Background: Severe spinal deformity manifests as a pronounced deviation from the normal curvature of the spine in the frontal, sagittal, and horizontal planes, where the coronal plane curvature exceeds 90 degrees and may coincide with hyperkyphotic deformity. The most severe deformities exhibit rigidity, with flexibility below 30%. If left untreated or improperly treated, these deformities can result in serious complications associated with progression of the curvature. A combination of surgical techniques is frequently employed to attain optimal outcomes and minimize the risk of complications. The overall medical condition of the patient, their capacity to endure extensive procedures, the expertise of the surgeon, and the resources available all play significant roles in determining the course of management. A systematic and thorough review of the relevant literature was conducted utilizing a variety of electronic databases. The primary objective of this study was to scrutinize the surgical techniques commonly employed in complex spine surgeries for the management of severe scoliosis without resection vertebral body techniques, with higher potential risk of major complications, including permanent neurological deficit. Conclusions: Halo-gravity traction, halo femoral traction, and all techniques for releases of the spine (anterior, posterior, or combine), as well as thoracoplasty, have demonstrated significant effectiveness in managing severe and rigid idiopathic scoliosis. The combination of several of these methods can lead to optimal alignment correction without the need to perform high-risk techniques involving three-column osteotomies. Surgeons must customize the indications based on factors such as available resources, characteristics of the deformity, and the patient’s individual profile. Surgical correction of severe scoliosis without vertebral body resection surgeries decreases the potential risks related to neurological and pulmonary complications while providing significant clinical improvement outcomes. The powerful Ponte osteotomy is indicated for severe scoliosis, curves with poor flexibility, for better restoration of hypokyphosis, and decrease of hyperkyphosis. These corrective techniques combined with HGT or temporary internal distraction rods are recommended as viable options for managing individuals with severe rigid spine deformity characteristics. Therefore, they also should be considered and performed by a proficient surgical team. The presence of neuromonitoring is crucial throughout these procedures.

Background: Congenital kyphosis is a spinal deformity that arises from the inadequate anterior development or segmentation of the vertebrae in the sagittal plane during the initial embryonic stage. Consequently, this condition triggers atypical spinal growth, leading to the manifestation of deformity. Concurrently, other congenital abnormalities like renal or cardiac defects within the gastrointestinal tract may co-occur with spinal deformities due to their shared formation timeline. In light of the specific characteristics of the deformity, the age range of the patient, deformity sizes, and neurological conditions, surgical intervention emerges as the optimal course of action for such cases. The selection of the appropriate surgical approach is contingent upon the specific characteristics of the anomaly. Case Presentation: This investigation illustrates the utilization of a surgical posterior-only strategy for correcting pediatric congenital kyphoscoliosis through the implementation of a vertebral column resection method along with spine reconstruction employing a mesh cage. The individual in question, a 16-year-old female, exhibited symptoms such as a progressive rib hump, shoulder asymmetry, and back discomfort. Non-invasive interventions like bracing proved ineffective, leading to the progression of the spinal curvature. After the surgical procedure, diagnostic imaging displayed a marked enhancement across all three spatial dimensions. After a postoperative physical assessment, it was noted that the patient experienced significant enhancements in shoulder alignment and rib hump prominence, with no discernible neurological or other adverse effects. Conclusions: Surgical intervention is considered the optimal approach for addressing such congenital anomalies. Typically, timely surgical intervention leads to favorable results and has the potential to halt the advancement of deformity and curvature enlargement.

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.

Background/Objectives: Cervical spine disease requiring surgical intervention is a major cause of disability. Anterior cervical discectomy and fusion (ACDF) is a well-established procedure for treating cervical pathology; however, there remains no consensus on whether 1-level versus 2-level ACDF yields comparable outcomes. This study compares 1-level versus 2-level ACDF by evaluating surgery-related and postoperative outcomes, radiographic parameters, and patient-reported outcome measures (PROMs). Methods: PubMed, Embase, Scopus, and Cochrane Library were searched through 10 July 2024. Studies comparing 1-level with 2-level ACDF were included. Data on operating room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), complications, and PROMs, including Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain, were extracted. Results: Thirteen studies met our inclusion criteria, comprising 2091 patients (1078 undergoing 1-level and 1013 2-level ACDF). No statistically significant differences were observed in EBL or LOS between the cohorts. However, the 2-level ACDF group showed significantly longer OR times (p-value < 0.001) and higher odds of developing dysphagia (p-value = 0.05). Patients undergoing 2-level ACDF showed greater correction in cervical lordosis. Both cohorts reported similar statistically and clinically significant improvements in VAS neck and NDI scores at final follow-up. There was no difference in adjacent segment disease or revision surgery at final follow-up. Conclusions: Both 1-level and 2-level ACDF improve clinical and radiographic outcomes. The choice should be tailored to the patient’s pathology and anatomy while considering the higher dysphagia risk with additional fusion levels. This study highlights the importance of individualized surgical planning to optimize postoperative outcomes while minimizing complications.

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.