Purpose This study analyses the complications of spinal deformity surgery in adults to highlight pre-disposing factors. Methods The clinical records and imaging were reviewed for 48 consecutive patients, 12 males and 36 females, with a mean age of 64 (31-86), who had surgery for spinal deformity. Mean follow-up time was 36 months (24-60). Patient data recorded were age, diagnosis and co-morbidities; deformity assessment: curve type, sagittal and coronal balance, Cobb angle. Operation details: number of instrumented levels, duration and intra-operative complications. Outcome: complications, re-operations, balance and Cobb angle. Results 28 patients (58 %) had at least 1, 15 patients (27 %) had 2 and 5 patients (9.5 %) had more than 2 comorbidities. Average time between 1st presentation and operation was 13 months (1-41). The mean number of levels fused was 10.8 (4-23). In addition to posterior pedicle screw instrumentation, 40 patients had chevron osteotomies and 8 had pedicle substraction osteotomies. Posterior interbody fusions were performed at one level in 17 of which 7 had 2 level fusion. Two patients had combined anterior and posterior approaches. Fusion to the pelvis was performed in 19 patients. There were a total of 27 major and minor complications in 19/48 (39.5 %) patients. Late complications included 5 patients who had revisions for proximal junctional kyphosis, 1 patient had revision for pseudoarthrosis and 4 patients had removal of mal-positioned screws. Conclusions Factors associated with high complication rate in adult spinal deformity surgery are age, co-morbidities and severe sagittal imbalance at the time of presentation.

The objective was to evaluate the efficacy of xenografts to improve the outcomes in elderly patients with tibial plateau fractures. Nineteen cases with a mean age of 74 years were followed prospectively from 1998 to 2003. Six patients each belonged to Schatzker types III, IV and V and one patient belonged to type II. Open reduction with fixation and xenograft impaction was carried out. Clinical and radiological union was assessed including infection rate, incorporation of the xenograft and average collapse of the fracture. The average union time was 20 weeks. No patient had wound infection and all had excellent incorporation of the xenograft with union. The average collapse was 4 mm on follow-up. This series shows the use of only an xenograft in acute fixation of these fractures with favourable outcome. Furthermore, it reduces operative time, bleeding and associated co-morbidities, which is of more significance in an elderly age group.

Multimodal monitoring allows early detection of impending neurological deficit that is superior to a single monitoring modality. To achieve optimal use of monitoring, continuous communication between surgical, anaesthetic and neurophysiology teams are required. As a result of our experience we have incorporated in our consent procedure the discussion of monitoring and the possibility of needing to abandon the procedure, and completing in a staged fashion at a later date. We believe multimodal monitoring is the current gold standard for complex spinal deformity surgery.

Demographics, pathology, and outcomes of 7 patellar tumors, including 2 giant cell tumors, 2 chondroblastomas, 1 osteoid osteoma, 1 osteitis fibrosa cystica, and 1 case of myelomatous infiltration, are described. Five male and 2 female patients with a mean age of 42.5 years were followed for an average of 3.5 years. Anterior knee pain was the main presenting symptom. Two patients presented with pathologic fracture. One patient with chondroblastoma underwent curettage only; the second patient underwent curettage and bone grafting. Both patients with giant cell tumors underwent total patellectomy. Patients with osteoblastoma and osteitis fibrosa cystica underwent excision of the lesion. The patient with myeloma underwent radiotherapy. Patellar tumors represent special management problems because of their subcutaneous location, relationship to the extensor mechanism, and difficulties in interpretation of radiographs. A satisfactory outcome can be expected in the majority because of the predominantly benign nature of the lesions and straightforward operative intervention after diagnosis.[J Knee Surg. 2008;21:212-216.]

Intramedullary nailing appears safe and effective for treatment of metastatic bone disease, and confers good functional results, pain relief, and mobility.