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Advances in Spine Surgery: Best Practices and Future Directions
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Advances in Spine Surgery: Best Practices and Future Directions

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

Deadline for manuscript submissions: 28 November 2025 | Viewed by 1203

Special Issue Editors

Prof. Dr. Martin N. Stienen

E-Mail Website
Guest Editor
Department of Neurosurgery & Interdisciplinary Spine Center, HOCH Health Ostschweiz, Kantonsspital St. Gallen, Medical School of St. Gallen, CH-9007 St. Gallen, Switzerland
Interests: spinal deformity; revision surgery; spine trauma; spinal oncology; complication research; outcome measures; spinal endoscopy; minimally invasive surgery; intradural microsurgery; training concept
Dr. Stefan Motov

E-Mail Website
Guest Editor
Department of Neurosurgery & Interdisciplinary Spine Center, HOCH Health Ostschweiz, Kantonsspital St. Gallen & Medical School of St. Gallen, CH-9007 St. Gallen, Switzerland
Interests: spinal endoscopy; minimally invasive spine surgery; spine trauma; education; spinal navigation; artificial intelligence

Special Issue Information

Dear Colleagues,

We would like to invite you to contribute to the Special Issue “Advances in Spine Surgery: Best Practices and Future Directions” in the Journal of Clinical Medicine. This Special Issue aims to showcase the latest innovations, evidence-based practices, and emerging technologies that are shaping the future of spine surgery.

Scope and Topics of Interest:

We welcome original research articles, systematic reviews, meta-analyses, and clinical studies that contribute to the advancement of spine surgery, including but not limited to the following:

  • Minimally Invasive Spine Surgery (MISS)—Techniques, outcomes, and comparative effectiveness;
  • Robotics and Navigation in Spine Surgery—Applications, benefits, and future potential;
  • Spinal Deformity Correction—Advances in scoliosis and sagittal deformity treatment;
  • Regenerative Medicine and Biologics—Stem cell therapy, tissue engineering, and biomaterials in spinal fusion;
  • Enhanced Recovery After Surgery (ERAS) Protocols—Best practices for perioperative care and patient outcomes;
  • Artificial Intelligence and Machine Learning—Their role in preoperative planning, intraoperative guidance, and postoperative rehabilitation;
  • Spinal Trauma and Degenerative Conditions—Novel treatment strategies for disc degeneration, spondylolisthesis, and spinal stenosis;
  • Complications and Risk Mitigation—Strategies to reduce infection, hardware failure, and adjacent segment disease.

Authors are encouraged to submit high-quality manuscripts that provide new insights, clinical applications, and critical reviews in spine surgery. All submissions will undergo a rigorous peer-review process to ensure scientific excellence.

For inquiries, please contact the Guest Editors at the above-mentioned contact information.

We look forward to your contributions to this important field of research!

Prof. Dr. Martin N. Stienen
Dr. Stefan Motov
Guest Editors

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.

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
  • spinal endoscopy
  • spinal robotics
  • spinal navigation
  • ERAS
  • machine learning
  • artificial intelligence
  • complication management
  • revision surgery
  • spinal deformity
  • innovation
  • future direction

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (2 papers)

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23 pages, 4123 KiB  
Systematic Review
Management of Retained Epidural Catheter Fragments: A Narrative Review of Individual Patient Data
by Felix Corr, Yasser F. Almealawy, Silvio Heinig, Linda Bättig, Erik Schulz, Nader Hejrati, Lorenzo Bertulli, Stephan Heisinger, Oliver Bozinov, Martin N. Stienen and Stefan Motov
J. Clin. Med. 2025, 14(12), 4265; https://doi.org/10.3390/jcm14124265 - 16 Jun 2025
Viewed by 397
Abstract
Background/Objectives: Retained epidural catheter fragments are an infrequent but clinically relevant complication of neuraxial anesthesia. Optimal management remains undefined, with limited evidence guiding treatment selection or risk stratification. This systematic review synthesized individual patient data to compare treatment strategies, examine surgical outcomes, and [...] Read more.
Background/Objectives: Retained epidural catheter fragments are an infrequent but clinically relevant complication of neuraxial anesthesia. Optimal management remains undefined, with limited evidence guiding treatment selection or risk stratification. This systematic review synthesized individual patient data to compare treatment strategies, examine surgical outcomes, and determine predictors of intervention. Methods: A systematic review was conducted across six databases in accordance with PRISMA guidelines (PROSPERO: CRD420025638305). Adult cases of retained epidural catheter fragments were included. Functional outcomes were standardized using modified MacNab, McCormick, and Therapy–Disability–Neurology (TDN) scores. Predictors of surgery and detectability were assessed using univariate and multivariate logistic regression models with Firth correction. Results: Forty studies comprising 51 patients were included. Conservative management was chosen in 23 cases (45%); 39.1% (n = 9) ultimately required delayed surgery due to symptom onset during follow-up. Surgical removal (n = 28, 55%) was safe and yielded excellent outcomes in 95.8% of cases. Fragment length was significantly associated with increased odds of surgery (OR = 1.05, 95% CI: 1.01–1.10, p = 0.04), while catheter material was associated with surgery in univariate analysis (OR = 2.49, 95% CI: 1.08–9.00, p = 0.03). An MRI demonstrated the highest diagnostic accuracy (AUC = 0.859, cutoff = 70 mm catheter length), outperforming CT (AUC = 0.611) and X-ray (AUC = 0.533). Across all patients, 84.3% achieved “Excellent” recovery per MacNab, with no neurological deterioration in any surgical case. Conclusions: Surgical removal of retained epidural catheter fragments is safe and effective in symptomatic patients. Conservative management is viable for asymptomatic cases under structured surveillance. Catheter material and fragment length may dictate imaging selection and treatment decisions. Full article
(This article belongs to the Special Issue Advances in Spine Surgery: Best Practices and Future Directions)
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11 pages, 1079 KiB  
Technical Note
Visuohaptic Feedback in Robotic-Assisted Spine Surgery for Pedicle Screw Placement
by Giuseppe Loggia, Fedan Avrumova and Darren R. Lebl
J. Clin. Med. 2025, 14(11), 3804; https://doi.org/10.3390/jcm14113804 - 29 May 2025
Viewed by 509
Abstract
Introduction: Robotic-assisted (RA) spine surgery enhances pedicle screw placement accuracy through real-time navigation and trajectory guidance. However, the absence of traditional direct haptic feedback by freehand instrumentation remains a concern for some, particularly in minimally invasive (MIS) procedures where direct visual confirmation [...] Read more.
Introduction: Robotic-assisted (RA) spine surgery enhances pedicle screw placement accuracy through real-time navigation and trajectory guidance. However, the absence of traditional direct haptic feedback by freehand instrumentation remains a concern for some, particularly in minimally invasive (MIS) procedures where direct visual confirmation is limited. During RA spine surgery, navigation systems display three-dimensional data, but factors such as registration errors, intraoperative motion, and anatomical variability may compromise accuracy. This technical note describes a visuohaptic intraoperative phenomenon observed during RA spine surgery, its underlying mechanical principles, and its utility. During pedicle screw insertion with a slow-speed automated drill in RA spine procedures, a subtle and rhythmic variation in resistance has been observed both visually on the navigation interface and haptically through the handheld drill. This intraoperative pattern is referred to in this report as a cyclical insertional torque (CIT) pattern and has been noted across multiple cases. The CIT pattern is hypothesized to result from localized stick–slip dynamics, where alternating phases of resistance and release at the bone–screw interface generate periodic torque fluctuations. The pattern is most pronounced at low insertion speeds and diminishes with increasing drill velocity. CIT is a newly described intraoperative observation that may provide visuohaptic feedback during pedicle screw insertion in RA spine surgery. Through slow-speed automated drilling, CIT offers a cue for bone engagement, which could support intraoperative awareness in scenarios where tactile feedback is reduced or visual confirmation is indirect. While CIT may enhance surgeon confidence during screw advancement, its clinical relevance, reproducibility, and impact on placement accuracy have yet to be validated. Full article
(This article belongs to the Special Issue Advances in Spine Surgery: Best Practices and Future Directions)
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