Spine Neurosurgery: Clinical Advances and Future Directions

Dear Colleagues,

Degenerative spinal disease is among the leading causes of disability worldwide, and the demand for spinal surgery continues to grow as populations age and as patients with substantial medical comorbidity increasingly become surgical candidates. Against this background, the center of gravity in spine neurosurgery has shifted decisively from wide exposure toward targeted, tissue-preserving approaches. Minimally invasive spine surgery (MISS)—and full-endoscopic and unilateral biportal endoscopic techniques in particular—has expanded well beyond selected discectomy indications to decompression for central and foraminal stenosis, interbody fusion, revision surgery, spinal infection, and even intradural pathology. In parallel, intraoperative navigation, robotic guidance, augmented and mixed reality, and artificial intelligence are reshaping how these procedures are planned, executed, and audited, with the promise of shortening learning curves, reducing radiation exposure to both patient and surgical team, and making outcomes more reproducible across surgeons and institutions.

These opportunities arrive with unresolved questions. Comparative evidence between competing minimally invasive techniques remains methodologically heterogeneous: estimated blood loss, learning-curve definitions, and outcome instruments are inconsistently defined, and much of the literature is single-center and retrospective. Robotic and navigated workflows still require robust cost-effectiveness and long-term clinical data rather than accuracy endpoints alone. Artificial intelligence models are frequently developed on small, single-institution datasets with limited external validation and unsettled regulatory, privacy, and research-integrity implications. Motion preservation, anterior and lateral access corridors, bone quality assessment, biomaterials, and perioperative optimization each raise their own evidence gaps. Translating bench-level innovation into everyday clinical practice therefore demands rigorous, transparently reported clinical research rather than technical enthusiasm alone.

This Special Issue aims to present and disseminate the most recent advances in spine neurosurgery, with particular emphasis on minimally invasive and endoscopic techniques, robotics and navigation, artificial intelligence, and emerging surgical technologies. We seek contributions addressing clinical outcomes, safety and complication avoidance, technique development, and technology validation. Original clinical research, prospective and retrospective comparative studies, systematic reviews and meta-analyses, technical notes, and expert perspectives are all welcome. Studies reporting negative findings, complications, or critical methodological appraisal are equally encouraged, as these are essential to a balanced assessment of new technology.

Topics of Interest

• Minimally invasive spine surgery: Indications, clinical outcomes, and complications.
• Full-endoscopic and unilateral biportal endoscopic decompression and fusion.
• Endoscopic management of complex pathology: Revision surgery, infection, tumor, and deformity.
• Robot-assisted and navigation-guided instrumentation: Accuracy and workflow.
• Augmented, virtual, and mixed reality in surgical planning, intraoperative guidance, and training.
• Artificial intelligence and machine learning for spinal imaging analysis, risk stratification, and outcome prediction.
• Radiation exposure, fluid and thermal dynamics, and complication avoidance in endoscopic spine surgery.
• Motion preservation and anterior/lateral access spine surgery, including arthroplasty and OLIF/LLIF.
• Bone quality assessment, osteoporosis management, biomaterials, and bone substitutes in spinal fusion.

We look forward to your contributions.

Dr. Jung Woo Hur
Guest Editor

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