There are several varieties of cervical fusion surgery including anterior fusion, posterior screw fixation, and combined anterior and posterior fusion. Surgeons must be aware of the possible surgery-related complications and their management during each step of the operative procedure. Acceptable surgical outcomes require meticulous surgical execution and careful consideration of patients’ surgical indications and contraindications. In this literature review, we discuss the strategies for avoiding complications associated with cervical fusion surgery and for managing these complications.

  Incidence of degenerative spine disease has been rapidly rising with the advent of our aging societies. Symptoms associated with degenerative spine disease have a negative impact on the activities of daily living of elderly individuals, discourage social participation, and decrease their quality of life, while inducing psychological disorders. Thus, finding long-term preventive strategies for elderly individuals is a major challenge faced by our society.

  In terms of long-term preventive care for elderly individuals and extension of the healthy human lifespan, coping with these symptoms is important. However, the evidence for selecting the best approaches such as symptomatic treatments (providing fast-acting benefits or alleviating pain) and surgical treatments (achieving decompression of constrictions) is still scarce.

  The number of surgeries for degenerative spine disease has been increasing in recent years. One of the reasons for this is the availability of minimally invasive surgical treatments along with the evolution of surgical devices. The indications for minimally invasive spinal surgery in elderly patients who cannot undergo conventional surgical procedures have increased, but careful selection of cases is still needed.

  Degenerative spine disease involves static (ligamentum flavum, intervertebral disc, facet joint, and vertebral body) and dynamic factors (posture, movements, spinal instability, and spinal misalignment). Additionally, age-associated degenerative changes induce anatomical spinal changes (in the ligamentum flavum, the intervertebral disc, etc.) that differ from the characteristics present in intracranial disorders. Therefore, neurosurgeons need to consider this fact while diagnosing spine disorders.

  Here we report an overview of the pathophysiology of degenerative spine disease along with a literature review of surgical indications and specific procedures.

  Spinal instrumentation surgery has become common in recent decades due to advances in medical devices and surgical techniques and has thus become an essential surgical tool for spine surgeons.

  To maximize benefits and minimize neurological/vascular complications during spinal instrumentation surgery, safety and minimal invasiveness are key. Accurate implant placement is critical for achieving this goal. Recent developments in intraoperative image guidance techniques have been remarkable, and radiation imaging can be integrated with the computed navigation system to enhance surgical safety. However, there is serious concern about intraoperative radiation exposure to patients as well as surgeons. In this review, the benefits and limitations of intraoperative image guidance for spinal instrumentation surgery, including the hybrid operation suite, are discussed with reference to the literature.

  The surgical treatment of spinal cord tumors remains one of the important challenges for neurosurgeons, due to their relatively infrequent occurrence and complex surgical management. Based on our experience, an accurate preoperative diagnosis, and an optimal pre-surgical strategy are retrospectively reviewed. Then they are proved to be indispensable for achieving a successful surgical outcome. With the advent of diagnostic investigations and newer imaging techniques in recent years, the preoperative diagnosis in intracranial operative procedures has gradually become easier. However, the preoperative diagnosis of spinal cord tumors remains difficult and the surgical approach to the lesion is still challenging, especially in cases with spinal intramedullary tumors and ventral thoracic lesions. The spinal cord is a clinically eloquent structure. Therefore, we have paid attention to the existence of the spinal cord tumors, to be aware of the pitfalls of the preoperative diagnostic process. This will enable us to devise an optimal surgical strategy for managing spinal cord tumors, in order to prevent postoperative neurological impairment.

  We report a case of isolated neurosarcoidosis mimicking malignant meningioma. A 75-year-old woman presented to our hospital due to right hemiparesis, aphasia, and impaired mental activity. Magnetic resonance imaging (MRI) revealed an intradural enhanced tumor attaching from the left convexity to the falx cerebri with coexisting peripheral edema in left frontoparietal white matter. Positron emission tomography (PET) using ¹⁸F-fluorodeoxy glucose, ¹¹C-methionine, and ¹¹C-choline tracers showed high uptake in the enhanced lesion on MRI. Magnetic resonance spectroscopy (MRS) of the lesion revealed elevated choline and lactate peaks. Based on these neuroimaging findings, malignant meningioma was suspected, and the patient underwent subtotal surgical resection via frontotemporal craniotomy. The pathological diagnosis was isolated neurosarcoidosis, which can present similar neuroimaging findings on MRI, PET, and MRS to malignant meningioma.

  In cases of intracranial tumors, isolated neurosarcoidosis mimicking malignant meningioma should be considered preoperatively as a differential diagnosis to allow for appropriate treatment planning.