SUMMARY A series of 14 patients with a protruded thoracic intervertebral disc is reported. We believe that the true incidence may be as high as one patient per million population per annum. Trauma, sometimes mild, seems to have played a significant role in this series. This fact coupled withpronounced numbnessand disagreeableparaesthesiae should suggest the diagnosis with thoracic spinal lesions. Armed with clinical suspicion, radiological verification of the lesion can be expected using a thorough myelographic technique supported if necessary by tomography. A posterolateral approach which combines laminectomy, complete excision of the ligamentum flavum, and the extradural removal of protruded disc is described. The technique is safe and effective.

A small series of five patients with more than one aneurysm on the same internal carotid artery is reported. The author believes that similar cases must have been observed by many neurosurgeons but can find no specific reference to the technical and diagnostic problems created by such lesions. Sometimes these lesions can be clipped separately, but when the aneurysms are contiguous it may be helpful to apply a clip with its jaws parallel to the long axis of the internal carotid artery. The author suggests that more case reports would help to advertise the relative frequency of such lesions and thereby should improve their management.

The medical treatment of eight patients with paraparesis associated with Paget's disease of the vertebrae is described. Treatment, for 3 to 87 months, with calcitonin or with diphosphonates produced marked clinical improvement in seven of these patients. From this series and a review of 19 additional case reports it is concluded that favourable clinical response is seen in about 90 per cent of patients, and that this may occur very rapidly. Results are as good or better than those obtained by surgical decompression. It seems possible that paraparesis in some cases may be due to diversion of blood supply from the spinal cord to the highly vascular Pagetic bone giving rise to a vascular "steal" syndrome. It is suggested that medical treatment should be used more widely to avoid or delay the need for operation and reduce the risks of recurrence. These patients, however treated, require lifelong follow-up because relapses are common.

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