Response to Letter to the Editor Regarding “Complications in Full-Endoscopic Posterior Cervical Surgery: A Review of the Literature and Preventive Strategies”

Dear authors,

We thank the authors for their thoughtful and constructive comments on our recent narrative review, “Complications in Full-Endoscopic Posterior Cervical Surgery: A Review of the Literature and Preventive Strategies.” ¹ We appreciate their engagement and would like to respond to the points raised.

Regarding the use of simple pooling to estimate overall complication rates, we acknowledge the limitations of this method, particularly its inability to account for inter-study heterogeneity. As noted in Table 3, our calculation was based on the total number of complications divided by the total number of patients across studies. Given the narrative nature of our review and the inconsistent and limited complication reporting in the literature, we opted for a straightforward approach to provide an easily interpretable summary for readers. We recognize that more sophisticated statistical techniques, such as random-effects models, ² would offer greater analytical rigor if more granular and standardized data were available. As the evidence base continues to grow and reporting improves, we fully agree that future studies should employ such methods for more robust estimations.

On the issue of clinical trial registration and complication reporting, we concur that a lack of standardized definitions and predefined assessment intervals presents challenges for data synthesis. In narrative reviews such as ours, it is inherently difficult to determine uniform time points for complication assessment due to variability in study design and follow-up protocols. Nonetheless, we recognize the importance of standardization and support the use of established frameworks such as the Clavien-Dindo classification and the Comprehensive Complication Index (CCI).^3-5 We will consider incorporating these systems in future prospective investigations to enhance the consistency and quality of complication reporting.

We are encouraged by the shared commitment to improving patient safety and surgical outcomes in full-endoscopic cervical spine surgery. The comments raised by the letter authors align with the goals of our review—to increase awareness of potential complications and promote evidence-based preventive strategies. We appreciate their engagement and welcome continued dialogue to further advance this evolving field.