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Clinical Advances in Spinal Neurosurgery

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Dr. Jang-Won Yoon

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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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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

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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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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

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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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