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We report on 69 retrospectively reviewed patients who received 73 Bryan (Medtronic Sofamor Danek, Memphis, TN, USA) total disc arthroplasties for recent soft cervical disc herniations over a 9.3 year period. Three patients returned with radiculopathy due to the redevelopment of uncoforaminal stenosis at the Bryan segment and later underwent posterior decompression of the uncoforaminal area without modification to the prosthesis. They recovered from the radiculopathy after decompression; however, one patient later required adjacent segment fusion to recover from concomitant cervicalgia. After posterior decompression, all prostheses continued to function normally. In one patient, however, bony bridging of the prosthesis is imminent, despite being currently asymptomatic. We normally exclude patients with uncoforaminal stenosis from Bryan arthroplasty. Analysis of three of these patients (4.3% of patients, 4.1% of prostheses) revealed that they received a prosthesis despite slight uncoforaminal stenosis (slight stenosis was known prior to surgery in one instance, two others were only discovered intra-operatively). Our observation raises the suspicion that slight uncoforaminal stenosis could also recur in physiologically working arthroplasty segments, and that in some instances this spur formation may progress into prosthesis bridging. However, more research is required to confirm the significance of uncoforaminal stenosis discovered pre- or intra-operatively in arthroplasty patients. Posterior minimally invasive decompression using the Frykholm–Scoville keyhole approach successfully treats uncoforaminal stenosis without revising the prosthesis.

Osteoporosis and cancer patients may suffer sudden severe back pain due to vertebral body osteolysis, microfractures and/or compression fractures. These patients need immediate restabilisation of the vertebral body to eliminate the pain generator, to prevent further crushing, and to reduce the comorbidity of prolonged immobilisation. Vertebroplasty combined with pedicular instrumentation is presented as a therapy for a selected group of such patients. Eight patients with an average age of 69.1 years experienced significant relief from disabling back pain. The ability to ambulate increased significantly. The risks associated with prolonged bed rest and hospital stay were reduced. There were only minor surgical complications. Follow-up was short because of the limited life expectancy of these severely ill patients. Disabling back pain was successfully treated and ongoing vertebral body collapse was prevented by vertebroplasty combined with pedicular instrumentation in the eight selected osteoporosis and cancer patients.

The Wilhelm Tell technique is a novel instrumented anterior lumbar interbody fusion (ALIF) procedure using a specially designed composite carbon fibre cage and a single short-threaded cancellous screw that obliquely passes through the upper adjacent vertebral body, the interbody cage itself and through the lower adjacent vertebral body. This single-stage fusion method, which is in principle a combination of the Louis technique and modern cage surgery, is reported to have a lower rate of pseudoarthrosis formation than stand-alone cage techniques. In addition, it eliminates both the surgical trauma of paravertebral muscle retraction and the risk of neural damage by poorly located pedicular screws. This anterior approach allows decompression of neural structures within the anterior part of the spinal canal and the foraminal region. It is the purpose of this case report, to present the successful application of this novel technique in a 32-year-old woman who concurrently suffered from severe instability-related back pain from L4/5 isthmic spondylolisthesis and marked L5/S1 degenerative disc disease.

Post-traumatic undiagnosed disco-ligamentous and osseous lesions of the cervical spine may eventually result in irreducible extreme kyphosis. Correction of such consolidated deformities requires major surgery with a combined posterior and anterior approach, aiming to correct bony impingement on neural and vascular structures, reduce deformity and to attain circumferential instrumentation and fusion in physiological alignment. This can be achieved using either a single-staged or a two-staged procedure. Regardless, this type of major surgery entails considerable neurological risks. Therefore, thorough planning of the intervention and considerable surgical experience is needed. We present an elderly woman with gross restriction of forward gaze and intractable nuchal and radicular pain due to cervical spine deformity. Her cervical kyphosis was corrected using preoperative skeletal axial traction for four days and subsequent operative reduction with circumferential instrumentation and fusion. The post-operative course was complicated by a temporary anterior spinal artery syndrome despite normal intraoperative somatosensory evoked potentials (SSEP) and by a wound infection requiring removal of the implant. Nevertheless, segmental fusion in physiological alignment was successfully achieved and the patient fully recovered from the neurological deficit and infection. Quality of life was significantly improved.

Lumbar Schmorl nodes usually remain asymptomatic. Painful nodes either heal spontaneously or respond to conservative therapy in most instances. Diagnosis and treatment may be difficult in patients presenting with chronic back pain. We present a 31-year-old man with a lumbar Schmorl node that was unrecognised for 10 years as the origin of his severe chronic back pain. Finally, MRI revealed a significant oedematous rim around a huge Schmorl node in the L4 vertebra. After conservative therapy failed the patient underwent a successful fluoronavigation-assisted, percutaneous vertebroplasty. In the absence of other pathological conditions, an oedematous rim around the node (as seen on MRI) is probably the pain generator in chronic back pain. We believe that the relevant nociceptors are located in the oedematous rim and not in the node itself. Therefore, cement augmentation of the rim is expected to be a successful treatment. Fluoronavigation facilitates safe access to the vertebral body.