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Precision and Innovation in Spine Surgery: Advanced Techniques for Spinal Disorders

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

Deadline for manuscript submissions: 10 November 2026 | Viewed by 1702

Editor

Dr. Jung Woo Hur

E-Mail Website
Guest Editor
Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
Interests: spinal surgery; minimally invasive spine surgery; endoscopic spine surgery; motion preservation spine surgery; anterior access spine surgery

Special Issue Information

Dear Colleagues,

Spinal disorders remain among the leading causes of disability worldwide, affecting hundreds of millions of individuals and imposing a substantial burden on healthcare systems globally. Conditions ranging from degenerative disc disease and spinal stenosis to complex deformities and spinal instability continue to challenge clinicians, demanding solutions that balance effective neural decompression, structural restoration, and functional preservation.

Over the past two decades, the field of spine surgery has undergone a remarkable transformation, driven by rapid technological innovation and an evolving understanding of spinal biomechanics and pathology. The emergence of minimally invasive spine surgery (MISS), full-endoscopic techniques, advanced anterior and lateral access approaches, and motion-preserving technologies has fundamentally reshaped how we approach spinal pathology—shifting the paradigm from extensive open procedures toward more targeted, tissue-sparing interventions that aim to reduce surgical morbidity, accelerate recovery, and improve long-term patient outcomes.

Despite these advances, significant challenges remain. The adoption of novel techniques varies widely across institutions and regions, and robust evidence comparing outcomes across approaches continues to evolve. Questions surrounding patient selection, the learning curve associated with new technologies, long-term durability of motion-preserving implants, and the integration of navigation, robotics, and artificial intelligence into the surgical workflow remain areas of active investigation. Furthermore, as the global population ages and patient expectations rise, the demand for safe, effective, and reproducible spinal interventions has never been greater. There is a pressing need for high-quality research that bridges the gap between technological capability and clinical evidence, ultimately guiding best practices and informing shared decision-making.

This Special Issue of Journal of Clinical Medicine aims to present and disseminate the most recent advances related to modern surgical techniques for the treatment of spinal disorders. We consider contributions addressing clinical outcomes, technical innovations, and comparative studies that advance our understanding and application of contemporary spine surgery.

Topics of interest for publication include, but are not limited to, the following:

  • Minimally invasive spine surgery (MISS): techniques, outcomes, and innovations;
  • Full-endoscopic spine surgery for degenerative and non-degenerative conditions;
  • Anterior and lateral access approaches to the thoracolumbar spine;
  • Motion preservation strategies, including cervical and lumbar disc arthroplasty and dynamic stabilization;
  • Robotic-assisted and navigation-guided spine surgery;
  • Artificial intelligence and machine learning applications in spinal surgery planning and outcomes prediction;
  • Advances in spinal fusion techniques;
  • Management of complex spinal deformities using modern surgical approaches;
  • Perioperative optimization and enhanced recovery protocols in spine surgery;
  • Comparative effectiveness studies across surgical approaches;
  • Simulation, and the learning curve in adopting advanced spinal techniques.

We welcome original research articles, systematic reviews, meta-analyses, and narrative reviews that contribute to advancing the field. We look forward to receiving your contributions to this important and timely Special Issue.

Dr. Jung Woo Hur
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • minimally invasive spine surgery
  • endoscopic spine surgery
  • motion preservation
  • disc arthroplasty
  • anterior lumbar interbody fusion
  • robotic spine surgery
  • spinal navigation
  • spinal deformity correction
  • degenerative disc disease
  • enhanced recovery after spine surgery
  • artificial intelligence in spine surgery
  • dynamic stabilization

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Published Papers (3 papers)

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Research

11 pages, 1244 KB  
Article
i-Factor™ Bone Graft Versus Demineralized Bone Matrix for Single-Level Anterior Cervical Discectomy and Fusion: A Propensity Score-Matched Analysis
by Dong Hun Kim, Jung-Woo Hur, Jin-Young Kim and Jae-Taek Hong
J. Clin. Med. 2026, 15(11), 4120; https://doi.org/10.3390/jcm15114120 - 26 May 2026
Viewed by 449
Abstract
Background/Objectives: i-Factor™ Bone Graft is a composite bone substitute containing P-15 synthetic collagen fragment that has demonstrated noninferiority to local autograft in single-level anterior cervical discectomy and fusion (ACDF); however, direct head-to-head comparisons with demineralized bone matrix (DBM) using contemporary 3D-printed titanium cages [...] Read more.
Background/Objectives: i-Factor™ Bone Graft is a composite bone substitute containing P-15 synthetic collagen fragment that has demonstrated noninferiority to local autograft in single-level anterior cervical discectomy and fusion (ACDF); however, direct head-to-head comparisons with demineralized bone matrix (DBM) using contemporary 3D-printed titanium cages are lacking. The aim of this retrospective study was to compare radiographic fusion rates, segmental stability, and clinical outcomes between i-Factor™ and DBM in single-level ACDF, with a particular focus on the early time course of fusion. Methods: A retrospective propensity score-matched cohort study was conducted in patients with single-level cervical degenerative disc disease (cervical disc herniation, cervical spondylotic radiculopathy, or cervical spondylotic myelopathy) operated between December 2021 and January 2024 at a single tertiary care hospital. Seventy-six consecutive patients undergoing single-level ACDF with 3D-printed titanium cages were matched 1:1 (i-Factor™ vs. DBM) on age, sex, and operative level. Fusion status was assessed by serial dynamic radiographs at 1, 3, 6, and 12 months and by 3D-CT at 12 months in all patients (with additional CT at earlier timepoints when plain films were equivocal), by two independent spine surgeons blinded to graft type; inter-rater agreement (Cohen’s κ) was computed. Results: Mean follow-up was 18.1 months. Fusion rates for i-Factor™ at 3, 6, and 12 months were 94.7%, 100%, and 100%, respectively, compared to 71.1%, 84.2%, and 94.7% for DBM. The differences were statistically significant at 3 months (p = 0.047) and 6 months (p = 0.012), but not at 12 months (p = 0.493). Inter-rater agreement was almost perfect (κ = 0.86–1.00). No adverse reactions or device-related complications were observed. Conclusions: In this matched cohort, i-Factor™ was associated with significantly faster fusion than DBM in single-level ACDF, with similar 12-month fusion rates. No adverse reactions were observed, although the sample size is insufficient to exclude rare complications. Full article
(This article belongs to the Special Issue Precision and Innovation in Spine Surgery: Advanced Techniques for Spinal Disorders)
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14 pages, 2230 KB  
Article
Implementation of Intraoperative Cone-Beam CT (Loop-X) in an Established Robotic-Assisted Pedicle Screw Program: An Epoch-Based Cohort Study
by Julien N. Jost, Kristina Catalano, Jaqueline Lattmann, Debora Cipriani, Thomas Rhomberg, Lukas Andereggen, Gerrit A. Schubert and Markus Bruder
J. Clin. Med. 2026, 15(10), 3749; https://doi.org/10.3390/jcm15103749 - 13 May 2026
Cited by 1 | Viewed by 486
Abstract
Background/Objectives: Reliable intraoperative imaging is essential for robotic-assisted (RA) pedicle screw placement. Mobile intraoperative cone-beam CT (iCBCT) systems like Loop-X have been introduced into RA workflows, but implementation data remain limited. We evaluated whether Loop-X introduction was associated with efficiency or safety, [...] Read more.
Background/Objectives: Reliable intraoperative imaging is essential for robotic-assisted (RA) pedicle screw placement. Mobile intraoperative cone-beam CT (iCBCT) systems like Loop-X have been introduced into RA workflows, but implementation data remain limited. We evaluated whether Loop-X introduction was associated with efficiency or safety, and whether associations differed by surgeon experience. Methods: We performed a retrospective epoch-based cohort study of 146 patients undergoing RA pedicle screw placement using 3D C-arm navigation (3D-BV) or Loop-X iCBCT. Outcomes were operating room (OR) time, estimated blood loss (EBL), and length of stay (LOS). The safety endpoint was 30-day complications (Clavien–Dindo grade III or higher). Multivariable regression models adjusted for patient- and procedure-related covariates; the complication model was kept parsimonious because of the limited number of events. Interaction terms tested surgeon experience. Results: After adjustment, implementation phase was not independently associated with OR time (β 30.76 min, 95% CI −31.97 to 93.48; p = 0.33), EBL (β −19.94 mL, 95% CI −287.01 to 247.14; p = 0.88), or LOS (β 3.21 days, 95% CI −3.31 to 9.72; p = 0.33). No significant interaction with surgeon experience was detected. Major complications occurred in 16 of 146 cases (11.0%) and were not associated with Loop-X implementation (OR 0.41, 95% CI 0.10–1.74; p = 0.224). Patient factors and procedural complexity were the main determinants of outcomes. Conclusions: In this cohort, Loop-X implementation in an RA pedicle screw program was not associated with deterioration in perioperative efficiency or short-term safety after adjustment. These findings support feasibility in practice, but do not establish superiority, equivalence, or imaging-specific effects. Full article
(This article belongs to the Special Issue Precision and Innovation in Spine Surgery: Advanced Techniques for Spinal Disorders)
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14 pages, 509 KB  
Article
Traumatic Spine Injury in Southern Ethiopia: Falls, Delayed Presentation, and High Early Mortality at a Tertiary Referral Center
by Mengistu G. Mengesha, Sultan Baz, Hermella Damenu, Hana-Joy Hanks, Ryan Beyer, Alexander Nazareth, Sohaib Hashmi and Hao-Hua Wu
J. Clin. Med. 2026, 15(9), 3276; https://doi.org/10.3390/jcm15093276 - 25 Apr 2026
Viewed by 401
Abstract
Background/Objectives: Traumatic spine injury is a major cause of morbidity and mortality in low- and middle-income countries, yet detailed epidemiologic data from sub-Saharan Africa remain limited. We used a fracture registry to characterize injury patterns, care pathways, and short-term outcomes among patients [...] Read more.
Background/Objectives: Traumatic spine injury is a major cause of morbidity and mortality in low- and middle-income countries, yet detailed epidemiologic data from sub-Saharan Africa remain limited. We used a fracture registry to characterize injury patterns, care pathways, and short-term outcomes among patients presenting with traumatic spine injury at a tertiary referral center in Ethiopia. Methods: We performed a retrospective analysis of a prospectively maintained fracture registry at a tertiary referral hospital in Ethiopia from June 2023 to July 2025. Patients with traumatic spine injury were included. Variables included demographics, injury mechanism and context, injury region, AO morphology, neurologic status (ASIA), referral status, mode of transportation, time to presentation, treatment, and 30-day outcomes. Descriptive statistics were used to summarize the cohort. Bivariate associations were assessed using chi-square or Fisher’s exact tests, and crude odds ratios were calculated for prespecified 2 × 2 comparisons. Results: A total of 252 patients were included (mean age: 33.1 ± 13.6 years; 81.3% male). Falls (45.2%) and road traffic accidents (26.2%) were the most common mechanisms, and injuries most often occurred on farms (40.1%) and roads/streets (33.7%). The thoracolumbar (31.3%) and cervical (30.6%) regions were most frequently affected. Complete spinal cord injury (ASIA A) occurred in 36.5% of patients. Most patients were referred (88.5%), 62.7% presented >24 h after injury, and 65.5% were managed non-operatively. Referral status was strongly associated with delayed presentation (OR: 10.49, 95% CI: 3.84–28.64). Thirty-day mortality was 22.2%. Complete SCI (OR: 6.17, 95% CI: 3.23–11.90) and cervical/thoracic injuries (OR: 6.54, 95% CI: 3.12–13.70) were associated with higher mortality. Conclusions: Traumatic spine injury in this Ethiopian cohort disproportionately affected young adults and was marked by severe neurologic injury, delayed presentation, and high early mortality. Full article
(This article belongs to the Special Issue Precision and Innovation in Spine Surgery: Advanced Techniques for Spinal Disorders)
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