FP images provide diagnostically useful information by depicting tissue vascularization and perfusion.

En-bloc resection, extracorporeal irradiation and re-implantation of the irradiated bone have been used to treat 15 patients suffering from primary malignant tumours of bone or cartilage and two with benign lesions. This treatment is an alternative to replacement by prosthesis or allograft bridging techniques. After a mean follow-up of over five years results are encouraging, despite some complications and the relatively long period before weight-bearing is allowed.

Overall accuracy was excellent (86%) with a negative predictive value of 100%. 18F-fluorodeoxyglucose positron emission tomography holds promise to become the standard imaging technique in this difficult patient population, as it is straightforward, provides a rapid result (2 hours) and because accurate alternatives are lacking.

We retrospectively reviewed 107 patients with 108 malignant or locally aggressive bone tumours treated between 1978 and 2009 by extracorporeal irradiation with 300 Gy to eradicate the tumour, and reimplantation of the bone as an orthotopic autograft. Patient subgroups were defined according to resection type. We describe the local recurrence rate, the graft infection rate and the factors affecting graft healing and graft survival. No local recurrences were detected in the irradiated grafts. At fiveyear follow-up, graft healing had occurred in 64% of patients, providing a stable and lasting reconstruction. For various reasons, 11% of grafts were removed, although no single factor was predictive of failure. All patient subgroups had comparable results. Early infection predicted the development of pseudarthrosis. Pelvic reconstructions had a worse graft survival. Rigid fixation and bridging of the graft appeared to be important technical points.

Anterior lumbar interbody fusion (ALIF) has increased in popularity because it has advantages over posterior fusion. Because there is disagreement about the stability of stand-alone cage ALIF, some surgeons use various types of supplementary fixation, including anterior plates, pedicle screw systems and translaminar screws, to increase segmental stability. Many factors associated with both the cages and endplates influence the time of onset and extent of subsidence after use of stand-alone cage ALIF. A large round cage with an adequate central opening is recommended to facilitate maximum contact with the periphery of the endplate. With regard to the relationship between radiographic fusion and recurrence of symptoms with the development of subsidence, most researchers have reported finding no correlation. Subsidence may be due to a process of bone incorporation between cages and endplates. Does subsidence or nonfusion really matter clinically? Further prospective, randomized controlled trials are very much needed to answer these questions.