Standing posture is made possible by hip extension and lumbar lordosis. Lumbar lordosis is correlated with pelvic parameters, such as the declivity angle of the upper surface of the sacrum and the incidence angle, which determine the sagittal morphotype. Incidence angle, which is different for each individual, is known to be very important for upright posture, but its course during life has not yet been established. Incidence angle was measured on radiographs of 30 fetuses, 30 children and 30 adults, and results were analysed using the correlation coefficient r and Student's t test. A statistically significant correlation between age and incidence angle was observed. Incidence angle considerably increases during the first months, continues to increase during early years, and stabilizes around the age of 10 years. Incidence is a mark of bipedism, and its role in sagittal balance is essential.

To evaluate the long-term effectiveness of a single cervical epidural steroid injection (CESI) performed with or without morphine, 24 patients, without need of surgery, but suffering for more than 12 months from cervical radicular pain, were included in a prospective and randomised study. The cervical epidural space was injected (C7-D1; 18-ga needle) with an increasing volume (10 ml maximum) of isotonic saline solution to exacerbate the patient's radicular pain. The patients were then randomly allocated to 2 groups: the steroid group (group S, n = 14) received an equivalent volume of 0.5% lidocaine plus triamcinolone acetonide (10 mg/ml) and the steroid plus morphine group (group S + M, n = 10) received the same combination plus 2.5 mg of morphine sulphate. Pain relief was assessed as the percentage of pain decrease on a visual analogue scale on day 1 and at months 1, 3, 6, 8 and 12 after CESI, up to 48 months. Anthropometric data between the 2 groups were similar. The mean volume injected in the epidural space was: 6.6 +/- 2.1 and 6.3 +/- 1.9 ml in groups S and S + M, respectively, and this volume exacerbated pain in 21 of 24 patients. Despite observing a better transient improvement the day after CESI in the S + M group, long-term results did not differ. The success rate was 78.5% in group S and 80% in group S + M providing pain relief of 86.8 +/- 14.7% and 86.9 +/- 17.9%, respectively. Pain relief remained stable with time (mean follow-up: 43 +/- 18.1 months).(ABSTRACT TRUNCATED AT 250 WORDS)

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IntroductionThe principal drawback of surgery for bony metastatic locations, particularly vertebral metastases (VM), is, for many surgeons, the relative frequency of complications due to the procedures themselves. We decided to verify whether this fear is well founded by determining the frequency of immediate and secondary complications of such surgery, and to look for causes or predisposing factors that might point to means for reducing the frequency of these complications. Materials and methodsWe carried out a retrospective study of 145 patients operated in our unit between 1982 and 1991 for vertebral metastasis of malignant tumours. The surgery was indicated to reduce pain, prevent onset or aggravation of neural deficits, and to improve the quality of life of the patients. Primary vertebral tumours were excluded from this series. Vertebral locations of haematological malignancies, which involve problems similar to those encountered in solid tumour metastases, were, on the other hand, included. EpidemiologyPrimary tumor (Table 1) The 145 patients operated were among 155 patients hospitalized between 1982 and 1991 in our unit, for secondary locations of malignant tumours. Among these 155 patients, the primary tumour had already been diagnosed in 103 patients at the time that one or more metastases were detected. Vertebral metastasis was the inaugural manifestation of cancer in the other 52 patients (33.5%).In the majority of cases in which the primary tumour was already known at diagnosis of vertebral metastasis, either breast cancer (n = 39, 37.8%), lung cancer (n = 13, 12.6%) or colon cancer (n = 8, 7.7%, all colic locations combined) was involved.Among the rarer locations were noted tumours of the kidney, prostate, uterus (neck or body), oesophagus and bladder. We classed the even rarer tumours into the category "others" (synoviosarcoma, neuroendocrine carcinoma, leiomyosarcoma, malignant melanoma, malignant fibrous histiocytoma, tumour of the pancreas, tumour of the pharynx), when they were already diagnosed at the time of discovery of VM. AbstractThe authors report their experience concerning complications of spinal metastasis surgery. The purpose of this study was to assess the frequency of such complications and analyse the factors influencing their occurrence. The records of 145 patients treated between 1982 and 1991 for metastatic disease of the spine were retrospectively reviewed for intra-and postoperative complications. Other factors such as radiation therapy, emergent nature of surgery, and neurologic deficits were analysed for potential correlations with the frequency of complications. Twentyseven (18.6%) patients developed postoperative complications. Wound dehiscence and infection (11%) were the most frequent complications. Statistical analysis showed a significant influence of three factors: preoperative radiation therapy, paraplegia before surgery, and surgery under emergency conditions. The rate of complications in this surgery is lower than might be expected and can be significantly reduced....

Cervical spine trauma occurs frequently in front-line rugby players. To evaluate the accumulative effects of this trauma, magnetic resonance imaging scans of the cervical spine were performed on 47 rugby players and 40 age-matched control subjects. The aim of this study was to compare the changes in the cervical spine of players at different points in their careers. A study of cervical spine changes, including spinal curve, spinal constituents, posttraumatic deformities, and degenerative modifications, was completed by a study of cervical measurements. Front-line rugby players showed more early degenerative alterations on magnetic resonance imaging scans than did the control subjects of the same age. These changes correlated with age and were probably linked with repetitive cervical trauma throughout the players' careers. Particular attention should be paid to the data confirming cervical spine canal stenosis in front-line players, which may place these athletes at risk for acute neurapraxia while playing this collision sport.