Postoperative outcomes following cervical spine surgery remain heterogeneous, limiting effective preoperative risk stratification. Methods: A systematic review was conducted in accordance with PRISMA 2025 guidelines. The search identified 117 records, of which 18 studies published between 2021 and 2025 met inclusion criteria. Most studies used internal validation only, reported discrimination metrics (AUC range approximately 0.74-0.92), and demonstrated high or unclear risk of bias on PROBAST, primarily within the analysis domain. Rigorous external validation, standardized imaging workflows, and improved reporting of calibration and clinical utility are needed before these approaches can be responsibly integrated into routine practice.
