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Basing on clinical experience of 212 surgically treated spinal tumours the authors present the principal problems in surgical treatment of neoplasmatic disease of the spine. The essential aim of surgical treatment is the tendency to the radical removal of the tumour and, in the same time, to achieve a good stabilization of the spine. The best method of stabilization of the spine is internal stabilization, transpedicular and interbody. The removed parts of the vertebral column should be replaced with bone grafts. The surgical treatment should be combined with oncological and rehabilitation.

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29 cases of the peripheral nerve tumours treated in the Department of Neurosurgery Military Medical Academy in Lódz between 1971 and 1993 are presented. The clinical symptoms, diagnostic methods, methods of operation and results are discussed. The differences are stressed, related to histological types of tumours. The reason of this management was given.

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In 1971-1985 surgical treatment was carried out of 29 patients in the Neurosurgery Department WAM in Lódz and 5 in the Rehabilitation Centre in Konstancin for spondylolisthesis complicated with signs of cauda equina damage. In the surgical treatment the technique used was that of a combination of neurosurgical approach (full decompression of the nervous elements in the vertebral canal by laminectomy with foraminectomy or facetectomy, removal of protruding discs and osteophytes and parts of the vertebral bodies narrowing the vertebral canal), and orthopaedic procedures (spondylodesis between vertebral bodies posterior spondylodesis and a combination of both techniques). In one case spring alloplasty was done and in one case Harrington's rods were used. The operation was carried out at one time from the same posterior approach. The follow-up was from 1 to 15 years. A very good result was obtained in 20.6% of cases, good in 55.9%, satisfactory in 23.5%. In no case of worsening or lack of improvement were observed.

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The authors report the clinical material from the Department of Neurosurgery, WAM in Lódz from the last 11 years including cases of damage to the deep branch of the ulnar nerve. In view of the importance of this branch for the function of the hand, damage to it requires very careful surgical management with autogenous graft. Sometimes this is technically difficult in view of the topographic conditions in this area. Damage to the deep branch of this nerve is usually associated with damage to the sensory part of the ulnar nerve, to the median nerve and tendons of finger flexors.

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In the period 1971-1981 operations were carried out in 1114 cases of discopathy or lumbar spondylosis. Three patients in this group had pains of the type of intermittent claudication as the main symptoms. In all these cases narrowing of the vertebral canal was found in the lumbar part caused in two cases by degenerative changes and herniation of the intervertebral discs, and in a third case it was due to an extensive connective tissue scar at the site of previously done laminectomy. The nerve roots of the cauda were relieved from pressure surgically and in all cases pains disappeared. The authors discuss factors contributing to the development of neurogenic intermittent claudication.

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The authors discuss the tactics in the surgical approach in radical operations on the spinal cord, cauda and spine. The discussion is based on 1972 operations on the spine and spinal cord. The group of radical operations comprises 192 cases. The operative mortality in this material was 1%. The authors believe that the surgical tactics in these diseases should be considerate but also as radical as possible.

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Glomangiomas are most frequently situated on fingers and toes, especially in the vicinity of the ungual plate. The authors report five cases of glomangiomas of atypical location/in the knee joint, in the vicinity of femoral and tibial epiphyses, and in the subcutaneous tissue on the forearm. The clinical findings are described, stressing the lack of parallelism between the intensity of symptoms and the size of the tumour which rarely exceeds the size of a millet grain. Complete removal of the tumour produces complete disappearance of pain and recurrences are not observed.

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The authors present a method of surgical treatment of progressive paresis of the ulnar nerve by means of transposition of this nerve to the anterior aspect of the cubital fossa. This method was used in 35 cases. The most frequent cause of the paresis was old fracture or contusion of the region of the cubital joint. In all cases the therapeutic result was good.

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The authors present the microsurgical technique of grafting thin cutaneous nerves at the site of peripheral nerve defect. The application of grafts in place of end-to-end suture makes possible elimination of nerve stretching at the time of suturing and at the time of rehabilitation. The use of cutaneous nerves makes possible good revascularization of grafts and their correct regeneration. The use of the microsurgical technique makes possible a good evaluation of the fascicular structure of nerve trunks, their adequate resection, and good adaptation of nerve stumps and grafts connecting the corresponding nerve fascicles. The use of the technique of nerve gluing with autologous plasma enables a stable connection of grafts and stumps to be obtained, with simultaneous elimination of foreign material (threads) from the area of connection.

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The authors present the first in the Polish literature group of 320 cases of autogenic nerve cable grafts. The overall results of this treatment are: very good and good in 43.3%, satisfactory in 29.1%, poor in 18.2%, bad in 9.4%. Nearly all bad results were obtained in grafting nerves in the lower extremity. A comparison of the results obtained with the classic nerve suture and short cable grafts shows a decidedly evident superiority of grafts over the classic suture. The advantages of grafts are discussed, particularly with respect to nerve blood supply. The importance of early surgical treatment and prolonged heat treatment is stressed.

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The authors report two cases of Horton's neuralgia treated surgically. In one patient the result is very good, in the other one it is poor. The pathophysiological mechanisms and anatomical-functional basis of this type of headache are discussed stressing the contribution to the knowledge of these mechanisms made by Professor Jerzy Choróbski. It seems that more patients should be referred for this treatment that it is done presently. The operation with sectioning of this nerve is not particularly troublesome and it may be a good supplementation of pharmacological treatment.

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