Degenerative cervical myelopathy (DCM) is a progressive spinal cord disorder driven by static compression and dynamic instability. Cervical sagittal alignment has recently emerged as a potential factor influencing both pathogenesis and surgical outcomes. This review synthesizes current evidence on alignment parameters and their clinical relevance in DCM management, with the primary aim of guiding surgical decision-making. A narrative literature review was performed, analyzing radiological parameters of cervical alignment, their normative thresholds, and associations with functional outcomes. Both cranio-cervical and subaxial metrics were examined, alongside emerging global alignment concepts. Key parameters include C2-C7 sagittal vertical axis (SVA), cervical lordosis (CL), T1 slope (T1S), and the T1S-CL mismatch. Malalignment is generally defined as SVA >40 mm, CL < 15°, or T1S-CL > 20°. Increased SVA and cervical kyphosis correlate with reduced mJOA scores and poorer surgical results. Alignment also informs surgical strategy: anterior approaches are favored in kyphosis or ventral compression, while posterior techniques are preferred in lordotic or neutral spines. Novel measures such as the C2-T1 Pelvic Angle (CTPA) seek to contextualize cervical alignment within global sagittal balance. Evidence further suggests reciprocal cervical adaptations following thoracolumbar correction. Cervical sagittal alignment is clinically relevant in DCM pathophysiology and surgical decision-making. While correlations between alignment parameters and outcomes are established, robust evidence defining corrective thresholds remains limited. Prospective studies are required to validate these measures and refine realignment strategies in DCM.

Background/Objectives: Postoperative cerebrospinal fluid (CSF) fistulas remain a significant concern in spinal neurosurgery, particularly following dural closure. The incidence of dural tears during spinal surgery is estimated between 1.6% and 10%. While direct suturing remains the gold standard, it has a failure rate of 5–10%. Various materials and techniques have been used to enhance dural closure. This study aims to assess the effectiveness of non-penetrating titanium clips (AnastoClip^®) for dural closure in intradural spinal lesion surgeries. Methods: A prospective analysis was conducted on 272 patients who were operated on for intradural spinal lesions from August 2017 to December 2023. Dural closure was performed using non-penetrating titanium clips with sealant, and, in select cases, autologous grafts. Postoperative care included early mobilization and routine MRI to assess outcomes. A comparative analysis was performed with a cohort of 81 patients treated with traditional sutures. Results: Among the 272 patients, postoperative CSF leaks occurred in 32 cases (11.76%), requiring various management approaches. Thirteen cases required surgical revision, while others resolved with external lumbar drainage or fluid aspiration. Compared to the suture group, which had a fistula rate of 23.46%, the titanium clip group had a significantly lower fistula rate. Logistic regression analysis did not find statistically significant associations between fistula risk and clinical factors. Conclusions: Non-penetrating titanium clips provide an effective alternative to sutures for dural closure, reducing CSF leak rates. They preserve dural integrity, reduce operative time, and avoid imaging artifacts, making them a viable advancement in spinal surgery with outcomes comparable to, or better than, traditional techniques.

Background: Spinal metastases affect approximately 40% of patients with systemic cancers; metastatic epidural spinal cord compression (MESCC) occurs in up to 20% of cases and leads to potential significant morbidity. Recent advancements in high-dose conformal radiation techniques, such as Stereotactic Body Radiation Therapy (SBRT) and Stereotactic Radiosurgery (SRS), enable histology-independent ablative treatments, yet optimal dose fractionation remains undetermined. Methods and Results: This case of vertebral metastases with high-grade ESCC exemplifies the model of a comprehensive treatment workflow that emphasizes interdisciplinary collaboration, within the framework of a personalized medicine. The “Hybrid Therapy” combines Separation Surgery, aimed at achieving circumferential spinal cord decompression, with SBRT/SRS. The oncologic resection has been performed in a navigation-assisted technique that is tailored to the SBRT target, pre-operatively defined on the neuronavigation station. Conclusions: This seamless integration during initial planning of surgery with the ideal radio-oncological target is aimed at avoiding delays in referral and limitations in subsequent treatment options. This integrative holistic strategy not only prioritizes functional preservation, minimizing surgical invasiveness, but also promotes tumor control, thus offering potential promising new avenues for patient-centered oncologic care. Future high-quality studies are warranted to validate the widespread potential utility and safety of this approach.

Carbon-Fiber-Reinforced Polyetheretherketone (CFR-PEEK) instrumentation is increasingly preferred in spinal oncology for its physical properties, minimizing imaging artifacts and facilitating precise postoperative radiotherapy planning and tumor surveillance. However, a significant technical limitation exists: the current unavailability of dedicated CFR-PEEK pedicle screws for the cervical spine. The smallest available implants are designed for thoracic use (minimum diameter 4.5 mm, minimum length 25 mm), posing substantial risks of neurovascular injury when applied to smaller cervical pedicles. We present a technical note/feasibility report illustrated by a single case of robot-assisted placement of thoracic CFR-PEEK screws in the cervical spine for the treatment of a C7 Giant Cell Tumor. Following neoadjuvant therapy with Denosumab, a single-stage, two-step circumferential resection and reconstruction was performed. The anterior step was complicated by an iatrogenic injury to the highly adherent left vertebral artery (VA), which was successfully repaired. Consequently, the posterior step required maximal precision to preserve the sole remaining intact VA on the right side. Given the anatomical mismatch between the 4.5 mm thoracic screws and the narrow cervical pedicles (measuring as narrow as 3.2 mm on the critical right side), robotic navigation (ExcelsiusGPS^®) was utilized to plan and execute safe trajectories. Specifically, on the side of the intact VA, a small, controlled medial cortical violation was planned to avoid lateral vascular compromise. The procedure resulted in rigid, artifact-free stabilization with no immediate neurological sequelae. This single-case experience suggests that robotic guidance may facilitate adaptation of thoracic CFR-PEEK instrumentation to the cervical spine in selected oncologic scenarios; reproducibility, costs, and long-term outcomes remain uncertain.

Thoracic disc herniations (TDHs) are rare, and surgery is typically reserved for patients with radiculopathy, myelopathy, or intractable back pain. Despite established algorithms, the optimal surgical strategy remains debated. What are the clinical, surgical, and radiological outcomes of anterior and posterior surgical approaches for TDHs over a 10-year period? A retrospective analysis of 54 patients who underwent surgery for TDHs (2013-2022) was performed. Patients were grouped by surgical approach: anterior (34 patients) and posterior (20 patients). Data included preoperative and postoperative outcomes such as operative times, hospital stays, complications, reoperations, and assessments using the Frankel scale, Nurick score, and Visual Analog Scale (VAS) for pain. Both approaches improved clinical outcomes. No significant differences in postoperative Nurick or VAS pain scores were observed. However, the anterior approach showed better Frankel score improvements but was associated with longer operative times and hospital stays. Complications were more frequent in the anterior group. Both approaches effectively alleviate symptoms in symptomatic TDHs. The anterior approach offers greater neurological improvement but carries higher complication risks. Surgical strategy should be tailored based on herniation characteristics and surgeon expertise. Anterior approaches are ideal for central, large, or calcified herniations, while posterior approaches are preferable for lateral ones.

Background/Objectives: Sclerosing epithelioid fibrosarcoma (SEF) is a rare soft tissue sarcoma with high rates of local recurrence and distant metastasis. Primary spinal involvement is exceedingly uncommon and often misdiagnosed due to radiological and histopathological resemblance to more frequent spinal tumors. The objective of this study is to present a rare case of thoracic spinal SEF and to contextualize it within the available literature. Methods: We describe the case of a 37-year-old woman presenting with progressive back pain and dysesthesia. MRI demonstrated a heterogeneously enhancing mass at the left T10–T11 neural foramen, initially interpreted as a common nerve sheath tumor. Gross total resection (GTR) was achieved, and histopathological analysis revealed a SEF. Clinical course, adjuvant therapies, and outcomes were evaluated, together with a review of previously reported spinal SEF cases. Results: Despite GTR followed by adjuvant chemotherapy, local recurrence occurred 18 months later. The patient underwent subtotal resection (STR) with adjuvant proton therapy. At 18-month follow-up after the second procedure, she remained neurologically stable and disease-free. The literature review confirmed the rarity of spinal SEF, its frequent misdiagnosis, and the absence of standardized therapeutic protocols. Conclusions: Spinal SEF is a rare malignancy that can mimic benign spinal tumors, delaying diagnosis. Its management relies on multidisciplinary assessment, individualized therapy, and long-term follow-up. This report increases awareness of spinal SEF and provides additional evidence to support clinical decision-making in rare spinal tumors.