Thalidomide: a comeback?

Thalidomide, a synthetic glutamic acid derivative first marketed in 1954 as a sedative, rapidly gained worldwide notoriety as a cause of phocomelia. To prevent further cases of this severe birth defect, thalidomide was removed from the market. Over the last few years, however, thalidomide has been found to exhibit properties of potential usefulness in a range of conditions. Trials are under way in rheumatic diseases, and safer analogs have been developed.     

The value of disk replacement?

The high costs associated with spine surgery underlie the increasing importance to evaluate new treatments such as disc replacement. In order to prove their value as a surgical modality in spine surgery, both clinical efficacy and cost-analysis data must be examined closely. Efficacy data shows promising short-term results for both cervical and lumbar disc replacement. However, cost data remains scarce for both treatments. In this review of the literature, there were seven studies evaluating cost, three of which calculated quality-adjusted life-years (QALY), and only one that calculated incremental cost-effectiveness ratios (ICER). The short-term data suggests that both cervical and lumbar disc replacement are less costly than fusion for single-level disease. Further long-term cost data is necessary to better elucidate the true value of disc replacement and whether it should be accepted as a standard alternative to fusion.