Introduction and purpose Little information exists on surgical characteristics, complications and outcomes with corrective surgery for rigid cervical kyphosis (CK). To collate the experience of international experts, the CSRS-Europe initiated an international multi-centre retrospective study. Methods Included were patients at all ages with rigid CK. Surgical and patient specific characteristics, complications and outcomes were studied. Radiographic assessment included global and regional sagittal parameters. Cervical sagittal balance was stratified according to the CSRS-Europe classification of sagittal cervical balance (types AD). Results Eighty-eight patients with average age of 58 years were included. CK etiology was ankylosing spondlitis (n = 34), iatrogenic (n = 25), degenerative (n = 9), syndromatic (n = 6), neuromuscular (n = 4), traumatic (n = 5), and RA (n = 5). Blood loss averaged 957 ml and the osteotomy grade 4.CK-correction and blood loss increased with osteotomy grade (r = 0.4/0.6, p < .01). Patients with different preop sagittal balance types had different approaches, preop deformity parameters and postop alignment changes (e.g. C7-slope, C2-7 SVA, translation). Correction of the regional kyphosis angle (RKA) was average 34° (p < .01). CK-correction was increased in patients with osteoporosis and osteoporotic vertebrae (POV, p = .006). 22% of patients experienced a major long-term complication and 14% needed revision surgery. Patients with complications had larger preop RKA (p = .01), RKA-change (p = .005), and postop increase in distal junctional kyphosis angle (p = .02). The POV-Group more often experienced postop complications (p < .0001) and revision surgery (p = .02). Patients with revision surgery had a larger RKA-change (p = .003) and postop translation (p = .04). 21% of patients had a postop segmental motor deficit and the risk was elevated in the POV-Group (p = .001). Conclusions Preop patient specific, radiographic and surgical variables had a significant bearing on alignment changes, outcomes and complication occurrence in the treatment of rigid CK.

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Halo treatment for cervical spine fracture in patients with ankylosing spondylitis is a challenging task for orthopedic surgeons and neurosurgeons.

We report the case of a 46-year-old woman who underwent surgery for an adamantinous craniopharyngeoma (WHO grade I). The postoperative course, during which the patient received 16 mg/day of dexamethasone, was initially uneventful. After a fortnight the patient developed infectious signs and an intracranial abscess at the operation site with simultaneous purulent coxitis. Both the intracranial abscess and the coxitis were evacuated and drained. In tissue samples and pus obtained during re-craniotomy and during surgery on the hip, Salmonella enteritidis was detected by cultivation. Salmonella enteritidis was also isolated from several stool specimens. There was no known salmonellosis in the patient's medical history. She recovered as a result of antibiotic treatment with ciprofloxacin and chloramphenicol. The intracranial abscess healed without leaving any neurological deficit. Unfortunately the left hip subsequently required further surgery, culminating in removal of the entire femoral head. Prosthetic replacement could not yet be performed due to the recurrent septic course of the hip. Our case illustrates a serious complication with presumed haematogenous spread of the infection from a pre-existing asymptomatic and unknown colon infection. The immunosuppressive effect of corticosteroids in the treatment of the brain neoplasm might have been a contributing factor to the sudden exacerbation of the latent infection.

Bilateral fractures of the femoral neck are rare injuries. We report about the case of a 33-year old male with multiple injuries including fractures of both femoral neck after a fall from great height. The fractures were successfully treated with 130 degrees blade plates, allowing early mobilisation.

This case report is about a 62 year old woman who was involved in an accident while driving her car, during which the driver side air bag deployed. She experienced intense anterior chest pain that radiated to her left arm after the accident, but was otherwise well; there was no significant medical history. An electrocardiogram done one and half hours after admission revealed 1 mm ST segment elevation in leads V2 and V3 and troponin 1 level was raised. She underwent cardiac catheterisation but three months after the accident both ECG and echocardiographic studies were normal. It is suggested that she underwent cardiac contusion rather than a myocardial infarction.