Objectives Cervical disc arthroplasty (CDA) has become an alternative treatment for cervical radiculopathy and myelopathy. This technique preserves appropriate motion at both the index and adjacent disc levels and consequently may prevent adjacent segment degeneration (ASD). The authors performed a meta-analysis to compare the safety and efficacy of CDA to those of the gold standard, anterior cervical discectomy and fusion (ACDF). Both surgical and clinical parameters were employed to verify the hypothesis that CDA can reduce the risk of ASD. Methods The meta-analysis comprised high-quality randomized controlled trials that compared CDA and ACDF treatments of cervical degenerative disc disease. Included papers reported data for at least one of the following outcomes: 1) surgical parameters, 2) questionnaire clinical indices (pre- and postoperative values), and 3) complication rates at 24 months; in addition, for ASD we analyzed 60 month or longer follow-ups. We used mean differences (MDs) or ORs to compare treatment effects between CDA and ACDF. Results Twenty studies with 3,656 patients (2,140 with CDA and 1,516 with ACDF) met the inclusion criteria. CDA surgery, with mean duration longer than that of ACDF, was associated with higher blood loss. Visual analog scale neck pain score was significantly smaller for CDA (mean difference =−2.30, 95% CI [−3.72; −0.87], P =0.002). The frequency of dysphagia/dysphonia (OR =0.69, 95% CI [0.49; 0.98], P =0.04) as well as the long-term ASD rate for CDA was significantly smaller (OR =0.33, 95% CI [0.21; 0.50], P <0.0001). Conclusion A significantly lower probability of ASD reoperations in the CDA cohort after a 60-month or longer follow-up was the most important finding of this study. Despite the moderate quality of this evidence, the pooled data corroborated for the very first time that CDA was efficacious in preventing ASD.

Only a few cases of iatrogenic lumbar injury have been reported in the literature. A 58-year-old male with severe back pain was admitted to our department. The patient was qualified for the transpedicular stabilization with interbody fixation at L4/L5 and L5/S1 levels. On the first day after surgery, the patient was mobile and reported significant pain relief. He was discharged the same day. After 2 weeks, the patient returned with severe right lower abdominal pain and radicular pain in his right leg. He was administered to the Neurology Department where the presence of a lumbar muscle hematoma and lumbar artery pseudoaneurysm were discovered. He was transferred to the Vascular Surgery Department where aortography was performed and the pseudoaneurysm was embolized. After few days, the patient’s overall condition improved significantly. Eight weeks after surgery, he was pain-free. Our case shows how initially innocuous symptoms may be the result of serious complications.

Patients with degenerative disc disease may suffer from chronic lumbar discogenic (DP) or radicular leg (RLP) pain. Minimally invasive DiscoGel therapy involves the percutaneous injection of an ethanol gel into the degenerated disk’s nucleus pulposus. This paper compares the 1-year outcome of such treatment in DP and RLP patients. We operated on 67 patients (49 men and 18 women) aged 20–68 years (mean age 46 ± 11 years) with DP (n = 45) and RLP (n = 22), of at least 6–8 weeks duration, with no adverse effects. We evaluated the treatment outcome with Core Outcome Measures Index (COMI) and Visual Analog Scale (VAS). A year after the ethanol gel injection, in the DP cohort, COMI and VAS dropped by 66% (6.40 vs. 2.20) and 53% (6.33 vs. 2.97), respectively. For the RLP patients, the corresponding values dropped 48% (7.05 vs. 3.68) and 54% (6.77 vs. 3.13). There were no differences between the cohorts in COMI and VAS at the follow-up end. Six months into the study, 74% of DP and 81% of RLP patients did not use any analgesics. Ethanol gel therapy can be effective for many patients. Moreover, its potential failure does not exclude surgical treatment options.

Objective: This report aims to describe the surgical methodology and potential effectiveness of endoscopic separation surgery (ESS) in patients with metastatic spine disease. This concept may reduce the invasiveness of the procedure, which can potentially speed up the wound healing process and, thus, the possibility of faster application of radiotherapy. Materials and Methods: In this study, separation surgery for preparing patients for stereotactic body radiotherapy (SBRT) was performed with fully endoscopic spine surgery (FESS) followed by percutaneous screw fixation (PSF). Results: Three patients with metastatic spine disease in the thoracic spine were treated with fully endoscopic spine separation surgery. The first case resulted in the progression of paresis symptoms that resulted in disqualification from further oncological treatment. The remaining two patients achieved satisfactory clinical and radiological effects and were referred for additional radiotherapy. Conclusions: With advancements in medical technology, such as endoscopic visualization, and new tools for coagulation, we can treat more and more spine diseases. Until now, spine metastasis was not an indication for the use of endoscopy. This method is very technically challenging and risky, especially at such an early stage of application, due to variations in the patient’s condition, morphological diversity, and the nature of metastatic lesions in the spine. Further trials are needed to determine whether this new approach to treating patients with spine metastases is a promising breakthrough or a dead end.

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