Anterior cervical decompression and fusion with anterior plating of the cervical spine is a well-accepted treatment for cervical radiculopathy. Recently, to minimise the extent of surgery, anterior interbody fusion with cages has become more common. While there are numerous reports on the primary stabilising effects of the different cervical cages, little is known about the subsidence behaviour of such cages in vivo. We retrospectively reviewed eight patients with cervical radiculopathy operated upon with anterior discectomy and fusion with a stand-alone titanium cervical cage. During surgery, only the cartilage portion of the end plate was removed and the cages were filled with autologous cancellous bone graft from the iliac crest. To assess possible subsidence or migration, three different radiographic measurements in the sagittal plane were taken for each case, postoperatively and at the latest follow-up. Subsidence was defined as any change in at least one of our parameters of at least 3 mm. Follow-up time was 12-18 months (average 15 months). Five of the nine fused levels had radiological signs of cage subsidence. No posterior or anterior migration was observed. However, subsidence did not correlate with clinical symptoms in four of the five patients. The remaining patient with signs of subsidence, whose neck pain and neurologic symptoms had regressed in the early postoperative course, suffered recurrence of radiculopathy 6 months after the surgery. Her symptoms were explained by the subsidence of the cage and the subsequent foraminal stenosis observed on the magnetic resonance imaging (MRI) scan. At 15 months' follow-up, her cage was broken. Our preliminary results, so far limited in number, represent a serious warning to the proponents of stand-alone cervical cages

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Utilization of thoracic pedicle screws is controversial, especially in the treatment of scoliosis. We present a case of a 15-year-old girl seen 6 months after her initial surgery for scoliosis done elsewhere. She complained of persistent epigastric pain, tremor of the right foot at rest, and abnormal feelings in her legs. Clinical examination revealed mild weakness in the right lower extremity, a loss of thermoalgic discrimination, and a forward imbalance. A CT scan revealed at T8 and T10 that the right pedicle screws were misplaced by 4 mm in the spinal canal. At the time of the revision surgery the somatosensory evoked potentials (SSEP) returned to normal after screw removal. The clinical symptoms resolved 1 month after the revision. The authors conclude that after pedicle instrumentation at the thoracic level a spinal cord compression should be looked for in case of subtle neurologic findings such as persistent abdominal pain, mild lower extremity weakness, tremor at rest, thermoalgic discrimination loss, or unexplained imbalance.