Background/Objectives: Intradural extramedullary (IDEM) spinal tumours are relatively rare and predominantly benign. Gross total resection (GTR) has been demonstrated as an effective treatment, with increasing evidence supporting the use of minimally invasive techniques to achieve GTR. This study reviews the current surgical management options for IDEM tumours and their outcomes. Methods: A systematic literature search without meta-analysis was conducted by two independent reviewers in December 2024. The population of interest comprised patients who underwent surgical treatment for IDEM tumours. Outcomes assessed included the extent of resection, postoperative neurological function, and complications. Results: Fifty-seven articles met the inclusion criteria, providing data on 4695 IDEM cases, of which 3495 were managed through open surgery and 750 via minimally invasive surgery. The extent of resection was high, with a mean GTR > 90% across studies. Open laminectomy and unilateral minimally invasive hemilaminectomy were the most common surgical approaches. Complications, such as cerebrospinal fluid leaks, were less frequent following minimally invasive procedures vs. open surgery (11.1% vs. 14.3%). Minimally invasive surgery also led to improved postoperative functional outcomes (mean McCormick score change −1.30 vs. −0.64) and a lower recurrence rate (1.4% vs. 10.0%). Conclusions: Whilst open surgery yields acceptable rates of resection and neurological improvement, there is growing evidence that minimally invasive surgery can achieve comparable, if not superior, rates of resection with fewer complications, leading to lower costs and shorter hospital stays.

Background/Objectives: Chiari 1 malformation (CM-1) is a structural abnormality characterised by cerebellar tonsillar descent of 5 mm or more through the foramen magnum. Despite improved imaging, surgical criteria remain inconsistent. This study evaluates the correlation between classical symptoms, imaging findings, and need for surgical intervention, as well as introducing a novel Chiari 1 scoring system aimed at refining the criteria for management options. Methods: A retrospective study was conducted on adult patients who were evaluated for CM-1 at a tertiary neurosurgical department with a specialised Chiari and Syringomyelia service over 12 months. Data included demographics, symptoms, imaging characteristics, and surgical intervention. Statistical analysis was performed using SPSS Version 30. Results: Sixty-nine (69) patients met the inclusion criteria (mean age, 36.26 years; male-to-female ratio, 1:3.1). Thirty patients (43.5%) had classic symptoms, of whom 26 had a tonsillar descent of >10 mm. A significant association was noted between surgery and classic symptoms (p < 0.01), tonsillar descent of >10 mm (p < 0.01), and syrinx presence (p = 0.02). Our novel scoring system had an AUC of 0.974 (95% CI 0.94–1.00; p < 0.001), with an optimum cut of the value of ≥3 points leading to a sensitivity of 100%, specificity of 89.5%, positive predictive value of 66.7% and negative predictive value of 100%. Conclusions: Surgical intervention remains an effective option for symptomatic patients. Our novel scoring system could provide a simplified, practical, and more accurate method for identifying patients who may benefit from surgical intervention.

Background: Robotic-assisted spinal instrumentation is increasingly used to support implant placement, reduce radiation exposure, and improve operative workflow. However, UK NHS data describing early programme experience across elective and emergency practice remain limited. This study aimed to evaluate the feasibility, safety profile, and early learning curve of robotic-assisted spinal instrumentation in an unselected UK NHS cohort. Methods: A retrospective, single-centre, single-arm observational cohort study was conducted, including the first 50 consecutive patients treated from programme inception between June 2024 and January 2026. No exclusion criteria were applied, and each record represented one patient and one operation. Missing data were not imputed, and denominators were reported per variable. Learning curve effects were assessed using Spearman correlation and cumulative sum analysis. Wilson 95% confidence intervals were reported for complication rates. Results: The mean age was 61.9 years; 50% were male; mean body mass index was 29.0; and median Charlson Comorbidity Index was 3. Indications were degenerative disease in 74%, trauma in 24%, and deformity in 2%. Emergency admissions accounted for 18/50 cases. Robot-specific adverse events included abandonment or conversion in 2/50 cases and system malfunction in 1/50. Surgical complications occurred in 7/50 patients. On surgeon-reviewed routine post-operative imaging, no screw malpositions required revision and no durotomies or vascular injuries were recorded; this represents a clinical revision rate rather than a formal radiological measure of screw accuracy, for which blinded Gertzbein–Robbins grading was not performed. Cumulative sum analysis suggested a potential fluoroscopy change point around case 30, with the median fluoroscopy events falling from 151 to 16 thereafter. Emergency cases involved more instrumented levels, longer operative times, and more open surgery than elective cases. Conclusions: Robotic-assisted spinal instrumentation was feasible across a diverse UK NHS caseload from C1 to S2, with a low observed complication rate. The findings suggest a fluoroscopy learning curve threshold around case 30. Larger comparative studies with formal radiological accuracy assessment are required.