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Clinical Advancements in Spine Surgery: Best Practices and Outcomes
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Clinical Advancements in Spine Surgery: Best Practices and Outcomes

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

Deadline for manuscript submissions: 20 September 2025 | Viewed by 2357

Special Issue Editor

Prof. Dr. Mitsuru Yagi

E-Mail Website
Guest Editor
Department of Orthopedic Surgery, School of Medicine, International University of Health and Welfare, Narita 286-8520, Japan
Interests: spine and spinal cord disease; bioimaging; frailty; biomechanics

Special Issue Information

Dear Colleagues,

This Special Issue, titled “Clinical Advancements in Spine Surgery: Best Practices and Outcomes”, aims to provide an interdisciplinary platform for sharing cutting-edge research and innovative techniques in spinal surgery. Current clinical challenges revolve around refining surgical procedures, optimizing patient outcomes, and minimizing adverse events. By addressing gaps in perioperative care, rehabilitation, and long-term monitoring, this Special Issue seeks to foster the development of evidence-based treatment strategies that can be integrated into routine clinical practice. Core problems to be explored include the need for standardized approaches to complex spine conditions, technological integration into surgical workflows, and robust patient-reported outcome measurements.

The scope of this collection encompasses topics ranging from minimally invasive spine surgery techniques and novel biologics to the use of advanced imaging modalities, robotics, and computer-assisted navigation systems. Articles focusing on the integration of enhanced recovery after surgery (ERAS) protocols, patient-specific planning tools, and rigorous research methodologies are highly encouraged. The Special Issue also welcomes review articles, clinical trials, and meta-analyses that elucidate the impact of surgical interventions on functional recovery and healthcare resource utilization.

Mobilization efforts will include broad outreach to neurosurgeons, orthopedic surgeons, biomechanical engineers, rehabilitation specialists, and researchers, encouraging interdisciplinary collaboration and the dissemination of findings that will ultimately improve patient care in spine surgery.

Prof. Dr. Mitsuru Yagi
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.

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

  • adult spinal deformity
  • scoliosis
  • frailty
  • biological age
  • big data analysis

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Published Papers (4 papers)

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Research

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11 pages, 3920 KiB  
Article
The Effectiveness and Practical Application of Different Reduction Techniques in Burst Fractures of the Thoracolumbar Spine
by Jan Cerny, Jan Soukup, Lucie Loukotova, Marek Zrzavecky and Tomas Novotny
J. Clin. Med. 2025, 14(13), 4700; https://doi.org/10.3390/jcm14134700 - 3 Jul 2025
Viewed by 204
Abstract
Background: The objective was to evaluate and compare the efficacy of direct fragment impaction, indirect reduction through ligamentotaxis, and the combination of both techniques in burst fractures of the thoracolumbar (TL) spine. Methods: The fractures were categorized using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) [...] Read more.
Background: The objective was to evaluate and compare the efficacy of direct fragment impaction, indirect reduction through ligamentotaxis, and the combination of both techniques in burst fractures of the thoracolumbar (TL) spine. Methods: The fractures were categorized using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and assessed via standard computed tomography (CT) scans for spinal canal area (SCA) and mid-sagittal diameter (MSD). The Frankel classification was used to assess neurological deficits. Only single vertebrae AO types A3 and A4 thoracic or lumbar fractures were included. All patients received bisegmental posterior stabilization, one of the reduction techniques, and, if neurological deficits were present, a spinal decompression. Mean preoperative (µSCApre/µMSDpre), postoperative (µSCApost/µMSDpost) and difference (∆SCA/∆MSD) in radiographic values were obtained and analyzed using the Mumford formula. The significance of the reduction from preoperative stenosis was assessed using a t-test, while the effectiveness of the reduction techniques was compared using the Kruskal–Wallis test and Dunn’s post hoc test. The manuscript was focused primarily on radiographic outcomes; therefore, aside from the neurostatus, no other clinical parameters were statistically analyzed. Results: Thirteen patients (38.2%) received stand-alone indirect reduction, 13 patients (38.2%) underwent direct reduction, and a combined reduction was used in eight patients (23.6%). All methods resulted in a statistically significant reduction in spinal canal stenosis (p < 0.05), with a minimal mean ∆SCA of 19%. Patients in the direct reduction group had significantly higher µSCApre values compared to those in the indirect reduction group (p = 0.02). Conclusions: All of the tested reduction techniques provided a significant reduction in spinal canal stenosis. Patients who underwent mere direct reduction had significantly higher preoperative spinal canal stenosis compared to the indirect reduction group. Full article
(This article belongs to the Special Issue Clinical Advancements in Spine Surgery: Best Practices and Outcomes)
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Review

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25 pages, 7842 KiB  
Review
Cervical Pyogenic Spondylitis: A Comprehensive Review of Diagnosis and Treatment Strategy
by Chae-Gwan Kong, Sung-Kyu Kim and Jong-Beom Park
J. Clin. Med. 2025, 14(10), 3519; https://doi.org/10.3390/jcm14103519 - 17 May 2025
Viewed by 713
Abstract
Cervical pyogenic spondylitis (CPS) is a rare but serious spinal infection with a high risk of neurological compromise due to the cervical spine’s narrow canal and proximity to critical neurovascular structures. Early diagnosis relies on a high index of suspicion supported by MRI, [...] Read more.
Cervical pyogenic spondylitis (CPS) is a rare but serious spinal infection with a high risk of neurological compromise due to the cervical spine’s narrow canal and proximity to critical neurovascular structures. Early diagnosis relies on a high index of suspicion supported by MRI, inflammatory markers, blood cultures, and tissue biopsy. Empirical intravenous antibiotics remain the cornerstone of initial treatment, followed by pathogen-specific therapy. Surgical intervention is indicated in cases of neurological deterioration, spinal instability, or failure of conservative management. Anterior approaches, including anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF), are widely used, with anterior plating providing biomechanical advantages in select cases. Posterior or combined anterior–posterior approaches are recommended in multilevel disease, deformity, or posterior element involvement. Graft selection—typically autograft or titanium/PEEK cages—must consider infection severity and biomechanical demands. Challenges in CPS management include optimal debridement extent, graft choice in infected environments, the standardization of antibiotic protocols, and the prevention of recurrence. This narrative review synthesizes the cervical-spine-specific literature on diagnosis, treatment strategies, surgical techniques, and postoperative care and proposes the following practical clinical guidance: (1) early MRI for timely diagnosis, (2) prompt surgical intervention in patients with neurological deficits or mechanical instability, and (3) individualized graft selection based on infection severity and bone quality. Full article
(This article belongs to the Special Issue Clinical Advancements in Spine Surgery: Best Practices and Outcomes)
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21 pages, 4894 KiB  
Review
Reoperation Strategy for Failure of Cervical Disc Arthroplasty at Index and Adjacent Levels
by Chae-Gwan Kong and Jong-Beom Park
J. Clin. Med. 2025, 14(6), 2038; https://doi.org/10.3390/jcm14062038 - 17 Mar 2025
Viewed by 814
Abstract
Cervical disc arthroplasty (CDA) is a motion-preserving alternative to anterior cervical discectomy and fusion (ACDF) for cervical degenerative disease, reducing adjacent segment degenerative disease (ASD). Despite its benefits, some patients experience CDA failure due to prosthesis-related complications, heterotopic ossification, segmental kyphosis, ASD, or [...] Read more.
Cervical disc arthroplasty (CDA) is a motion-preserving alternative to anterior cervical discectomy and fusion (ACDF) for cervical degenerative disease, reducing adjacent segment degenerative disease (ASD). Despite its benefits, some patients experience CDA failure due to prosthesis-related complications, heterotopic ossification, segmental kyphosis, ASD, or facet joint degeneration, necessitating revision surgery. Reoperation strategies depend on the failure mechanism, instability, sagittal malalignment, and neural compression. Anterior revision is suited for prosthesis failure, recurrent disc herniation, or ASD, enabling prosthesis removal, decompression, and fusion. In select cases, reimplantation may restore motion. Posterior approaches are preferred for facet degeneration, multilevel stenosis, or posterior hypertrophy, with options including foraminotomy, laminoplasty, or laminectomy and fusion. Complex cases may require combined anterior and posterior surgery for optimal decompression and stability. This narrative review outlines revision strategies, emphasizing biomechanical assessment, radiographic evaluation, and patient-specific considerations. Despite surgical challenges, meticulous planning and execution can optimize outcomes. Full article
(This article belongs to the Special Issue Clinical Advancements in Spine Surgery: Best Practices and Outcomes)
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Other

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12 pages, 5233 KiB  
Case Report
New Technique for S1 Nerve Root Transforaminal Percutaneous Fluoroscopically Guided Approach for Difficult Cases of Altered Anatomy
by Łukasz Kubaszewski, Adam Druszcz, Wojciech Łabędź, Zofia Kubaszewska and Mikołaj Dąbrowski
J. Clin. Med. 2025, 14(9), 3126; https://doi.org/10.3390/jcm14093126 - 30 Apr 2025
Viewed by 390
Abstract
Background: S1 nerve roots are difficult to approach during percutaneous procedures for the diagnostic and treatment procedures of low back pain with radicular symptoms. This is harder in older patients with obscure anatomies, due to the low bone density with overimposing degenerative changes [...] Read more.
Background: S1 nerve roots are difficult to approach during percutaneous procedures for the diagnostic and treatment procedures of low back pain with radicular symptoms. This is harder in older patients with obscure anatomies, due to the low bone density with overimposing degenerative changes in the facets and deformations. The otherwise straightforward procedure for the lumbar nerve roots, placing the needle in the proximity of the S1 under fluoroscopic guidance, becomes quite a challenge. Case presentation: In the proposed technique, the initial target for the needle is the lower part of the S1 facet in the convergent trajectory of the needle. After achieving contact with the bone the tip of the needle is moved caudally as, in proximity, it reaches the dorsal foramina of the S1/S2 segment—this is named “wandering to the hole”. The convergent trajectory of the needle ensures the success of the procedure with a minimal risk of intravenous drug administration, which is characteristic for the suprapedicular technique. Conclusions: The proposed technique is straightforward and reproducible due to the combination of the understanding of the surgical and radiological anatomy of this region, in spite of degenerative changes in the spine. Full article
(This article belongs to the Special Issue Clinical Advancements in Spine Surgery: Best Practices and Outcomes)
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