Surgical treatment of spondylodiscitis is associated with many complications and raises a number of issues for discussion. The aim of the study was to evaluate a group of patients who had undergone surgery for inflammation of the spine, and to discuss the optimal operative procedure. Between January 2000 and February 2005, a total of 81 patients were treated at our department for pyogenic or tuberculous spondylodiscitis. Of these, 31 (11 women and 20 men) underwent surgery. Patients treated by CT-guided abscess drainage puncture with antibiotic therapy were not included. Indications for surgery included neurological deficit in 20 patients, deformity or mechanic instability in six, and progressing septic condition in three patients. Simple decompression of nerve structures from the posterior approach, combined with drainage, was performed in seven patients, revision surgery from the posterior approach and fusion completed with suction drainage was done in five, anterior radical debridement and stabilization of the anterior column by replacement of the vertebral body was performed in 15 patients, and an anterior procedure completed with posterior instrumentation and fusion was carried out in four patients. The patients were followed up and evaluated at 3, 6 and 12 months post-operatively. Improvement in neurological deficit by one or more Frankel grades was recorded in 30 % of the patients treated by posterior decompression and suction drainage, and in 83 % of the patients undergoing anterior debridement and stabilization. Further progression of deep infection requiring revision surgery and implant removal occurred in one patient. Clinical outcomes assessed as good or satisfactory were found in 68 % and poor results were in 32 % of the patients. The selection of an optimal surgical procedure in spondylodiscitis depends on the primary localization of infectious lesions. In a typical anterior form of spondylodiscitis, anterior debridement and suction drainage are preferred. Reconstruction of the anterior spinal column in the presence of major destruction, and stabilization of an infected spine still remain challenging issues. Radical debridement with deformity correction and segmental stabilization provide an efficient method of treatment for the most frequent anterior forms of pyogenic and tuberculous spondylodiscitis. The use of titan implants does not significantly increase the risk of persistent infection or its recurrence.

PURPOSE OF THE STUDY The study presents the monocentric retrospective study of a group of patients with malignant tumours around the knee, treated by a wide resection and a reconstruction with megaprosthesis due to infectious complications. Provided is a detailed analysis of each operative treatment due to the manifestation and process of periprostethic infection of the knee megaprosthesis and the use of external fixator during a two-stage revision. MATERIAL AND METHODS Between 01/1993 and 12/2013, a total of 67 cemented megaprostheses were assessed, with a detailed analysis of 12 patients with periprosthetic infection. The Kaplan-Meier method and MSTS for lower extremity clinical assessment were used and a range of motion was evaluated. RESULTS The endoprosthesis failed due to all kinds of complications (mechanical, biological, infection) in 27 (40.3%) patients. The estimated one-year survival rate from the surgery was 94%, the five-year survival rate was 72%, and the ten-year survival rate was 46%. Based on the statistical analysis of the implant survival due to infection, the one-year survival rate was 94%, the five-year survival rate was 75%, and the ten-year survival rate was 57%. Three patients were treated with radical surgical debridement. Five patients were treated with a two-stage revision with a cement spacer and external fixator, and three patients underwent nail fixation. Clinical values before and two years after the revision surgery for periprosthetic infection using MSTS were assessed. The mean of the difference of clinical values was 1.91 and the p value of paired t-test was 0.24, therefore there was no prove of the clinical result difference using MSTS before and after the revision surgery. DISCUSSION The acute radical debridement and lavage is preferred, if the surgery can be done up to three weeks after the first clinical signs of infection under the condition of good retention of the implant. In case of extensive infectious damage, when abscess, fistula and loosening of the implant are present and when the patient has a good oncological prognosis, we prefer a twostage revision with a cement spacer stabilized by an external fixator. In patients with mitigated infection or uncertain oncological prognosis we prefer a two-stage revision with the combination of a cement spacer and intramedullary nail fixation. CONCLUSIONS The study presents the results of operative treatment of periprosthetic infection of megaprosthesis and the modification of the two-stage replantation of infected MP with the use of external fixation for stabilisation of a non-articulated cement spacer allowing the patient to remain active during the time before the second stage. Key words: periprosthetic infection, megaprosthesis, bone tumour, external fixator, two-stage revision.

PURPOSE OF THE STUDY The surgical treatment of osteoporotic vertebral body fractures is associated with many complications. Vertebroplasty (VP) and kyphoplasty (KP) are minimally invasive procedures allowing us to strengthen the vertebral body and thus stabilize it. The aim of this non-randomized study is to evaluate a group of patients treated by VP and KP procedures and to discuss related risks. MATERIAL Between September 2005 and October 2007, a total of 32 patients (37 vertebrae) were treated by the VP and KP techniques. Vertebroplasty was used in 21 and kyphoplasty in 11 patients. In this initial group, four patients were excluded from evaluation because of a tumour aetiology of the fracture. The remaining 28 patients who had an osteoporotic vertebral body fracture verified by CT scan findings were followed up and evaluated. METHODS The evaluation was based on modified Oswestry disability index (ODI) and visual analogue scale (VAS) scores recorded at 6 weeks, 3 and 6 months and 1 year postoperatively. Cement leakage detected by X-ray was assessed by means of the classification used by Yeom et al. and, at the same time, the occurrence of adjacent vertebral fracture, if any, was detected by 1 year after surgery. RESULTS Radiographic cement leakage was found in eight patients (21.6%), with clinical manifestation in two (5.4%). One had an incomplete motor lesion due to cement leakage into the spinal column, and the other had pulmonary embolism due to cement leakage into the mediastinum. The whole group showed marked improvement in clinical condition, as assessed by the ODI. When expressed as per cent, the average ODI was 57% pre- and 15.7 % post-operatively. All patients reported pain relief in the affected spine. The average VAS score of 8.1 pre-operatively decreased to an average of 2.6 post-operatively. There were no radiographic findings of adjacent vertebral body fracture. DISCUSSION Vertebroplasty and kyphoplasty are currently used to treat osteoporotic vertebral fracture. Their advantages include an immediate stabilization of the vertebra by cement solidification, possibility of percutaneous application under local anaesthesia, and early patient mobilization without any external fixation. However, when evaluating these techniques, safety of the surgical procedure should be taken into consideration. The most frequent risk is cement leakage. CONCLUSIONS Vertebroplasty and kyphoplasty can, under strict adherence to the operative protocol, be an effective approach to the treatment of osteoporotic vertebral body fracture. It permits early mobilization of the patient without the necessity of external fixation. Key words: vertebroplasty, kyphoplasty, osteoporotic spine fracture, osteoporosis.

Gangrenous pyoderma is a rare complication of surgical treatment mimicking bacterial necrotizing fasciitis. The characteristic symptoms include a pre-existing immune disorder, negative results of the relevant microbiological examinations, no response to any antibiotic therapy, and deteriorating of the condition after radical debridement. Another typical feature is a discrepancy between an ominous appearance of the wound accompanied by leucocytosis and an elevated CRP level, and the patient s good general condition with low-grade fever and no signs of sepsis. The case of a 68-year-old man who underwent an elective open reconstruction of rotator cuff tears of the left shoulder is presented. The surgery was complicated with pyoderma gangrenosum that was first treated unsuccessfully by repeated revision surgery and broad-spectrum antibiotic therapy. The patient was ultimately cured with corticosteroids. The sequellae included limited motion of the shoulder joint and extensive destruction and scarring of the adjacent soft tissue. gangrenous pyoderma, necrotizing fasciitis, corticosteroids.

Purpose: This study aimed to compare the clinical and radiological outcomes of treating unstable osteoporotic vertebral fractures using hybrid fixation with uncemented transpedicular screws (Group A) versus polymethylmethacrylate (PMMA) cement-augmented screws (Group B). Methods: A retrospective comparative study of 55 patients treated between 01/2017 and 03/2024. Group A included 35 patients (mean age 71.22 ± 6.12 years); Group B included 20 patients (mean age 72.9 ± 7.75 years). Clinical outcomes were compared preoperatively, 6 weeks and 1 year after surgery. For clinical evaluation, the ODI and VAS for back pain were used. Restoration of the sagittal spinal profile was evaluated using the sagittal Cobb angle and the height of the fractured vertebral body. Results: Both groups showed significant clinical improvement in ODI and VAS scores at 6 weeks and 1 year postoperatively (p < 0.001), without significant between-group differences. The ODI changed from a preoperative value of 75.07 ± 21.13 to 50.72 ± 17.7 at 6 weeks postoperatively, and to 28.83 ± 20.9 at 1 year postoperatively in Group A. In Group B, the preoperative ODI value of 66.8 ± 14.56 changed to 47.00 ± 11.72 at 6 weeks and to 19.8 ± 9.15 at 1 year postoperatively The VAS decreased from 7.55 ± 1.43 preoperatively to 3.50 ± 1.17 at 6 weeks and to 1.52 ± 1.18 at 1 year postoperatively in Group A, and from 7.53 ± 1.39 preoperatively to 2.53 ± 1.02 at 6 weeks and to 1.52 ± 1.18 at 1 year postoperatively in Group B. In Group A, preoperative Cobb angle values of 11.01 ± 13.85 improved to 7.33 ± 16.17 at 6 weeks, with subsequent loss to 12.96 ± 14.75 degrees at 1 year postoperatively. In Group B, preoperative values were 11.44 ± 17.84, corrected to 5.16 ± 8.33 at 6 weeks, and to 7.37 ± 9.28 degrees at 1 year postoperatively. Conclusions: Good clinical outcomes were achieved in both evaluated groups using uncemented or cement-augmented screws, without a statistically significant difference. Differences were noted in the radiological evaluation of the success of sagittal profile correction. While both groups showed initial radiological improvement, the uncemented screw group experienced a statistically significant loss of correction at the 1-year follow-up.