Open research questions in Cervical and Thoracic Myelopathy

What the literature leaves open

• The study faced challenges in terms of variable clinical presentation and correlation with imaging findings. The research required the development of a quantitative grading system to assess cervical spinal canal stenosis. The study needed to account for multilevel stenosis and focus on the level with the greatest degree of anatomical compromise.

  Quantitative versus qualitative MRI criteria for cervical spinal canal stenosis and cord compression: a comparative analysis and their relationship with clinical symptoms · 2026 · DOI

• Further studies are needed to investigate the relationship between quantitative MRI parameters and clinical symptoms, - Research on the diagnostic accuracy of quantitative MRI parameters in cervical spinal canal stenosis is needed, - Studies on the correlation between quantitative metrics and mJOA scores in different subgroups of patients

  Quantitative versus qualitative MRI criteria for cervical spinal canal stenosis and cord compression: a comparative analysis and their relationship with clinical symptoms · 2026 · DOI

• However, it could not determine the clinical utility in this cohort due to the study design for feasibility outcomes.

  Objective Cervical Stiffness Assessment Using the Pregnolia System Prior to Induction of Labour: The CASPAR Feasibility Cohort Study · 2026 · DOI

• Abstract Background The optimal extent of cervical excision according to transformation zone anatomy remains uncertain.

  Transformation zone type, margin localization, and exploratory cone length estimates in cervical conization: a retrospective cohort study · 2026 · DOI

• Choosing between anterior and posterior surgical approaches remains controversial, highlighting the need to consider various factors such as sagittal balance and compression severity.

  Clinical results after surgical treatment for degenerative cervical myelopathy: a retrospective 1-year follow-up descriptive analysis · 2024 · DOI

• Small sample size of 7 patients - Limited to patients with K-line (-) OPLL or a canal occupying ratio of ≥50% - No comparison with conventional PDF techniques

  Exoscopic Minimally Invasive Open-Door Laminoplasty with Pedicle Screw Fixation for Cervical Ossification of the Posterior Longitudinal Ligament: A Technical Note and Preliminary Clinical Experience · 2026 · DOI

• Further studies with larger sample sizes are needed to confirm the efficacy of ExLAPPS - Comparison with conventional PDF techniques is necessary to determine the advantages of ExLAPPS

  Exoscopic Minimally Invasive Open-Door Laminoplasty with Pedicle Screw Fixation for Cervical Ossification of the Posterior Longitudinal Ligament: A Technical Note and Preliminary Clinical Experience · 2026 · DOI

• The study requires external validation before clinical implementation. Future research should investigate the use of AI-based tools in other areas of spine surgery. The development of personalized treatment plans based on the model's predictions is a potential area of future research.

  Machine Learning Prediction of Prevertebral Soft Tissue Swelling after Single-Level Anterior Cervical Surgery : A Proof-of-Concept Study · 2026 · DOI

• There is a need for a predictive model to identify high-risk patients for PSTS after single-level ACSS. Previous studies have identified risk factors, but a predictive model is needed to enhance preoperative patient assessment.

  Machine Learning Prediction of Prevertebral Soft Tissue Swelling after Single-Level Anterior Cervical Surgery : A Proof-of-Concept Study · 2026 · DOI

• Further studies are needed to validate the AI model in larger patient populations. The use of other machine learning algorithms, such as deep learning, may improve the predictive performance of the model. The integration of the AI model with clinical decision support systems can enhance its practical applications.

  Artificial intelligence–based detection of acute postoperative airway complications following anterior cervical spine surgery: a retrospective imaging evaluation · 2026 · DOI

• The risk factors contributing to the development of postoperative airway obstruction are not well characterized. There is a need for early detection of radiographic warning signs to prevent severe outcomes. The use of AI in detecting airway complications is a novel approach that can improve patient outcomes.

  Artificial intelligence–based detection of acute postoperative airway complications following anterior cervical spine surgery: a retrospective imaging evaluation · 2026 · DOI

• There is a need for a comprehensive evaluation of PCBESS for cervical radiculopathy. The current literature lacks a thorough subgroup analysis of the procedure's effectiveness and safety.

  Insights into posterior cervical biportal endoscopic spine surgery outcomes in radiculopathy: a systematic review and meta-analysis · 2026 · DOI

• Achieving prompt spinal cord decompression in time-critical scenarios. Limited availability of conventional traction devices or anesthesia. Need for substantial spine surgeon expertise and continuous neurological monitoring.

  Awake closed manual reduction of cervical spine dislocation as an emergency bridge to surgery: a case report · 2026 · DOI

• There is a need for alternative techniques for closed reduction in time-critical scenarios. Current techniques require specialized equipment or anesthesia, which may not always be available. There is a lack of standardized protocols for awake closed manual reduction.

  Awake closed manual reduction of cervical spine dislocation as an emergency bridge to surgery: a case report · 2026 · DOI

• Despite their long-standing description, controversy remains regarding the denticulate ligaments' number, morphology, and function. There is little literature about variations of the ligaments.

  A comprehensive review of the denticulate ligaments: application to surgery of the craniocervical junction and spine · 2026 · DOI

• There is a need for alternative graft materials that can provide optimized fusion outcomes. Traditional graft materials have limitations, including donor site morbidity and limited availability.

  Bioactive glass-ceramic spacer alone versus spacer augmented with ABM/P-15 in single-level ACDF: a retrospective cohort study comparison of fusion rates and clinical outcomes · 2026 · DOI

• The risk of cervical injuries in contact sports, particularly in wrestling. The challenge of achieving spinal cord decompression and stabilization in cervical spine trauma. The need for prompt medical attention and treatment in cases of suspected neck injuries.

  Significant Neurological Recovery After Severe Cervical Spine Injury in Elite Wrestling Athlete: A Case Report · 2026 · DOI

• The limited number of reports on the use of ACDF in traumatic multilevel cervical disc herniation. The need for further research on the treatment and management of cervical spine trauma in contact sports.

  Significant Neurological Recovery After Severe Cervical Spine Injury in Elite Wrestling Athlete: A Case Report · 2026 · DOI

• Variability in surgeon experience and expertise. Complexity of cases such as multilevel stenosis and severe central canal conditions. Need for long-term follow-up data on the efficacy of TELD.

  Transforaminal Endoscopic Lumbar Decompression: Defining Its Scope and Limitations · 2026 · DOI

• The study is limited to the perspectives of spine surgeons and may not reflect the experiences of other healthcare professionals. The survey instrument may not have captured all relevant aspects of TELD. The study does not provide long-term follow-up data on the efficacy of TELD.

  Transforaminal Endoscopic Lumbar Decompression: Defining Its Scope and Limitations · 2026 · DOI

• There is a need to compare the effectiveness of NMES and isometric exercises in managing Cervicogenic Headache. The current study aims to address this gap.

  Comparative Effectiveness of Neuromuscular Electrical Stimulation Versus Isometric Exercises in Patients with Cervicogenic Headache: A Randomized Controlled Trial · 2026 · DOI

• There is a lack of dedicated studies on atlas hypoplasia. Prior studies have focused on Asian populations, with few studies on North American populations.

  Hypoplasia of the Atlas Does Not Correlate With Subaxial Canal Stenosis: A Retrospective Cohort Study · 2026 · DOI

• 2026 Yokogawa et al. Cureus 18(5): e109541. DOI 10.7759/cureus.109541 7 of 9 In this study, we presented the largest sample size to date to examine the association between atlas hypoplasia, aging, and subaxial stenosis. There are several limitations, as with any study. The retrospective design using a homogeneous cohort may affect generalizability and result in selection bias. The study also did not include patients with associated genetic disorders that could cause atlas-level stenosis, such as os odontoideum and Klippel-Feil syndrome. Additional research into predisposing pathologies may be warranted. In addition, this study did not evaluate soft tissue damage, spinal cord injury, or atlantoaxial instability. Further analysis of the degree of cord compression and factors associated with stenosis, along with atlas hypoplasia, would be useful. The atlas hypoplasia subgroup was small, with only 17 patients, which limits the statistical strength of conclusions drawn from this subgroup analysis and should be interpreted with caution. Furthermore, while CT measurements were performed by fellows under the supervision of orthopaedic spine surgeons with experience in cervical radiographic anatomy, formal intra-rater and inter-rater reliability testing was not conducted, which represents an additional methodological limitation. Finally, this study was intentionally designed as a radiographic and anatomical investigation and did not include correlation with clinical symptoms, neurologic examination findings, MRI-based cord signal changes, or long-term patient outcomes. Such correlations would substantially strengthen the clinical relevance of these findings and are identified as a priority area for future investigation.

  Hypoplasia of the Atlas Does Not Correlate With Subaxial Canal Stenosis: A Retrospective Cohort Study · 2026 · DOI

• The standard posterior surgical approach can cause damage to the posterior ligamentous complex. Few studies have investigated the use of spinous process osteotomy for posterior cervical spine exposure.

  Spinous Process Osteotomy for Exposure of the Posterior Cervical Spine: An Innovative Technique to Preserve Midline Structures · 2026 · DOI

• The biomechanical differences between two-screw and four-screw zero-profile fusion devices are unclear. There is a need to compare the biomechanical performance of these devices using finite element analysis. The effects of micromotion on bone formation and the osseointegration process are not well understood.

  Biomechanical comparison of two-screw and four-screw zero-profile fusion devices in anterior cervical discectomy and fusion using finite element analysis · 2026 · DOI

Most-cited papers in Cervical and Thoracic Myelopathy

• Rupture of the Intervertebral Disc with Involvement of the Spinal Canal · New England Journal of Medicine · 1934 · 1,421 citations
• Interobserver Reproducibility of Cervical Cytologic and Histologic Interpretations<SUBTITLE>Realistic Estimates From the ASCUS-LSIL Triage Study</SUBTITLE> · JAMA · 2001 · 898 citations
• The Cervical Vertebral Maturation (CVM) Method for the Assessment of Optimal Treatment Timing in Dentofacial Orthopedics · Seminars in Orthodontics · 2005 · 881 citations
• Natural History and Prognosis of Cervical Spondylosis · BMJ · 1963 · 321 citations
• Low-risk criteria for cervical-spine radiography in blunt trauma: A prospective study · Annals of Emergency Medicine · 1992 · 230 citations
• Research ethics : a strategy for promoting professional ethics : research paper · Perspectives in Education · 2003 · 225 citations
• Distribution and patterns of blunt traumatic cervical spine injury · Annals of Emergency Medicine · 2001 · 215 citations
• REMARKS ON THE HISTOPATHOLOGICAL CHANGES IN THE SPINAL CORD DUE TO IMPACT. AN EXPERIMENTAL STUDY · The Journal of Nervous and Mental Disease · 1914 · 200 citations
• External Cervical Resorption: A Review · Journal of Endodontics · 2009 · 196 citations
• Invasive cervical resorption · Endodontic Topics · 2004 · 173 citations

Most recent work

• Radiographic and clinical effects of core stabilization on cervical pain and sagittal balance in forward head posture: a randomized controlled trial · Asian Spine Journal · 2026
• A Nationwide Registry Study Comparing Long-term Risk of Adjacent Segment Disease Requiring Reoperation Following Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty · Neurospine · 2026
• Clinical evolution in the treatment of degenerative cervical myelopathy in Japan: excellence born from necessity · International Orthopaedics · 2026
• Endothelial senescence of the vertebral artery in the context of cervical degeneration: biomechanically driven remodeling of the hemodynamic environment · Frontiers in Cell and Developmental Biology · 2026
• Patient and Surgeon Willingness to Participate in a Randomized Trial of Surgery Versus Observation for Mild Cervical Spondylotic Myelopathy: A Cross-Sectional Survey Study · medRxiv · 2026
• Angiogenesis in ossification of the posterior longitudinal ligament: progress from mechanism to targeted intervention · Frontiers in Cell and Developmental Biology · 2026
• Exoscopic Minimally Invasive Open-Door Laminoplasty with Pedicle Screw Fixation for Cervical Ossification of the Posterior Longitudinal Ligament: A Technical Note and Preliminary Clinical Experience · Journal of Clinical Medicine · 2026
• Machine Learning Prediction of Prevertebral Soft Tissue Swelling after Single-Level Anterior Cervical Surgery : A Proof-of-Concept Study · Journal of Korean Neurosurgical Society · 2026
• Predicting intraoperative blood loss using cervical vertebral bone quality scores in cervical corpectomy and fusion procedure · European Spine Journal · 2026
• Artificial intelligence–based detection of acute postoperative airway complications following anterior cervical spine surgery: a retrospective imaging evaluation · Asian Spine Journal · 2026

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