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Study Design Case report. Objective Lumbar juxtafacet cysts (synovial and ganglion cysts) are a rare cause of low back and radicular leg pain. Most patients with lumbar cysts are in their sixth decade of life and have significant facet joint and disk degeneration. Lumbar synovial cysts (LSCs) are extremely rare in adolescence and young adulthood, and to our knowledge, only two pediatric cases of LSC have been reported in the literature. We aim to prove the existence of LSC in adolescent patients as a real entity that causes low back and radicular complaints and to discuss the possibility of traumatic injury as a pathogenic cause of LSC formation in adolescence. A case of an 18-year old patient with LSC is presented. We report the clinical presentation, management, outcome, and review of the literature, focusing on issues that remain debatable. Methods The case is presented together with its clinical course, the diagnostic techniques, the surgical findings, histologic results, and the treatment outcome. Results After surgical treatment, the patient's complaints were alleviated and almost no complaints were registered during the next 6 months' follow-up. Conclusions LSCs are extremely rare in adolescence, but they could be considered in the differential diagnosis in adolescent patients with low back pain and radiculopathy. Surgical removal of LSC could be considered as a treatment option to provide immediate and safe symptomatic relief.

AIM: The modern spinal surgery accepts the percutaneous vertebroplasty (PV) with polymethylmethacrylate (PMMA) as a routine procedure for treatment of painful osteoporotic, neoplastic and traumatic compression fractures in the thoracic and lumbar region of the spinal column. Although considered to be a minimally invasive and safe procedure, it could be affected by severe disabling and even life-threatening complications. The aim of the present study is to evaluate the different potential complications with their clinical presentation, diagnostics and different treatment options. MATERIALS AND METHODS: The study analyzed a cohort of 56 consecutive patients (66 levels) treated with PV in our clinic for the period January, 2008-July, 2012. Of them, 31 (55.4%) were women and 25 (44.6%)-men at a mean age of 61.7 (23-80) years. The osteoporotic and traumatic compression fractures subgroup was comprised of 44 (78.6%) patients, while the patients with neoplastic fractures were 12 (21.4%). All the fractures were classified as A1 Magerl's fractures with no neurologic deficit. RESULTS: Complications and unwanted events were registered in 9 (16.1%) patients. Of them, 2 experienced transient increased pain syndrome intensity, one of the patients presented with index level radiculopathy, 2 patients were diagnosed with extravertebral leakage of the cement in the spinal canal with compression of the neural structures and subsequently operated, 1 patient had a cement leak in the adjacent disk, 2 patients-a cement leak in the paravertebral soft tissues and the paravertebral venous system, and one had cement pulmonary embolism. CONCLUSION: PV is a minimally invasive and effective procedure that is used in the treatment of painful osteoporotic, traumatic and neoplastic compression fractures on neurologically intact patients. The clinically significant complications and unwanted events are a relatively rare encounter and in the majority of the cases are treatable with conservative measures. The epidural cement migration with neural elements compression is the only indication for surgical decompression and removal of the compressing cement.

OBjECTIVES: Patients with traumatic central cord syndrome (TCCS) provide some of the most dramatic opportunities for neurological improvement when compared to other subgroups of SCI, particularly evident in young patients with TCCS. The purpose of this study is to review a series of patients with central cord syndrome and to corroborate the consensus about optimal treatment and surgical timing for decompression. MATERIALS AND METHODS: Patients developing this suffering belong to two relative categories-the first group are relatively young patients with a high-energy injury that leads to fracture/subluxation or dislocation. The second category are older individuals who, due to a low-energy fall or cervical hyperextension injury present with TCCS that occurs in the presence of cervical spondylosis but without obvious injury to the spinal column. The main tool for refinement of the operative window was ASIA motor score. RESULTS: Thirty-two patient were divided in two groups-patients with ASIA motor score less than or equal to 50 p. (mean-42.4 p.)-10, and patients with a score higher than 50 p. (mean-67.45 p.)-22. Patients with ASIA M scores less than 50 p. were operated within 24 hours, but 2 patients from these-within 20 days. Patients with ASIA M score higher than 50 p. underwent decompression within 72 hours. All patients sustained improvement in neurological status with the exception of these two, who underwent late decompression. DISCUSSION: These cases clearly demonstrate to what range should operative activity be targeted in patients with TCCS. Patients with ASIA M score 80 and above, with MRI fracture evidence and those who may have already experienced significant motor improvement between the time of injury and the moment of initial neurological evaluation, may undergo delayed surgical treatment. CONCLUSIONS: There was a recommendation based on low-quality evidence that early (as soon as feasible) surgical decompression for patients with TCCS and spondylosis should be recommended when their initial neurological impairment is significant.

AIM: The vertebral compression fractures (VCF) are among the most common complications of osteoporosis that could be a cause for permanent and debilitating pain, restricted mobility and hence-significant worsening of the quality of the life. The surgical treatment of VCF is indicated after a failure of the conservative treatment or after established spinal instability or neurological deficit. The most commonly used surgical procedures are the percutaneous vertebroplasty with polymethyl methacrylate (PMMA) and the transpedicular screw fixationreconstruction. The aim of the present investigation is to summarize and elucidate the indications for the different types of spinal techniques, the potential complications and their treatment. MATERIALS AND METHODS: 72 consecutive patients with compression spinal osteoporotic fractures treated in our clinic from January, 2009 to July, 2012 were analyzed. Of these, 38 patients (M14 / F24) at an average age of 66.8 years (54-80) underwent PV on 46 levels. All the fractures were without neurological deficit and classified as A1 type in Magerl. The remaining 34 patients (M5 / F29) at an average age of 67.3 years (56-85) underwent transpedicular screw spinal reconstruction addressing incomplete burst compression fractures in which the anterior two columns were damaged. A total of 40 levels were addressed. The indications for surgery were severe pain syndrome, neurological deficit, presence of bone fragments in the spinal canal or spinal instability. RESULTS: In our series the VCF are most commonly located in the thoracolumbar (Th11-L2) segment of the spine-75.6%, (65/86) levels. In 7 patients 2 levels were treated in one settings, 2 patients had 3 levels treated and one patient 4 levels. Our PV subgroup showed very good outcome in 84.2% (32/38) of the patients. Due to migration of the cement in the spinal canal, two patients underwent surgical decompression. The results in the spinal instrumentation subgroup are good in 82.4% (28/34) of the cases. In 6 of the instrumented cases a revision surgery was performed, due to progressing neurological deficit and persistent pain. The surgery addressed screw pull-outs and implant malposition/displacement. CONCLUSION: Our results indicate that modern surgical treatment of osteoporotic patients with symptomatic VCF presents low incidence of complications and allows for a significant reduction of pain, spinal stability, improved quality of life and prolonged active life. PV is a minimally invasive procedure with a good effectiveness and uncommon complications that are clinically significant. The spinal instrumented reconstruction is indicated in cases of severe multilevel VCF, spinal instability, and compression of the neural structures.