Study Design.: Systematic review and meta-analysis. Objective.: To compare functional, radiographic, and complication outcomes among ACDF, PCDF, and laminoplasty for multilevel cervical spondylotic myelopathy (CSM). Summary of Background Data.: CSM is a major source of patient morbidity in the United States. Three surgical approaches are commonly employed for this degeneration: ACDF, PCDF, and laminoplasty. Comparative data is warranted to guide approach selection. Methods.: In accordance with PRISMA guidelines, PubMed, Embase, CENTRAL, and Scopus were searched through February 2026 to identify comparative studies reporting outcomes among adult patients undergoing ACDF, PCDF, or laminoplasty for multilevel (≥3 levels) CSM. Twelve studies comprising 1,129 patients met inclusion criteria and were organized into three pairwise comparisons: ACDF versus laminoplasty, PCDF versus laminoplasty, and ACDF versus PCDF. Functional, radiographic, and complication outcomes were comparatively assessed. Continuous outcomes were pooled as mean differences (MD) with 95% confidence intervals (CI). Dichotomous outcomes were pooled as odds ratios (OR) with 95% CI. Heterogeneity was assessed using the I² statistic. Results.: JOA score improvement did not differ between ACDF and laminoplasty (MD=−0.20, P =0.43) or ACDF and PCDF (MD=1.06, P =0.21). VAS neck pain favored ACDF over laminoplasty (MD=−1.05, P =0.03). ACDF demonstrated reduced cervical range of motion (MD=−9.14°, P <0.001) compared with laminoplasty. Hospital stay was shorter after ACDF (MD=−2.62 days, P =0.002) and longer after PCDF (MD=1.19 days, P <0.001) relative to laminoplasty. ACDF was associated with lower rates of axial pain (Peto OR=0.21, P =0.007) and C5 palsy (Peto OR=0.27, P =0.049) but higher rates of dysphagia (Peto OR=5.88, P <0.001) compared with laminoplasty. SSI was more frequent after PCDF than laminoplasty (Peto OR=4.27, P =0.01). Conclusions.: ACDF, PCDF, and laminoplasty demonstrated similar neurological recovery for multilevel CSM. Procedure-specific differences in cervical range of motion, length of stay, and complication profiles support approach selection guided by preoperative alignment and patient-specific concerns.

Background/Objectives: Chlorhexidine and iodine-based preparations are both widely used, and the existing literature suggests a possible advantage of chlorhexidine in clean elective surgery. Whether this extends to instrumented degenerative spine surgery is unknown. We asked whether chlorhexidine-based skin preparation reduces 90-day postoperative infection compared with iodine-based preparation after instrumented degenerative cervical or lumbar spine surgery. Methods: A retrospective TriNetX cohort study was performed among adults undergoing instrumented degenerative cervical or lumbar spine surgery. Patients were stratified by anatomic region and by preoperative preparation exposure: chlorhexidine-based versus iodine-based. Moreover, 1:1 propensity-score matching was performed within each anatomic stratum on demographics, Charlson Comorbidity Index (CCI), diabetes, smoking, obesity and BMI, immunosuppression, methicillin-resistant Staphylococcus aureus (MRSA) carrier status, and index procedure codes. The primary outcome was 90-day postoperative infection. Secondary outcomes were superficial and deep surgical site infection, MRSA infection, incision and drainage, debridement, sepsis, urinary tract infection, and pneumonia. Results: After matching, the cervical cohort included 3528 patients per group and the lumbar cohort 4164 per group. Postoperative infection did not differ in the cervical cohort (1.76% vs. 1.59%; risk ratio [RR] 1.11, 95% confidence interval [CI] 0.77–1.58; p = 0.578) or the lumbar cohort (3.17% vs. 3.29%; RR 0.96, 95% CI 0.76–1.22; p = 0.757). Superficial and deep infection, MRSA infection, debridement, sepsis, urinary tract infection, and pneumonia did not differ significantly in either cohort. Conclusions: No statistically significant difference in 90-day postoperative infection was found between chlorhexidine-based and iodine-based skin preparation after instrumented degenerative cervical or lumbar spine surgery.

Background/Objectives: Irritable bowel syndrome (IBS) is among the most prevalent disorders of gut–brain interaction, yet its implications for spine surgery remain poorly characterized. This narrative review examines how IBS influences symptom presentation and postoperative outcomes in spine surgery patients. Methods: We synthesized the neurobiologic, epidemiologic, and perioperative literature linking IBS with musculoskeletal pain, spine-related symptomatology, and surgical outcomes, drawing on spine-specific data where available and on related surgical and chronic-pain populations where it was not. Results: IBS is characterized by central sensitization, impaired descending inhibition, increased temporal summation, autonomic dysregulation, and a high prevalence of psychiatric comorbidity, which manifest as widespread hyperalgesia and symptom amplification that overlap with pain mechanisms common in spine surgery patients. Epidemiologic studies indicate that patients with IBS undergo musculoskeletal and spinal procedures at disproportionately high rates, reflecting both symptom burden and diagnostic uncertainty from viscerosomatic overlap. These same factors have been associated with greater postoperative pain, elevated opioid requirements, slower functional recovery, and reduced satisfaction after spine surgery, although direct IBS-specific spine data remain limited. IBS may also confound preoperative assessment by mimicking radicular, discogenic, or sacroiliac pain. Conclusions: IBS represents an under-recognized potential modifier of symptom localization, perioperative pain trajectories, and functional recovery in spine surgery. Greater awareness of IBS-related nociplastic and psychosocial mechanisms may improve preoperative evaluation, risk stratification, perioperative management, and the design of future outcome studies.