Open research questions in Cervical and Thoracic Myelopathy

What the literature leaves open

• Several limitations must be acknowledged in this study. Firstly, the retrospective nature of the research introduces inherent biases that cannot be entirely eliminated, potentially affecting the reliability and validity of the findings.

  Excessive intraoperative diastolic blood pressure decrease during anesthesia lead to a higher risk of postoperative hematoma following anterior cervical discectomy and fusion (ACDF): a single-center study of 10,615 patients · 2026 · DOI

• The lack of clear differentiation between bone loss and osteolysis. The need for a systematic review to guide clinical management. The requirement for standardised definitions for bone loss and osteolysis.

  Bone loss or osteolysis after cervical disc arthroplasty? A systematic review on clinical differentiation · 2026 · DOI

• The need for a comprehensive evaluation of postoperative complication profiles between ACDF and CDA. The lack of a large, propensity-matched national dataset with long-term follow-up. The uncertainty surrounding the safety of CDA in the management of degenerative cervical spine disease.

  Cervical disc arthroplasty versus anterior cervical discectomy and fusion in the young adult patient population: A propensity-matched cohort study · 2026 · DOI

• The need to minimize errors from SC curvature and positioning.

  Spinal nerves as landmarks for spinal cord segment delineation: cervical cross-sectional area measurement in healthy subjects · 2026 · DOI

• The study used a limited number of subjects in the OpenNeuro dataset. The study did not investigate the application of the proposed method to neurodegenerative diseases. The study only used 3-T scanners for MRI data acquisition.

  Spinal nerves as landmarks for spinal cord segment delineation: cervical cross-sectional area measurement in healthy subjects · 2026 · DOI

• There is a lack of studies exploring the CTJ as a whole. Prior work has investigated cervical and thoracic regions separately. Demographic variables such as height, age, and BMI have rarely been examined in the literature.

  Radiological morphometric analysis of cervicothoracic junction vertebrae pedicles · 2026 · DOI

• The relationship between preoperative cervical range of motion and cage subsidence has not been investigated. The impact of cage-endplate interface stress on subsidence has received less attention.

  Is preoperative cervical range of motion associated with cage subsidence after anterior cervical discectomy and fusion? · 2026 · DOI

• Outcomes following 3-level ACDF remain poorly understood. Many existing studies pool constructs of varying lengths and operative levels, limiting their ability to isolate the biomechanical and clinical implications of 3-level fusions.

  The impact of operative level on reoperation rates and short-term patient-reported outcomes in 3-level anterior cervical discectomy and fusion · 2026 · DOI

• One of the challenges is the limited visualization and working angles in current minimally invasive techniques. Another challenge is the risk of dural injury during decompression. The Infinity Decompression technique addresses these challenges by providing a reproducible framework for decompression and minimizing the risk of dural injury.

  Infinity decompression: a stepwise biportal endoscopic over-the-top decompression – surgical technique and outcomes · 2026 · DOI

• Current minimally invasive techniques have limitations regarding visualization and working angles. There is a need for a standardized method for over-the-top lumbar decompression. The Infinity Decompression technique addresses these gaps by providing a reproducible framework for decompression.

  Infinity decompression: a stepwise biportal endoscopic over-the-top decompression – surgical technique and outcomes · 2026 · DOI

• The lack of systematic reports on the epidemiological characteristics of spinal cord hypertension syndrome. The need to identify the factors associated with the occurrence of spinal cord hypertension syndrome. The importance of understanding the core mechanism of spinal cord hypertension syndrome.

  Epidemiology of spinal cord hypertension syndrome in water-mediated uniportal full endoscopic thoracolumbar surgery: a single-center experience · 2026 · DOI

• The study identifies technical challenges in evaluating carotid atherosclerotic changes, such as the need for accurate and reliable measurements. The study notes the challenge of managing cerebrovascular risk in patients with degenerative cervical myelopathy. The study identifies the challenge of optimizing perioperative management strategies to prevent cerebrovascular events.

  Preoperative carotid ultrasound in degenerative cervical myelopathy: from routine screening to selective use · 2026 · DOI

• The study aims to address this gap by investigating the use of carotid ultrasonography in this patient population.

  Preoperative carotid ultrasound in degenerative cervical myelopathy: from routine screening to selective use · 2026 · DOI

• Insufficient posterior spinal cord shift limits effective decompression in conventional posterior-only approaches. 540° surgery is associated with substantial physiological burden, including extended operative times, increased blood loss, and elevated perioperative morbidity.

  Vertebral body sliding osteotomy as a less invasive alternative to 540° surgery for cervical myelopathy with rigid kyphosis · 2026 · DOI

• The current literature lacks a comprehensive understanding of the risk factors associated with 90-day surgical site infection after cervical disc arthroplasty. There is a need to identify the dominant determinants of surgical site infection risk in the cervical disc arthroplasty population.

  Patient factors outweigh procedure extent in infection risk after cervical disc arthroplasty · 2026 · DOI

• The conventional approach has a substantial biological cost. There is a need for a novel approach that provides immediate stability while minimizing biological cost. The current techniques may not provide adequate visualization of the extraforaminal component.

  Posterior unilateral approach with unilateral pedicle and contralateral laminar screw combined with lateral mass reconstruction for cervical dumbbell tumors: case series and technical note · 2026 · DOI

• Future studies incorporating detailed patient-reported outcome measures will be important to clarify the psychological dimensions and confirm the clinical relevance of the findings. Research should investigate the impact of motion preservation through cervical disc arthroplasty on postoperative functional recovery and the risk of developing new-onset depression.

  New-onset depression following anterior cervical discectomy and fusion or cervical artificial disc replacement: a retrospective cohort study using a multi-institutional claims database · 2026 · DOI

• Few studies have investigated the development of new-onset depression following cervical spine surgery. The study aims to fill this gap by comparing the incidence of new-onset depression in patients undergoing ACDF or ADR.

  New-onset depression following anterior cervical discectomy and fusion or cervical artificial disc replacement: a retrospective cohort study using a multi-institutional claims database · 2026 · DOI

• Precise evaluation of small or subtle ossification is clinically important. CT remains the reference standard for detailed assessment of OPLL morphology.

  Vendor-neutral-CT-like bone contrast MRI in ossification of posterior longitudinal ligament · 2026 · DOI

• Transient neural irritation may occur during decompression or nerve root manipulation. The working corridor in endoscopic cervical decompression is narrow and visualization is inherently limited. Intraoperative neuromonitoring alerts may not necessarily indicate limited predictive value of monitoring, but rather reflect the effectiveness of intraoperative responses triggered by these alerts.

  Intraoperative neuromonitoring in endoscopic cervical decompression: a signal–event–response perspective · 2026 · DOI

• The study had a relatively low number of patients, which limited the ability to detect statistically significant differences. The short follow-up period of 6 months limited the ability to evaluate the long-term clinical implications of the radiographic changes.

  Is there a difference in early postoperative adjacent segment angles following anterior cervical discectomy and fusion compared to cervical disc replacement? · 2026 · DOI

• The overall number of patients included remains relatively low for a definitive analysis, - The short follow-up period of 6 months limits the ability to evaluate long-term clinical implications, - Implant-specific data were not…

  Is there a difference in early postoperative adjacent segment angles following anterior cervical discectomy and fusion compared to cervical disc replacement? · 2026 · DOI

• Further studies are needed to explore the morphometry of CTJ vertebrae in different populations, - Studies that examine the relationship between demographic variables and CTJ morphometry are needed, - Research on the application of CTJ morphometry in clinical practice…

  Radiological morphometric analysis of cervicothoracic junction vertebrae pedicles · 2026 · DOI

• The study had a retrospective design, - The sample size was limited to 80 patients, - The study only included patients with degenerative cervical spine disease, - The follow-up period was relatively short, with a mean follow-up length of 14.7 ± 2.6…

  Is preoperative cervical range of motion associated with cage subsidence after anterior cervical discectomy and fusion? · 2026 · DOI

• Temporal allocation bias cannot be excluded, - Surgical decision-making may have been influenced by evolving institutional preference and growing familiarity with the VBSO technique over time, - The study had a retrospective design, - The sample size was limited to 57 consecutive…

  Vertebral body sliding osteotomy as a less invasive alternative to 540° surgery for cervical myelopathy with rigid kyphosis · 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

• Perioperative GLP-1 Receptor Agonist Use is Associated With Reduced Revisions and Complications Following ACDF: A Propensity-Matched Analysis · Global Spine Journal · 2026
• Impact of different paraspinal muscle mass on the prognosis of ACDF—a finite element analysis · Frontiers in Bioengineering and Biotechnology · 2026
• Impact of Ankylosing Spondylitis/Diffuse Idiopathic Skeletal Hyperostosis on Postoperative and Patient-Reported Outcomes Following Elective Cervical and Lumbar Surgery · Global Spine Journal · 2026
• 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
• Muscle-Specific Biomechanical Adaptations Following Rehabilitation Treatment in Cervical Spondylosis: A Pilot Study · Life · 2026
• Decreasing Medicare Payments for Anterior Cervical Discectomy and Fusion From 2013 to 2023 · Neurosurgery · 2026
• Pathophysiology, diagnosis, and management of cervical disc herniation · The American Journal of Medicine · 2026

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