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Clinical Advances in Spinal Neurosurgery

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 25 January 2027 | Viewed by 7118

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Editor

Dr. Jang-Won Yoon

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Guest Editor

Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
Interests: neurosurgery; spine surgery; spinal deformity; lumbar interbody fusion

Special Issue Information

Dear Colleagues,

Spinal neurosurgery continues to evolve, with the goal of improving both surgical techniques and patient outcomes. While minimally invasive approaches—including lateral, anterior, and endoscopic spine surgery—have revolutionized treatment by reducing morbidity and enhancing recovery, there remains a critical need for better ways to assess functional outcomes, patient satisfaction, and long-term success. Emerging perioperative strategies, advanced imaging modalities, and refined outcome measures are playing a pivotal role in optimizing surgical decision-making and postoperative care. Additionally, efforts to standardize patient-reported outcomes and integrate objective biomechanical assessments are shaping a more data-driven approach to evaluating surgical success.

This Special Issue welcomes original research, clinical studies, and reviews on the latest innovations in spinal neurosurgery, with a focus on novel surgical techniques, enhanced recovery pathways, and improved methods for measuring patient outcomes. We encourage contributions exploring minimally invasive spine surgery, advanced perioperative assessment tools, patient-reported outcome measures, and objective functional metrics that enhance our understanding of post-surgical recovery.

Dr. Jang-Won Yoon
Guest Editor

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Keywords

minimally invasive spine surgery
lateral lumbar interbody fusion
endoscopic spine surgery
patient-reported out-comes
functional assessment
perioperative care
surgical decision-making

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Published Papers (5 papers)

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Research

Jump to: Review, Other

15 pages, 1968 KB

Open AccessArticle

Robotic-Assisted Spinal Instrumentation from C1 to S1 Experience of a UK Neurosurgical Tertiary Referral Centre

by Asfand Baig Mirza, Wajiha Rauf, Ibrahim Muhyiddin Muhammad, Feras Fayez, Ariadni Georgiannakis, Amisha Vastani, Varinder Singh Alg, Anjum Qureshi, Bhaskar Thakur, Babak Arvin, Ahmed-Ramadan Sadek and Taofiq Desmond Sanusi

J. Clin. Med. 2026, 15(15), 5905; https://doi.org/10.3390/jcm15155905 - 29 Jul 2026

Viewed by 314

Abstract

Background: Robotic-assisted spinal instrumentation is increasingly used to support implant placement, reduce radiation exposure, and improve operative workflow. However, UK NHS data describing early programme experience across elective and emergency practice remain limited. This study aimed to evaluate the feasibility, safety profile, and early learning curve of robotic-assisted spinal instrumentation in an unselected UK NHS cohort. Methods: A retrospective, single-centre, single-arm observational cohort study was conducted, including the first 50 consecutive patients treated from programme inception between June 2024 and January 2026. No exclusion criteria were applied, and each record represented one patient and one operation. Missing data were not imputed, and denominators were reported per variable. Learning curve effects were assessed using Spearman correlation and cumulative sum analysis. Wilson 95% confidence intervals were reported for complication rates. Results: The mean age was 61.9 years; 50% were male; mean body mass index was 29.0; and median Charlson Comorbidity Index was 3. Indications were degenerative disease in 74%, trauma in 24%, and deformity in 2%. Emergency admissions accounted for 18/50 cases. Robot-specific adverse events included abandonment or conversion in 2/50 cases and system malfunction in 1/50. Surgical complications occurred in 7/50 patients. On surgeon-reviewed routine post-operative imaging, no screw malpositions required revision and no durotomies or vascular injuries were recorded; this represents a clinical revision rate rather than a formal radiological measure of screw accuracy, for which blinded Gertzbein–Robbins grading was not performed. Cumulative sum analysis suggested a potential fluoroscopy change point around case 30, with the median fluoroscopy events falling from 151 to 16 thereafter. Emergency cases involved more instrumented levels, longer operative times, and more open surgery than elective cases. Conclusions: Robotic-assisted spinal instrumentation was feasible across a diverse UK NHS caseload from C1 to S2, with a low observed complication rate. The findings suggest a fluoroscopy learning curve threshold around case 30. Larger comparative studies with formal radiological accuracy assessment are required. Full article

(This article belongs to the Special Issue Clinical Advances in Spinal Neurosurgery)

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9 pages, 1745 KB

Open AccessArticle

Reliability of Preoperative MRI Findings for Differentiating Spontaneous Spinal Subdural and Epidural Hematomas: A Multi-Institutional Retrospective Study of 27 Surgically Treated Cases

by Shun Okuwaki, Hiroshi Takahashi, Katsuya Nagashima, Tomoyuki Asada, Takane Nakagawa, Takahiro Sunami, Yosuke Ogata, Kotaro Sakashita, Hisanori Gamada, Kousei Miura, Hiroshi Noguchi, Yosuke Takeuchi, Toru Funayama, Masao Koda and Masaki Tatsumura

J. Clin. Med. 2026, 15(7), 2602; https://doi.org/10.3390/jcm15072602 - 29 Mar 2026

Viewed by 950

Abstract

Background/Objectives: Spontaneous spinal subdural hematoma (SSSDH) is a rare and severe condition that causes rapid neurological decline. Spontaneous spinal epidural hematoma (SSEH) presents similarly but is more common, and surgical management differs because SSSDH requires an intradural approach. Few studies have assessed the reliability of magnetic resonance imaging (MRI) features used to distinguish SSSDH from SSEH in patients requiring surgery. Methods: We retrospectively reviewed 27 patients who underwent surgical evacuation of spinal hematomas at two institutions (2015–2025). Definitive hematoma location was determined intraoperatively. Four MRI features—shape (crescentic vs. biconvex), location (ventral vs. dorsal), craniocaudal length (<5 vs. ≥5 segments), and spinal region—were independently evaluated by two reviewers. Inter- and intra-rater reliability was assessed using agreement rate and Cohen’s kappa (κ) with 95% confidence intervals (95% CIs). Results: Among 27 cases, three (11.1%) were SSSDH and 24 were SSEH. Hematoma location, length, and spinal region demonstrated perfect inter- and intra-rater agreement (κ = 1.00). For hematoma shape, intra-rater agreement was good (96.2%, κ = 0.84; 95% CI 0.52–1.00), whereas inter-rater agreement was poor to fair (84.6%, κ = 0.26; 95% CI −0.25–0.77). Notably, two of the three SSSDHs demonstrated a biconvex configuration, and 83.3% of SSEHs also exhibited a biconvex morphology. Conclusions: MRI features such as hematoma location, extent, and spinal level were highly reproducible, whereas hematoma shape showed limited reliability. Although ventral hematomas most strongly suggest SSSDH, atypical SSEH presentations occur. When dorsal exposure reveals no epidural hematoma, intradural exploration should be promptly considered. Full article

(This article belongs to the Special Issue Clinical Advances in Spinal Neurosurgery)

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16 pages, 829 KB

Open AccessArticle

Evaluating the Efficacy of a Novel Titanium Cage System in ALIF and LLIF: A Retrospective Clinical and Radiographic Analysis

by Ryan W. Turlip, Mert Marcel Dagli, Richard J. Chung, Daksh Chauhan, Richelle J. Kim, Julia Kincaid, Hasan S. Ahmad, Yohannes Ghenbot and Jang Won Yoon

J. Clin. Med. 2025, 14(16), 5814; https://doi.org/10.3390/jcm14165814 - 17 Aug 2025

Cited by 1 | Viewed by 1675

Abstract

Background/Objectives: The success of lumbar interbody fusion depends on the implant design and the surgical approach used. This study evaluated the clinical and radiographic outcomes of lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF) using a 3D-printed porous titanium interbody cage system. Methods: A retrospective, single-center review of 48 patients treated for degenerative lumbar spine disease was conducted. Patients underwent LLIF, ALIF, or a combination of both using a 3D-printed titanium cage system (J&J MedTech, Raynham, MA, USA). The Oswestry disability index (ODI) and Patient-Reported Outcomes Measurement Information System (PROMIS) metrics were assessed after 6 weeks, 3 months, 6 months, and 12 months. Linear mixed-effects models evaluated the pre- and post-operative differences. Fusion performance and complications were assessed using the Bridwell grading system over 24 months. Results: A total of 78 levels (62 LLIF and 16 ALIF) were analyzed. Fusion rates were 90.3% (56/62) for LLIF levels and 81.3% (13/16) for ALIF levels by the end of 12 months. ODI scores improved significantly after 3 months (MD −13.0, p < 0.001), 6 months (MD −12.3, p < 0.001), and 12 months (MD −14.9, p < 0.001). PROMIS Pain Interference scores improved after 3 months (MD −6.1, p < 0.001), 6 months (MD −3.4, p < 0.001), and 12 months (MD −5.8, p < 0.001). PROMIS Physical Function scores improved after 3 months (MD +3.4, p = 0.032) and 12 months (MD +4.9, p < 0.001). Conclusions: This novel interbody cage demonstrated high fusion rates, significant pain and function improvements, and a favorable safety profile, warranting further comparative studies. Full article

(This article belongs to the Special Issue Clinical Advances in Spinal Neurosurgery)

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Review

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15 pages, 1548 KB

Open AccessReview

The Impact of Irritable Bowel Syndrome on Spine Surgery Outcomes: A Comprehensive Narrative Review

by Nicolas L. Carayannopoulos, Puru Sadh, Zvipo M. Chisango, Siddharth Jasti, Michael J. Farias, Joseph E. Nassar, Jeffrey Okewunmi, Jinseong Kim, John Czerwein, Eren O. Kuris, Bryce A. Basques and Alan H. Daniels

J. Clin. Med. 2026, 15(13), 5192; https://doi.org/10.3390/jcm15135192 - 2 Jul 2026

Viewed by 660

Abstract

Background/Objectives: Irritable bowel syndrome (IBS) is among the most prevalent disorders of gut–brain interaction, yet its implications for spine surgery remain poorly characterized. This narrative review examines how IBS influences symptom presentation and postoperative outcomes in spine surgery patients. Methods: We synthesized the neurobiologic, epidemiologic, and perioperative literature linking IBS with musculoskeletal pain, spine-related symptomatology, and surgical outcomes, drawing on spine-specific data where available and on related surgical and chronic-pain populations where it was not. Results: IBS is characterized by central sensitization, impaired descending inhibition, increased temporal summation, autonomic dysregulation, and a high prevalence of psychiatric comorbidity, which manifest as widespread hyperalgesia and symptom amplification that overlap with pain mechanisms common in spine surgery patients. Epidemiologic studies indicate that patients with IBS undergo musculoskeletal and spinal procedures at disproportionately high rates, reflecting both symptom burden and diagnostic uncertainty from viscerosomatic overlap. These same factors have been associated with greater postoperative pain, elevated opioid requirements, slower functional recovery, and reduced satisfaction after spine surgery, although direct IBS-specific spine data remain limited. IBS may also confound preoperative assessment by mimicking radicular, discogenic, or sacroiliac pain. Conclusions: IBS represents an under-recognized potential modifier of symptom localization, perioperative pain trajectories, and functional recovery in spine surgery. Greater awareness of IBS-related nociplastic and psychosocial mechanisms may improve preoperative evaluation, risk stratification, perioperative management, and the design of future outcome studies. Full article

(This article belongs to the Special Issue Clinical Advances in Spinal Neurosurgery)

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Other

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18 pages, 2310 KB

Open AccessSystematic Review

Is Ti-Coated PEEK Superior to PEEK for Lumbar and Cervical Fusion Procedures? A Systematic Review and Meta-Analysis

by Julia Kincaid, Richelle J. Kim, Akash Verma, Ryan W. Turlip, David D. Liu, Daksh Chauhan, Mert Marcel Dagli, Richard J. Chung, Hasan S. Ahmad, Yohannes Ghenbot, Ben Gu and Jang Won Yoon

J. Clin. Med. 2025, 14(21), 7696; https://doi.org/10.3390/jcm14217696 - 30 Oct 2025

Cited by 3 | Viewed by 2838

Abstract

Background/Objectives: Utilization of polyetheretherketone (PEEK) cages for spinal fusion has surged in the U.S., yet comprehensive comparisons evaluating its postoperative effectiveness with alternative materials remain limited. This systematic review investigates the efficacy of PEEK cages against traditional fusion materials across various surgery types, elucidating PEEK’s impact on fusion rates, postoperative outcomes, and long-term success. Methods: A systematic search of PubMed, CINAHL, Scopus, Embase, and Web of Science was conducted through 14 October 2024. Included studies were randomized controlled trials (RCTs) comparing PEEK cages with titanium, silicon nitride, and metal-coated PEEK cages for anterior cervical discectomy and fusion (ACDF), posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF). Article quality was assessed using GRADE criteria. Results: From 288 initially screened articles, 25 RCTs involving 2046 patients (mean follow-up 23.1 ± 18.2 months) met inclusion criteria and were determined as moderate (n = 21) or high (n = 4) quality. Fusion rates by cage material for PEEK (n = 1041), Ti-PEEK (n = 291), and titanium (n = 53) were 85.63 ± 18.00%, 80.05 ± 19.9%, and 92.75 ± 11.31%, respectively. In ACDF, titanium cages achieved higher fusion rates than PEEK (100% vs. 94%). In PLIF and TLIF, coated PEEK outperformed uncoated PEEK (75% vs. 71% and 94% vs. 84%, respectively). Uncoated PEEK achieved fusion rates of 94.04 ± 5.04% for ACDF, 71.21 ± 21.93% for PLIF, and 83.50 ± 24.66% for TLIF, with titanium outperforming PEEK in early fusion outcomes. Coated PEEK demonstrated potential improvements in fusion rates over uncoated PEEK in PLIFs and TLIFs. Conclusions: Selection of cage material for spinal fusions should be tailored to surgical requirements and patient needs. While titanium and PEEK are effective, their performance varies across contexts. New materials and surface modifications may enhance these outcomes further, warranting future research in long-term studies and development of novel materials. These findings can help surgeons choose cage materials according to procedure type, patient characteristics, and imaging needs. Full article

(This article belongs to the Special Issue Clinical Advances in Spinal Neurosurgery)

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