The spinal column represents the third most common site for metastases after the lungs and the liver, and the most common site for metastatic bone disease. With life-extending advances in the systemic treatment of cancer patients, the surgical procedures performed for spinal metastases will increase, and their related complications will increase unavoidably. Furthermore, considering the high complication rates reported in the spinal literature regarding spine surgery overall, it becomes clear that a better understanding of complications that the cancer patients with spinal metastases may experience is necessary. This article aims to summarize and critically examine the current evidence for complications after spine surgery for metastatic spinal disease, in both the perioperative and postoperative period. This paper would be useful for the treating physicians of these patients in their clinical practice.

IntroductionTraumatic lumbosacral spondylolisthesis is a very uncommon lesion. The literature testifies to this rareness, reporting only 22 cases over the last 50 years [1, 2, 4, 5, 7, 9-11, 13-15, 21, 22]. These include seven cases of pure bilateral dislocation [1,4,5,7,11,15,22]. The specific features of the lesion, as well as the different possible radiographic and clinical findings that characterize it, have encouraged many researchers to attempt to propose possible interpretations of the kinematics of the lesion. PathomechanicsThe mechanics of the lesion, on the basis of its rareness and its association with monolateral fractures of the lumbar transverse apophyses, which occur in a very high percentage of cases, has been the subject of numerous studies, the conclusions of which often appear to disagree.Hyperextension has been pointed to as an efficient traumatic vector [23]; other authors appear to disagree, believing that the main mechanism responsible for the lesion is constituted by the association between hyperflexion, compression and rotation [4,11,21,24], or by the action of the direct traumatic vectors [1,17].In the cases that came to our observation, an accurate history of each patient allowed us to generally reconstruct the dynamics of the trauma. The patient with a "pure" dislocation had undergone sudden hyperflexion of the lumbosacral spine, with his thighs flexed on the pelvis. This had been provoked by doing a somersault in the air and landing on his bottom. In the patient with fracture-dislocation, the main traumatic mechanism had been violent and direct posterior trauma in the lumbar spine (the patient had been thrown from a motorcycle ending up against a pole). This mechanism, in clear contrast to what has been affirmed by Roaf [20], appears to be similar to that described by Beguiristain et al. [1], and it may be likened to an actual lesion caused by the application of shear traumatic vectors. AbstractThe literature reports that traumatic spondylolisthesis of L5 is an uncommon lesion. The authors report their experience of three cases of this particular fracture-dislocation of the lumbosacral spine. They stress the importance of certain radiographic signs in the diagnosis: namely, the presence of unilateral multiple fracture of the transverse lumbar apophysis. As far as the treatment is concerned, they state the need for an open reduction and an internal segmental fixation by posterior approach. A preoperative MRI study appears mandatory in order to evaluate the integrity of the L5-S1 disc. In the event of a traumatic disruption of the disc, they state the importance of posterior interbody fusion by means of a strut graft carved from the ilium or, in case of iliac wing fracture (which is not uncommon in these patients), by means of interbody cages.Key words Lumbosacral spine · Fracture-dislocations · Traumatic L5-S1 spondylolisthesis · Surgical treatment ORIGINAL ARTICLE Eur Spine J (1999) 8 : 290-295

Intraoperative distraction appears to be truly effective in reducing severe lumbosacral olyshtesis in children. Posterior interbody fusion (and eventual sacral dome osteotomy) successfully combines the goals of solid fusion with the requirements of root decompression. No neurologic problems were seen as a consequence of distraction. The solidity of the posterior segmental pedicle instrumentation combined with the anterior strut graft eliminate the need for postoperative casting.

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The aim of our prospective non-randomized clinical study was to analyze operative data, short-term results, safety, efficacy, complications, and prognostic factors for single-level total lumbar disc replacement (TLDR), and to compare results between different levels (L4-L5 vs. L5-S1). Thirty-six patients with single-level L4-L5 or L5-S1 TLDR, with 1-year minimum follow-up (FU), had complete clinical [SF36, visual analog scale (VAS), Oswestry Disability Index (ODI)] and radiological data, and were included in our study. Mean FU was 38.67 +/- 17.34 months. Replaced level was L4-L5 in 12 (33.3%) cases, and L5-S1 in 24 cases (66.7%). Mean age at diagnosis was 41.17 +/- 7.14 years. 24 (66.7%) were females and 12 (33.3%) were males. Statistical analyses were assessed using t tests or Mann-Whitney test for continuous variables and Chi-square test or Fisher's exact test analyses for categorical variables. Univariate linear regression and binary logistic regression analyses were utilized to evaluate the relationship between surgical outcomes and covariates (gender, age, etiology, treated level, pre-operative SF36, ODI, and VAS). Mean operative time was 147.03 +/- 30.03 min. Mean hospital stay was 9.69 +/- 5.39 days, and mean return to ambulation was 4.31 +/- 1.17 days. At 1-year FU, patients revealed a statistical significant improvement in VAS pain (P = 0.000), ODI lumbar function (P = 0.000), and SF36 general health status (P = 0.000). Single-level TLDR is a good alternative to fusion for chronic discogenic low back pain refractory to conservative measures. Our study confirmed satisfactory clinical results for monosegmental L4-L5 and L5-S1 disc prosthesis, with no difference between the two different levels for SF36 (P = 0.217), ODI (P = 0.527), and VAS (P = 0.269). However, replacement of the L4-L5 disc is affected by an increased risk of complication (P = 0.000). There were no prognostic factors for intraoperative blood loss or return to ambulation. Age (P = 0.034) was the only prognostic factor for operative time. Hospital stay was affected by level (P = 0.036) and pre-op VAS (P = 0.006), while complications were affected by the level (P = 0.000) and pre-op ODI (P = 0.049). Complete pre-operative assessment (in particular VAS and ODI questionnaires) is important because more debilitating patients will have more hospital stay and higher complications or complaints. Patients had to be informed that complications, possibly severe, are particularly frequent (80.6%).