Objective: This study aims to assess global trends in the use of open surgery versus minimally invasive surgery (MIS) for the treatment of single-level L4–5 degenerative lumbar spondylolisthesis (DLS). Methods: A cross-sectional online survey issued by the AO Spine Knowledge Forum Degenerative was conducted among AO Spine members between July and September 2023. Participants were presented with 3 clinical cases of L4–5 grade 1 DLS, each with varying degrees of stenosis and instability. The survey captured surgeon demographics and preferences for open versus MIS approaches. Statistical analysis, including chi-square tests and logistic regression, was performed to explore associations between surgical choices and surgeon demographics. Results: A total of 943 surgeons responded, with 479 completing the survey. Open surgery was the preferred approach in all 3 cases (58.8%, 57.3%, and 42.4%, respectively), particularly in cases involving central and bilateral foraminal stenosis. MIS was the second most common choice, particularly for unilateral foraminal stenosis with mild instability (38.8%). Surgeons’ preferences varied significantly by region, age, and fellowship training, with younger and fellowship-trained surgeons more likely to prefer MIS. Conclusion The study highlights the continued predominance of open surgery for DLS, especially in complex cases, despite the growing acceptance of MIS. Significant regional and demographic variations in surgical preferences suggest the need for tailored guidelines and standardized training protocols to optimize patient outcomes. Future research should focus on the long-term efficacy of these approaches and the impact of evolving technologies on surgical decision-making.

Objective: This study aims to assess global trends in the use of open surgery versus minimally invasive surgery (MIS) for the treatment of single-level L4–5 degenerative lumbar spondylolisthesis (DLS). Methods: A cross-sectional online survey issued by the AO Spine Knowledge Forum Degenerative was conducted among AO Spine members between July and September 2023. Participants were presented with 3 clinical cases of L4–5 grade 1 DLS, each with varying degrees of stenosis and instability. The survey captured surgeon demographics and preferences for open versus MIS approaches. Statistical analysis, including chi-square tests and logistic regression, was performed to explore associations between surgical choices and surgeon demographics. Results: A total of 943 surgeons responded, with 479 completing the survey. Open surgery was the preferred approach in all 3 cases (58.8%, 57.3%, and 42.4%, respectively), particularly in cases involving central and bilateral foraminal stenosis. MIS was the second most common choice, particularly for unilateral foraminal stenosis with mild instability (38.8%). Surgeons’ preferences varied significantly by region, age, and fellowship training, with younger and fellowship-trained surgeons more likely to prefer MIS. Conclusion The study highlights the continued predominance of open surgery for DLS, especially in complex cases, despite the growing acceptance of MIS. Significant regional and demographic variations in surgical preferences suggest the need for tailored guidelines and standardized training protocols to optimize patient outcomes. Future research should focus on the long-term efficacy of these approaches and the impact of evolving technologies on surgical decision-making.

Objective: This study aims to assess global trends in the use of open surgery versus minimally invasive surgery (MIS) for the treatment of single-level L4–5 degenerative lumbar spondylolisthesis (DLS). Methods: A cross-sectional online survey issued by the AO Spine Knowledge Forum Degenerative was conducted among AO Spine members between July and September 2023. Participants were presented with 3 clinical cases of L4–5 grade 1 DLS, each with varying degrees of stenosis and instability. The survey captured surgeon demographics and preferences for open versus MIS approaches. Statistical analysis, including chi-square tests and logistic regression, was performed to explore associations between surgical choices and surgeon demographics. Results: A total of 943 surgeons responded, with 479 completing the survey. Open surgery was the preferred approach in all 3 cases (58.8%, 57.3%, and 42.4%, respectively), particularly in cases involving central and bilateral foraminal stenosis. MIS was the second most common choice, particularly for unilateral foraminal stenosis with mild instability (38.8%). Surgeons’ preferences varied significantly by region, age, and fellowship training, with younger and fellowship-trained surgeons more likely to prefer MIS. Conclusion The study highlights the continued predominance of open surgery for DLS, especially in complex cases, despite the growing acceptance of MIS. Significant regional and demographic variations in surgical preferences suggest the need for tailored guidelines and standardized training protocols to optimize patient outcomes. Future research should focus on the long-term efficacy of these approaches and the impact of evolving technologies on surgical decision-making.

Objective: This study aims to assess global trends in the use of open surgery versus minimally invasive surgery (MIS) for the treatment of single-level L4–5 degenerative lumbar spondylolisthesis (DLS). Methods: A cross-sectional online survey issued by the AO Spine Knowledge Forum Degenerative was conducted among AO Spine members between July and September 2023. Participants were presented with 3 clinical cases of L4–5 grade 1 DLS, each with varying degrees of stenosis and instability. The survey captured surgeon demographics and preferences for open versus MIS approaches. Statistical analysis, including chi-square tests and logistic regression, was performed to explore associations between surgical choices and surgeon demographics. Results: A total of 943 surgeons responded, with 479 completing the survey. Open surgery was the preferred approach in all 3 cases (58.8%, 57.3%, and 42.4%, respectively), particularly in cases involving central and bilateral foraminal stenosis. MIS was the second most common choice, particularly for unilateral foraminal stenosis with mild instability (38.8%). Surgeons’ preferences varied significantly by region, age, and fellowship training, with younger and fellowship-trained surgeons more likely to prefer MIS. Conclusion The study highlights the continued predominance of open surgery for DLS, especially in complex cases, despite the growing acceptance of MIS. Significant regional and demographic variations in surgical preferences suggest the need for tailored guidelines and standardized training protocols to optimize patient outcomes. Future research should focus on the long-term efficacy of these approaches and the impact of evolving technologies on surgical decision-making.

Objective: This study aims to assess global trends in the use of open surgery versus minimally invasive surgery (MIS) for the treatment of single-level L4–5 degenerative lumbar spondylolisthesis (DLS). Methods: A cross-sectional online survey issued by the AO Spine Knowledge Forum Degenerative was conducted among AO Spine members between July and September 2023. Participants were presented with 3 clinical cases of L4–5 grade 1 DLS, each with varying degrees of stenosis and instability. The survey captured surgeon demographics and preferences for open versus MIS approaches. Statistical analysis, including chi-square tests and logistic regression, was performed to explore associations between surgical choices and surgeon demographics. Results: A total of 943 surgeons responded, with 479 completing the survey. Open surgery was the preferred approach in all 3 cases (58.8%, 57.3%, and 42.4%, respectively), particularly in cases involving central and bilateral foraminal stenosis. MIS was the second most common choice, particularly for unilateral foraminal stenosis with mild instability (38.8%). Surgeons’ preferences varied significantly by region, age, and fellowship training, with younger and fellowship-trained surgeons more likely to prefer MIS. Conclusion The study highlights the continued predominance of open surgery for DLS, especially in complex cases, despite the growing acceptance of MIS. Significant regional and demographic variations in surgical preferences suggest the need for tailored guidelines and standardized training protocols to optimize patient outcomes. Future research should focus on the long-term efficacy of these approaches and the impact of evolving technologies on surgical decision-making.

Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults, representing substantial morbidity and significant financial and resource burdens. Typically, patients with progressive DCM will eventually receive surgical treatment. Nonetheless, despite advancements in pharmacotherapeutics, evidence for pharmacological therapy remains limited. Health professionals from various fields would find interest in pharmacological agents that could benefit patients with mild DCM or enhance surgical outcomes. This review aims to consolidate all clinical and experimental evidence on the pharmacological treatment of DCM. We conducted a comprehensive narrative review that presents all pharmacological agents that have been investigated for DCM treatment in both humans and animal models. Riluzole exhibits effectiveness solely in rat models, but not in treating mild DCM in humans. Cerebrolysin emerges as a potential neuroprotective agent for myelopathy in animals but had contradictory results in clinical trials. Limaprost alfadex demonstrates motor function improvement in animal models and exhibits promising outcomes in a small clinical trial. Glucocorticoids not only fail to provide clinical benefits but may also lead to adverse events. Cilostazol, anti-Fas ligand antibody, and Jingshu Keli display promise in animal studies, while erythropoietin, granulocyte colony-stimulating factor and limaprost alfadex exhibit potential in both animal and human research. Existing evidence mainly rests on weak clinical data and animal experimentation. Current pharmacological efforts target ion channels, stem cell differentiation, inflammatory, vascular, and apoptotic pathways. The inherent nature and pathogenesis of DCM offer substantial prospects for developing neurodegenerative or neuroprotective therapies capable of altering disease progression, potentially delaying surgical intervention, and optimizing outcomes for those undergoing surgical decompression.

Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults, representing substantial morbidity and significant financial and resource burdens. Typically, patients with progressive DCM will eventually receive surgical treatment. Nonetheless, despite advancements in pharmacotherapeutics, evidence for pharmacological therapy remains limited. Health professionals from various fields would find interest in pharmacological agents that could benefit patients with mild DCM or enhance surgical outcomes. This review aims to consolidate all clinical and experimental evidence on the pharmacological treatment of DCM. We conducted a comprehensive narrative review that presents all pharmacological agents that have been investigated for DCM treatment in both humans and animal models. Riluzole exhibits effectiveness solely in rat models, but not in treating mild DCM in humans. Cerebrolysin emerges as a potential neuroprotective agent for myelopathy in animals but had contradictory results in clinical trials. Limaprost alfadex demonstrates motor function improvement in animal models and exhibits promising outcomes in a small clinical trial. Glucocorticoids not only fail to provide clinical benefits but may also lead to adverse events. Cilostazol, anti-Fas ligand antibody, and Jingshu Keli display promise in animal studies, while erythropoietin, granulocyte colony-stimulating factor and limaprost alfadex exhibit potential in both animal and human research. Existing evidence mainly rests on weak clinical data and animal experimentation. Current pharmacological efforts target ion channels, stem cell differentiation, inflammatory, vascular, and apoptotic pathways. The inherent nature and pathogenesis of DCM offer substantial prospects for developing neurodegenerative or neuroprotective therapies capable of altering disease progression, potentially delaying surgical intervention, and optimizing outcomes for those undergoing surgical decompression.

Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults, representing substantial morbidity and significant financial and resource burdens. Typically, patients with progressive DCM will eventually receive surgical treatment. Nonetheless, despite advancements in pharmacotherapeutics, evidence for pharmacological therapy remains limited. Health professionals from various fields would find interest in pharmacological agents that could benefit patients with mild DCM or enhance surgical outcomes. This review aims to consolidate all clinical and experimental evidence on the pharmacological treatment of DCM. We conducted a comprehensive narrative review that presents all pharmacological agents that have been investigated for DCM treatment in both humans and animal models. Riluzole exhibits effectiveness solely in rat models, but not in treating mild DCM in humans. Cerebrolysin emerges as a potential neuroprotective agent for myelopathy in animals but had contradictory results in clinical trials. Limaprost alfadex demonstrates motor function improvement in animal models and exhibits promising outcomes in a small clinical trial. Glucocorticoids not only fail to provide clinical benefits but may also lead to adverse events. Cilostazol, anti-Fas ligand antibody, and Jingshu Keli display promise in animal studies, while erythropoietin, granulocyte colony-stimulating factor and limaprost alfadex exhibit potential in both animal and human research. Existing evidence mainly rests on weak clinical data and animal experimentation. Current pharmacological efforts target ion channels, stem cell differentiation, inflammatory, vascular, and apoptotic pathways. The inherent nature and pathogenesis of DCM offer substantial prospects for developing neurodegenerative or neuroprotective therapies capable of altering disease progression, potentially delaying surgical intervention, and optimizing outcomes for those undergoing surgical decompression.

Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults, representing substantial morbidity and significant financial and resource burdens. Typically, patients with progressive DCM will eventually receive surgical treatment. Nonetheless, despite advancements in pharmacotherapeutics, evidence for pharmacological therapy remains limited. Health professionals from various fields would find interest in pharmacological agents that could benefit patients with mild DCM or enhance surgical outcomes. This review aims to consolidate all clinical and experimental evidence on the pharmacological treatment of DCM. We conducted a comprehensive narrative review that presents all pharmacological agents that have been investigated for DCM treatment in both humans and animal models. Riluzole exhibits effectiveness solely in rat models, but not in treating mild DCM in humans. Cerebrolysin emerges as a potential neuroprotective agent for myelopathy in animals but had contradictory results in clinical trials. Limaprost alfadex demonstrates motor function improvement in animal models and exhibits promising outcomes in a small clinical trial. Glucocorticoids not only fail to provide clinical benefits but may also lead to adverse events. Cilostazol, anti-Fas ligand antibody, and Jingshu Keli display promise in animal studies, while erythropoietin, granulocyte colony-stimulating factor and limaprost alfadex exhibit potential in both animal and human research. Existing evidence mainly rests on weak clinical data and animal experimentation. Current pharmacological efforts target ion channels, stem cell differentiation, inflammatory, vascular, and apoptotic pathways. The inherent nature and pathogenesis of DCM offer substantial prospects for developing neurodegenerative or neuroprotective therapies capable of altering disease progression, potentially delaying surgical intervention, and optimizing outcomes for those undergoing surgical decompression.

Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults, representing substantial morbidity and significant financial and resource burdens. Typically, patients with progressive DCM will eventually receive surgical treatment. Nonetheless, despite advancements in pharmacotherapeutics, evidence for pharmacological therapy remains limited. Health professionals from various fields would find interest in pharmacological agents that could benefit patients with mild DCM or enhance surgical outcomes. This review aims to consolidate all clinical and experimental evidence on the pharmacological treatment of DCM. We conducted a comprehensive narrative review that presents all pharmacological agents that have been investigated for DCM treatment in both humans and animal models. Riluzole exhibits effectiveness solely in rat models, but not in treating mild DCM in humans. Cerebrolysin emerges as a potential neuroprotective agent for myelopathy in animals but had contradictory results in clinical trials. Limaprost alfadex demonstrates motor function improvement in animal models and exhibits promising outcomes in a small clinical trial. Glucocorticoids not only fail to provide clinical benefits but may also lead to adverse events. Cilostazol, anti-Fas ligand antibody, and Jingshu Keli display promise in animal studies, while erythropoietin, granulocyte colony-stimulating factor and limaprost alfadex exhibit potential in both animal and human research. Existing evidence mainly rests on weak clinical data and animal experimentation. Current pharmacological efforts target ion channels, stem cell differentiation, inflammatory, vascular, and apoptotic pathways. The inherent nature and pathogenesis of DCM offer substantial prospects for developing neurodegenerative or neuroprotective therapies capable of altering disease progression, potentially delaying surgical intervention, and optimizing outcomes for those undergoing surgical decompression.