the spine from a practical point of view, based on our personal experience and a review of the literature. If bone metastases, multiple myeloma, lymphomas, hemangiomas, and enostoses are excluded, only eight types of tumors account for 80% of all vertebral tumors. These are chordomas, osteoblastomas, chondrosarcomas, giant-cell tumors, osteoid osteomas, Ewing's sarcomas, osteosarcomas, and aneurysmal bone cysts.

A 17-year-old adolescent boy's known case of classical seminoma stage IB for which he underwent right radical orchiectomy. At the first-year follow-up, CT abdomen and pelvis was performed and showed lytic vertebral lesion with left paravertebral necrotic mass that warranted further investigation to exclude disease recurrence. FDG PET/CT scan was performed to evaluate the extent of disease and showed high uptake in the same areas. A biopsy was obtained from the hypermetabolic soft tissue lesion and did not reveal malignant cells. Subsequently, serologic tests were suggestive of brucellosis.

OBJECTIVE To compare single photon emission computed tomography (SPECT) with planar whole body bone scan (WBBS) in diagnosis of solitary vertebral lesion in non-skeletal malignancies in terms of diagnostic accuracy. STUDY DESIGN Cross-sectional study. PLACE AND DURATION OF STUDY Nuclear Medical Centre, Armed Forces Institute of Pathology, Rawalpindi, July 2014 to June 2016. METHODOLOGY After fulfilling the inclusion and exclusion criteria and taking written informed consent, 74 patients of various extra-skeletal malignancies were enrolled in the study. Patients were injected with 740 MBq of 99mTc-methylene diphosphonate (MDP) intravenously. WBBS images were acquired in anterior and posterior projections 3 hours after injection. SPECT images of the desired vertebral region were acquired subsequently along with low dose CT. All the images were read by two experienced nuclear medicine physicians. Lesions were diagnosed as definitely benign, indeterminate/equivocal and definitely malignant separately on WBBS and SPECT. With SPECT/CT as gold standard, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy were calculated. RESULTS For planar WBBS, sensitivity was 91.43%, NPV was 86.96%, specificity was 51.28% and PPV remained 62.75%. For SPECT, sensitivity and NPV were 100%, specificity was 92.31% and PPV remained 92.11%. Accuracy remained 70.27% and 95.95% for planar WBBS and SPECT, respectively. CONCLUSION SPECT imaging significantly increases the specificity (p

Background Persistent first intersegmental artery (PFIA) is one of the most frequently vertebral artery (VA) variations. The presence of PFIA obviously increases the complexity and difficulty of vertebral lesion treatment. Thus, preoperative detection of PFIA is necessary to increase the successful rate of surgeries. We attempted to evaluate the utility value of three-dimension (3D) computed tomography angiography (CTA) for detecting PFIA in the north Chinese population. Materials and methods Consecutive patients subjected to CTA between June 2012 and March 2014 were recruited from 5 clinical centers in the north of China. . The VA-cervical atlas complexus were observed by CTA. The assessment of PFIA was performed by reconstructing the images via Materialise's interactive medical image control system (MIMICS) and the measurement of VA diameter was performed on the source images. PFIA including unilateral and bilateral was calculated. The dominant side was defined as the unilateral VA with 130% fold larger diameter than the other side. Results A total of 200 north Chinese patients with mean age of 57.8 ± 9.3 years old were enrolled in the present study. Total 400 VA-cervical atlas complexus were observed by 3D-CTA, among which 9 complexus (2.25%) were diagnosed with PFIA, and 3 complexus (0.75%) were presented with the dominant VA. The spinal surgical procedures were performed successfully in all the patients with no injury and complications to the VA. Conclusions The incidence of PFIA in 400 VA-cervical atlas complexus are relatively high (2.25%) in our patient population. On the basis of relatively high prevalence of this anomaly, the preoperative detection of PFIA by 3D-CTA is recommended for the north Chinese population.

Resume Introduction Le mal de Pott (MP) ou spondylodiscite tuberculeuse est une atteinte tuberculeuse rare mais il represente la forme la plus frequente de la tuberculose osteoarticulaire dans les pays endemiques. Patients et methodes De janvier 2000 a decembre 2010, nous avons collige 16 observations de MP dont nous avons analyse le profil clinique, radiologique, les moyens de confirmation et le traitement. Resultats Les signes d’appel etaient domines par les douleurs rachidiennes et thoraciques. Quatre patients avaient des signes neurologiques. Le diagnostic a ete pose par la mise en evidence de Bacille de Koch (BK) a l’examen direct et a la culture dans le pus de l’abces paravertebral dans six cas, par l’etude histologique de la biopsie discovertebrale dans cinq cas, la biopsie d’un autre site tuberculeux dans un cas et devant un faisceau d’arguments radiocliniques avec une bonne evolution sous antibacillaires dans quatre cas. Le traitement, a base d’une association de quatre antibacillaires, a ete indique et correctement suivi par tous les patients. Un drainage chirurgical a ete associe dans cinq cas. L’evolution a ete bonne dans tous les cas. Discussion Le diagnostic de MP peut etre retarde en l’absence de signes neurologiques. L’imagerie rachidienne peut permettre le diagnostic precoce depuis l’avenement de l’IRM. Le pronostic est bon lorsque la prise en charge est precoce.

Resume Les plaies penetrantes cervicales sont aussi souvent « seches » que cause d’hemorragies ou de lesions des zones adjacentes. Le diagnostic lesionnel repose sur l’etat des fonctions vitales, la region du cou concernee, l’examen clinique et la tomodensitometrie du cou. L’arteriographie des quatre axes cervicaux et l’œsophagoscopie ne sont pas systematiques, mais decidees en fonction de la clinique ou de l’angioscanner. Laryngoscopie et fibroscopie tracheobronchique dependent de la clinique. Les risques vitaux sont l’obstruction des voies aeriennes superieures (VAS), l’hemorragie brutale, l’ischemie cerebrale ou medullaire et l’infection. Une hemorragie franche, un hematome pulsatile en expansion, une lesion manifeste des VAS doivent conduire le malade au bloc sans delai et sans intermediaire. L’hemorragie et l’obstruction des VAS sont possibles a tout moment, sous l’effet du remplissage, de l’agitation ou du retrait d’un corps etranger fiche dans la plaie. L’intubation orotracheale est souvent realisable ; la cricothyroidotomie est la meilleure alternative. A l’hopital, ce controle des VAS est plus sur en salle d’operation, chirurgien present. Des qu’un malade est ventile, on doit craindre la decompensation d’un eventuel pneumothorax. Les lesions carotidiennes minimes sans consequences cerebrales n’imposent pas une reparation systematique. Les lesions carotidiennes compliquees de deficit neurologique central doivent etre reparees, sauf coma profond sans autre origine. Les lesions arterielles vertebrales sont plus accessibles par voie endovasculaire.

Fourteen cases of cervico-thoracic (C-T) vertebral osteomyelitis in calves were investigated over a 6 year period. The onset of clinical signs was between 2 and 9 weeks of age. There was no breed or sex predisposition. The clinical history prior to referral extended from 5 days to 8 weeks (mean 20 days). The most common clinical presentation was difficulty in rising with a tendency to knuckle or kneel on the forelimbs which displayed hypotonia and hyporeflexia. In over half the cases pain could be elicited on manipulation of the neck. The lesion in all cases involved one or more of the vertebrae from C6 to T1. The diagnosis was confirmed by radiology and/or at post mortem. Four animals were discharged after treatment, 10 animals were humanely destroyed. Salmonella dublin was isolated from the vertebral lesion in eight of the 10 calves at post mortem.

Focal dermal hypoplasia or Goltz syndrome is a rare clinical entity, usually presenting in early childhood as a mix of ectodermal and mesodermal anomalies. Previously reported cases have included skeletal lesions of the long bones, metacarpals, metatarsals and pelvis. We present a case with a vertebral lesion causing neurologic deficit. A discussion of the history of the syndrome is included as well as detailed histologic description.

Spinal biopsies are carried out to obtain specimens of vertebral bodies or vertebral lesions. This provides biological samples for cytological and histopathological analyses. Primary and secondary tumors and infectious diseases are the most common causes for which vertebral biopses are required.

Analysis of 483 skeletons from Arica (Chile) and review of mummy dissection records demonstrates an overall 1% prevalence rate for tuberculosis between 2000 B.C. and A.D. 1500. Tuberculosis cases cluster in the period A.D. 500-1000 which correlates with fully agropastoral societies. Considering only these agropastoral societies, about 2% of their members show tuberculosis lesions. A segment of DNA unique to Mycobacterium tuberculosis was identified in an extract from the vertebral lesion of a 12-year-old girl with Pott's disease from about A.D. 1000, establishing the pre-Columbian presence of tuberculosis with the most specific evidence currently available.

Retrospective data analysis. Traumatic spinal cord injury (TSCI) is a devastating injury that causes a lifelong disability, involving mostly young men. The aim of the study was to analyse some clinical and epidemiological features of TSCI patients admitted to the Spinal Unit of Florence, Italy, during 30 years, from 1981 to 2010. Spinal Unit, Careggi University Hospital, Florence, Italy. The medical files from the computerised database of the patients who sustained TSCI from 1 January 1981 to 31 December 2010 and received comprehensive care in the same centre were analysed. Information was collected with regard to demographic data, causes of injury, time of injury, associated injuries, treatment of the vertebral lesion and neurological condition at discharge. A total of 1479 patients were included. The number of two-wheeler road traffic accidents (RTAs) has increased over the years, whereas the percentage of falls and sports accidents has been quite constant. The lesions due to 4-wheeler RTAs tend to decrease. Lesions due to falls mainly affected older persons than those due to sports accidents, with a mean age at the time of injury of 52 and 25 years, respectively. Diving was the most common cause among sports and leisure accidents. Associated injuries were present in 56% of all the cases included. The cases of spinal cord injury due to two-wheeler RTAs have increased over the years probably because of the increasing diffusion of the use of such a vehicle, and such an eventuality has to be taken into consideration in future prevention strategies.

Epithelioid hemangioendothelioma is a rare vascular tumour which occasionally occurs in bone. It presents predominantly as multifocal lesions in young males and is frequently misdiagnosed as metastatic carcinoma. We describe a case presenting as a solitary vertebral lesion in a 48-year-old female, which was initially misdiagnosed as a carcinoma and which responded well to radiotherapy.

Kyphoplasty (KP) and vertebroplasty (VP) are both minimally invasive surgical techniques, which can enhance the mechanical stability of the vertebral lesion by injecting filling materials into the fractured vertebra. The filling materials used in KP and VP include injectable PMMA, composite bone cement, biodegradable bone cement, calcium phosphate cement (CPC), and others. Different filling materials have different effects on the biomechanical properties of vertebral bodies, causing various biomechanical effects on the adjacent vertebral bodies. In conclusion, the development of filling materials can improve the anti-pressure capacity and effectively maintain good morphological characteristics of fractured vertebral bodies.

Osteoporotic vertebral fractures and pathological vertebral lesions are frequent clinical situations causing severe back pain. The pharmacological treatment of the underlying disease and the analgetic treatment of the associated back pain usually do not rid the patient's back pain completely and are insufficient to prevent the fracture-weakened vertebral body from further fracturing with long term consequences for the biomechanical competence of the entire spine. In the last 10 years the minimal invasive treatment options vertebroplasty (VP) and balloon kyphoplasty (BK) have spread quickly because these procedures appeared to be promising treatments to stop the fracture and vertebral lesion associated back pain and to internally stabilize a fractured vertebral body. Numerous published reports on VP and BK appeared to support the notion of an immediate and lasting pain reduction after VP and BK in additon to a prevention of further fracturing of the treated vertebrae. The first three randomized controlled and partly blinded trials have been published this year. Two of these trials demonstrate that VP does not result in a better pain control than a sham operation whereas BK was shown to reduce back pain due to verterbal fractures for at least 12 months. Considering that more than 1.5 million people world-wide have been treated with VP and BK until now this work discusses the recent trials and suggests clinical and academic consequences on the basis of the most recent evidence.

A giant vertebral notochordal rest is a newly described, benign entity that is easily confused with a vertebral chordoma. As microscopic notochordal rests are rarely found in adult autopsies, the finding of a macroscopic vertebral lesion is a new entity with only seven previously presented cases. We report here radiological findings, including diffusion weighted images, of a patient with a giant notochordal remnant confined to the L5 vertebra, with an emphasis on its distinction from a chordoma.

Background: The presence of vertebral lesion, whether symptomatic or not presents a diagnostic challenge. Open biopsy of spine is associated with considerable clinical morbidity. Hence it was decided to evaluate the efficacy of fluoroscopic guided fine needle aspiration biopsy (FGFNAB) in providing a definitive diagnosis in pathologies of the spine and to determine the degree of co-relation between the histopathological diagnosis and the presumptive clinicoradiological diagnosis. Methods: A prospective study of 103 patients in whom a presumptive diagnosis was made by available imaging techniques (including magnetic resonance imaging) was undertaken. All patients underwent histopathological /cytological examination for confirmation of the presumptive diagnosis, using material obtained through FGFNAB. Results: A definitive diagnosis was established, through FGFNAB, in 76 (73.8%) patients. Non concordant diagnosis was seen in 13(12%) of patients. In 27 (26.2%) patients the results of FGFNAB were inconclusive. Conclusion: FGFNAB is a minimally invasive, technically easy, quick and cost-effective procedure. It can be done on an outpatient basis, under local anaesthesia and often eliminates the need for an open biopsy. FGFNAB can clinch the diagnosis early and helps institute definitive therapy. Hence we strongly recommend FGFNAB as a basic investigation in all pathological lesions of the spine.

INTRODUCTION Osteomuscular hydatidosis is an uncommon disease in which the spine is involved in 50% of the cases. Preoperative diagnosis is difficult in our setting because of its low incidence and the absence of specific radiological criteria. CLINICAL CASE We present the case of a 72 year-old woman who consulted for slowly progressive paraparesia and was diagnosed, using CT and MR, as having a vertebral lesion of T3. The patient was operated on and many vesicular lesions of hydatidosis were removed surgically. CONCLUSION We review the different forms of presentation of spinal hydatid cysts and the possible therapeutic options.

The efficacy of modern drugs in the treatment of tuberculosis of the spine has been evaluated by a personal follow-up for three to ten years. Operation on the vertebral lesion was done only for those patients with or without neural complications who failed to respond favourably to drug therapy and rest. Thus absolute indications for operation were present in only 6 per cent of cases without neural involvement and in 60 per cent of patients with neural deficit. Of the patients who responded to drug therapy alone, only 19 per cent revealed increase of kyphosis by more than 10 degrees. The diseased area showed radiological evidence of osseous replacement in 29.6 per cent of cases, of fibro-osseous union in 50 per cent and of fibrous replacement in 202 per cent. The overall results of this regime compare favourably with those of radical operation. It is suggested that freatment should in the first place be by modern antitubercular drugs.

A bone image demonstrating a "photopenic" vertebral lesion was found to be caused by tumor infiltration of adjacent muscle and probable secondary osseous ischemia. Magnetic resonance imaging was valuable in detecting the muscle abnormality.

A retrospective study of 20 cases of multiple myelomatosis and paraparesis treated during 1966–77 is presented. All patients but one had been submitted to decompressive laminectomy. A close correlation between duration of paraparesis before operation and prognosis was found, eight patients with a duration of paraparesis of several days remaining paraplegic. No particular paraparesisprone patient group with respect to duration of myelomatous disease, Ig class or various laboratory findings could be identified. In several instances radionuclide scan was effective in localizing vertebral lesion. In most patients radicular type back pain signalled vertebral damage and subsequent paraparesis. In many cases long survival after operation and excellent to good functional results made surgery a worthwhile procedure. The importance of postoperative radiotherapy and adequate chemotherapy is stressed.

The natural history of a prospectively selected group of neurologically symptomless patients with extracranial arterial disease (EAD) was studied. 23 of 122 patients died over a period of follow-up of from eleven to thirty-six months (mean=seventeen), but only 3 from stroke and 10 from cardiac failure. Among those patients still alive 8 reported transient ischaemic attacks, 1 a stroke, and 90 remain symptomless. Thus, by life-table analysis, the cumulative stroke rate was only 7%, irrespective of death or survival, the same as the average risk of death in a normal population. However, by subsequent continuous-wave Doppler examination of carotid and vertebral arteries, the probability of EAD progression was 85%. Involvement of initially unaffected arteries occurred either alone (25) or in combination with a deterioration of the original stenosis (14) —the latter alone was seen in 9 patients. A combined carotid and vertebral lesion was found to be the only significant indicator of cerebrovascular risk, which was six times greater than that for unilateral or bilateral carotid lesions.

Three cases of neoplastic pathological fractures of long bones were made suitable for internal fixation devices by filling with methylmethacrylate. A single case of a neoplastic vertebral lesion which was repaired with this bone cement is also discussed. Both the diagnostic and therapeutic radiologist should be familiar with this useful procedure.

Injury to the cord by fracture-dislocation of the spine frequently demands that consideration be given to measures which will protect the cord from further injury by pressure of displaced bone. The impossibility of regeneration of the cord being accepted, it logically follows that the treatment of cord injuries, so far as restoration of function of the cord is concerned, is effective only in those cases in which the cord has not been entirely destroyed at the level of the vertebral lesion. It is often stated that, because of the concussion and spinal shock associated with severe injuries to the cord produced by fracture-dislocation, it is impossible to make an early differentiation between complete physiologic interruption which may later show some recovery and a total transverse lesion which is permanent.1 It seems improbable that concussion is a factor of importance in cases of fracture-dislocation due to indirect violence. A better