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New Challenges and Perspectives in Surgical Treatment of Spinal Deformity

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

Deadline for manuscript submissions: 20 April 2026 | Viewed by 1243

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Special Issue Editor

Prof. Dr. Jung-Hee Lee

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Guest Editor

Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
Interests: spine surgery; adult spinal deformity; kyphosis; deformity correction; orthopedic surgery

Special Issue Information

Dear Colleagues,

Adult spinal deformity (ASD) surgery has advanced considerably, yet mechanical complications—proximal junctional kyphosis/failure (PJK/PJF), rod fracture, implant loosening, and decompensation—remain major obstacles to durable outcomes. This Special Issue will highlight novel strategies to prevent and manage these failures. We particularly welcome studies on innovative alignment parameters such as fused spinopelvic angle, lordosis distribution index, and apex alignment, which refine conventional spinopelvic targets. Surgical technique–based approaches, including lateral lumbar interbody fusion with posterior column osteotomy and three-column osteotomies, will be emphasized in relation to long-term stability. Construct optimization using flexible rods, accessory rods, tethers, or transition techniques is another focus. Advances in navigation, robotics, patient-specific planning, and AI-driven risk prediction are opening new perspectives for precision and complication reduction. By integrating novel alignment concepts, refined surgical strategies, and technological innovation, this Special Issue aims to provide practical guidance for minimizing mechanical complications in ASD surgery.

Prof. Dr. Jung-Hee Lee
Guest Editor

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Keywords

adult spinal deformity
decompensation
kyphosis
lateral lumbar interbody fusion
orthopedic surgery
osteotomy
proximal junctional kyphosis
rod fracture

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Published Papers (3 papers)

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Research

10 pages, 2446 KB

Open AccessArticle

Radiographic Clarity of the External Auditory Meatus as a Cranial Reference Point in Spinal Deformity Patients: A Pilot Interobserver Study

by Dongkyu Kim, Dong Kyu Chin, Sejun Park, Jaemin Kim, Insu Lee, Jun-Woo Ha, Hyun Jun Jang, Kyung Hyun Kim, Jeong Yoon Park, Sung Uk Kuh, Keun Su Kim, Pyung Goo Cho and Bong Ju Moon

J. Clin. Med. 2026, 15(8), 2971; https://doi.org/10.3390/jcm15082971 - 14 Apr 2026

Viewed by 240

Abstract

Background/Objectives: The external auditory meatus (EAM) is widely used as a surrogate cranial reference point, based on its proximity to the midpoint of the nasion–inion line (MNI). However, its radiographic clarity has not been thoroughly validated. This study aimed to evaluate the radiographic clarity and interobserver reproducibility of the EAM compared with the sella turcica as a control landmark. Methods: A retrospective review was performed on patients who underwent surgical correction for sagittal spinal deformity between 2021 and 2024. Preoperative standing whole-spine radiographs were analyzed. Horizontal and vertical distances from the EAM and the posterior border of the sella turcica to the MNI were measured. Radiographic clarity was categorized into three groups. Five independent neurosurgeons conducted all measurements, and interobserver reliability was assessed using the intraclass correlation coefficient with a two-way random-effects model [ICC(2,1)]. Results: The EAM was horizontally closer to the MNI (1.1 mm vs. 13.8 mm) but exhibited poorer radiographic clarity, with only 14.1% classified as single point and clear compared with 84.5% for the sella turcica. Interobserver reproducibility was lower for the EAM (ICC: 0.84 horizontal, 0.89 vertical) than for the sella turcica (0.97, 0.95). Horizontal deviation among observers was significantly greater for the EAM (major deviation 6.3 mm vs. 2.2 mm, p < 0.001), whereas vertical deviation did not differ significantly. Conclusions: Although anatomically close to the MNI, the EAM demonstrated inferior radiographic clarity and reproducibility. These findings suggest that the EAM may have limitations as a cranial reference landmark. Full article

(This article belongs to the Special Issue New Challenges and Perspectives in Surgical Treatment of Spinal Deformity)

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13 pages, 1381 KB

Open AccessArticle

The Effect of Thoracolumbar Kyphosis on the Presence and Affected Level of Lumbar Degenerative Spondylolisthesis

by Şahin Karalar, Muhammed Furkan Darilmaz, Mustafa Abdullah Özdemir, Serkan Bayram, Turgut Akgül and Fatih Dikici

J. Clin. Med. 2026, 15(5), 2030; https://doi.org/10.3390/jcm15052030 - 6 Mar 2026

Viewed by 361

Abstract

Background: This study aimed to evaluate the relationship between thoracolumbar kyphosis (TLK) and lumbar degenerative spondylolisthesis (LDS) and to determine whether TLK can serve as an independent radiological predictor for both the presence and the specific affected level of LDS. Methods: Initially, 211 patients were screened for this study. After applying exclusion criteria, a final cohort of 129 patients (76 women and 53 men; mean age 62.1 ± 9.1 years) who underwent surgical intervention for degenerative lumbar spinal stenosis and had preoperative full-spine standing radiographs were retrospectively analyzed. Patients were divided into two groups: an LDS group (n = 54) comprising patients with concurrent degenerative spondylolisthesis, and a control group (n = 75) consisting of surgical patients without spondylolisthesis. Sagittal parameters, including TLK (T10–L2 angle), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis (TK), were measured. LDS was classified by the affected level (L3–L4, L4–L5, L5–S1). Group differences were compared, ROC analysis was performed to identify a threshold value, and multivariate logistic regression was used to determine independent predictors. Results: Multivariate analysis revealed that the T10–L2 angle (TLK) (OR: 1.15, p = 0.001), sacral slope (OR: 1.40, p = 0.017), pelvic tilt (OR: 1.50, p = 0.003), pelvic incidence (OR: 0.68, p = 0.004), and lumbar lordosis (OR: 1.09, p = 0.005) were significant independent predictors of LDS. Conversely, global thoracic kyphosis (TK) demonstrated an inverse relationship (OR: 0.88, p = 0.001), indicative of a secondary compensatory adaptation. ROC analysis established a TLK cut-off of ≥19.5° (AUC = 0.68, p = 0.001) for predicting LDS. Furthermore, Roussouly Type 3 alignment was significantly more prevalent in the L5–S1 LDS cohort (48.1%) Conclusions: Increased TLK is independently associated with LDS, particularly at lower lumbar levels. A TLK value ≥ 19.5° may serve as a practical radiographic marker, and TLK assessment should be incorporated into sagittal alignment evaluation and surgical planning. Full article

(This article belongs to the Special Issue New Challenges and Perspectives in Surgical Treatment of Spinal Deformity)

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11 pages, 1379 KB

Open AccessArticle

Observational Comparative Study for Surgical Outcomes of One- or Two-Level Lumbar Fusion Surgery Between Transforaminal Lumbar Interbody Fusion and Lateral Lumbar Interbody Fusion

by Seok-In Jang, Bong-Su Mun, Sang-Min Park, Ohsang Kwon, Jin S. Yeom and Ho-Joong Kim

J. Clin. Med. 2026, 15(3), 1066; https://doi.org/10.3390/jcm15031066 - 29 Jan 2026

Viewed by 372

Abstract

Background/Objectives: Transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are widely utilized techniques for degenerative lumbar diseases. This study compared radiological and clinical outcomes of LLIF and TLIF in patients undergoing lumbar fusion. Methods: This non-randomized prospective observational study enrolled 117 patients (LLIF: n = 17; TLIF: n = 100), with an inherent imbalance in group sizes, who underwent one- or two-level lumbar interbody fusion. Primary outcome was segmental lordotic angle (SLA) at the operated level. Secondary outcomes included disc height, lumbar lordotic angle, sagittal vertical axis, and patient-reported outcomes. Assessments were conducted at baseline, 3, 6, 12, and 24 months. Linear mixed models analyzed longitudinal data. Results: Mean SLA improvement was not significantly different between the groups (LLIF: 3.04° vs. TLIF: 3.18°, p = 0.782). No significant differences were observed for disc height (p = 0.518), lumbar lordotic angle (p = 0.718), or sagittal vertical axis (p = 0.866). Patient-reported outcomes improved significantly in both groups. Linear mixed model analysis revealed no significant between-group effects for Oswestry Disability Index (p = 0.335) or low back pain (p = 0.069). TLIF showed higher rates of dural tears and wound complications, while LLIF had more sympathetic chain injuries and transient psoas weakness. Overall complication rates were comparable (p > 0.05). Conclusions: TLIF and LLIF demonstrate comparable radiographic and clinical outcomes at 24-month follow-up. Surgical technique selection should be individualized based on patient-specific anatomical and clinical factors, considering distinct approach-specific complication patterns. Full article

(This article belongs to the Special Issue New Challenges and Perspectives in Surgical Treatment of Spinal Deformity)

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New Challenges and Perspectives in Surgical Treatment of Spinal Deformity

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