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Targeted Diagnosis and Treatment in Lumbar and Spine Surgeries
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Targeted Diagnosis and Treatment in Lumbar and Spine Surgeries

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

Deadline for manuscript submissions: closed (31 August 2024) | Viewed by 9011

Special Issue Editor

Dr. Giuseppe La Rocca

E-Mail Website
Guest Editor
1. Unit of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy
2. Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, 00168 Rome, Italy
Interests: degenerative spine; traumatic spine; spine tumor; spine surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue aims to provide a comprehensive overview of the latest clinical advances in lumbar and spine surgeries. Lumbar and spine disorders are prevalent conditions that can significantly impact patients' quality of life. Traditional surgical approaches have been effective, but there is a constant need for improvement to minimize invasiveness, reduce complications and enhance patient outcomes. This Special Issue will focus on emerging techniques and technologies in the field, including minimally invasive procedures, advanced imaging modalities, innovative surgical instruments and evidence-based treatment strategies. By highlighting these clinical advances, this Special Issue seeks to contribute to the refinement of surgical techniques, optimize patient care and improve long-term outcomes for individuals with lumbar and spine disorders.

Dr. Giuseppe La Rocca
Guest Editor

Manuscript Submission Information

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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

  • lumbar surgery
  • spine surgery
  • clinical advances
  • minimally invasive spine surgery (MISS)
  • advanced imaging
  • surgical instruments
  • treatment strategies
  • patient care
  • long-term outcomes
  • percutaneous spine surgery

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Published Papers (5 papers)

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Research

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14 pages, 4042 KiB  
Article
A Comparative Study between Single-Level Oblique Lumbar Interbody Fusion with Transforaminal Lumbar Interbody Fusion for Lumbar Adjacent Segment Disease
by Chung-Tse Chang, Yu-Hsien Lin, Yun-Che Wu, Cheng-Min Shih, Kun-Hui Chen, Chien-Chou Pan and Cheng-Hung Lee
J. Clin. Med. 2024, 13(19), 5843; https://doi.org/10.3390/jcm13195843 - 30 Sep 2024
Viewed by 1034
Abstract
Background/Objectives: Various surgical approaches have been proposed for treating adjacent segment disease (ASD) after lumbar fusion. However, studies using oblique lumbar interbody fusion (OLIF) to treat ASD are lacking. The current study assessed the postoperative outcomes of single-level OLIF for ASD, comparing [...] Read more.
Background/Objectives: Various surgical approaches have been proposed for treating adjacent segment disease (ASD) after lumbar fusion. However, studies using oblique lumbar interbody fusion (OLIF) to treat ASD are lacking. The current study assessed the postoperative outcomes of single-level OLIF for ASD, comparing the results with those for patients undergoing transforaminal lumbar interbody fusion (TLIF). Methods: Patients who underwent single-level OLIF or TLIF for lumbar ASD were retrospectively included. Clinical outcomes, that is, the results of assessments using the Euroqol 5-Dimension quality of life scale (EQ-5D), the Oswestry Disability Index, and the visual analog scale, were evaluated. Radiologic parameters, including disc height (DH), segmental lordosis (SL), segmental coronal angle (SCA), lumbar lordosis, and pelvic incidence–lumbar lordosis mismatch, were also assessed. Results: A total of 65 patients were enrolled: 32 in the OLIF group and 33 in the TLIF group. The median follow-up time was 24.0 months in both groups. The clinical outcomes and radiologic parameters significantly improved in both groups postoperatively. According to intergroup comparisons, the OLIF group had significantly less blood loss and superior improvement in radiologic parameters (DH, SL, and SCA) whereas the TLIF group had significantly shorter operation times. For the OLIF patients who did not undergo posterior decompression, the operation time was similar to that of the TLIF group, but the surgical blood loss and length of hospital stay were significantly reduced compared with the TLIF group. Conclusions: Compared with TLIF, OLIF provides similar clinical outcomes, leads to less surgical blood loss, and has superior radiologic parameters; however, the operation time is significantly longer. OLIF without posterior decompression may be a superior option to TLIF for certain patients. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment in Lumbar and Spine Surgeries)
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12 pages, 4673 KiB  
Article
Use of a Triaxial Accelerometer to Measure Changes in Gait Sway and Related Motor Function after Corrective Spinal Fusion Surgery for Adult Spinal Deformity
by Tomoyoshi Sakaguchi, Naveen Sake, Masato Tanaka, Yoshihiro Fujiwara, Shinya Arataki, Takuya Taoka, Yuya Kodama, Kazuhiko Takamatsu, Yosuke Yasuda, Masami Nakagawa, Kayo Utsunomiya and Hiroki Tomiyama
J. Clin. Med. 2024, 13(7), 1923; https://doi.org/10.3390/jcm13071923 - 26 Mar 2024
Cited by 2 | Viewed by 1308
Abstract
Background: Adult spinal deformity is a complex condition that causes lower back pain, causing spinal imbalance and discomfort in activities of daily life. After corrective spinal surgery, patients’ gait and balance abilities might not revert to normalcy and they might be at [...] Read more.
Background: Adult spinal deformity is a complex condition that causes lower back pain, causing spinal imbalance and discomfort in activities of daily life. After corrective spinal surgery, patients’ gait and balance abilities might not revert to normalcy and they might be at increased risk of falling. Therefore, early evaluation of such a risk is imperative to prevent further complications such as a fall, or even worse, fractures in post-surgery ASD patients. However, there has been no report of an investigation of such early changes in gait sway before and after ASD surgery. This is a prospective to investigate changes in gait sway before and following ASD surgery, using accelerometers, and also to examine motor function related to postoperative gait sway. Methods: Twenty patients were included who underwent corrective surgery as treatment for ASD, from October 2019 to January 2023. Measurement parameters included a 10 m walking test and the timed up-and-go test (TUG), gait sway was evaluated using accelerometers (root mean square; RMS), and hip flexion and knee extension muscle strength were tested. RMS included RMS vertical: RMSV; RMS anterior posterior: RMSAP; RMS medial lateral: RMSML. The radiographic spinopelvic parameters were also evaluated preoperatively and postoperatively. p < 0.05 was noted as remarkably significant. Results: Preoperative and postoperative RMSV were 1.07 ± 0.6 and 1.31 ± 0.8, respectively (p < 0.05). RMSML significantly decreased from 0.33 ± 0.2 to 0.19 ± 0.1 postoperatively (p < 0.01). However, RMSAP did not change postoperatively (0.20 ± 0.2 vs. 0.14 ± 0.1, p > 0.05). Patients’ one-month postoperative hip flexor muscle strength became significantly weaker (0.16 ± 0.04 vs. 0.10 ± 0.03 kgf/kg, p = 0.002), but TUG was maintained (11.6 ± 4.2 vs. 11.7 s, p = 0.305). RMSV was negatively correlated with quadriceps muscle strength and positively with TUG. RMSAP was negatively correlated with quadriceps muscle strength. All spinopelvic parameters became normal range after surgery. Conclusions: After corrective spinal fusion for ASD patients, the gait pattern improved significantly. Iliopsoas (hip flexor) and quadriceps femoris (knee extensor) muscles may play important roles for gait anterolateral and vertical swing, respectively. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment in Lumbar and Spine Surgeries)
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11 pages, 417 KiB  
Article
Safety and Efficacy of Zero-Profile Polyetheretherketone (PEEK) Cages Filled with Biphasic Calcium Phosphate (BCP) in Anterior Cervical Discectomy and Fusion (ACDF): A Case Series
by Marco Battistelli, Edoardo Mazzucchi, Mario Muselli, Gianluca Galieri, Filippo Maria Polli, Fabrizio Pignotti, Alessandro Olivi, Giovanni Sabatino and Giuseppe La Rocca
J. Clin. Med. 2024, 13(7), 1919; https://doi.org/10.3390/jcm13071919 - 26 Mar 2024
Cited by 1 | Viewed by 1197
Abstract
Background: In the evolving landscape of anterior cervical discectomy and fusion (ACDF), the integration of biomechanical advancements and proper fusion-enhancing materials is crucial for optimizing patient outcomes. This case series evaluates the efficacy and clinical implications of employing zero-profile polyetheretherketone (PEEK) cages [...] Read more.
Background: In the evolving landscape of anterior cervical discectomy and fusion (ACDF), the integration of biomechanical advancements and proper fusion-enhancing materials is crucial for optimizing patient outcomes. This case series evaluates the efficacy and clinical implications of employing zero-profile polyetheretherketone (PEEK) cages filled with biphasic calcium phosphate (BCP) in ACDF procedures, focusing on fusion and subsidence rates alongside patient disability, residual pain, and quality of life. Methods: This case series comprises 76 consecutive patients, with a median follow-up of 581 days. The Bridwell classification system was used for assessing fusion rates while subsidence occurrence was recorded, correlating these radiographic outcomes with clinical implications. Results: The results demonstrated a satisfactory fusion rate (76.4% for grades I and II). The subsidence rate was low (6.74% of segments). Significant clinical improvements were observed in pain, disability, and quality-of-life metrics, aligning with the minimum clinically important difference thresholds; however, subgroup analyses demonstrated that subsidence or pseudoarthrosis group improvement of PROMs was not statistically significant with respect to baseline. ANOVA analyses documented that subsidence has a significant weight over final follow-up pain and disability outcomes. No dysphagia cases were reported. Conclusions: These findings underscore the efficacy of zero-profile PEEK cages filled with BCP in ACDF, highlighting their potential to improve patient outcomes while minimizing complications. Pseudoarthrosis and subsidence have major implications over long-term PROMs. The study reinforces the importance of selecting appropriate surgical materials to enhance the success of ACDF procedures. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment in Lumbar and Spine Surgeries)
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Review

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13 pages, 583 KiB  
Review
Spinal Anesthesia for Awake Spine Surgery: A Paradigm Shift for Enhanced Recovery after Surgery
by John Preston Wilson, Bryce Bonin, Christian Quinones, Deepak Kumbhare, Bharat Guthikonda and Stanley Hoang
J. Clin. Med. 2024, 13(17), 5326; https://doi.org/10.3390/jcm13175326 - 9 Sep 2024
Cited by 2 | Viewed by 2956
Abstract
Awake surgery has been applied for various surgical procedures with positive outcomes; however, in neurosurgery, the technique has traditionally been reserved for cranial surgery. Awake surgery for the spine (ASFS) is an alternative to general anesthesia (GA). As early studies report promising results, [...] Read more.
Awake surgery has been applied for various surgical procedures with positive outcomes; however, in neurosurgery, the technique has traditionally been reserved for cranial surgery. Awake surgery for the spine (ASFS) is an alternative to general anesthesia (GA). As early studies report promising results, ASFS is progressively gaining more interest from spine surgeons. The history defining the range of adverse events facing patients undergoing GA has been well described. Adverse reactions resulting from GA can include postoperative nausea and vomiting, hemodynamic instability and cardiac complications, acute kidney injury or renal insufficiency, atelectasis, pulmonary emboli, postoperative cognitive dysfunction, or malignant hyperthermia and other direct drug reactions. For this reason, many high-risk populations who have typically been poor candidates under classifications for GA could benefit from the many advantages of ASFS. This narrative review will discuss the significant historical components related to ASFS, pertinent mechanisms of action, protocol overview, and the current trajectory of spine surgery with ASFS. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment in Lumbar and Spine Surgeries)
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Other

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13 pages, 4966 KiB  
Systematic Review
H3K27-Altered Diffuse Glioma of the Spinal Cord in Adult Patients: A Qualitative Systematic Review and Peculiarity of Radiological Findings
by Anna Maria Auricchio, Giovanni Pennisi, Grazia Menna, Alessandro Olivi, Marco Gessi, Gerrit H. Gielen, Simona Gaudino, Nicola Montano and Fabio Papacci
J. Clin. Med. 2024, 13(10), 2972; https://doi.org/10.3390/jcm13102972 - 18 May 2024
Cited by 1 | Viewed by 1764
Abstract
Background: Primary spinal cord diffuse gliomas (SpDG) are rare tumors that may harbor, like diffuse intrinsic pontine gliomas (DIPG), H3K27M mutations. According to the WHO (2021), SpDGs are included in diffuse midline H3K27-altered gliomas, which occur more frequently in adults and show [...] Read more.
Background: Primary spinal cord diffuse gliomas (SpDG) are rare tumors that may harbor, like diffuse intrinsic pontine gliomas (DIPG), H3K27M mutations. According to the WHO (2021), SpDGs are included in diffuse midline H3K27-altered gliomas, which occur more frequently in adults and show unusual clinical presentation, neuroradiological features, and clinical behavior, which differ from H3 G34-mutant diffuse hemispheric glioma. Currently, homogeneous adult-only case series of SpDG, with complete data and adequate follow-up, are still lacking. Methods: We conducted a qualitative systematic review, focusing exclusively on adult and young adult patients, encompassing all studies reporting cases of primitive, non-metastatic SpDG with H3K27 mutation. We analyzed the type of treatment administered, survival, follow-up duration, and outcomes. Results: We identified 30 eligible articles published between 1990 and 2023, which collectively reported on 62 adult and young adult patients with primitive SpDG. Postoperative outcomes were assessed based on the duration of follow-up, with outcomes categorized as either survival or mortality. Patients who underwent surgery were followed up for a mean duration of 17.37 months, while those who underwent biopsy had a mean follow-up period of 14.65 months. Among patients who were still alive, the mean follow-up duration was 18.77 months. The radiological presentation of SpDG varies widely, indicating its lack of uniformity. Conclusion: Therefore, we presented a descriptive scenario where SpDG was initially suspected to be a meningioma, but was later revealed to be a malignant SpDG with H3K27M mutation. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment in Lumbar and Spine Surgeries)
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