Treatment modalities for cervical spondylosis remain controversial, and more data suggest that mildly symptomatic or asymptomatic patients can be temporarily observed, and if surgery is performed, the results are similar for the anterior and posterior approaches. Similarly, a large retrospective study analyzing the outcomes of elderly patients with odontoid fractures provides insight into which is better for comparing surgical or non-surgical treatment. There have been positive advances in standardizing posterior cervical internal fixation, and simpler methods have emerged to avoid infection in the surgical location. Spinal cervical spondylosis There are two general approaches to the surgical management of spinal cervical spondylosis: 1/ anterior decompressive implant fusion. 2/ posterior vertebroplasty. In most cases, the former provides direct decompression of the anterior compression, but brings complications such as dysphagia, graft compression and cerebrospinal fluid leakage. Posterior vertebroplasty has a broader indication but affects cervical curvature straightening or slightly anterior protrusion in the sagittal position and results in a higher incidence of C5 nerve root palsy symptoms. Recently, a multicenter clinical study has shown that both surgical approaches result in substantial improvements in function, neurological symptoms, and quality of life, with no differences. However, the reoperation rate is relatively high with anterior surgery. Odontoid fractures Geriatric odontoid fractures are difficult to treat, have high comorbidity, and have a lethality rate of >20% within one year. In the multicenter study, 159 patients were followed up for 12 months. The treatment plan was decided jointly by the physician and the patient after consultation. One-third of the patients were treated conservatively. There were no differences between the two groups of patients in terms of age, symptoms and medical conditions. The overall mortality rate was at 18.1%, with 25.9% in the conservative treatment group and 13.9% in the surgical group. Statistical analysis showed that conservative treatment, advanced age and more comorbidities led to a higher lethality rate. In the nonoperative group, 17 of 59 patients had nonhealing fractures, 13 of which required additional C1-2 fusion. In the nonoperative group, clinical symptoms were similar regardless of fracture healing, and no patient experienced worsening neurologic symptoms as a result of the nonoperative procedure. Lateral block fixation. Posterior cervical fixation is widely used and a standard is desperately needed. The regulation of these devices is problematic and there is no classification standard for their specifications and application. This has had some detrimental effects. Training is only available in surgery because there is no training in their use. In September 2012, the FDA classified these devices as Class II. The FDA and CSRS each conducted separate systematic reviews of the devices. The FDA and CSRS conducted separate independent systematic reviews of the devices. In both reviews, the fusion rate was greater than 98%, and the complication rate was low. Recently, the FDA is ready to upgrade its classification level to Class II, which implies greater development of this class of devices in their intended application areas. Surgical site infections Avoiding surgical area infections is an essential component of patient safety. Based on extensive data analysis, the incidence of surgical area infections for different cervical spine surgery modalities was calculated. The overall surgical area infection rate was approximately 0.45% for anterior cervical discectomy with internal fixation of the bone graft, 0.97% for posterior decompression, and 1.82% for postoperative cervical stiffness. Surgical-area infections resulted in a fourfold increase in lethality, an average 15-day longer hospital stay, and an average $32,000 increase in cost. In order to avoid the occurrence of surgical area infections, a method has been studied. That is to cover the wound surface with vancomycin powder during the suturing process. In animal studies, spinal incisions containing internal fixation were placed with Staphylococcus aureus. In contrast, the vancomycin powder coverage caused the symptoms of incisional infection to disappear in all animals. In contrast, all animals in the control group showed positive signs of infection. No cytotoxic side effects of vancomycin were observed. In a clinical study, patients who underwent posterior decompression fusion had topical vancomycin powder coverage of the incision applied and compared with historical controls. The rate of infection in the surgical area was reduced from 15% to 0%, and no systemic distribution of vancomycin or adverse effects were observed. The reported results are similar to other reports that vancomycin powder application decreases the rate of infection in the surgical area. The risk of local tissue application of vancomycin powder appears to be minimal, and whether long-term application increases the incidence of drug-resistant bacteria is not known.