REVIOUS STUDIES HAVE SHOWNthat the incidence of distal forearm fractures in children peaks during early adolescence around the time of the pubertal growth spurt. [1][2][3] This observation has been explained on the basis of a transient increase in cortical porosity that results from enhanced bone turnover in response to greater calcium demand at the time of maximal longitudinal bone growth. 4 Such a process might be especially problematic given the thin cortex of the metaphyseal region of the distal radius, 5 and growth-related structural changes in the metaphysis further compromise bone strength in the distal forearm. 6 Adolescence is also characterized by the increase in physical activity necessary to maximize skeletal mass. 7-9 Thus, Parfitt 4 has suggested that forearm fractures in adolescence are "an inescapable consequence of an appropriate level of physical activity, and [are] the price that has to be paid in order to maximize bone accumulation during growth and minimize fracture risk in old age." To some extent, then, forearm fractures in adolescence may represent a transient imbalance between physical activity and acquisition of bone mass during puberty. This relationship may have changed over the years, due either to changing patterns of physical activity or to alterations in acquisition of bone mass, related perhaps to changing dietary habits.The incidence of distal forearm fractures among Rochester, Minn, residents younger than 35 years in 1969-1971 was reported previously. 10 The purpose of the present investigation was to estimate the incidence of such fractures among comparable Rochester residents 10, 20, and 30 years later in 1979-

Surgical decompression for the treatment of cervical spondylotic myelopathy was associated with improvement in functional, disability-related, and quality-of-life outcomes at one year of follow-up for all disease severity categories. Furthermore, complication rates observed in the study were commensurate with those in previously reported cervical spondylotic myelopathy series.

With continued growth of the elderly population and improvements in cancer therapies, the number of patients with symptomatic spinal metastases is likely to increase, and this is a condition that commonly leads to debilitating neurological dysfunction and pain. Advancements in surgical techniques of resection and spinal reconstruction, improvements in clinical outcomes following various treatment modalities, generally increased overall survival in patients with metastatic spine disease, and a recent randomized trial by Patchell and colleagues demonstrating the superiority of a combined surgical/radiotherapeutic approach over a radiotherapy-only strategy have led many to suggest increasingly aggressive interventions for patients with such lesions. Optimal management of spinal metastases encompasses numerous medical specialties, including neurosurgery, orthopedic surgery, medical and radiation oncology, radiology, and rehabilitation medicine. In this review, the clinical presentation, diagnosis, and management of spinal metastatic disease are discussed. Ultimately, the goal of treatment in patients with spinal metastases remains palliative, and clinical judgment is required to select the appropriate patients for surgical intervention.

SINS demonstrated near-perfect inter- and intraobserver reliability in determining three clinically relevant categories of stability. The sensitivity and specificity of SINS for potentially unstable or unstable lesions were 95.7% and 79.5%, respectively.