The authors retrospectively reviewed a series of 18 hard thoracic herniated discs (HTHD) operated by thoracoscopy. Isolated cases of HTHD have been reported in the literature, but no series describing these lesions has been published. Seventy-two percent of the herniated discs were situated between T8 and T12. Fifty-six percent of the patients had radiographic sequelae of Scheuermann's disease. Postoperatively, 83% had neurological improvement. In seven cases (39%), a plane separating the herniated disc and the dura mater was found surgically. In 11 patients, no separating plane was found during surgery. The lesion was intradural in three patients (17%) and adherent to the dura mater in eight (44%). Among these 11 patients, surgery was complicated by a dural tear in the first seven that led to a high risk of cerebrospinal fluid fistula: four of these seven patients had required surgical revision. In the last four, the zone of adhesion of the HTHD to the dura mater was preserved, successfully preventing dural tear Keywords Calcified thoracic disc herniation AE MRI AE Scheuermann AE Thoracic spine AE Thoracoscopy Eur Spine J (2006) 15: 537-542

Surgical treatment improves neurologic deficit in more than 80% of cases of spinal cord compromise caused by solitary osteochondroma. The risk of recurrence or sarcomatous transformation justifies clinical and radiologic follow-up review.

A case description and a review of the literature. To report a case of deformity secondary to cervical vertebral osteoradionecrosis (ORN) associated with severe wound complications and review the pertinent medical literature. The incidence of deformity after ORN is rare and its association with extensive damage of soft tissues makes surgical treatment difficult. The spine surgeon should be aware of this to adapt the evaluation and surgery and be prepared to manage the numerous potential complications. A case of post-irradiation symptomatic kyphosis involving ORN of C5-C6 is reported. Failure of the anterior approach surgery was observed, and the secondary course was marked by the development of substantial cutaneous necrosis associated with severe and extensive post-irradiation cutaneous and muscular atrophy. Failure of the anterior approach surgery justified the use of posterior stabilization. Secondary destabilization of the posterior fixation at the cervico-thoracic junction required extension of the osteosynthesis to the middle thoracic region. Extensive posterior stabilization permitted obtaining reliable mechanical control of the radio-induced kyphosis with a 3-year follow-up. Wound freshening and covering with well-vascularized tissue was used to fill dead spaces and helped prevent soft-tissue complications after revision surgery. Radio-induced kyphotic deformity is an important entity. Surgeons should be aware of the complications that can lead to further deformity. Corrective procedures are also at high risk for mechanical, atrophic and infectious complications. Surgical repair strategies should be based on thorough comprehension and work-up of the disorder.

In cervical spondylotic myelopathy, extended anterior spinal cord decompression necessitates subsequent stable vertebral reconstruction. Reconstruction with an iliac crest graft and screw-plate fixation gives satisfactory clinical and radiological results, but they are often compromised by morbidity involving the bone harvest.