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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 2425

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 (4 papers)

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Research

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13 pages, 7025 KiB  
Article
Bilateral–Contralateral Endoscopic Decompression as a Fusion-Deferral Strategy in Upper Lumbar Stenosis: A Structural Rationale and Conditional Framework—A Technical Note with Cases Review
by Dong Hyun Lee, Sang Yeop Han, Seung Young Jeong and Il-Tae Jang
J. Clin. Med. 2025, 14(16), 5726; https://doi.org/10.3390/jcm14165726 - 13 Aug 2025
Viewed by 226
Abstract
Background/Objectives: Upper lumbar spinal stenosis presents unique challenges because vertically oriented facet joints and narrow laminae increase the risk of iatrogenic instability following decompression. Traditional decompression techniques may damage the facet joints, potentially resulting in further instability and degeneration. This study introduces a [...] Read more.
Background/Objectives: Upper lumbar spinal stenosis presents unique challenges because vertically oriented facet joints and narrow laminae increase the risk of iatrogenic instability following decompression. Traditional decompression techniques may damage the facet joints, potentially resulting in further instability and degeneration. This study introduces a novel, facet-preserving bilateral–contralateral decompression strategy using unilateral biportal endoscopy (UBE) for upper lumbar stenosis, aiming to defer unnecessary spinal fusion. Methods: This retrospective series of three cases involved patients with upper lumbar stenosis characterized by vertically oriented facets (>60°) and narrow laminae, including cases of adjacent segment stenosis (ASS) and stenosis with grade 1 spondylolisthesis. Patients were selected using the authors’ facet angle–based criteria (>60°) and laminar morphology to identify anatomically vulnerable segments. All patients exhibited vertical facet orientation and narrow laminae, without significant dynamic instability or severe foraminal compromise. Bilateral–contralateral decompression was performed using biportal endoscopy to preserve facet integrity and defer fusion where feasible. Results: This series demonstrated that bilateral–contralateral decompression provided effective neural decompression and symptom relief while preserving facet structures in the upper lumbar spine characterized by vertical facets and narrow laminae. No progression to instability or requirement for additional fusion was observed during the 6-month follow-up, even among patients with ASS and grade 1 spondylolisthesis. Conclusions: The authors propose that bilateral–contralateral decompression may serve as a facet-preserving and fusion-deferral strategy for upper lumbar stenosis with vertically oriented facets and narrow laminae. This approach is particularly applicable in cases such as ASS and spinal stenosis with grade 1 spondylolisthesis, where preserving structural reserve is critical. These preliminary findings highlight the need for prospective validation through carefully designed observational studies and larger case series. Full article
(This article belongs to the Special Issue Advances in Spine Surgery: Best Practices and Future Directions)
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12 pages, 603 KiB  
Article
Predictors of Implant Subsidence and Its Impact on Cervical Alignment Following Anterior Cervical Discectomy and Fusion: A Retrospective Study
by Rose Fluss, Alireza Karandish, Rebecca Della Croce, Sertac Kirnaz, Vanessa Ruiz, Rafael De La Garza Ramos, Saikiran G. Murthy, Reza Yassari and Yaroslav Gelfand
J. Clin. Med. 2025, 14(16), 5660; https://doi.org/10.3390/jcm14165660 - 10 Aug 2025
Viewed by 329
Abstract
Background/Objectives: Anterior cervical discectomy and fusion (ACDF) is a common procedure for treating cervical spondylotic myelopathy. Limited research exists on the predictors of subsidence following ACDF. Subsidence can compromise surgical outcomes, alter alignment, and predispose patients to further complications, making it essential [...] Read more.
Background/Objectives: Anterior cervical discectomy and fusion (ACDF) is a common procedure for treating cervical spondylotic myelopathy. Limited research exists on the predictors of subsidence following ACDF. Subsidence can compromise surgical outcomes, alter alignment, and predispose patients to further complications, making it essential to prevent and understand it. This study aims to identify key risk factors for clinically significant subsidence and evaluate its impact on cervical alignment parameters in a large, diverse patient population. Methods: We conducted a retrospective review of patients who underwent ACDF between 2013 and 2022 at a single institution. Subsidence was calculated as the mean change in anterior and posterior disc height, with clinically significant subsidence being defined as three millimeters or more. Univariate analysis was followed by regression modeling to identify subsidence predictors and analyze patterns. Subgroup analyses stratified patients by implant type, number of levels fused, and cage material. Results: A total of 96 patients with 141 levels of ACDF met the inclusion criteria. Patients with significant subsidence were younger on average (52.44 vs. 55.94 years; p = 0.074). Those with less postoperative lordosis were more likely to experience significant subsidence (79.5% vs. 90.2%; p = 0.088). Patients with significant subsidence were more likely to have standalone implants (38.5% vs. 16.7%; p < 0.01), taller cages (6.62 mm vs. 6.18 mm; p < 0.05), and greater loss of segmental lordosis (7.33 degrees vs. 3.31 degrees; p < 0.01). Multivariate analysis confirmed that standalone implants were a significant independent predictor of subsidence (OR 2.679; p < 0.05), and greater subsidence was positively associated with loss of segmental lordosis (OR 1.089; p < 0.01). Subgroup analysis revealed that multi-level procedures had a higher incidence of subsidence (35.7% vs. 28.1%; p = 0.156), and PEEK cages demonstrated similar subsidence rates compared to titanium constructs (28.1% vs. 29.4%; p = 0.897). Conclusions: Standalone implants are the strongest independent predictor of significant subsidence, and those that experience subsidence also show greater loss of segmental lordosis, although not overall lordosis. These findings have implications for surgical planning, particularly in patients with borderline bone quality or requiring multi-level fusions. The results support the use of plated constructs in high-risk patients and emphasize the importance of individualized surgical planning based on patient-specific factors. Further research is needed to explore these findings and determine how they can be applied to improve ACDF outcomes. Full article
(This article belongs to the Special Issue Advances in Spine Surgery: Best Practices and Future Directions)
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Other

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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 661
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 701
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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