Spine Surgery and Rehabilitation: Current Advances and Future Options

Dear Colleagues,

In recent, spinal surgery has undergone significant changes. On the one hand, intraoperative imaging techniques have allowed for the correction of major vertebral malformations or degenerative defects. On the other hand, the development of intraoperative neuromonitoring techniques has enabled the extensive removal of tumor lesions involving the spinal cord and roots. Many patients undergoing these complex procedures require rehabilitation periods. Today, motor rehabilitation procedures can benefit from the advancement of technologies such as virtual reality and augmented reality. In-depth studies of the dynamics and biomechanics of the spine will facilitate the application of the most advanced technologies to the rehabilitation of patients undergoing spinal surgery.

Dr. Delia Cannizzaro
Guest Editor

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• spinal cord injury
• neuronal plasticity
• spinal surgery
• spinal deformities
• spinal tumors
• motor rehabilitation
• physical therapy modalities

Title: Scoliosis, Surgery, and Motherhood—Is It Possible? Unresolved Questions of Patients Suffering from and Undergoing Treatment for Scoliosis—A Comprehensive Literature Review
Authors: Pawel Grabala; Piotr Kowalski; Michal Grabala
Affiliation: Department of Pediatric Orthopedic Surgery and Traumatology, University Children’s Hospital, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland
Abstract: Background: Scoliosis, the most prevalent spinal deformity in children, is often associated with adolescent idiopathic scoliosis (AIS). Curves surpassing 50 degrees can deteriorate, especially thoracic curves, leading to pulmonary limitations. Surgical intervention is usually advised for curvatures exceeding 50 degrees to halt further progression. Severe AIS is notably more frequent in females, yet knowledge regarding subsequent pregnancies and associated risks is scarce. Female patients often inquire about conception, pregnancy, labor, and future back pain (BP) concerns. Reports on the long-term outcomes after pediatric AIS treatment and pregnancy consequences remain limited. Uncertainty looms over the likelihood of increased back pain (BP), cesarean sections (CSs), or other pregnancy-related issues following surgical AIS management. In this investigation, an attempt was made to scrutinize the existing research on individuals afflicted with scoliosis who received either conservative or surgical treatment, with the aim of delineating crucial and pragmatic findings that can serve as a compass for spine surgeons when counseling young patients with adolescent idiopathic scoliosis regarding the ailment, its repercussions, the available treatment modalities, and the associated outcomes. A comprehensive analysis pinpointed the optimal data at hand. Consequently, the primary objective of this investigation was to assess the patient-reported and clinical consequences in scoliosis patients who have undergone segmental posterior fusion and subsequently conceived. Conclusions: While the majority of individuals with AIS are capable of conceiving and bearing children, they may encounter greater challenges in fertility than healthy women unaffected by AIS. Pregnant women with a prior history of spinal fusion for AIS can undergo pregnancy and childbirth with no significant escalation in perinatal complications. Women who have undergone surgical procedures for AIS have been observed to exhibit a prevalence of back pain comparable with that of healthy pregnant women; however, a higher incidence of low back pain is evident when spinal fusion is extended to the L3 or L4 vertebra. Although back pain is a common occurrence in pregnant women with AIS, the spinal alterations induced by pregnancy are typically minor and transient. In comparison with healthy women, individuals with a history of spinal fusion necessitate cesarean section more frequently. The degree of correction loss during pregnancy is lower in previous reports involving pedicle screw instrumentation than in previous reports involving Harrington or hybrid segmental instrumentation.

Title: Non-Laminotomy Bilateral Decompression (NLBD) : a novel approach in biportal endoscopic spine surgery (BESS) for spinal stenosis
Authors: Dae-Young Lee; Hee Soo Kim; Si-Young Park; Jun-Bum Lee
Affiliation: Department of Orthopaedic Surgery, Saegil Hospital
Abstract: Biportal endoscopic spine surgery (BESS) is an emerging technique for lumbar spinal stenosis. Previous techniques of BESS have involved partial osteotomy for access to the spinal canal such as partial laminotomy, partial facetectomy, and other forms of osteotomy before the removal of the ligamentum flavum. However, minimizing damage to posterior structures, which impact segmental stability, could potentially improve postoperative outcomes. We aim to introduce a BESS surgical technique, non-laminotomy bilateral decompression(NLBD) that allows for decompression through the interlaminar space without damaging the posterior bony structures. For this, we prefer using a variety of curved curettes over the Kerrison Rongeur for decompression of the spinal canal. The design of these curettes, featuring smaller tips and smoother backs, allows for easier navigation through the interlaminar space into the spinal canal, effectively reducing the risk of nerve damage during the procedure without necessitating any osteotomy for access. Furthermore, interchangeability between the two portals enhances our ability to achieve complete decompression. In conclusion, NLBD represents another alternative approach of BESS that achieves adequate decompression while preserving the posterior structure as possible.