Study Design: Narrative review. Objective: To synthesize contemporary evidence on perioperative complications in primary and metastatic cervical spine tumor surgery and to provide an evidence-informed framework for their prevention and management. Summary of Background Data: Cervical spine tumor surgery converges dense neurovascular and aerodigestive anatomy with a medically fragile, frequently irradiated patient population. Although cervical metastases represent only about 8–20% of spinal metastatic disease, their mismanagement carries disproportionately severe consequences, ranging from disabling pain to high-level paralysis and death. Cervical-specific risk-stratification tools are lacking, and most available evidence is extrapolated from degenerative anterior cervical cohorts. Methods: This is a narrative review of perioperative complications in cervical spine oncology. PubMed/MEDLINE and Google Scholar were searched for English-language articles published through May 2026, prioritizing literature from the past 5 years while including seminal earlier references where foundational, using combinations of the terms “cervical spine,” “spinal metastasis,” “spinal tumor,” “perioperative complications,” “airway,” “vertebral artery,” “wound,” “dysphagia,” “venous thromboembolism,” and “hardware failure.” Reference lists of included articles were hand-searched for additional sources. Studies were selected by author consensus for relevance to the complication domains discussed; formal risk-of-bias assessment and quantitative pooling were not performed, consistent with a narrative design. Because oncology-specific evidence is limited, data derived from degenerative cervical cohorts are identified as such throughout. Results: Major complication domains include airway compromise (highest with multilevel corpectomy, combined approaches, and cervicothoracic constructs), vascular and neurologic injury, CSF leak, wound failure and infection in irradiated fields, hardware failure, venous thromboembolism, and dysphagia. Conclusions: Outcomes depend on preoperative risk stratification, multidisciplinary coordination, and individualized postoperative care rather than any single intraoperative maneuver. Because the evidence base remains largely Level III–IV without validated cervical oncology-specific tools, described practices should be regarded as reasonable, evidence-informed considerations rather than standards of care.
Study Design Narrative review of contemporary literature alongside institutional experience applying the NOMS framework to cervical spine tumors. Objective To supplement the NOMS framework with cervical spine–specific considerations: summary of background data. The NOMS framework provides a widely applicable approach to spinal oncology based on neurological, oncologic, mechanical, and systemic factors. Methods Contemporary literature and published institutional experience addressing cervical spine tumors were reviewed Results Cervical spine tumors require region-specific modification of conventional NOMS decision-making. Mechanical considerations are particularly important at the occipitocervical and cervicothoracic junctions, where tumor-related or iatrogenic instability may necessitate extended constructs and careful fixation strategies. Systemic factors, including frailty, malnutrition, prior radiation, active therapy, and prognosis, remain critical determinants of surgical candidacy. Complex cases may require multidisciplinary planning. Conclusions NOMS remains a useful foundation for cervical spine oncology but should be supplemented by region-specific anatomic and biomechanical considerations. Treatment should be individualized according to neurological compromise, tumor biology, mechanical stability, systemic disease, and surgical morbidity. As radiation and systemic therapies advance, surgery should primarily address decompression, stabilization, and tissue diagnosis rather than serve as a stand-alone modality for local control.
Study Design: Case presentation. Objective: The interlaminar endoscopic lateral recess decompression (IE-LRD) represents a novel surgical alternative to consider in carefully selected cases, particularly when patients do not respond to conservative treatment. Background: Lumbar spinal stenosis (LSS) constitutes one of the most prevalent spinal conditions in the elderly population around the world. A myriad of causes have been elucidated, and although infrequent, vertebral compression fractures (VCF) may also cause LSS. Conservative treatment might be the first option; however, patients often require surgery. Methods: A 76-year-old woman with a medical history of dementia consulted for radicular pain in her left leg during the past 6 months, without any favorable response to conservative treatment. Neurological examination revealed a positive straight leg raising test on the left. A spine MRI revealed a VCF in L5, linked with spondylolisthesis (grade I) at L5–S1. An IE-LRD was planned, as the patient did not consent to a classical open surgery. The incision was placed over the inferior medial edge of the left L4 lamina. Following sequential dilatators, the working channel was located on the inferomedial edge of the left L4 lamina. Lateral fluoroscopy (LF) guided the entire procedure. During the procedure, laminotomy was extended cranially and caudally to ensure sufficient vertebral decompression. Results: After surgery, the patient was mobilized in the first 6 hours and discharged in the next 24 hours. Her lower back pain score improved significantly to 2–3, while her leg VAS pain improved to 0–1. After a follow-up for 18 months, the patient did not manifest complications or recurrences, and no additional treatment was carried out. Conclusion: (1) IE-LRD might be a useful and safe surgical procedure for the surgical management of LSS caused by VCF. (2) Consider this surgical alternative for elderly patients without a previous response to conservative medical treatment.
Background Data: Pediatric patients undergoing surgery for secondary scoliosis are at special risk for surgical site infections (SSIs). The application of dexamethasone (Dexa) for perioperative prophylaxis of postoperative nausea and vomiting is an established method. Despite the benefits, there is still concern regarding an increased risk for SSI. Objective: This study aimed to evaluate the association between perioperative Dexa administration for PONV prophylaxis and the occurrence of SSI requiring surgical revision in pediatric patients undergoing surgery for secondary scoliosis. Study Design: Single-center retrospective cohort study. Methods: Patients younger than 18 years undergoing surgical treatment for secondary scoliosis between January 2017 and December 2021 were included. Demographic and surgical data were extracted from medical records and discharge summaries. SSI requiring surgical reintervention was the primary outcome. Statistical analysis was conducted using the Mann-Whitney U test, Fisher exact test, and Fisher-Freeman-Halton test, univariable and bivariable logistic regression. Results: One hundred sixty-two patients were included (Dexa: n=30, control: n=132). There were no significant differences considering demographics ( P >0.05). Patients receiving Dexa underwent undergoing revision surgery more often or had meningomyelocele (MMC). The overall incidence of infection was 11/162. Patients receiving Dexa showed a higher incidence of SSI requiring surgical reintervention (6/30 vs. 5/132, P =0.01) and were at higher Odds for SSI (OR: 5.25, 95% CI: 1.53–18.15, P =0.007), which remained significant after adjusting for confounders (MMC: OR: 3.97, 95% CI: 1.08–14.38, P =0.033; revision surgery: OR: 3.97, 95% CI: 1.08–14.38, P =0.033). Conclusions: This study observed an association between the preoperative application of Dexa for PONV prophylaxis in secondary scoliosis surgery and an increased risk of SSI. Our results give reason for a more thoughtful application of Dexa-based PONV prophylaxes in the perioperative therapy of a population of high-risk children for SSI with secondary scoliosis.
Study Design: Case report and literature review. Objective: To report a rare case of delayed cerebrospinal fluid leakage complicated by central nervous system infection following posterior cervical laminectomy, and to elucidate the associated diagnostic and management challenges. Background: Acute cerebrospinal fluid (CSF) leakage is a recognized complication of posterior cervical spine surgery, whereas delayed CSF leakage remains exceedingly rare. When delayed CSF leakage coincides with central nervous system infection, delayed diagnosis may lead to catastrophic outcomes. We describe an unusual case of this complication following a cervical laminectomy. Methods: A 60-year-old male underwent a posterior cervical C3-5 laminectomy and decompression with lateral mass screw-rod fixation for traumatic cervical spinal cord injury and multilevel cervical spinal stenosis. Postoperatively, he developed fever, cervicodorsal pain, and headache. The diagnostic workup consisted of magnetic resonance imaging, cerebrospinal fluid analysis, and microbial culture. Results: Magnetic resonance imaging revealed a fluid collection at the surgical site, and cerebrospinal fluid analysis confirmed bacterial meningitis caused by Enterobacter aerogenes . The patient achieved complete neurological recovery following combined antimicrobial therapy and lumbar cistern drainage. Conclusion: This case highlights that nonspecific symptoms such as orthostatic headache and fever, emerging more than 48 hours postoperatively—even in the absence of an intraoperative dural tear—should raise suspicion for delayed cerebrospinal fluid (CSF) leakage with central nervous system infection. Definitive diagnosis requires prompt magnetic resonance imaging and CSF analysis. Early intervention with targeted antibiotics and lumbar cistern drainage is essential for optimal outcomes.
