Eosinophilic granuloma of the liver: a characteristic lesion with relationship to visceral larva migrans.

Children with the clinical syndrome of visceral larva migrans as a result of Toxocara species have typical lesions in the liver and other viscera, consisting of palisading granulomas that contain numerous eosinophils and often Charcot-Leyden crystals; recognizable parasites are uncommon. Similar eosinophilic granulomas that are found incidentally in adults often cause diagnostic problems. To define better the clinical, laboratory, and pathologic features of these lesions, we reviewed 43 cases of hepatic eosinophilic granuloma (excluding cases of Langerhans' cell histiocytosis) collected in the files of the AFIP over a period of 31 years. The eosinophilic granulomas were found in patients of all ages (range 12 months to 77 years); 30% were younger than 20 years. There were 26 male and 17 female patients. Most patients (26 of 43; 60%) were asymptomatic, and the lesions were discovered incidentally. Others had fever (20%) or abdominal pain (20%). The granulomas were typically multiple (61%), with central necrosis surrounded by a mixed inflammatory infiltrate with numerous eosinophils and variable numbers of neutrophils. lymphocytes, and a palisade of epithelioid histiocytes and/or giant cells. Charcot-Leyden crystals were present in 19 cases (44%). Remnants of parasites (eight Toxocara sp., two Capillaria sp.) were identified in the tissue in 10 patients. There was a positive serologic test for Toxocara sp. in five additional cases. Immunohistochemical staining using polyclonal antiserum against Toxocara canis larvae demonstrated positivity in macrophages in eight of 13 cases tested. We conclude that identification of an eosinophilic granuloma in the liver should suggest the diagnosis of visceral larva migrans and prompt a search for the causative organism with serial sectioning of the block and serologic tests for Toxocara and other causative parasites.     

Surgical treatment of bone metastases in patients with lung cancer

Lung cancer is the leading cause of cancer mortality. Bone metastases are a common complication in lung cancer. The therapeutic approach and the type of surgical treatment of these lesions have not been clearly defined. Outcome and prognosis of patients with bony metastases and a variety of surgical interventions were analysed retrospectively. In 58 patients we performed 62 surgeries. The most common locations of metastases were the spine (32 patients), the proximal femur (10) and the pelvis (11). Twenty-one patients had a singular and 20 had multiple osseous lesions; 17 showed additional visceral involvement. Nine patients had a local progression of their disease and 49 a systemic progression. Patients with local progression (n = 9) had a better prognosis than the patients with systemic progression (p = 0.0083). Fracture (p = 0.0017) worsened prognosis, whereas the number of bone lesions or the presence of a visceral lesion did not. Patients with small lesions showed a better survival than patients with large lesions (p = 0.02). Ten percent of the patients died within 30 days and 78% within one year after surgery. Fracture of bone due to metastatic lung cancer worsens the prognosis whereas the number of bone lesions, the presence of a visceral lesion and the surgical approach do not.     

Radiculopathy as a manifestation of Langerhans' cell histiocytosis

Langerhans' cell histiocytosis (LCH) is a rare condition of children and young adults in which Langerhans' cells proliferate. The clinical spectrum ranges from solitary or few focal lesions to multisystem involvement mimicking vasculitis or hematological malignancy. Focal bone lesions, known as eosinophilic granulomas, are the most common manifestations. Eosinophilic granuloma usually presents with a variable combination of pain, swelling, fracture, and fever. Facial bone involvement may manifest as an ear discharge, hearing loss, or exophthalmos. Nerve root pain is rarely reported, even in patients with lesions in the axial skeleton. We report four cases of nerve root pain caused by LCH. Two male patients aged 25 and 34 years, respectively, presented with truncated femoral neuralgia related to acetabular granulomas. A 25-year-old woman with involvement of the L5 vertebral body and a 41-year-old man with a sacral lesion presented with sciatica.     

骨嗜酸性肉芽肿的影像诊断

目的探讨骨嗜酸性肉芽肿的影像表现特点。方法回顾性分析10例经手术病理证实的骨嗜酸性肉芽肿的X线、CT及MRI表现。10例患儿均接受CT检查,3例同时接受患部X线平片检查,5例同时接受患部MR检查,其中4例接受MR增强扫描。结果病变单发8例,多发2例。累及颅面骨4例,长骨3例（肱骨1例,胫骨1例,股骨1例）,髂骨2例,锁骨2例,椎体1例,肩胛骨1例。不同部位病变影像学表现有差异,主要表现为骨质破坏,形成软组织肿块,边缘清楚、无硬化。结论综合影像学检查能显示骨嗜酸性肉芽肿的病变形态、范围、特点,有助于诊断及鉴别诊断。     

骨嗜酸细胞肉芽肿的临床特征与治疗

目的探讨骨嗜酸细胞肉芽肿的临床表现、诊断和治疗效果。方法1991年3月至2006年3月收治骨嗜酸细胞肉芽肿28例,男19例,女9例;年龄1-61岁,平均22.4岁。病程20d～10个月。单发24例,多发4例。影像学表现为溶骨性改变,15例伴软组织肿物影。于外院确诊5例,入院后误诊为原发肿瘤及转移癌12例。所有病例均经病理学确诊。单发病例行化疗1例,手术治疗20例,手术后辅以放疗、化疗、激素综合治疗3例;多发病例采用放疗1例,激素治疗1例,综合治疗2例。结果全部病例随访7个月￣15年,平均5.3年。20例手术者手术治愈率100%;术后辅以放疗、化疗及激素治疗者无复发;植骨者6～12个月骨性愈合,随访功能不受限。1例行胸椎椎板减压术者截瘫部分恢复。4例多发病例中2例出现复发,再次给予激素及放疗、化疗后缓解。结论骨嗜酸细胞肉芽肿临床症状及影像学表现与肿瘤类似,误诊率极高。术前应尽可能行穿刺活检。对单发病例宜采用手术治疗,可辅以放疗或化疗;多发病例病灶多、范围广,不宜采用手术治疗,可选择放疗、化疗、激素治疗等综合疗法。     

Positive and negative prognostic variables for patients undergoing spine surgery for metastatic breast disease

The histology of the primary tumor in metastatic spine disease plays an important role in its treatment and prognosis. However, there is paucity in the literature of histology-specific analysis of spinal metastases. In this study, prognostic variables were reviewed for patients who underwent surgery for breast metastases to the spinal column. Respective chart review was done to first identify all patients with breast cancer over an 8-year period at a major cancer center and then to select all those with symptomatic metastatic disease to the spine who underwent spinal surgery. Univariate and multivariate analyses were used to assess several prognostic variables. Presence of visceral metastases, multiplicity of bony lesions, presence of estrogen receptors (ER), and segment of spine (cervical, thoracic, lumbar, sacral) in which metastases arose were compared with patient survival. Eighty-seven patients underwent 125 spinal surgeries. Those with estrogen receptor (ER) positivity had a longer median survival after surgery compared to those with estrogen receptor negativity. Patients with cervical location of metastasis had a shorter median survival compared with those having metastases in other areas of the spine. The presence of visceral metastases or a multiplicity of bony lesions did not have prognostic value. In patients with spinal metastases from breast cancer, aggressive surgical management may be an option for providing significant pain relief and preservation/improvement of neurological function. Interestingly, in patients undergoing such surgery, cervical location of metastasis is a negative prognostic variable, and ER-positivity is associated with better survival, while presence of visceral or multiple bony lesions does not significantly alter survival.     

甲状腺癌骨转移的外科治疗及预后因素分析

 目的 探讨甲状腺癌骨转移的临床特点、外科治疗策略及影响预后的因素。方法 回顾性分析1999年1月至2011年7月间接受外科治疗且有完整随访资料的46例甲状腺癌骨转移患者的临床资料,男20例,女26例;年龄40~87岁,平均56.87岁。中轴骨转移占91.3%,四肢骨转移占8.7%。分化型甲状腺癌占76.1%,低分化型占23.9%。19例为单发骨转移,27例为多发骨转移。应用Kaplan-Meier生存分析和COX回归对性别、年龄、病理类型、骨转移病灶数目、转移部位、内脏转移、骨科并发症、转移时长、首诊时已发生骨转移、原发病灶手术、接受131I治疗、原发病灶接受放化疗、术前一般情况、手术方式、病灶性质、术中出血量、应用预防出血措施、围手术期并发症、远期并发症19项因素进行分析。结果 78.3%的患者接受了切除性手术,平均出血量为2603.26 ml,术后5年生存率为37.3%,10年生存率为12.4%。分化型甲状腺癌、单发骨转移、接受131I治疗、术前一般情况良好为预后良好因素,其中单发骨转移和接受131I治疗为独立影响因素。结论 明确甲状腺骨转移患者的预后因素有助于确定手术适应证,从而进一步提高甲状腺癌骨转移患者的治疗效果和生存期。     

Eosinophilic granuloma in the temporal bone and skull

Eosinophilic granuloma is a benign lytic lesion of bone, probably arising from an abnormal proliferation of histiocytes. It may occur within the temporal bone and be confused with more common disorders such as aural polyps or chronic suppurative otitis media. If untreated, the disease may destroy the bony labyrinth and spread to the middle and posterior cranial fossas. Temporal bone lesions may represent only one manifestation of a more extensive multifocal disorder (i.e., Hand-Schüller-Christian or Letterer-Siwe disease). From 1967 to 1982, 25 patients with eosinophilic granuloma of the skull were treated in the radiation therapy department of The Methodist Hospital in Houston. Six of these patients had disease involving the temporal bone. After analyzing these cases and reviewing the literature, we conclude that the management of the patient with eosinophilic granuloma in the temporal bone requires a diagnosis based on microscopic examination of the affected tissue, a definition of the extent of disease, therapy consisting of biopsy and low-dosage radiotherapy in the unifocal disease, and careful and continued follow-up.     

Treatment concepts in osseous manifestations of Langerhans cell histiocytosis]

INTRODUCTION: Patients with Langerhans Cell Histiocytosis (LCH or Eosinophilic granuloma) were assessed from the orthopaedic point of view to give recommendations for the management of the disease. MATERIAL AND METHODS: The results of 36 cases of histologically proven bony manifestations out of 48 treated cases were reviewed. A retrospective analysis of our treated cases with bony manifestations of LCH between 1970 and 1995 was performed. RESULTS: Twenty-two cases exhibited isolated bony manifestations, 18 were monoostotic and 4 were polyostotic. We treated 14 cases with multi-organ disease including bony manifestations of LCH. In the cases of exclusive bony manifestations reactivations were rare and usually occurred in other bones. CONCLUSIONS: In order to assure stability local control is the general goal of orthopaedic treatment. In isolated lesions control can be achieved by excochleation and filling with cancellous bone or prednisolon instillation. Multiple lesions should be treated primarily by systemic drugs and operative procedures are only necessary if severe local problems occur. Additionally, we recommend interdisciplinary cooperation between ortopedic surgeon, pediatrist and pathologist.     

Eosinophilic granuloma of the spine

The contribution to the clinical picture of eosinophilic granuloma of the spine. This tumor-like, osteolytic bone lesion presents both diagnostic and therapeutic problems. Solitary eosinophilic granuloma of the spine is not common. Compared to the multiple manifestation of eosinophilic granuloma, which seldom spares the spine, vertebral involvement is rare in cases of solitary eosinophilic granuloma (about 10 p.c.). Spinal involvement of this disease is mainly characterized by an undramatic, uneventful clinical course, even in cases of extensive osteolytic bone defects, varying laboratory findings as well as partial or complete collapse of a vertebra, mostly in form of a true vertebrae plana. Open biopsy is recommended instead of needle aspiration biopsy in solitary eosinophilic granuloma of the spine in order to exclude Ewing's sarcoma, neuroblastoma, or bony manifestations of leukemia. In cases of solitary eosinophilic granuloma various therapeutic methods have been tried. Some authors have registered good results by means of prolonged immobilization, similar to fracture treatment. Others have used radiation therapy in moderate doses. We suggest operative treatment of solitary eosinophilic granuloma. Our procedure comprises open biopsy, frozen section examination, and curettage of the affected vertebral body, taking care not to destroy the epiphyseal plate or the intervertebral disc. Vertebral body replacement is achieved by means of a bone graft, taken from the iliac crest. The original height of the vertebra is thus restored and immediate stability of the involved area guaranteed. Undisturbed bone growth of the end plated of the vertebral body can be observed. This technique is to prevent disturbances of spinal growth and permanent deformities.(ABSTRACT TRUNCATED AT 250 WORDS)     

62例胫骨干骨折骨不连的形成原因及治疗

目的探讨胫骨干骨折后骨不连的发生原因和临床各种不同处理方法的治疗效果。方法对1998年1月至2007年1月期间我院收治的62例胫骨干骨折后骨不连病例临床资料进行回顾性分析。其中男50例,女12例;年龄平均37.4岁。AO 42-A型10例,42-B型9例,42-C型43例。开放性骨折34例,其中Gustilo型1例,型3例,A型12例,B型16例,C型2例,闭合性骨折28例。其中上1/3段5例,中1/3段14例,下1/3段43例。吸烟患者42例,非吸烟患者20例。根据骨不连类型将患者分为三组,其中肥大型骨不连组18例,萎缩型骨不连组31例,感染性骨不连组13例。采用交锁髓内钉固定34例,加压钢板内固定11例（其中1例为附加钢板固定）,外固定支架16例,单纯植骨1例。采用成组秩和检验比较患者骨折的愈合时间,美国骨科学会（american academy of orthopaedic surgeons,AAOS）下肢功能评分情况。结果本组患者骨不连的原因分别为局部血供差、机械性不稳定、骨折断端接触不良、感染、吸烟及全身因素等。61例患者达到骨折临床愈合,骨折愈合时间肥大型骨不连（5.2±1.5）个月,萎缩型骨不连（6.0±2.9）个月,感染性骨不连（9.8±3.8）个月,AAOS下肢功能评分肥大型骨不连（88.7±6.6）分,萎缩型骨不连（86.1±9.2）分,感染性骨不连（78.0±11.2）分。与肥大型、萎缩型骨不连相比,感染性骨不连骨折愈合时间长,功能结果差。结论胫骨干骨折后骨不连的原因很多,要尽量避免医源性因素导致骨不连发生的情况。在术前必须要明确每例骨不连患者的个体特异性,才能选择正确的手术治疗方式。感染性骨不连骨折愈合时间长,功能效果差,要在临床上尽量避免感染性骨不连的发生。     

Surgical treatment of bone metastases in patients with breast cancer

In this retrospective study, the effect of surgical therapy on a series of 70 patients with breast cancer who were surgically treated for metastasis of the bone was evaluated. At presentation, 19 patients had one osseous lesion, 19 patients had multiple bone lesions, and 32 patients had additional visceral involvement. The surgical procedures included 60 palliative procedures, six radical resections, and four biopsies. In 14 surviving patients, the mean observation period was 35.6 +/- 40.1 months. Of the six patients with radically resected solitary bone lesions, five patients had systemic progression of the disease develop. Of the 19 patients with presumably solitary bone lesions, five currently are free of tumor. Of the 19 patients with multiple bone lesions and initially no visceral tumor spread, only two are alive. Of the 32 patients with additional visceral metastases at surgery, four are alive with the disease. For the entire group, the survival rate was 59% after 1 year, 36% after 2 years, 13% after 5 years, and 7% after 10 years. The only two independent factors that were associated with survival were the extent of the disease and the duration of symptoms from bone metastasis. These findings suggest that in orthopaedic surgery in patients with bone metastases secondary to breast cancer, wide resection is not likely to be necessary. Patients with solitary bone lesions have a 39% chance of living 5 years.     

Anterior cervical corpectomy and fusion using miniplate and screws in a 7-year-old child with eosinophilic granuloma of the cervical spine.

STUDY DESIGN: This is a case report of a 7-year-old child with eosinophilic granuloma in the cervical spine, which underwent anterior cervical corpectomy and fusion by using Miniplate and screws. OBJECTIVES: To describe the use of Miniplate and screws for pediatric cervical anterior fusion. SUMMARY OF BACKGROUND DATA: Eosinophilic granuloma is a rare disease causing destructive bony lesions of the cervical spine in children. A complete resection and fusion were considered to be the preferable treatment in our case. However, cervical spinal fusion and instrumentation in children may be technically difficult because of the size of the vertebral body and the iliac bone. In addition, a proper device for an internal fixation in pediatric patients is not yet available. METHODS: A case of eosinophilic granuloma in pediatric spine was presented. RESULTS: We confirmed successful bony fusion and the restoration of the normal cervical curvature without recurrence of the tumor 2 years after the procedure. CONCLUSIONS: For proper internal fixation and prevention of dislodgement of the grafted bone, we used the Miniplate and screws as internal fixator after intralesional resection of the tumor mass.     

非典型性脊柱结核影像学分型与表现形式

 目的 探讨成人非典型性脊柱结核的影像学分型与表现形式。方法 回顾性分析并总结2000年2月至2012年10月经病理确诊的45 例成人非典型性脊柱结核患者资料,男29例,女16例;年龄20~71岁,平均46.2岁;25例有潮热、乏力及消瘦表现,20例无明显全身结核中毒表现;37例红细胞沉降率为25~107 mm/1 h,8例正常。所有患者均摄脊柱X 线片,并行CT扫描及MR检查, 其中12例辅加脊柱螺旋CT三维重建,2例辅加PET-CT检查。45例患者均行外科手术治疗,其中3例术前行CT引导下病灶穿刺活检;均经病理检查证实为脊柱结核。结果 非典型性脊柱结核的影像学分型包括,单椎体型（9例）,MRI T2WI示单一椎体病灶呈不均匀高信号,CT扫描示老年人病变椎体以虫蚀样、溶骨性破坏为主,青年人病变椎体内呈单个均匀透光的圆形溶骨性骨质破坏区;单脊椎椎体附件型（2例）,MRI T2WI示椎体附件呈高信号改变,CT扫描示椎板及椎弓根呈虫蚀样骨质破坏;单脊椎全椎骨型（8例）,CT扫描示单脊椎的椎体及附件均呈虫蚀样广泛骨质破坏;椎间盘型结核（5例）,MRI示椎间盘信号减低,团状的椎盘组织突入椎管压迫脊髓;多发性相邻型脊柱结核（14例）,螺旋CT示多个相邻椎体虫蚀样骨质破坏;多发性非相邻型（跳跃型）脊柱结核（7例）,MRI示非相邻多个椎体在T2WI上呈现椎体骨质结构破坏的混杂信号,其中个别病例T2WI示高信号的椎旁脓肿通过流注方式波及多个非相邻椎体。结论 非典型性脊柱结核有多种影像学表现形式且极不典型,但虫蚀样骨质破坏、骨髓水肿、前和（或）后纵韧带高信号等影像学改变均为非典型性脊柱结核影像学的特征性表现。
     

Role of endovascular surgery in presence of rupture of the thoracic aorta in patients with severe multisystemic post-traumatic surgical lesions

The endovascular treatment (ET) of traumatic rupture of the thoracic aorta (TRTA) may represent, particularly in patients with severe multisystemic post-traumatic surgical lesions, an alternative approach to traditional surgery. We observed (October 2001- November 2004) 5 male patients (age: range 23-42 years - average 32,4) affected by TRTA (3 isthmic aortic ruptures - 2 distal descending thoracic aorta ruptures), all successfully treated with an endovascular approach. The Glasgow Coma Score (GCS) ranged between 5 and 13. After performing resuscitation manoeuvres, all patients were investigated with total body CT scans in order to evaluate the thoracic aorta and to identify associated visceral lesions. In 4 cases were evident associated visceral lesions (3 cases: bone, abdominal and neurosurgical trauma - 1 case: bone, abdominal, neurosurgical and thoracic trauma). All the procedures were performed in the operative room using DSA (Digital Subtraction Angiography). The mean operating time was 105 minutes (range 80 - 125). We didn't observed early and late complications (follow-up: average 24 months, range 12-36). In conclusion the ET of TRTA represents in 'critical' patients with severe polytrauma an alternative approach to traditional surgery in order to 'stabilizing' the cardiovascular clinical parameters and to treating 'safety' the other associated surgical lesions.     

Treatment of splenic injuries. Retrospective study of 101 cases

101 patients with splenic trauma were treated during the period 1978 to 1988. They included 76 men and 25 women aged between 16 and 85 years, with a mean age of 38 years 6 months. Exclusively splenic lesions were present in 33 cases (32.67%) and bony or visceral lesions were also present in 68 cases (67.33%). 61 cases (60.39%) suffered from multiple trauma. 97 patients underwent laparotomy, 86 (85.1%) subsequently underwent total splenectomy and 11 (10.8%) conservative surgical treatment (10 partial splenectomies and 1 splenorrhaphy). Four patients did not undergo surgery and were kept under surveillance in a surgical ward for 3 weeks. The majority of partial splenectomies were carried out after 1985 though the first was performed in 1981. There was no operative mortality and post-operative mortality was 9.9% (10 deaths). The overall mean duration of hospitalisation was 20.2 days: 15.6 days for patients who underwent partial splenectomy, 19.6 days for patients who underwent total splenectomy and 21 days for cases involving simple surveillance. Operative complications occurred in 28 patients who underwent laparotomy. Complications did not occur in the 4 patients who received simple surveillance. The most frequent complications were sepsis, pneumonia, thrombo-embolic complications and four patients required reoperation for hemoperitoneum. Conservative surgical treatment is increasingly being used in splenic trauma. The criteria for avoidance of surgical intervention remain difficult to define at the present time.     

Occult osseous lesions documented by magnetic resonance imaging associated with anterior cruciate ligament ruptures

Magnetic resonance images (MRI) were performed within three weeks of anterior cruciate ligament (ACL) rupture on 75 skeletally mature patients. Occult bony lesions were documented in 64 (85%) of the patients. Of the 64 patients with bone injuries, 83% had lesions of the lateral compartment. The lateral femoral condyle was involved in 50%, and the lateral tibial plateau was injured in 50% of the patients with changes. Nineteen of the 64 patients had more than one area of bony injury. Although the majority of bony lesions resolve, permanent alterations remained in some cases. This study has implications that may affect rehabilitation and the long-term prognosis in those patients with extensive bony and associated articular cartilage injuries.     

Mycobacterium marinum infections of the hand

Fifteen patients had culture proven Mycobacterium marinum infections of the hand; 11 had injured their hands while fishing in water around Long Island. No patient had type I lesions (verrucal), six patients had type II lesions (subcutaneous granulomas), and nine patients had type III lesions (deep). Histologic examination showed noncaseating granulomas in all cases. A specific defect in the patients' lymphocytes ability to respond to M. marinum antigens was identified. A combination of surgery and tetracycline provided effective treatment. Follow-up averaged 2 1/2 years.     

The use of an antibiotic-impregnated,osteoconductive, bioabsorbable bone substitute in the treatment of infected long bone defects: early results of a prospective trial

OBJECTIVE: We sought to evaluate the use of a bioabsorbable, tobramycin-impregnated bone graft substitute (calcium sulfate alpha-hemihydrate pellets) in the treatment of patients with infected bony defects and nonunions. STUDY DESIGN/METHODS: Twenty-five patients (15 male and 10 female, mean age 43 years (range 27-69 years) requiring surgical debridement of culture-positive long bone infection (16 with associated nonunion) were entered into an ongoing consecutive, prospective clinical trial. Involved bones included the tibia ( 15), femur ( 6), ulna ( 3), and humerus ( 1). All defects were posttraumatic in origin, and each patient had had previous surgery at the involved site (mean 4.3 surgeries; range 1-8 surgeries). The duration of infection ranged from 4 months to 20 years (mean 43 months). According to the Cierny-Mader classification system, there was 1 stage I (medullary osteomyelitis), 6 stage III (localized osteomyelitis), and 18 stage IV (diffuse osteomyelitis) lesions. There were 4 normal (A) hosts and 21 locally and/or systemically compromised (B) hosts. Mean bone defect/void was 30.5 cm (range 3-192 cm ). RESULTS: Mean follow-up was 28 months (range 20-38 months). Radiographically, pellets were resorbed at a mean of 2.7 months postoperatively. Infection was eradicated in 23 of 25 patients (92%). Isolated bony defects healed in all nine patients without further treatment. Fourteen of 16 patients with nonunion achieved union, although nine required autogenous bone grafting. Union was achieved in five of seven nonunion patients treated with bone graft substitute in isolation. Complications included refracture (three), recurrence of infection (two), persistent nonunion (two), and superficial wound necrosis (one). Eight patients developed sterile draining sinuses that healed upon radiographic resorption of the pellets. CONCLUSIONS: In patients with posttraumatic osteomyelitis, the bone graft substitute was effective in eradicating bone infection in 23 of 25 patients. Isolated bony defects healed reliably (nine of nine) following addition of bone graft substitute alone. The role of the bone graft substitute in isolation in the treatment of nonunion is unclear at present.     

The treatment of multiple myeloma of the cervical spine with a halo vest

Two patients with multiple myeloma involving the cervical spine and causing instability were treated in a halo vest while radiotherapy and chemotherapy were instituted. Further instability and neurological loss were prevented while continuing this treatment. The bony lesions eventually healed and mechanical stability was restored in both patients. Temporary halo vest placement with concurrent chemo- and/or radiotherapy can be a reasonable and safe alternative to surgery in those patients with multiple myeloma involving the cervical spine, and often results in bone reconstitution and stability.