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. 2025 May 3;10(1):1–10. doi: 10.22603/ssrr.2025-0062

Technological Innovation in Cervical Spine Injury and Disease Treatment: A Systematic Bibliometric Review of Current Trends and Literature on Patent Technology

Mark Kurapatti 1, Sarah Lu 2, Lucy Shang 1, Bashar Zaidat 1, Suhas Etigunta 1, Junho Song 1, Jun S Kim 1, Samuel K Cho 1
PMCID: PMC12895166  PMID: 41695910

Abstract

Background

Although spine surgery has a high number of patented technologies, there has been little prior application of bibliometric analyses to effectively evaluate the technological literature in the cervical spine field. The aim of this review is to summarize and identify current patent trends in technologies for the stabilization and surgical management of cervical spine pathologies.

Methods

Multiple databases were systematically queried using Lens.org to identify technology patents designed to stabilize or surgically manage cervical spine injury or disease. The patents were then ordered by forward citation count, and the top 50 unique patents were included and organized into five categories: fusion/stabilization/fixation devices, external brace/supporter devices, arthroplasty implants, surgical instruments, and spacer/expansion devices. Subsequent assessments included patent priority year, publication year, priority region, legal status, and rank.

Results

The search results on March 11, 2024, yielded 440 patents published between 1973 and 2014. Of the top 50 most-cited patents, fusion/stabilization/fixation devices were the most common (27), followed by external brace/support devices (18). Patents for fusion/stabilization/fixation devices were more recent, peaking in 2001. The most common patents in the first to third quintiles were for fusion/stabilization/fixation devices.

Conclusions

Most patents before 1995 were for cervical brace and supporter devices. Since the turn of the 21st century, patented surgical fusion/fixation/stabilization devices have markedly increased. Further analysis of trends in cervical spine device technology can assist in guiding future innovation efforts.

Keywords: cervical, spine, patent, technology, fusion, fixation

Introduction

The volume and success of spine injury and disease treatments have largely increased over the past several decades due to major strides in technological innovation, with spine surgery holding the greatest number of patented technologies relative to any other medical subspecialty1,2). There has been an increased focus on spine patents given the integral role of devices, especially pedicle instrumentation and vertebral interbody devices, and the associated high costs of patented implants3,4).

In 2015, more than 200 million people experienced neck pain lasting more than three months, and neck pain is one of the leading causes of years lived with disability across most countries and age groups5). Thus, cervical spine disease is a focal point in both basic science and translational research, clinical studies, and device innovation. In a 50-year review of innovation and new technologies in spine surgery, the keyword “cervical” ranked second highest in terms of publications between 1970 and 20196). Surgery for cervical spine disease is one of the most common inpatient procedures performed in the US, with anterior cervical discectomy and fusion (ACDF), posterior cervical fusion, and posterior cervical decompression indicated for symptomatic cervical myelopathy and radiculopathy. Common patented technologies used to stabilize and treat cervical spine injury or disease include cervical braces, plates, interbody devices, pedicle and lateral mass screws, imaging-guidance tools, robotics, and biologics6). Across lumbar and cervical technology patents, there was slow growth in mechanical technologies and biologics from the 1990s, followed by exponential growth in 20086). More modern imaging-based navigation and robotics tools have seen steady growth since 20086).

As populations age and the prevalence of cervical degenerative spine disease increases, factors such as the cost of treatment, decreased productivity, and loss of personal income are becoming increasingly burdensome7). Thus, understanding recent innovations, including the current status of patented technologies to treat cervical spine disease, has become increasingly important. However, there is sparse literature on comprehensive patent analyses of technology for cervical spine injury and disease. A bibliometric analysis is a useful method to identify, analyze, and project the growth of current literature volume dedicated to a specific topic8). However, there has been little prior application of bibliometric analyses to effectively evaluate technological literature, such as patents. Thus, the current study aimed to conduct a bibliometric analysis of the top 50 most-cited unique technology patents related to managing cervical spine injury and disease and identify patent technological trends to further guide future innovations in the cervical spine field.

Materials and Methods

Study Design

The search for the present study utilized Lens.org, a comprehensive open-access platform with over 370 million patent sequences, 127 million global patent records, and 225 million scholarly works9). The Lens aggregates patent and scientific datasets and allows querying from PubMed, Microsoft Academic, CrossRef, ORCID, the World Intellectual Property Organization, and other sources. We queried the Lens database for any patents in the English language that contained the words ‘cervical’, ‘spine’, and ‘device’ in the title, abstract, or claims sections, using standard Boolean search terms across variable search fields. The search and data extraction were done on March 11, 2024. Additional filtering was conducted by selecting granted patents only and applying the Cooperative Patent Classification code A61, which pertains to human necessities, medical or veterinary science. The search term was as follows:

● (title:(“cervical” AND “spine” AND “device”) OR abstract:(“cervical” AND “spine” AND “device”) OR claim:(“cervical” AND “spine” AND “device”)) AND class_cpc.symbol:A61*

The search results were not limited by time frame, although the patent publication dates that met our search criteria spanned from 1973 to 2014. After obtaining the initial results from the search criteria, we removed any patents with zero forward citations, a metric referring to the number of other patents that have cited a particular patent record, along with duplicates. This was followed by a manual review of the title, abstract, and claims of each patent, screening for relevance to devices for cervical spine surgery, and removing patents focused on other subject matter. The inclusion criteria consisted of patents describing cervical spine devices designed to stabilize or surgically treat cervical injury or disease in a medical setting. At-home postural support devices, traction tables, exercise devices, and comfort cushions were excluded. Two authors worked independently to manually screen studies, and results were ensured to be in agreement before proceeding. The top 50 remaining patents were then ordered by forward citation count and organized into five categories: (1) fusion/stabilization/fixation devices, (2) external brace/supporter devices, (3) arthroplasty implants, (4) surgical instruments, and (5) spacer/expansion devices (Table 1). We also evaluated these patents based on patent priority year, publication date, legal status, and rank. The region where the first patent priority application was filed, or priority region, was noted. Patents were also characterized as active (patent is in effect and grants legal protection over the device), inactive (patent renewal fees were not paid or patent was withdrawn), or expired (patent reached the end of its legal lifespan).

Table 1.

Top 50 Patents for Cervical Spine Surgery.

Rank Forward citations Patent category Patent title Priority date Publication date Priority country Legal status
1 586 Fusion/stabilization/ fixation Superelastic spinal stabilization system and method 3/1/00 2001 North America expired
2 586 Fusion/stabilization/ fixation Interbody spinal fusion implants with multi-lock for locking opposed screws 5/5/99 2003 North America expired
3 576 Fusion/stabilization/ fixation Devices and methods for posterior spinal fixation 12/17/93 1996 North America expired
4 379 Fusion/stabilization/ fixation Anterior cervical column support device 8/25/99 2001 North America expired
5 356 Fusion/stabilization/ fixation Cross-coupled vertebral stabilizers 2/25/00 2001 North America expired
6 345 Fusion/stabilization/ fixation Spinal implant with bone screws 3/28/94 2002 North America expired
7 336 Arthroplasty implant Apparatus and method for the replacement of posterior vertebral elements 3/8/02 2003 North America expired
8 334 Fusion/stabilization/ fixation Method and apparatus for augmenting osteointegration of prosthetic implant devices 1/14/99 2001 North America expired
9 307 Fusion/stabilization/ fixation Anterior spinal implant system for vertebral body prosthesis 4/7/97 1999 North America expired
10 288 Fusion/stabilization/ fixation Vertebral compression clamp for surgical repair to damage to the spine 10/18/91 1995 Europe expired
11 243 Fusion/stabilization/ fixation Interbody spinal fusion implants with single-lock for locking opposed screws 5/5/99 2006 North America expired
12 227 Arthroplasty implant Artificial expansile total discs for posterior placement without supplemental instrumentation and its adaptation for anterior placement of artificial cervical, thoracic, and lumbar discs 5/13/04 2006 North America inactive
13 214 Fusion/stabilization/ fixation Cervical plate for stabilizing the human spine 10/31/01 2004 North America active
14 212 Fusion/stabilization/ fixation Spinal vertebral fusion implant and method 9/26/02 2005 North America active
15 208 Arthroplasty implant Intervertebral prosthesis 3/12/02 2006 Europe active
16 200 Fusion/stabilization/ fixation Single-lock anterior cervical plating system 2/11/97 2003 North America active
17 186 Fusion/stabilization/ fixation Cross-coupled vertebral stabilizers including cam-operated cable connectors 2/25/00 2002 North America expired
18 145 Spacer/expansion device Inter-cervical facet implant and method 12/13/04 2010 North America active
19 139 Fusion/stabilization/ fixation Dynamic cervical plates and cervical plate constructs 12/22/03 2008 North America active
20 137 Fusion/stabilization/ fixation Method and apparatus for spinal fixation 7/19/02 2010 North America active
21 134 Surgical instrument Instrument system for preparing a disc space between adjacent vertebral bodies to receive a repair device 12/29/00 2006 North America expired
22 131 Fusion/stabilization/ fixation Method and apparatus utilizing interference fit screw shanks for nonmetallic spinal stabilization 10/16/00 2004 North America expired
23 117 Fusion/stabilization/ fixation Apparatus for compressing a spinal disc space disposed between two adjacent vertebral bodies of a cervical spine 2/11/97 2003 North America expired
24 116 Fusion/stabilization/ fixation System and method for minimally invasive posterior fixation 4/25/03 2009 North America active
25 115 Fusion/stabilization/ fixation Clamp for stabilizing a cervical spine segment 9/3/93 1997 Europe expired
26 110 External brace/supporter Cervical Collar 12/7/71 1973 North America expired
27 104 Fusion/stabilization/ fixation Spondylodesis device 4/23/03 2009 Europe active
28 103 Fusion/stabilization/ fixation Apparatus and method for connecting spinal vertebrae 2/11/03 2007 North America inactive
29 99 External brace/supporter Prone support apparatus for spinal procedures 4/14/00 2001 North America expired
30 97 External brace/supporter Halo traction brace 12/16/86 1989 North America expired
31 94 Fusion/stabilization/ fixation Stabilizing device for intervertebral disc, and methods thereof 9/24/02 2007 North America inactive
32 93 External brace/supporter Cervical spine brace and traction device 4/14/03 2006 North America inactive
33 91 Fusion/stabilization/ fixation Spinous process stabilization device and method 4/14/08 2012 North America inactive
34 90 External brace/supporter Cervical Stabilization Device 9/27/71 1973 North America expired
35 88 External brace/supporter Extrication and spinal restraint device 3/6/90 1991 North America expired
36 86 External brace/supporter Transportable cervical immobilization device 10/13/95 1999 North America expired
37 82 External brace/supporter Cervical brace 12/16/86 1990 North America expired
38 81 Fusion/stabilization/ fixation Side-biased orthopedic fastener retention 3/17/05 2013 North America active
39 79 Fusion/stabilization/ fixation Apparatus and method of spinal implant and fusion 12/5/08 2013 North America active
40 79 Fusion/stabilization/ fixation Cervical immobilization device 4/18/83 1985 North America expired
41 78 External brace/supporter First aid splint for cervical spine injuries 7/31/78 1980 North America expired
42 78 External brace/supporter Multi-positional support device 5/3/00 2002 North America expired
43 75 External brace/supporter Temporary cervical immobilizing orthosis 5/23/77 1979 North America expired
44 72 External brace/supporter Method and device for stabilizing a patient’s head on a spine board 10/28/02 2005 North America inactive
45 69 External brace/supporter Cervical-thoracic orthosis and method 11/10/86 1988 North America expired
46 69 External brace/supporter Support device method 4/15/97 1999 North America expired
47 68 Fusion/stabilization/ fixation Support device and associated method 3/31/95 1998 North America expired
48 66 External brace/supporter Disposable cervical immobilization means 9/13/84 1986 North America expired
49 65 External brace/supporter Apparatus and methods for reducing brain and cervical spine injury 2/6/09 2014 North America active
50 63 External brace/supporter Emergency Medical Collar, Collar/Stabilizer, Collar/Stabilizer/Head Immobilizer 11/17/87 1991 North America expired
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Results

The initial query for the search term “cervical spine” on the Lens website yielded 440 search results. Most of the patents (27) were a fusion/stabilization/fixation device, followed by (18) external brace/support devices (Fig. 1). There were three arthroplasty implants, one spacer/expansion device, and one surgical instrument. Forty-six (92%) of the top 50 patent priority applications were filed in North America, and 4 (8%) were filed in Europe. Approximately 62.7% of the patents are expired, 23.5% are active, and 13.7% are inactive (Fig. 2).

Figure 1.

Figure 1.

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Number of patents by cervical spine technology patent category.

Figure 2.

Figure 2.

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Top 50 cited cervical spine technology patents by legal status.

There was little correlation between a patent's rank and the priority year, as Pearson's R was -0.25, and the R-squared value was 0.06 (Fig. 3). When the patents are viewed using a quintile distribution, fusion/stabilization/fixation devices occupy most of quintile Q1 to Q3 and half of Q4 (Fig. 4). There was one other arthroplasty implant in Q1, with the remaining arthroplasty implant and spacer/expansion devices appearing in Q2. The only surgical instrument device was in Q3. External brace/supporter patents increased in count beginning in Q3 and were the only device in Q5.

Figure 3.

Figure 3.

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Top 50 cited cervical spine technology patent rank by priority year.

Figure 4.

Figure 4.

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Top 50 cited cervical spine technology patents stratified by quintile.

The patent priority years spanned from 1971 to 2009 (Fig. 5). The early years (1971 to 1978) included only external brace/supporter devices. This trend continued to dominate until 1990 and peaked in 1986, except in 1983, when there were only fusion/stabilization/fixation devices. Since 2000, external brace/supporter devices have appeared sparsely every few years. From 1991 to 1994, there was a brief rise in fusion/stabilization/fixation devices; these patents continued to increase in count until 2003 and decreased in 2005 and 2008. Arthroplasty appeared with the greatest count in 2002 and decreased in 2004. Surgical instruments were only seen in 2000, and spacer/expansion devices were only present in 2004. Comparatively, the publication years ranged from 1973 to 2014 (Fig. 6). From 1973 to 1991, external brace/supporter devices were the only devices and remained steady, with the peak number of patents in 1973 and 1991. However, in 1985, fusion/stabilization/fixation devices were the only type of patent present. From 1999 onward, external brace/supporter devices appeared sparsely, almost yearly. From 1995 to 1997, fusion/stabilization/fixation devices steadily dominated as the only type of patent present; this type of device peaked in count in 2001 and generally declined until 2013. Spacer/expansion device patents were only present in 2010, and surgical instrument patents only appeared in 2006. Lastly, arthroplasty implants appeared in 2003 and peaked in 2006.

Figure 5.

Figure 5.

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Top 50 cervical spine device technology patents by category by priority year.

Figure 6.

Figure 6.

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Top 50 cervical spine device technology patents by category by publication year.

The number of patents granted per priority year and granted year had a general bell curve distribution with a negative skew (Fig. 7, 8). The number of patents slowly increased and peaked around the early 2000s (2000 to 2003).

Figure 7.

Figure 7.

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Number of top 50 cited cervical spine device patents granted by priority year.

Figure 8.

Figure 8.

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Number of top 50 cited cervical spine device patents granted per each granted year.

Discussion

Cervical braces are one of the oldest devices used in cervical spinal surgery and can be used preoperatively to stabilize injury and perioperatively to assist in alignment10). Cervical braces are also used postoperatively in an effort to immobilize and support the cervical spine to allow for optimal healing, protect the recovering cervical spine from external trauma, reduce pain and discomfort, reduce complications like hardware migration or implant failure, and/or help the patients mentally recover by providing a sense of security10). We found most (61%) of the brace devices of the top 50 cervical spine device patents were published before 1995, which is likely a result of their long history of use and, thus, innovation in the cervical bracing field plateauing as the devices have become optimized. Furthermore, a body of literature beginning in the early 2000s has demonstrated that postoperative cervical bracing may not necessarily improve outcomes. As such, it may not be as commonly used in the postoperative protocol for some safer elective cervical spine procedures11-15). For example, a recent systematic review by Hasan et al.11) demonstrated no significant differences in elective fusion rates or complications between braced vs unbraced patients in any of the seven included studies. Nevertheless, despite plateauing cervical brace innovation, bracing still plays a critical role in managing acute cervical spine injury and non-elective postoperative recovery16,17).

A third reason why brace devices in the top 50 patent list are mainly localized to the 1900s pertains to the more recent rise of fusion, stabilization, and fixation devices. How fusion, stabilization, and fixation devices in cervical spine surgery overtook cervical brace innovation is two-fold: (1) fusion, stabilization, and fixation procedures have become increasingly minimally invasive and safer, and are expanded to older and higher-risk populations, with concurrent rapid device innovation18-20). This is evidenced by fusion, stabilization, and fixation device patents being overrepresented in the first to third quintiles, while the top 50 patents in the cervical spine brace/supporter category mainly occupy the fourth and fifth quintiles. (2) Fusion, stabilization, and fixation device innovation itself has inherently made novel bracing developments in cervical spine surgery less essential. For example, technological advancements in ACDF plates and interbody cages have been shown to increase fusion rates, maintain alignment, prevent dislodgement, and limit the motion between the bone graft and vertebral bodies to allow for fusion healing21-24). This would decrease the need for external cervical brace research and development (R&D) and postoperative usage, and explains how corrective cervical spine technology may have shifted from braces in the 1900s to fusion technology in the 2000s.

One of the most well-known advances in treating cervical spine pathology has been the implementation and improvement of the ACDF procedure. ACDF entails the removal of the degenerated or herniated disc(s), followed by insertion of allograft, autograft, or synthetic bone graft (contained in a cage) to promote fusion of adjacent vertebrae. A construct consisting of devices such as a plate, spacer, and screws, or an integrated plate-spacer with fixation (i.e., screws), can be used to stabilize the vertebral segment to allow for fusion. Marawar et al.25) identified almost 772,000 ACDF procedures from 1990 to 2004, with an 8-fold increase in total prevalence over this period. Notably, there was a 28-fold increase in utilization in patients over 65, while complication rates decreased from 4.6% to 3.03%. To treat unstable cervical injuries, posterior instrumented fusion may also be performed. Yukawa et al.26) demonstrated low rates of screw malpositioning, no secondary instrumentation dislodgement, high rates of solid posterior bone fusion, and low rates of surgery-related complications with cervical pedicle screw fixation in 100 consecutive patients from 1995 to 2003. Furthermore, there was increasing literature on cervical pedicle screws, lateral mass screws, and other stabilization techniques during this same period26-28).

Around the turn of the 21st century, there was explosive development and implementation of fusion and fixation procedures to treat cervical spine degeneration and instability25-28). Thus, it is not surprising that fusion, stabilization, and fixation devices (including interbody fusion cage implants, pedicle/lateral mass screws, rods, anterior plates, and bone graft systems) overtook brace devices in the 2000s with respect to patent counts by publication year and are the most common technology category of the top 50 cervical spine device patents. Furthermore, ACDF continues to serve as the gold standard against which other procedures, such as cervical disc arthroplasty (CDA), are assessed29). This aligns with our findings that 67% of the top 50 cervical spine device patents published in the 2000s are fixation, stabilization, and fusion devices, and this category most commonly occupies the first to third patent quintiles.

Although not as common as fusion devices and braces, one of the top 50 cervical spine devices was an inter-cervical facet implant consisting of two inter-facet implants bridged by an elongated collar. Such spacer devices are inserted between adjacent facets to restore disc height, provide indirect decompression of neural structures, and offer additional construct stability30). Innovation in the cervical spine spacer/expansion device arena has been a key focus of recent spine R&D efforts; modern spacers may also contain biological material to aid in fusion procedures31). For example, Boakye et al.32) published a highly cited retrospective study demonstrating that patients who underwent ACDF with polyetheretherketone (PEEK) spacers containing recombinant human bone morphogenetic protein (rhBMP)-2. These patients had high fusion rates with positive clinical outcomes, avoiding complications associated with autograft harvesting. Thus, the rise in fusion procedures at the turn of the century has motivated and will likely continue to drive the concurrent development of bone expansion/spacer devices to aid in fusion and stabilization procedures.

In the context of cervical spine surgery, disc arthroplasty is a motion-preserving procedure that is an alternative to fusion33,34). In our top 50 cervical spine device list, there were two patents related to disc arthroplasty: an artificial expansile total disc patent and a second intervertebral disc prosthesis patent. CDA was a concept first described in the 1960s35). While there was much difficulty with the application of cervical disc implants, especially regarding fixation to the vertebral body, more durable materials (titanium and various composites) have enabled better results and recent multilevel applications36). For example, a randomized controlled trial comparing a titanium ceramic composite-based cervical disc at two levels with ACDF demonstrated that disc replacement maintained improved clinical outcomes and segmental motion 10 years after surgery37). Given the relative recency of CDA success, we only identified two highly cited disc arthroplasty implants published in the early 2000s. Furthermore, there was a third arthroplasty patent for an apparatus designed to replace the natural lamina, spinous process, pars interarticularis, and/or facets of the corresponding first and second vertebrae. To our knowledge, this device is conceptual and has not yet undergone clinical implementation.

We identified only one surgical instrument in the present manuscript: a device that prepares a space between adjacent vertebral bodies to allow for the subsequent placement of a surgical implant. Disc space preparation is critical for ensuring that the implant is inserted in the optimal position and that violation of the endplates is avoided38). This precision is important, as over-preparation may predispose to endplate subsidence, and under-preparation may hinder fusion39). For example, Lee et al.39) attributed a high subsidence rate of 22.9% in 104 CDA patients to possible endplate over-preparation or disc space over-distraction during placement. Thus, innovations and advancements in instruments to optimize this step of cervical spine procedures may profoundly impact surgical outcomes.

With respect to priority patent application locations, our analysis revealed that over 90% of the top 50 cervical spine-related patents were first filed in the United States. This trend may be attributed to several factors that make the United States a favorable environment for initial technological innovation and patent filing. The country has a well-established intellectual property protection system, a robust R&D infrastructure supported by government agencies and private investments, and one of the largest healthcare markets in the world, which provides strong commercialization opportunities despite its highly complex structure40-42). Additionally, the presence of active venture capital funding and a patent-friendly legal system further incentivizes medical technology innovation. These factors likely collectively contribute to the high volume of patents filed in the United States in the field of cervical spine injury and disease treatment. Future studies are necessary to explore how regional differences in regulatory frameworks, research funding, and health care policies impact the global distribution of cervical spine-related technological advancements.

Limitations

This study is not without limitations. For example, because our study's Boolean search query only searched three patent fields using three keywords, it cannot be ruled out that some relevant patents did not have keywords in pertinent fields (title, abstract, claims) and were consequently missed. Another limitation is that our search only included patents written in English, so patents in other languages were not accounted for. Further, this bibliometric analysis is intrinsically limited by the platform used (Lens.org). While Lens.org is one of the most comprehensive platforms for medical device patent querying, it is possible that some influential patents in the field of cervical spine surgery were missed. In addition, the authors of this study undertook much discussion before deciding on categorizing the top 50 cited patents, but the categories are nevertheless inherently subjective and may be grouped differently by others, thereby impacting the results. However, regardless of how the technology patents were grouped, the list of the top 50 cervical spine injury and surgical device patents would remain the same. Finally, while citation impact provides a useful proxy for patent activity and characterizes the influence of various cervical spine device categories within the field, it does not inherently validate the efficacy or clinical adoption of these technologies. Additionally, variations in patent regulations across countries may influence the distribution of innovations identified in our analysis. Future research should incorporate clinical outcome assessments, expert validation, and longitudinal studies to directly assess which categories of cervical spine device innovations have translated into the most meaningful advancements in patient care.

Conclusions

This study is the first of its kind to evaluate the current literature for technological trends in the field of cervical spine injury and surgery through a bibliometric analysis of the top 50 most-cited device patents. We identified a decreasing trend in cervical bracing/support device patents and a marked increase in patented devices for fusion, fixation, stabilization, and other surgical devices since the early 2000s. Most of these top 50 devices were granted a patent in the 21st century, and fusion/stabilization/fixation devices most commonly occupy the first to third patent quintiles. By conducting a thorough analysis of the available patent databases, this study identified trends in cervical spine device patents to improve the understanding of cervical spine technology evolution and thus guide future cervical spine treatment efforts.

Author Contributions: Mark Kurapatti: Data curation, Investigation, Methodology, Project Administration, Writing - Original Draft, Writing - Reviewing and Editing, Sarah Lu: Data curation, Investigation, Writing - Original Draft, Writing - Reviewing and Editing, Lucy Shang: Writing - Original Draft, Writing - Reviewing and Editing, Bashar Zaidat: Conceptualization, Methodology, Formal Analysis, Writing - Reviewing and Editing, Suhas Etigunta: Writing - Original Draft, Writing - Reviewing and Editing, Junho Song: Supervision, Writing - Reviewing and Editing, Samuel K. Cho: Conceptualization, Supervision, Writing - Reviewing and Editing

Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

Institutional Review Board (IRB) Approval: IRB approval was not required for this study, which reviewed publicly available online patents and did not involve human participants or identifiable private information.

Informed Consent: Informed consent was not required for this study as it reviewed publicly available online patents and does not involve human participants or identifiable private information.

Permissions: There is no copyrighted material, images, or figures in the present manuscript. All authors grant Spine Surgery and Related Research full reproducibility rights upon acceptance.

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