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Background Context: Transpedicular vertebroplasty is an effective procedure to reduce pain and stabilize osteoporotic vertebral fractures. It is, however, difficult to perform after transpedicular instrumentation because the pedicle screws are in the way., Purpose: To determine if vertebroplasty can be performed in patients who have previously undergone osteosynthesis pedicle-screw fixation., Study Design: We postulate that an alternate transdiscal route can be used in cases with instrumentation in order to successfully perform vertebroplasty., Methods: We report the case of a 73-year-old male patient presenting with a fresh osteoporotic fracture of L2 and L3 6 weeks after having undergone a dorsal operative stabilization between L3 and L5., Results: Vertebroplasty was performed using a transdiscal descending approach to treat the two adjacent vertebral levels. The patient reported a 50% decrease in pain and was able to walk with a stick at 3 months. At late follow-up at 18 months his walking had further improved and he experienced only sporadic lumbar pain., Conclusions: Vertebroplasty can be performed in patients having previously undergone transpedicular instrumentation. The transdiscal route represents such a new approach.

Normal aging, leukoaraiosis (LA) and vascular disease particularly involve the human frontal lobes. We decided to investigate a population of elderly patients referred for neuroimaging because of progressive minor cognitive deficits but no dementia. They underwent conventional Magnetic resonance imaging (MRI) using axial T1 and T2-weighted imaging as well as coronal FLAIR sequences in addition to the axial diffusion-weighted MRI. MRI allowed us to differentiate patients with leukoaraïosis (LA+) from those without it (LA-) and mapping of the apparent diffusion coefficient (ADC) to investigate local tissular water motion. We observed an increase in the ADC in all investigated patients with increasing age (r=0.326, p=0.002). This increase was observed in both patients groups (LA+ and LA-). In addition, the LA+ group had significant higher ADC values than the LA- group after controlling for age (p<0.0001).

This paper first goal is to establish what "critical" aneurysm means. We decided to consider as "critical" aneurysms those whose correct clipping-treatment would be particularly difficult; this particular difficulty could concern the malformation intrinsic characteristics as well as extrinsic factors (the patient's clinical conditions as well as insufficient organizational or technical facilities). We thus reviewed 277 aneurysms operated in the Neurosurgical Department of Varese from 1988 to 1994. We excluded 18 vertebro-basilar system aneurysms; the clinical and surgical charts of the 259 remaining aneurysms were reviewed and informations regarding their last clinical conditions were gathered. In this way it was possible for us to distinguish different categories of critical aneurysms: critical for their anatomical position, morphology, size and for their number; unpredictably critic aneurysms and aneurysms associated with the patient's critical conditions were also considered. After describing our technical solutions and those suggested by the current literature we concluded that what is required to treat these critical aneurysms is not an extraordinary surgical skill, but a good organizational and technical facility at the surgical-team's disposal.