Objective: Endoscopic spine surgery is gaining popularity, with efficacy comparable to that of traditional techniques. Apart from Germany, European countries are tentatively beginning to consider endoscopic surgery as a valid alternative to conventional procedures, and Italy is no exception. This survey aimed to reveal which spine surgeons currently use endoscopy in Italy, the levels of their skills, and how they have attained them. Methods: We conducted an online survey of Italian spinal surgeons to gather information about their use of minimally invasive and endoscopic surgery. We collected data on their operating habits, including the percentage of minimally invasive techniques in their practice, the type of workplace, and experience. We also asked surgeons to analyze and resolve 4 cases of degenerative lumbar pathologies. Results: Orthopedists and neurosurgeons in public and private facilities performed endoscopic surgery. One-third of respondents had never tried it, while others encountered it through workshops or producer presentations. A minority of interviewees considered themselves experts in endoscopic surgery, while more than half had “some” or “no” experience. Among endoscopic surgeons, none had experience in thoracic endoscopy, and only a few had used it for cervical diseases. The majority preferred a non-endoscopic approach when faced with clinical cases. Conclusion The use and knowledge of endoscopic surgery in Italy are not widespread. Our survey highlights a lack of training in the implementation of techniques that should be recognized as additional tools in addition to the traditional procedures for treating not only lumbar, but also thoracic and cervical pathologies.

223Ra-dichloride is a bone-seeking targeted alpha (α)-emitting approved for bone metastases in prostate cancer. Here, we report a case of therapy-related acute promyelocytic leukemia (t-APL) following administration of 223Ra, showing some evidence of a causative relationship. A patient with metastatic prostate cancer received therapy with 223Ra, with 6 injections of the radiopharmaceutical at a standard dose of 55 kBq/kg at 4-week intervals for a cumulative administered activity of 26.3 MBq. PET/CT with 18F-methylcholine repeated 1 month after the conclusion of 223Ra was negative. After 8 months, he developed pancytopenia and we made a diagnosis of therapy-related acute promyelocytic leukemia (t-APL). We then studied the genomic locations of the breakpoints in the PML and RARA genes, which were at nucleotide positions 1708-09 of PML intron 3, respectively, outside the previously reported Topo II-associated hotspot region. t-APL was cured with all-trans-retinoic acid (ATRA) and arsenic trioxide. The type of PML/RARA rearrangement we identified, in absence of other myelotoxic treatments, is suggestive of a possible direct causal relationship with exposure to 223Ra and warrants further investigations.