Scielo RSS http://www.scielo.org.za/rss.php?pid=1681-150X20140002&lang=en vol. 13 num. 2 lang. en http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000200001&lng=en&nrm=iso&tlng=en http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000200002&lng=en&nrm=iso&tlng=en BACKGROUND: Neurogenic and referred leg pain are some of the most challenging clinical problems in spinal surgery due to the diversity of conditions that can act as aetiological factors. METHODS: The literature was reviewed and combined with case studies to demonstrate different aetiological factors. RESULTS: At least 300 conditions were identified that might cause neurogenic and referred leg pain. An aetiological classification of neurogenic and referred leg pain is presented. The classification includes systemic conditions, conditions from the brain, spinal cord, cervical and thoracic spinal canal, lumbar spinal canal, lumbar nerve root canal, lumbar extraforaminal area, the pelvis and the lower extremity. Each one of these conditions can mimic a lumbar disc herniation accurately. CONCLUSION: The aetiological classification can be used as a checklist when evaluating neurogenic and referred leg pain. Each condition deserves careful consideration and when overlooked might result in a missed diagnosis. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000200003&lng=en&nrm=iso&tlng=en Transarticular screw fixation offers acceptably high fusion rates but is not possible in 18% of patients due to a high riding vertebral artery. It also requires pre-operative anatomical reduction which is not always possible. The Harms technique utilises a posterior C1 lateral mass and C2 pedicle screw. This allows easier access due to the angle of drilling and has become an increasingly popular surgical technique. AIM: The aim of this study is to review and compare the above techniques with regard to surgery, complications and outcome. METHODS: A retrospective case note and radiographic review of 42 patients undergoing posterior C1-2 fusion in a single institution during the period 2003 to 2011, identified on a prospectively maintained database, was performed. The indication for surgery was atlanto-axial instability with post-traumatic and rheumatoid arthritis the commonest aetiologies. There was no difference in age and gender between the two groups. RESULTS: The Harms method had a slightly higher mean blood loss compared to the transarticular method. The surgical time was no different. The transarticular technique was abandoned in three cases due to inability to place the screw safely. The Harms technique was successfully completed in all cases. There were four unilateral vertebral artery injuries in the transarticular group and one in the Harms group. There were three intra-operative unintentional durotomies in the transarticular group with one in the Harms. All but one transarticular case fused, with five transarticular cases taking more than 9 months. CONCLUSION: Although the Harms technique had an increased blood loss, the incidence of vertebral artery and dura injury was lower. Fusion was similar in both groups with the only non-union occurring in the transarticular group. The Harms technique offers the advantage of intra-operative reduction and a smaller exposure due to the direction of access but at a higher instrumentation cost. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000200004&lng=en&nrm=iso&tlng=en Metatarsalgia of the lesser toes is commonly caused by metatarsophalangeal (MTP) joint instability. The clinical presentation varies but often includes pain on the plantar aspect of the forefoot that often progresses to the development of coronal and transverse plane malalignment. In some cases, frank MTP joint dislocation can develop. Operative treatment has historically included indirect surgical realignment utilising soft tissue release, soft tissue reefing, tendon transfer, and periarticular osteotomies. An improved understanding of plantar plate tears has recently led to the development of a clinical staging and anatomic grading system that helps guide treatment. A dorsal surgical approach, With the exposure augmented utilising a Weil osteotomy, allows the surgeon to directly access and repaid the plantar plate. Early clinical results suggest that direct plantar plate repair may be a significant advancement in the reconstruction and realignment of lesser MTP joint instability. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000200005&lng=en&nrm=iso&tlng=en To date, no evidence-based guidelines for the treatment of chronic osteomyelitis exist. Owing to certain similarities, treatment philosophies applicable to musculoskeletal tumour surgery may be applied in the management of chronic osteomyelitis. This novel approach not only reinforces certain important treatment principles, but may also allow for improved patient selection as surgical margins may be customised according to relevant host factors. When distilled to its most elementary level, management is based on a choice between either a palliative or curative approach. Unfortunately there are currently no objective criteria to guide selection of the most appropriate treatment pathway. The pre-operative diagnostic work-up should be tailored according to the relevant objective, albeit confirming the clinical suspicion of the presence of infection, host stratification, anatomical disease classification, pre-operative planning or post-operative follow-up. MRI and PET-CT are emerging as the imaging modalities of choice. interleukin-6, in combination with CRP, has been shown to have excellent sensitivity in the diagnosis of implant-associated infection. Molecular methods are growing rapidly as the method of choice in pathogen detection. Chronic osteomyelitis, as is the case with musculoskeletal tumours, can only be eradicated through complete resection of all infected bone. Chemotherapy, in the form of antibiotics, only plays an adjuvant role. Dead space management is essential following debridement, and the appropriate strategy should be selected according to the anatomical nature of the disease. Provision of adequate bony stability is crucial as it promotes revascularisation and maximisation of the host's immune response. Although there is currently a variety of fixation options available, external fixation is generally preferred. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000200006&lng=en&nrm=iso&tlng=en Telangiectatic osteosarcoma is a rare variant of osteosarcoma accounting for 3%-11% of all primary osteosarcomas.¹ It has well described distinctive radio-pathological features. Radiographically, these tumours appear as purely lytic destructive lesions located in the metaphyses of long bones. On gross clinical examination, it presents as a soft and cystic mass. Histologically findings are that of aneurysmally dilated spaces lined by osteoid-producing atypical stromal cells. This is a report on a patient with an atypical telangiectatic osteosarcoma which was missed by the primary treating medical team. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2014000200007&lng=en&nrm=iso&tlng=en Tibial non-unions not only result in significant physical impairment but also serve as a source of considerable psychological and socio-economic stress for the patient. Unnecessary delays in recognising potential non-unions lead to treatment delays that further exacerbate the morbidities associated with non-unions. Current definitions are not universally accepted and are considered by some to be too esoteric for general use. The lack of clear defining criteria for non-union may result in delays in diagnosis and appropriate management. The most frequently used classification systems currently are more than 30 years old and do not take new knowledge of biology and modern treatment modalities into account.