Osteoid osteoma is a tumour of bone characterised by pain which is relieved by aspirin and nonsteroidal anti-inflammatory drugs. Very high levels of prostaglandins have been found in the lesion. In five patients with osteoid osteoma, prostaglandin E2 (PGE2) and prostacyclin (PGI2) synthesis in the nidus yielded 1155.6 +/- 496.5 (mean +/- SD) and 245.2 +/- 89.8 pg/mg respectively, values which are 33 and 26 times higher than in fragments of normal bone. The sclerotic bone around the nidus produced both prostaglandins at the same rate as normal bone. In three patients the excretion rate of the major urinary metabolite of systemic PGI1 was reduced to 50% one month after removal of the tumour. The urinary excretion rate of 6-keto-PGF1 alpha, reflecting intrarenal PGI2 synthesis, was not changed after operation. These results offer new insight into the pain mechanism in osteoid osteoma.

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The aim of the study is to analyze and report the results of the surgical activity in a spinal unit of a trauma hub in central Italy during COVID-19 pandemic. Surgical activity was compared between COVID 19 pandemic and the same period of time in 2019 at our institution. A 50% reduction of surgical procedures during the last three months was observed compared with the same period of time in 2019. The compliance with the containment rules for the spread of the infection, were sufficient to allow safe surgical activity for the medical teams and patients.

Originally aimed at treating degenerative syndromes of the lumbar spine, percutaneous minimally invasive posterior fixation is nowadays even more frequently used to treat some thoracolumbar fractures. According to the modern principles of saving segment of motion, a short implant (one level above and one level below the injured vertebra) is generally used to stabilise the injured spine. Although the authors generally use a short percutaneous fixation in treating thoracolumbar fractures with good results, they observed some cases in which the high fragmentation of the vertebral body and the presence of other associated diseases (co-morbidities) did not recommend the use of a short construct. The authors identified nine cases, in which a long implant (two levels above and two levels below the injured vertebra) was performed by a percutaneous minimally invasive approach. Seven patients (five males/two females) were affected by thoracolumbar fractures. T12 vertebra was involved in three cases, L1 in two cases, T10 and L2 in one case, respectively. Two fractures were classified as type A 3.1, two as A 3.2, two as A 3.3 and one as B 2.3, according to Magerl. In the present series, there were also two patients affected by a severe osteolysis of the spine (T9 and T12) due to tumoral localisation. All patients operated on with long instrumentation had a good outcome with prompt and uneventful clinical recovery. At the 1-year follow-up, all patients except one, who died 11 months after the operation, did not show any radiologic signs of mobilisation or failure of the implant. Based on the results of the present series, the long percutaneous fixation seems to represent an effective and safe system to treat particular cases of vertebral lesions. In conclusion, the authors believe that a long implant might be an alternative surgical method compared to more aggressive or demanding procedures, which in a few patients could represent an overtreatment.

Percutaneous techniques may be helpful to reduce approach-related morbidity of conventional open surgery. The aim of the study was to evaluate the feasibility and safety of mini-open posterior lumbar interbody fusion for instabilities and degenerative disc diseases. From

This is the first study that has evaluated the possibility that gene variants of IL-6 and MMPs might be associated with scoliosis and suggests that MMP-3 and IL-6 promoter polymorphisms constitute important factors for the genetic predisposition to scoliosis.

Spinal epidural hematoma (SEH) is a rare cause of nerve root or cord compression; its pathogenesis is not always clearly recognizable. The aim of this paper was to investigate possible etiopathological factors in a consecutive series of patients affected by traumatic SEH treated at our institution. Seven patients with neurologic impairment due to traumatic SEH were retrospectively analyzed after diagnosis and surgical treatment. Thoracic localization was found in 5 cases, and lumbar and cervical localization were found in 1 patient each. One patient was affected by ankylosing spondylitis and one by diffuse idiopathic skeletal hyperostosis. SEH was associated with spine fractures in 6 cases. Only 2 cases of traumatic SEH resulted from high-energy trauma. All patients underwent surgical decompression within 24 hours after admittance to the hospital. Three patients recovered completely, 3 remained paraplegic, and 1 remained monoplegic. Several concomitant conditions are suggested to be predisposing factors for the development of SEH, although its inherent mechanism is still unknown. Two patients in the present series were affected by rheumatologic disorders, confirming the elevated incidence of hematomas in such patients compared to the normal population. Three very unusual cases of SEH occurred in senile patients affected by osteoporotic fractures. Early diagnosis and urgent decompression of the hematoma remain mandatory.

In this study 37 CTS hands underwent pre- and post-operative (15 days 2 and 6 months) evaluation of median nerve distal motor latency (DML) and sensory nerve conduction velocities (SNCV: I digit and III digit-wrist). Pre-operatively, CTS hands were classified as mild (decreased SNCV, normal DML), moderate (decreased SNCV, increased DML) or severe (absent sensory nerve action potentials, increased DML). Post-operatively, all hands presented clinical and neurophysiological improvement. The three groups of patient showed different clinical and neurophysiological responses to nerve decompression: we observed a rapid restitutio ad integrum in mild group, an improvement with normalisation in about 50% of the hands in moderate group, and a high percentage of restore of the sensory responses with no normalisation in severe group. A marked improvement of sensory symptoms was observed in all cases, but some degree of motor and/or sensory deficit was still present six months after surgery in more advanced cases. Preoperative electrophysiological assessment of median nerve function in CTS hands have an important role in predicting the outcome of surgical decompression.