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Advances in Cervical Spine Surgery: Techniques, Outcomes, and Complications
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Advances in Cervical Spine Surgery: Techniques, Outcomes, and Complications

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 20 October 2026 | Viewed by 766

Editors

Dr. Bartosz Godlewski

E-Mail Website
Guest Editor
Gabriel Narutowicz Municipal Specialist Hospital, 31-202 Krakow, Poland
Interests: cervical spine; fusion assessment; radiological measurements; subsidence
Dr. Tae Sik Goh

E-Mail Website
Guest Editor
Department of Orthopedics, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
Interests: spine surgery; scoliosis; artificial intelligence; fracture healing; osteoporosis; sarcopenia; biomarkers for surgical site infection

Special Issue Information

Dear Colleagues,

Cervical spine surgery has undergone remarkable evolution over the past decade, driven by technological innovations, refined surgical techniques, and improved understanding of biomechanics and patient outcomes. The cervical spine's anatomy and its critical role in protecting neural structures while maintaining mobility present unique challenges that continue to demand innovative solutions. From degenerative changes to traumatic injuries, tumors, and deformities, the spectrum of pathologies requiring surgical intervention is broad and clinically significant.

We invite you to contribute to this Special Issue dedicated to advancing the field of cervical spine surgery through the dissemination of high-quality research and clinical expertise. This Special Issue will provide a comprehensive platform for highlighting recent advances in surgical techniques, including minimally invasive approaches, motion-preservation technologies, and novel fixation methods. Furthermore, this Special Issue will explore patient outcomes, complication profiles, and strategies for complication prevention and management. By bringing together diverse perspectives from international experts, this Special Issue will contribute to enhancing the quality and safety of cervical spine surgery while identifying areas for future research and clinical improvement.

Dr. Bartosz Godlewski
Dr. Tae Sik Goh
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cervical spine
  • fusion assessment
  • surgical outcomes
  • cervical alignment
  • radiological measurements
  • subsidence
  • surgical complications

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Published Papers (3 papers)

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Research

14 pages, 898 KB  
Article
Radiological Alignment Trajectories and Late Functional Outcomes After Three-Level ACDF: A Single-Center Cohort Study
by Merdan Orunoglu, Ukbe Sirayder, Oguzhan Yilmaz and Murat Baloglu
J. Clin. Med. 2026, 15(12), 4739; https://doi.org/10.3390/jcm15124739 - 18 Jun 2026
Abstract
Background: Three-level anterior cervical discectomy and fusion (ACDF) is widely used for multilevel cervical degenerative disc disease; however, the relationship between postoperative alignment trajectories, adjacent segment degeneration (ASD), and late patient-reported outcomes remains incompletely defined. This study evaluated plane-specific radiological alignment changes, [...] Read more.
Background: Three-level anterior cervical discectomy and fusion (ACDF) is widely used for multilevel cervical degenerative disc disease; however, the relationship between postoperative alignment trajectories, adjacent segment degeneration (ASD), and late patient-reported outcomes remains incompletely defined. This study evaluated plane-specific radiological alignment changes, MRI-based ASD, and late functional outcomes in a homogeneous three-level ACDF cohort. Methods: This single-center observational cohort included 29 patients who underwent three-level ACDF between January 2018 and December 2023 and had complete radiographic follow-up. Radiological data were collected retrospectively from institutional records and imaging archives. Cervical sagittal and coronal alignment were assessed using Cobb angles on radiographs obtained preoperatively and at 6 months, 1 year, and 2 years postoperatively. ASD was evaluated at the superior adjacent segment on 2-year MRI. Late patient-reported clinical outcomes were assessed at a mean follow-up of 42.6 ± 6.8 months using the Visual Analog Scale (VAS), Neck Disability Index (NDI), and Nottingham Health Profile (NHP). Results: Sagittal Cobb angle changed significantly over time (χ2(3) = 12.60, p = 0.006; Kendall’s W = 0.145), whereas coronal Cobb angle showed a statistically significant reduction over time, although the absolute magnitude of change was small (χ2(3) = 28.74, p < 0.001; Kendall’s W = 0.330). Lower sagittal Cobb angle correlated with worse NDI (r = −0.46, p = 0.004), and greater coronal Cobb angle correlated with worse physical activity scores (r = 0.52, p = 0.006). Higher Pfirrmann grade correlated with worse NDI (r = 0.49, p = 0.004) and pain scores (r = 0.44, p = 0.021). In exploratory regression analysis, sagittal Cobb angle and Pfirrmann grade were retained in the model for NDI, but these findings should be interpreted as hypothesis-generating. Conclusions: After three-level ACDF, sagittal and coronal alignment followed different postoperative trajectories. Lower sagittal alignment and greater adjacent disc degeneration were associated with worse late neck-related disability. However, given the modest sample size and exploratory nature of the regression analysis, these findings should be interpreted as hypothesis-generating. Larger prospective studies are needed to confirm whether sagittal alignment and MRI-based adjacent segment degeneration independently contribute to late functional outcomes. Full article
(This article belongs to the Special Issue Advances in Cervical Spine Surgery: Techniques, Outcomes, and Complications)
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10 pages, 1897 KB  
Article
Minimally Invasive, CT Neuronavigated Posterolateral Pedicle Screw Placement in Upper Cervical Spine: A Retrospective Accuracy and Safety Analysis
by Piotr Stogowski, Stanisław Adamski, Jakub Wiśniewski, Mateusz Węclewicz, Oskar Liczbik, Patryk Kurlandt, Jan Czauderna, Jonasz Tempski, Mateusz Szczupak, Jacek Kobak, Wojciech Wasilewski and Wojciech Kloc
J. Clin. Med. 2026, 15(11), 4373; https://doi.org/10.3390/jcm15114373 - 5 Jun 2026
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Abstract
Background: Fractures of the upper cervical spine are challenging to treat due to their proximity to critical neurovascular structures and the need for immediate, stable fixation. Open posterior fixation remains the standard but is associated with soft-tissue disruption and morbidity. Minimally invasive, [...] Read more.
Background: Fractures of the upper cervical spine are challenging to treat due to their proximity to critical neurovascular structures and the need for immediate, stable fixation. Open posterior fixation remains the standard but is associated with soft-tissue disruption and morbidity. Minimally invasive, navigation-assisted pedicle screw fixation represents a viable alternative for older populations, significantly reducing surgical morbidity and tissue trauma. The present study evaluates the accuracy, safety, and perioperative outcomes of minimally invasive navigated posterolateral C1–C2 fixation. Methods: We conducted a retrospective consecutive case review of 51 patients who underwent minimally invasive C1–C2 screw fixation between 2019 and 2024. All procedures were performed using intraoperative O-arm imaging and StealthStation S8 navigation. Screw placement accuracy was assessed using the Bredow modification of the Gertzbein–Robbins and Heary classifications. Perioperative data, including operative time, screw dimensions, radiation dose, complications, and hospital stay, were recorded. Results: Fifty-one patients were included in the study. A total of 212 screws were placed. According to Gertzbein–Robbins grading, 92.4% were Grade A, 6.6% were Grade B, and 1% were Grade C. According to Heary grading, 95% were Grade I and 5% were Grade III. No vertebral artery injuries, new neurological deficits, or intraoperative hardware failures occurred. The mean screw lengths were 33.2 mm (SD = 3.38 mm) (C1) and 32 mm (SD = 4.30 mm) (C2). The mean operative time was 128 min (SD = 52.95 min). The mean radiation dose was 629.16 mGy·cm2 (SD = 372.2 mGy·cm2). One superficial wound infection occurred. The median postoperative NRS was 4 (IQR: 4–5). The mean hospital stay was 4.21 (SD = 3.77) days. Conclusions: Our findings demonstrate that the presented approach for C1–C2 fixation is a highly accurate and safe alternative to open posterior fixation for upper cervical fractures. Full article
(This article belongs to the Special Issue Advances in Cervical Spine Surgery: Techniques, Outcomes, and Complications)
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17 pages, 1786 KB  
Article
Preliminary Quantitative MRI Assessment After Combined Posterior Endoscopic Cervical Discectomy and Foraminotomy: An Exploratory Retrospective Cohort Study
by Tomasz Sienkiel, Barbara Jasiewicz, Dominik Taterra, Marcin Gąska, Przemysław Koszyk, Klemens Machajewski and Artur Gądek
J. Clin. Med. 2026, 15(11), 4129; https://doi.org/10.3390/jcm15114129 - 27 May 2026
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Abstract
Background/Objectives: Posterior endoscopic cervical foraminotomy is an established motion-preserving procedure for selected patients with unilateral cervical radiculopathy. However, isolated foraminal decompression may be insufficient in cases with concomitant foraminal stenosis and lateral soft disk herniation. This preliminary study evaluated clinical outcomes and [...] Read more.
Background/Objectives: Posterior endoscopic cervical foraminotomy is an established motion-preserving procedure for selected patients with unilateral cervical radiculopathy. However, isolated foraminal decompression may be insufficient in cases with concomitant foraminal stenosis and lateral soft disk herniation. This preliminary study evaluated clinical outcomes and quantitative MRI changes after combined posterior endoscopic cervical diskectomy and foraminotomy (CEDF) and explored the relationship between postoperative foraminal enlargement and clinical improvement. Methods: This retrospective single-center exploratory cohort study included 15 consecutive patients with single-level unilateral cervical radiculopathy caused by combined foraminal stenosis and lateral soft disc herniation who were treated between 2021 and 2023. All patients underwent CEDF using a posterior full-endoscopic approach. Clinical outcomes were assessed preoperatively, at 6 weeks, and at 12 months using the Visual Analog Scale for arm and neck pain, the Neck Disability Index, and modified MacNab criteria. Quantitative MRI assessment included minimal foraminal diameter, Foraminal Symmetry Index (FSI), and Quantitative Cervical Expansion (QCE). Correlations between radiological and clinical outcomes were analyzed as exploratory, hypothesis-generating analyses. Results: Mean minimal foraminal diameter increased from 1.9 ± 0.7 mm preoperatively to 4.1 ± 0.8 mm postoperatively, with improvement in FSI from 0.40 ± 0.12 to 0.89 ± 0.11. Significant clinical improvement was observed across all outcome measures. Mean arm pain decreased from 7.2 ± 1.3 preoperatively to 1.3 ± 1.4 at final follow-up, while NDI improved from 48.0 ± 14.0% to 18.3 ± 12.0%. The minimum clinically important difference for arm pain reduction was achieved in 14 of 15 patients. A moderate positive exploratory association was observed between foraminal enlargement and reduction in arm pain severity. No major neurological complications, postoperative instability, or revision procedures were observed in this small cohort during the available follow-up. Conclusions: In this preliminary retrospective single-center cohort, CEDF was associated with clinical improvement and measurable postoperative foraminal enlargement in carefully selected patients with unilateral cervical radiculopathy caused by combined foraminal stenosis and lateral soft disc herniation. The observed association between foraminal enlargement and arm pain reduction should be interpreted cautiously because of the small sample size and exploratory design. QCE and FSI should be regarded as preliminary quantitative radiological indices rather than validated markers of decompression adequacy or clinical response. Larger prospective comparative studies are required to validate these findings and define the role of CEDF among established cervical decompression procedures. Full article
(This article belongs to the Special Issue Advances in Cervical Spine Surgery: Techniques, Outcomes, and Complications)
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