Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure used to treat herniated discs, degenerative disc disease, and nerve root compression in the cervical spine. This systematic literature review aims to analyze the available literature on the incidence, risk factors, clinical considerations, and available therapies for spinal epidural hematoma (SEH) following ACDF. A systematic search was conducted in PubMed, Google Scholar, and Embase from database inception to June 18, 2025, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The search yielded 71 studies without duplicates. After applying the inclusion and exclusion criteria, 5 studies were selected for the final analysis. The overall incidence of SEH following ACDF was 0.835%. Most patients presented with dyspnea, paraplegia, or quadriplegia. A meta-analysis of the 5 studies (n = 3246; 28 events) confirmed this incidence, with moderate heterogeneity. Management varied on the basis of symptom severity, hematoma size, and neurological impairment. Surgical decompression was the most common treatment, although some cases were managed conservatively with success. SEH onset ranged from within 24 hours postoperatively to several days after surgery. Although uncommon, SEH after ACDF carries significant clinical risks. Preventive measures may help mitigate its occurrence. However, the limited literature prevents a precise determination of the incidence and associated risk factors, including coagulation disorders. There is a clear need for large-scale prospective and retrospective studies with standardized reporting to more accurately define the incidence, identify risk factors, and determine the optimal management of SEH following ACDF.

(1) Background: Our team has previously introduced the Single-Step Pedicle Screw System (SSPSS), which eliminates the need for K-wires, as a safe and effective method for percutaneous minimally invasive spine (MIS) pedicle screw placement. Despite this, there are ongoing concerns about the reliability and accuracy of screw placement in MIS procedures without traditional tools like K-wires and Jamshidi needles. To address these concerns, we evaluated the accuracy of the SSPSS workflow by comparing the planned intraoperative screw trajectories with the final screw positions. Traditionally, screw placement accuracy has been assessed by grading the final screw position using postoperative CT scans. (2) Methods: We conducted a retrospective review of patients who underwent lumbar interbody fusion, using intraoperative 3D navigation for screw placement. The planned screw trajectories were saved in the navigation system during each procedure, and postoperative CT scans were used to evaluate the implanted screws. Accuracy was assessed by comparing the Gertzbein and Robbins classification scores of the planned trajectories and the final screw positions. Accuracy was defined as a final screw position matching the classification of the planned trajectory. (3) Results: Out of 206 screws, 196 (95%) were accurately placed, with no recorded complications. (4) Conclusions: The SSPSS workflow, even without K-wires and other traditional instruments, facilitates accurate and reliable pedicle screw placement.

Background/Objectives: Adult degenerative scoliosis (ADS) is a spinal disease causing pain and reduced mobility, often occurring with degenerative lumbar spinal stenosis (DLSS). While fusion stabilizes the spine, it has drawbacks like loss of motion and adjacent segment degeneration. Minimally invasive techniques, such as tubular unilateral laminotomy for bilateral decompression (tULBD), provide a less invasive alternative, but their impact on ADS with DLSS is underexplored. This study examines the short-term effects of navigated tULBD on radiological and clinical outcomes in this patient population. Methods: This retrospective single-center study analyzed patients aged ≥18 years with DLSS and ADS (Cobb angle ≥ 10°), with or without grade I spondylolisthesis, who underwent navigated tULBD between June 2019 and October 2022. Radiological parameters were assessed pre- and post-operatively using AI-powered FXA™ Version 1.33, Raylytic Software GmbH, Leipzig, Germany, while clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) for back and leg pain. Statistical analyses were conducted with R Studio. Results: This study included 20 patients (mean age 74.6 ± 7.6 years, body mass index [BMI] 26.08 ± 3.7 kg/m²), with a median follow-up of 2 months. Most underwent single-level decompression (45%), with a median of 2 surgical levels (IQR: 1–3). Radiological parameters showed no significant changes (p > 0.05). Clinically, the median NRS back improved from 5 (IQR: 3–9) preoperatively to 2 (IQR: 0–2) postoperatively (p = 0.009) and 1 (IQR: 0–4.5) at follow-up (p = 0.004). NRS leg scores dropped from 3.5 (IQR: 0–5) to 0 postoperatively and at follow-up (p = 0.02, p = 0.04). ODI improved from 37.8 (IQR: 29–42.5) preoperatively to 17.5 (IQR: 5–24) at follow-up (p = 0.04). There were no neurological complications. Conclusions: Navigated tULBD is a promising, minimally invasive option for mild ADS and DLSS. It provides significant pain and disability relief without adversely affecting stability and alignment. Long-term studies are needed to confirm durability and efficacy, particularly in severe cases.

Background: Global Burden of Disease (GBD)-defined spinal cord lesion categories are major contributors to global disability. However, contemporary analyses focusing on age-specific disability burden, socio-demographic variation, and anatomical distribution remain limited. This study aimed to analyze global and regional trends in prevalence and disability burden associated with GBD-defined spinal cord lesions from 2014 to 2023, with particular emphasis on working-age adults aged 15–49 years, older adults aged ≥70 years, Socio-demographic Index (SDI) regions, and anatomical level. Methods: We performed a secondary analysis of Global Burden of Disease (GBD) 2023 Injuries by Nature data, extracting estimates for “spinal cord lesion at neck level” and “spinal cord lesion below neck level.” Global and regional prevalence and Years Lived with Disability (YLDs) were extracted. The cervical ratio was calculated as the proportion of total YLDs attributable to neck-level lesions. Temporal trends were assessed using log-linear regression and annual percent change (APC). Results: Between 2014 and 2023, the global age-standardized prevalence rate decreased from 363.17 to 318.28 per 100,000 population, corresponding to a 12.4% reduction (APC −1.97%/year; p = 0.002). The global age-standardized YLD rate decreased by 14.0% (APC −2.19%/year; p = 0.001). Absolute prevalence remained relatively stable, increasing slightly from 27.31 million to 27.54 million, while absolute YLDs changed from 8.16 million to 8.02 million without a significant linear trend. A clear age-related divergence was observed: YLDs increased by 31.5% among adults aged ≥70 years (APC +2.57%/year; p < 0.001), while they decreased by 11.7% among individuals aged 15–49 years (APC −1.87%/year; p = 0.005). Cervical-level lesions accounted for 63.5% of global YLDs in 2023, and the cervical ratio increased stepwise from low-SDI to high-SDI regions. Conclusions: Although age-standardized prevalence and YLD rates associated with GBD-defined spinal cord lesions declined globally, the absolute burden remained relatively stable and shifted toward older adults. These findings highlight the importance of considering age structure, socio-demographic development, and anatomical distribution when planning rehabilitation, long-term care, and health-system resources for populations affected by GBD-defined spinal cord lesions.