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Neurosurgery and Spine Surgery: From Up-to-Date Practitioners, 2nd Edition
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Neurosurgery and Spine Surgery: From Up-to-Date Practitioners, 2nd Edition

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

Deadline for manuscript submissions: 10 October 2025 | Viewed by 3069

Special Issue Editor

Dr. Massimiliano Visocchi

E-Mail Website
Guest Editor
Institute of Neurosurgery, Medical School, Catholic University of Rome, 00513 Rome, Italy
Interests: general neurosurgery; craniovertebral junction; complex spine neurosurgery; neurotraumatology; functional neurosurgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The “Neurosurgery and Spine Surgery: From Up-to-Date Practitioners, 2nd Edition” Special Issue provides a comprehensive summary of the latest advancements and best practices in the neurosurgery and spine surgery fields. This collection of articles showcases cutting-edge research, techniques, and clinical experiences from leading experts in these disciplines.

The Special Issue focuses on research articles and reviews, emphasizing the exclusion of case reports to maintain a high level of scientific rigor. The topics covered include innovative surgical approaches, emerging technologies, perioperative care, patient outcomes, and interdisciplinary collaboration in the treatment of neurological and spinal disorders.

This compilation serves as a valuable resource for healthcare professionals, researchers, and students interested in staying current with the rapidly evolving landscape of neurosurgery and spine surgery. The contributions of seasoned practitioners shed light on the most pressing issues and promising developments in these crucial medical specialties.

Dr. Massimiliano Visocchi
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 100 words) can be sent to the Editorial Office for announcement on this website.

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-blind 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.

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Keywords

  • neurosurgery
  • spine surgery
  • surgical techniques
  • research
  • advances
  • patient outcomes
  • interdisciplinary collaboration
  • healthcare
  • medical innovation
  • clinical practices

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Related Special Issue

Published Papers (5 papers)

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Research

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13 pages, 2038 KiB  
Article
Percutaneous Treatment of Traumatic A3 Burst Fractures of the Thoracolumbar Junction Without Neurological Impairment: The Role of Timing and Characteristics of Fragment Blocks on Ligamentotaxis Efficiency
by Mario De Robertis, Leonardo Anselmi, Ali Baram, Maria Pia Tropeano, Emanuela Morenghi, Daniele Ajello, Giorgio Cracchiolo, Gabriele Capo, Massimo Tomei, Alessandro Ortolina, Maurizio Fornari and Carlo Brembilla
J. Clin. Med. 2025, 14(8), 2772; https://doi.org/10.3390/jcm14082772 - 17 Apr 2025
Viewed by 185
Abstract
Background: This study aims to evaluate how surgical timing and the radiological characteristics of fragment blocks can affect the effectiveness of ligamentotaxis, in restoring the spinal canal area, and local kyphosis in adults with traumatic thoracolumbar A3 burst fractures without neurological impairment treated [...] Read more.
Background: This study aims to evaluate how surgical timing and the radiological characteristics of fragment blocks can affect the effectiveness of ligamentotaxis, in restoring the spinal canal area, and local kyphosis in adults with traumatic thoracolumbar A3 burst fractures without neurological impairment treated with percutaneous short-segment fixation. Methods: A retrospective observational study was conducted between January 2016 and December 2022 on neurologically intact adult patients with a single A3 thoracolumbar fracture. Data collected included demographics, injury mechanism, fracture level, and clinical and surgical details. Radiological assessments included spinal canal area, local kyphotic angle, anterior and posterior vertebral heights, and fragment block measurements. Results: Out of 101 treated patients, 9 met the criteria with a mean age of 52.22 years. Most fractures were at L1 (88.89%). All patients had moderate-to-severe pain (NRS 6.22 ± 1.09) at baseline. Five patients (55.55%) underwent surgery within 72 h, with a mean surgical time of 109.22 min. SCA and LKA values improved significantly in all patients post-surgery. Early surgical intervention (<72 h) correlated with greater improvements in spinal canal area (p = 0.016) and local kyphotic angle (p = 0.004). A significant association was found between spinal canal area improvement and the percentage ratio of fragment height to “normal” vertebral height (rho = 0.682; p = 0.043). Conclusions: Early (<72 h) short-segment percutaneous fixation is recommended for adults with high functional demands and moderate-to-severe axial pain due to single traumatic A3N0M0 thoracolumbar fracture. This “upfront” approach is associated with enhanced indirect decompression and better local kyphotic angle restoration. Considering the fragment morphology could also be important in surgical planning. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners, 2nd Edition)
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8 pages, 186 KiB  
Article
Effect of Cold Saline Pre-Washing on Cement Leakage in Vertebroplasty: A Novel Approach
by Réka Viola, Siran Aslan, Mohammad Walid Al-Smadi, András Gati, Konrád Szilágyi, Viktor Foglar and Árpád Viola
J. Clin. Med. 2025, 14(8), 2755; https://doi.org/10.3390/jcm14082755 - 17 Apr 2025
Viewed by 230
Abstract
Background: Cement leakage remains a significant challenge in percutaneous vertebroplasty (PVP). Leakage can lead to serious complications, including spinal cord compression, pulmonary embolism, and nerve root irritation. While several techniques have been proposed to minimize leakage, an effective and simple solution is still [...] Read more.
Background: Cement leakage remains a significant challenge in percutaneous vertebroplasty (PVP). Leakage can lead to serious complications, including spinal cord compression, pulmonary embolism, and nerve root irritation. While several techniques have been proposed to minimize leakage, an effective and simple solution is still needed. This study investigates the impact of pre-washing vertebral bodies with cold saline before cement injection as a potential method to reduce leakage. Methods: A retrospective analysis was conducted on patients who underwent PVP for osteoporotic vertebral compression fractures. Patients were divided into three groups: (1) conventional PVP, (2) PVP with room-temperature saline pre-injection, and (3) PVP with cold saline (4 °C) pre-injection. Cement leakage was assessed using intraoperative fluoroscopy and postoperative computed tomography (CT), categorized into paravertebral, intervertebral, retrograde, spinal canal, and distant venous leakage. Statistical analysis was performed to compare leakage rates among the groups. Results: A total of 262 patients with 461 treated vertebrae were analyzed. Cold saline pre-treatment significantly reduced cement leakage rates compared to conventional PVP and room-temperature saline pre-injection (p < 0.05). CT imaging detected significantly more cement extravasation than fluoroscopy (p < 0.01). The incidence of spinal canal and intervertebral leakage was lowest in the cold saline group, suggesting improved cement containment and distribution. Conclusions: Pre-washing vertebral bodies with cold saline before cement injection in PVP significantly reduces cement leakage, particularly in the spinal canal and intervertebral spaces. This simple and cost-effective approach may enhance surgical safety and improve patient outcomes. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners, 2nd Edition)
15 pages, 4529 KiB  
Article
Assessment of Neurophysiological Parameters During Anterior Cervical Discectomy and Fusion and Their Correlation with Clinical Findings
by Vedrana Karan Rakic, Djula Djilvesi, Djurdja Cvjetkovic Nikoletic, Tanja Lakic, Jelena Klasnja, Sonja Lukac Pualic and Mladen Karan
J. Clin. Med. 2025, 14(8), 2647; https://doi.org/10.3390/jcm14082647 - 12 Apr 2025
Viewed by 270
Abstract
Background: In this study, we used intraoperative neurophysiological monitoring (IONM) during anterior cervical discectomy and fusion (ACDF). Rather than emphasizing its use for safety purposes, our goal was to evaluate how neurophysiological parameters change during surgery and their correlation with clinical findings. Methods: [...] Read more.
Background: In this study, we used intraoperative neurophysiological monitoring (IONM) during anterior cervical discectomy and fusion (ACDF). Rather than emphasizing its use for safety purposes, our goal was to evaluate how neurophysiological parameters change during surgery and their correlation with clinical findings. Methods: This study included 30 patients who underwent ACDF. Detailed neurological examination was performed together with manual muscle testing (MMT), the Numeric Pain Rating Scale (NPRS), and the Neck Disability Index (NDI) questionnaire. During surgery, somatosensory-evoked potentials (SSEPs), motor-evoked potentials (MEPs), and spontaneous electromyography were registered. Results: There were statistically significant difference in the latency and amplitude of SSEPs of the right median nerve. Regarding the left median nerve, there was a statistically significant difference in amplitude, but not in latency. Differences were also observed in the amplitudes of right and left tibial nerve SSEPs, though no significant differences were found in their latencies. No statistically significant difference was found in the threshold values required to elicit MEPs between the beginning and end of the surgery. Additionally, we found a statistically significant positive correlation between the latency of the left and right median nerve and the left tibial nerve with somatosensory impairment. There was also a significant negative correlation between the amplitude of both tibial nerves and somatosensory impairment, and their latency showed a significant negative correlation with pain level before surgery. We found statistically significant decreases in NDI and pain level values one month after surgery. Conclusions: The results show significant changes in SSEPs and a correlation between clinical and neurophysiological findings and emphasize the importance of using MEPs to assess the condition of the motor system. Additionally, there was a general improvement in the patients’ condition, as assessed by NDI and pain scores. This study identifies critical surgical phases to consider in the absence of real-time neuromonitoring feedback and emphasizes that clinical observations may not fully reflect the condition of neurological structures in patients with myelopathy, which is crucial when deciding on timely surgery. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners, 2nd Edition)
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10 pages, 1452 KiB  
Article
Impact of Treatment Modalities and Fracture Stability on Survival in Thoracolumbar Fractures: A 5-Year Observational Study
by Reka Viola, Ádám Juhász, Dávid Süvegh, Dániel Sándor Veres, András Gati, Árpád Viola and Mohammad Walid Al-Smadi
J. Clin. Med. 2025, 14(3), 933; https://doi.org/10.3390/jcm14030933 - 31 Jan 2025
Viewed by 695
Abstract
Background/Objectives: Thoracolumbar fractures are a significant health burden, commonly caused by trauma, osteoporosis, or degenerative conditions, and can severely reduce quality of life and survival. These fractures, classified by the AO Spine Classification System, range from stable to unstable and require tailored management [...] Read more.
Background/Objectives: Thoracolumbar fractures are a significant health burden, commonly caused by trauma, osteoporosis, or degenerative conditions, and can severely reduce quality of life and survival. These fractures, classified by the AO Spine Classification System, range from stable to unstable and require tailored management strategies. This study aims to evaluate clinical outcomes and survival probabilities in patients aged 50+ with AO A1–A4 fractures, comparing conservative treatment, percutaneous vertebroplasty (PVP), and surgical stabilization, including minimally invasive spine surgery (MISS). Methods: This retrospective study analyzed 1356 patients treated for thoracolumbar fractures at Hungary’s largest trauma center (2014–2019). Patients aged 50+ with low-impact trauma-induced AO A1–A4 fractures were included. Fractures were categorized into stable (A1–A2) and unstable (A3–A4) groups. Treatments included conservative management, PVP, and surgical stabilization. Survival probabilities were analyzed using Cox proportional hazards models, and outcomes between open and MISS techniques were compared. Results: Spine stability is a crucial factor in determining patient outcomes. MISS enabled stabilization in older patients, reducing hospital stays compared to open surgery (median 6 vs. 10 days). Minimally invasive techniques increased surgical likelihood for unstable fractures, especially in patients over 70 years. Older age and male sex were associated with higher mortality. Conclusions: MISS offers reduced recovery time and broader surgical eligibility, making it effective for managing unstable thoracolumbar fractures in older patients. Tailored management strategies are essential for improving survival outcomes, particularly in elderly and frail populations. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners, 2nd Edition)
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Review

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15 pages, 2494 KiB  
Review
Microvascular Decompression for Trigeminal Neuralgia Secondary to Vertebrobasilar Dolichoectasia: Review of the Literature and Illustrative Case
by Massimiliano Visocchi, Fabio Zeoli and Francesco Signorelli
J. Clin. Med. 2024, 13(21), 6342; https://doi.org/10.3390/jcm13216342 - 23 Oct 2024
Cited by 2 | Viewed by 1248
Abstract
Classical trigeminal neuralgia (TN) is a chronic pain disorder characterized by severe, unilateral facial pain, often resulting from vasculonervous conflict. A less common cause of TN is vertebrobasilar dolichoectasia (VBD). Microvascular decompression (MVD) is the preferred surgical intervention for TN, but in case [...] Read more.
Classical trigeminal neuralgia (TN) is a chronic pain disorder characterized by severe, unilateral facial pain, often resulting from vasculonervous conflict. A less common cause of TN is vertebrobasilar dolichoectasia (VBD). Microvascular decompression (MVD) is the preferred surgical intervention for TN, but in case of VBD, the surgical procedure is more complex due to the aberrant vascular anatomy. This study aims to review the evidence on MVD for VBD-induced TN, and analyze operative challenges, efficacy, and postoperative outcomes. An illustrative case is also presented. We report on the case of a 62-year-old male with a 7-year history of right-sided TN affecting the maxillary (V2) and mandibular (V3) territories. The patient underwent MVD using the interposition technique, where Teflon sponges were placed between the basilar artery and the nerve. Postoperatively, the patient experienced complete pain relief without neurological deficits. At 12 months follow-up, the patient remained pain-free and off medications. We performed an extensive literature review using PubMed, Scopus, and Web of Sciences, highlighting the most relevant studies and findings on the topic. The literature review showed that, while MVD is effective in providing long-term pain relief in VBD-induced TN, the choice between interposition and transposition techniques remains debated. Interposition is easier to perform but may inadvertently increase nerve compression in some cases, whereas transposition offers more definitive decompression but carries higher technical risks. Our case and the available literature highlight the importance of individualized treatment planning in achieving optimal outcomes for patients with VBD-induced TN. Further research is needed to refine surgical techniques and minimize complications in this subset of TN patients. Full article
(This article belongs to the Special Issue Neurosurgery and Spine Surgery: From Up-to-Date Practitioners, 2nd Edition)
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