Despite the proven superiority of surgery in the management of refractory lumbar spinal stenosis, there is a lack of evidence-based data regarding the different surgical treatment options. The evaluation of modern, minimally invasive techniques is thus difficult.

The available scientific data are too sparse to enable evidence-based treatment of cervical myelopathy. Early surgical intervention is often recommended in the literature. Controversy remains regarding the choice of the appropriate surgical procedure, but there is consensus on the suitable options for many specific clinical situations.

The serum levels of calcium on day three could be useful for the prediction of mortality in patients with moderate and severe TBI.

C2 pedicle screws or transarticular atlantoaxial screws are technically demanding and carry an increased risk of vertebral artery injury. In up to 20% of cases, pedicle and transarticular screw placement is not possible due to a high-riding vertebral artery or very small C2 pedicles in addition to other anatomical variations. Translaminar screws have been reported to rigidly capture posterior elements of C2 and therefore appear to be a suitable alternative. We present our first experiences and clinical results with this new method in two neurosurgical spine centers. Twenty-seven adult patients were treated between 2007 and 2010 in two neurosurgical spine departments with C2 translaminar screw fixation for upper cervical spine instability of various origins (e.g., trauma, tumor, dens pseudarthrosis). Eight patients were men and 19 were women. Mean age was 68.9 years. In most cases, translaminar screws were used because of contraindications for pedicle or transarticular screws as a salvage technique. All patients were clinically assessed and had CT scans postoperatively to verify correct screw placement. Follow-up was performed with reexamination on an ambulatory basis. Mean follow-up was 7.6 months for all patients. In 27 patients, 52 translaminar screws were placed. There were no intraoperative complications. Postoperatively, we identified four screw malpositions using a new accuracy grading scale. One screw had to be revised because of violation of the spinal canal >4 mm. None of the patients had additional neurological deficits postoperatively, and all showed stable cervical conditions at follow-up. Two patients died due to causes not associated with the stabilization technique. The fusion rate for patients with C1/C2 fixation is 92.9%. Translaminar screws can be used at least as an additional technique for cases of upper cervical spine instability when pedicle screw placement is contraindicated or not possible. The current data suggest comparable biomechanical stability and fusion rates of translaminar screws to other well-known posterior fixation procedures. In addition, translaminar screw placement is technically less demanding and reduces the risk of vertebral artery injury.

Zusammenfassung Spinale Metastasen stellen eine h?ufige Ursache f?r eine deutlich eingeschr?nkte Lebensqualit?t bei Pat. mit metastasierenden Tumoren dar. Die Behandlung erfolgt interdisziplin?r abh?ngig vom klinischen Zustand des Patienten. Die Rolle der Chirurgie in der Therapie variiert erheblich je nach Literaturquelle, von keiner Bedeutung bis hin zur Empfehlung der radikalen chirurgischen Resektion. Die Behandlung spinaler Metastasen ist in ein interdisziplin?res Konzept einzubinden bei dem neben dem Onkologen und dem Radioonkologen auch der Wirbels?ulenchirurg eine entscheidende Rolle spielt. Die Behandlung sollte immer eine Individualentscheidung darstellen, wobei die Therapie die Beherrschung der Schmerzen, die Verhinderung neurologischer Defizite und damit die Verbesserung der Lebensqualit?t sowie ggf. eine langfristige Tumorkontrolle zum Ziel haben sollte.