Journal of Clinical Medicine

Research

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13 pages, 2016 KiB

Open AccessArticle

Primary Versus Iatrogenic Spondylolisthesis: A Multi-Dimensional Comparison of Outcomes

by Dana-Georgiana Nedelea, Diana Elena Vulpe, Serban Dragosloveanu and Ioan Cristian Stoica

J. Clin. Med. 2025, 14(7), 2193; https://doi.org/10.3390/jcm14072193 - 23 Mar 2025

Viewed by 392

Abstract

Background: Spondylolisthesis is an important cause of lumbar and/or leg pain and can occur primarily or following spinal surgery. Our study aimed to compare the outcomes, patient satisfaction, and complications in patients surgically treated for primary versus iatrogenic spondylolisthesis. Methods: We [...] Read more.

Background: Spondylolisthesis is an important cause of lumbar and/or leg pain and can occur primarily or following spinal surgery. Our study aimed to compare the outcomes, patient satisfaction, and complications in patients surgically treated for primary versus iatrogenic spondylolisthesis. Methods: We included 90 patients who underwent spinal surgery for primary (group A, n = 46) and iatrogenic (group B, n = 44) spondylolisthesis. Radiographs were performed before and after spinal surgery. Low back pain and leg pain were assessed with the Visual Analog Scale preoperatively, postoperatively, and at 12 months, the Frankel classification was used to assess neurological impairment, and the Oswestry Disability Index was assessed preoperatively at 6 and 12 months. Results: Patients in group A had better surgical outcomes, with shorter surgical time (p = 0.005), less intraoperative bleeding (p = 0.0015), and achieving higher degrees of spondylolisthesis reduction (p = 0.0128) with more reduction distance reached (p = 0.0153). Moreover, patients from group A had significantly higher levels of low back pain preoperatively compared to patients from group B (p = 0.0042). No significant differences were noted in low back pain and leg pain at the 6- and 12-month follow-ups. Fewer implant failures were seen in group B, while group A had a slightly faster arthrodesis rate. Conclusions: Iatrogenic spondylolisthesis requires additional surgeries with increased risks and socioeconomic costs. However, while surgical challenges differ based on the etiology of spondylolisthesis, the long-term outcomes might not vary significantly. Future research is needed to address the optimization of surgical techniques and rehabilitation strategies in order to improve the outcomes in both cohorts. Full article

(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Current Advances and Future Options)

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9 pages, 2757 KiB

Open AccessArticle

Resection of Calcified and Giant Thoracic Disc Herniation Through Bilateral Postero-Lateral Approach and 360° Cord Release: A Technical Note

by Ismail Zaed, Benjamin Pommier, Gabriele Capo and Cédric Y. Barrey

J. Clin. Med. 2024, 13(22), 6807; https://doi.org/10.3390/jcm13226807 - 12 Nov 2024

Viewed by 1145

Abstract

Background/Objectives: Surgical treatment of thoracic disc herniation (TDH) is risky and technically demanding due to its proximity to the spinal cord and the high possibility of the TDH being calcified (up to 40%), making the resection even more complex. Calcified TDH may be [...] Read more.

Background/Objectives: Surgical treatment of thoracic disc herniation (TDH) is risky and technically demanding due to its proximity to the spinal cord and the high possibility of the TDH being calcified (up to 40%), making the resection even more complex. Calcified TDH may be resected from an anterior via thoracotomy/thoracoscopy, lateral extra-cavitary, or a postero-lateral approach. Here, we present our experience in managing such pathology with an original technique Methods: This original technique, used successfully in more than 40 patients, is introduced, with a precise description of the surgical anatomy and the surgical steps to take. Indications for surgical management and neurological outcomes are also analyzed. This surgical approach consisted of transverso-pediculectomy, most often bilaterally, partial vertebral body drilling, 360° release of the cord, and short fixation. Results: A total of 44 patients were collected, with a mean age of 52.4 ± 11.7 years. Seven patients (15.9%) had complete calcifications, and thirty-one had partial calcifications (70.5%), while the remaining six did not have signs of calcifications. There were only 4 intraoperative complications (2 dural tears and 2 loss of evoked potentials). The TDH could be resected in total for 39 patients (88.6%) and partially, according to the “floating” technique, in 5 patients (11.4%). In the postoperative follow-up, all of the patients except two (presenting with sensory aggravation) reported an improvement in neurological conditions leading to an overall risk of neurological aggravation of 4.5%. Conclusions: The bilateral postero-lateral approach provides a large decompression of the cord (360°) and gives safe access to the TDH, even calcified, permitting high rates of total resection. It also prevents any prejudicial pressure on the spinal cord, reducing the risk of severe postoperative deficits and permitting optimal instrumentation (pedicle screw-based) of the spinal segment. The surgical sequence to resect the bony structures around the spinal cord is of great importance. Full article

(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Current Advances and Future Options)

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8 pages, 680 KiB

Open AccessArticle

Comparison of Standing Side Bending Using Biplanar Stereography and Fulcrum Bending for Flexibility Assessment of Adolescent Idiopathic Scoliosis

by Andreas Frodl, Tanja Wendling, Lukas Klein, Ferdinand C. Wagner, Nils Mühlenfeld, Benjamin Erdle, Moritz Mayr, Thomas Niemeyer and Peter Obid

J. Clin. Med. 2024, 13(21), 6370; https://doi.org/10.3390/jcm13216370 - 24 Oct 2024

Viewed by 767

Abstract

Background: The surgical treatment of adolescent idiopathic scoliosis (AIS) is influenced by factors such as skeletal maturity, curve magnitude, progression, and spinal flexibility. The assessment of spinal flexibility is crucial for surgical planning; supine bending radiographs are commonly used but there is [...] Read more.

Background: The surgical treatment of adolescent idiopathic scoliosis (AIS) is influenced by factors such as skeletal maturity, curve magnitude, progression, and spinal flexibility. The assessment of spinal flexibility is crucial for surgical planning; supine bending radiographs are commonly used but there is no consensus on the optimal technique. Fulcrum bending radiographs (FBRs) have shown better prediction of post-surgery correction compared to supine bending radiographs. New radiological techniques allow a significant reduction in radiation exposure. This study aims to compare spinal flexibility assessment and radiation exposure between FBRs and standing side-bending radiographs (SSRs) using biplanar stereoradiography. Materials and Methods: Twenty-five consecutive AIS patients scheduled for surgery were included in this prospective cohort study. Exclusion criteria were non-idiopathic etiology, age younger than 12 years, and older than 18 years. Pre-surgery FBRs and SSRs were performed, and the Cobb angles were measured. Flexibility and correction rates were calculated. Dose–area products (DAPs) were recorded. Statistical analysis was conducted using the Wilcoxon signed-rank test and Spearman correlation. Results: The mean pre-surgery Cobb angle of the thoracic curve was 66.3°. The FBR was superior to SSR for assessing flexibility for thoracic curves and provided a better prediction for post-surgery correction. There was no significant difference in lumbar curves between FBR and SSR. The mean DAP for SSRs was 0.81 Gy*cm² compared to 3.42 Gy*cm² for FBR, indicating a lower radiation exposure using SSRs. Conclusions: FBRs are superior for flexibility assessment of thoracic curves in AIS and offers a better prediction of post-surgery correction compared to SSRs. However, FBR is associated with a higher radiation exposure. Full article

(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Current Advances and Future Options)

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9 pages, 915 KiB

Open AccessArticle

Different Neurogenic Bladders in Patients with Cervical and Thoracic Myelopathy: Direct Comparison from a Prospective Case Series

by Hyoungmin Kim, Bong-Soon Chang, Sanghyun Park, Yunjin Nam and Sam Yeol Chang

J. Clin. Med. 2024, 13(14), 4155; https://doi.org/10.3390/jcm13144155 - 16 Jul 2024

Viewed by 1681

Abstract

Background/Objectives: This study aimed to identify the unique characteristics of neurogenic bladders and associated symptoms in patients with cervical or thoracic myelopathy using clinical surveys and urodynamic studies (UDSs). Methods: Patients with degenerative cervical (DCM) or thoracic (DTM) myelopathy and lower [...] Read more.

Background/Objectives: This study aimed to identify the unique characteristics of neurogenic bladders and associated symptoms in patients with cervical or thoracic myelopathy using clinical surveys and urodynamic studies (UDSs). Methods: Patients with degenerative cervical (DCM) or thoracic (DTM) myelopathy and lower urinary tract symptoms (LUTSs) scheduled for decompressive surgery were prospectively enrolled. A UDS was performed one day preceding surgery to evaluate the preoperative urological function. Subjective symptoms were evaluated using the International Prostate Symptom Score (IPSS) and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire before surgery and one year postoperatively. Results: Sixty-two patients (DCM: 50, DTM: 12) with a mean age of 63.2 years (men: 30, women: 32) were enrolled. The UDS revealed that 5 (8.1%) patients, all with DCM, exhibited completely normal UDS results, and the remaining 57 had at least one abnormal finding. Based on the International Continence Society classification, an underactive bladder was significantly more common in patients with DTM compared to patients with DCM (75.0% vs. 18.0%, p < 0.001). The results of the questionnaire showed that the voiding symptom IPSS were significantly worse, preoperatively, in patients with DTM (5.0 ± 4.4 [DCM] vs. 8.7 ± 4.5 [DTM]; p = 0.013). One year postoperatively, the IPSS grade of 24.0% of patients with DCM improved, whereas only one (8.3%) patient with DTM showed improvement. Conclusions: Patients with DTM reported worse voiding symptoms and exhibited more underactive bladders on UDS than patients with DCM before decompression. One year postoperatively, more patients with DCM showed subjective improvements in urinary function than those with DTM. Full article

(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Current Advances and Future Options)

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9 pages, 782 KiB

Open AccessArticle

Effects of Limbs’ Spasticity on Spinopelvic Alignment in Post-Stroke Patients: A Cross-Sectional Study

by Luciano Bissolotti, Alice Brojka, Marika Vezzoli, Stefano Calza, Federico Nicoli, Carlos Romero-Morales and Jorge Hugo Villafañe

J. Clin. Med. 2024, 13(13), 3840; https://doi.org/10.3390/jcm13133840 - 29 Jun 2024

Viewed by 1378

Abstract

Objectives: This study aimed to determine the impacts of upper and lower limb (UL and LL) spasticity and impairment on spinal alignment in chronic post-stroke patients. Methods: A total of 45 consecutive chronic post-stroke patients, 18 women and 27 men, from [...] Read more.

Objectives: This study aimed to determine the impacts of upper and lower limb (UL and LL) spasticity and impairment on spinal alignment in chronic post-stroke patients. Methods: A total of 45 consecutive chronic post-stroke patients, 18 women and 27 men, from 18 to 70 years old who presented post-stroke hemiparesis were recruited in this cross-sectional study. The clinical assessment included the Modified Ashworth Scale (UL-MAS and LL-MAS spasticity), Upper Limb Motricity Index (UL-MI), FAST-UL, and Five Times Sit-to-Stand Test (5T-STS); the Associated Reaction Rating Scale was used to measure associated reactions in the hemiparetic UL, the plumb line distance from the spinous process of C7 on the sagittal (PL-C7s) and frontal plane (Pl-C7f), the kyphosis apex (PL-AK), and the spinous process of L3 (PL-L3). Angular measures of spinal alignment were measured by a Bunnell scoliometer™ (angle of trunk rotation—ATR) and a gravity-dependent inclinometer (inclination at C7-T1 and T12-L1). Results: In chronic post-stroke patients, there was found to be an association between the 5T-STS and PL-C7f (β = 0.41, p = 0.05) and the angle of inclination at T12-L1 (β = 0.44, p = 0.01). The FAST-UL correlated with PL-C7f (β = −0.41, p = 0.05), while the UL-MI correlated with this last parameter (β = −0.36, p = 0.04) and the ATR (β = −0.31, p = 0.05). The UL-MAS showed correlation with the ATR (β = 0.38, p = 0.01). Conclusions: The results lead to the possibility that, in chronic post-stroke patients, spinal misalignment on the frontal and sagittal plane is associated both with strength impairment and UL spasticity. The improvement or restoration of spinopelvic parameters can take advantage of therapeutic interventions targeted at motor improvement and spasticity reduction of the hemiparetic side. Full article

(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Current Advances and Future Options)

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Review

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13 pages, 783 KiB

Open AccessReview

Strategies to Reduce Rebound Pain and Facilitate Early Recovery After Transforaminal Endoscopic Lumbar Discectomy

by Yong Ahn

J. Clin. Med. 2025, 14(10), 3529; https://doi.org/10.3390/jcm14103529 - 18 May 2025

Viewed by 168

Abstract

Background: Transforaminal endoscopic lumbar discectomy (TELD) is a minimally invasive and popular surgical method for the treatment of lumbar disc herniation. Although TELD offers favourable outcomes and enables fast recovery, some patients experience rebound pain and transient postoperative pain, which can delay [...] Read more.

Background: Transforaminal endoscopic lumbar discectomy (TELD) is a minimally invasive and popular surgical method for the treatment of lumbar disc herniation. Although TELD offers favourable outcomes and enables fast recovery, some patients experience rebound pain and transient postoperative pain, which can delay rehabilitation and decrease patient satisfaction. Methods: This narrative review was conducted based on a comprehensive literature search of the MEDLINE database, supplemented by the author’s clinical experience. Relevant articles were identified using the keywords “rebound pain” and “transforaminal endoscopic lumbar discectomy” or “percutaneous endoscopic lumbar discectomy”. A thorough examination of rebound pain after TELD was performed by reviewing what has currently been published about its clinical traits. It was also compared with what could be observed in open lumbar discectomy and proposed preventive measures. Results: Rebound pain typically occurs within 2 weeks postoperatively and resolves spontaneously within 3 weeks. The proposed pathologies include inflammatory edema, transient ischemia, neural hypersensitivity, and increased pressure inside the disc. Risk factors include early unreasonable activity, incomplete release, and psychological predispositions. Rebound pain must be distinguished from recurrent herniation. Prevention strategies include adequate decompression, minimal neural irritation, postoperative medications, and early mobilization protocols. Conclusions: Rebound pain after TELD is self-limiting but has a clinical effect that may delay timely rehabilitation and raise concerns for surgeons and patients. Awareness and early recognition can enhance postoperative care and optimize clinical outcomes after TELD. Full article

(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Current Advances and Future Options)

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30 pages, 5488 KiB

Open AccessReview

Rehabilitation to Improve Outcomes after Cervical Spine Surgery: Narrative Review

by Tomoyoshi Sakaguchi, Ahmed Heyder, Masato Tanaka, Koji Uotani, Toshinori Omori, Yuya Kodama, Kazuhiko Takamatsu, Yosuke Yasuda, Atsushi Sugyo, Masanori Takeda and Masami Nakagawa

J. Clin. Med. 2024, 13(18), 5363; https://doi.org/10.3390/jcm13185363 - 10 Sep 2024

Cited by 5 | Viewed by 5092

Abstract

Purpose: The increasing elderly patient population is contributing to the rising worldwide load of cervical spinal disorders, which is expected to result in a global increase in the number of surgical procedures in the foreseeable future. Cervical rehabilitation plays a crucial role in [...] Read more.

Purpose: The increasing elderly patient population is contributing to the rising worldwide load of cervical spinal disorders, which is expected to result in a global increase in the number of surgical procedures in the foreseeable future. Cervical rehabilitation plays a crucial role in optimal recovery after cervical spine surgeries. Nevertheless, there is no agreement in the existing research regarding the most suitable postsurgical rehabilitation program. Consequently, this review assesses the ideal rehabilitation approach for adult patients following cervical spine operations. Materials and Methods: This review covers activities of daily living and encompasses diverse treatment methods, including physiotherapy, specialized tools, and guidance for everyday activities. The review is organized under three headings: (1) historical perspectives, (2) patient-reported functional outcomes, and (3) general and disease-specific rehabilitation. Results: Rehabilitation programs are determined on the basis of patient-reported outcomes, performance tests, and disease prognosis. CSM requires strengthening of the neck and shoulder muscles that have been surgically invaded. In contrast, the CCI requires mobility according to the severity of the spinal cord injury and functional prognosis. The goal of rehabilitation for CCTs, as for CCIs, is to achieve ambulation, but the prognosis and impact of cancer treatment must be considered. Conclusions: Rehabilitation of the cervical spine after surgery is essential for improving physical function and the ability to perform daily activities and enhancing overall quality of life. The rehabilitation process should encompass general as well as disease-specific exercises. While current rehabilitation protocols heavily focus on strengthening muscles, they often neglect the crucial aspect of spinal balance. Therefore, giving equal attention to muscle reinforcement and the enhancement of spinal balance following surgery on the cervical spine is vital. Full article

(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Current Advances and Future Options)

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22 pages, 4033 KiB

Open AccessFeature PaperEditor’s ChoiceReview

The Impact of Navigation in Lumbar Spine Surgery: A Study of Historical Aspects, Current Techniques and Future Directions

by Ahmed Majid Heydar, Masato Tanaka, Shrinivas P. Prabhu, Tadashi Komatsubara, Shinya Arataki, Shogo Yashiro, Akihiro Kanamaru, Kazumasa Nanba, Hongfei Xiang and Huynh Kim Hieu

J. Clin. Med. 2024, 13(16), 4663; https://doi.org/10.3390/jcm13164663 - 8 Aug 2024

Cited by 6 | Viewed by 3140

Abstract

Background/Objectives: We sought to improve accuracy while minimizing radiation hazards, improving surgical outcomes, and preventing potential complications. Despite the increasing popularity of these systems, a limited number of papers have been published addressing the historical evolution, detailing the areas of use, and [...] Read more.

Background/Objectives: We sought to improve accuracy while minimizing radiation hazards, improving surgical outcomes, and preventing potential complications. Despite the increasing popularity of these systems, a limited number of papers have been published addressing the historical evolution, detailing the areas of use, and discussing the advantages and disadvantages, of this increasingly popular system in lumbar spine surgery. Our objective was to offer readers a concise overview of navigation system history in lumbar spine surgeries, the techniques involved, the advantages and disadvantages, and suggestions for future enhancements to the system. Methods: A comprehensive review of the literature was conducted, focusing on the development and implementation of navigation systems in lumbar spine surgeries. Our sources include PubMed-indexed peer-reviewed journals, clinical trial data, and case studies involving technologies such as computer-assisted surgery (CAS), image-guided surgery (IGS), and robotic-assisted systems. Results: To develop more practical, effective, and accurate navigation techniques for spine surgery, consistent advancements have been made over the past four decades. This technological progress began in the late 20th century and has since encompassed image-guided surgery, intraoperative imaging, advanced navigation combined with robotic assistance, and artificial intelligence. These technological advancements have significantly improved the accuracy of implant placement, reducing the risk of misplacement and related complications. Navigation has also been found to be particularly useful in tumor resection and minimally invasive surgery (MIS), where conventional anatomic landmarks are lacking or, in the case of MIS, not visible. Additionally, these innovations have led to shorter operative times, decreased radiation exposure for patients and surgical teams, and lower rates of reoperation. As navigation technology continues to evolve, future innovations are anticipated to further enhance the capabilities and accessibility of these systems, ultimately leading to improved patient outcomes in lumbar spine surgery. Conclusions: The initial limited utilization of navigation system in spine surgery has further expanded to encompass almost all fields of lumbar spine surgeries. As the cost-effectiveness and number of trained surgeons improve, a wider use of the system will be ensured so that the navigation system will be an indispensable tool in lumbar spine surgery. However, continued research and development, along with training programs for surgeons, are essential to fully realize the potential of these technologies in clinical practice. Full article

(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Current Advances and Future Options)

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11 pages, 272 KiB

Open AccessReview

From Rib Hump to Baby Hump—Common Questions of Patients Suffering from and Undergoing Treatment for Scoliosis—A Comprehensive Literature Review

by Pawel Grabala, Piotr Kowalski and Michal Grabala

J. Clin. Med. 2024, 13(13), 3814; https://doi.org/10.3390/jcm13133814 - 28 Jun 2024

Viewed by 1637

Abstract

Background: Scoliosis, the most prevalent spinal deformity in children, is often associated with adolescent idiopathic scoliosis (AIS). Curves surpassing 50 degrees can deteriorate, especially thoracic curves, leading to pulmonary limitations. Surgical intervention is usually advised for curvatures exceeding 50 degrees to halt [...] Read more.

Background: Scoliosis, the most prevalent spinal deformity in children, is often associated with adolescent idiopathic scoliosis (AIS). Curves surpassing 50 degrees can deteriorate, especially thoracic curves, leading to pulmonary limitations. Surgical intervention is usually advised for curvatures exceeding 50 degrees to halt further progression. Severe AIS is notably more frequent in females, yet knowledge regarding subsequent pregnancies and associated risks is scarce. Female patients often inquire about conception, pregnancy, labor, and future back pain (BP) concerns. Reports on the long-term outcomes after pediatric AIS treatment and pregnancy consequences remain limited. Uncertainty looms over the likelihood of increased back pain (BP), cesarean sections (CSs), or other pregnancy-related issues following surgical AIS management. In this investigation, an attempt was made to scrutinize the existing research on individuals afflicted with scoliosis who received either conservative or surgical treatment, with the aim of delineating crucial and pragmatic findings that can serve as a compass for spine surgeons when counseling young patients with adolescent idiopathic scoliosis regarding the ailment, its repercussions, the available treatment modalities, and the associated outcomes. A comprehensive analysis pinpointed the optimal data at hand. Consequently, the primary objective of this investigation was to assess the patient-reported and clinical consequences in scoliosis patients who have undergone segmental posterior fusion and subsequently conceived. Conclusions: While the majority of individuals with AIS are capable of conceiving and bearing children, they may encounter greater challenges in fertility than healthy women unaffected by AIS. Pregnant women with a prior history of spinal fusion for AIS can undergo pregnancy and childbirth with no significant escalation in perinatal complications. Women who have undergone surgical procedures for AIS have been observed to exhibit a prevalence of back pain comparable with that of healthy pregnant women; however, a higher incidence of low back pain is evident when spinal fusion is extended to the L3 or L4 vertebra. Although back pain is a common occurrence in pregnant women with AIS, the spinal alterations induced by pregnancy are typically minor and transient. In comparison with healthy women, individuals with a history of spinal fusion necessitate cesarean sections more frequently. The degree of correction loss during pregnancy is lower in previous reports involving pedicle screw instrumentation than in previous reports involving Harrington or hybrid segmental instrumentation. Full article

(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Current Advances and Future Options)

Other

Jump to: Research, Review

20 pages, 1011 KiB

Open AccessSystematic Review

Minimally Invasive Percutaneous Techniques for the Treatment of Cervical Disc Herniation: A Systematic Review and Meta-Analysis

by Magdalena Rybaczek, Zenon Mariak, Paweł Grabala and Tomasz Łysoń

J. Clin. Med. 2025, 14(10), 3280; https://doi.org/10.3390/jcm14103280 - 8 May 2025

Viewed by 499

Abstract

Background: In recent decades, the adoption of minimally invasive (non-endoscopic) cervical techniques has grown significantly. Advancements in surgical instrumentation have broadened the spectrum of available percutaneous interventions, thus providing viable alternative treatment options for patients with prolonged, conservative treatment-resistant ailments due to [...] Read more.

Background: In recent decades, the adoption of minimally invasive (non-endoscopic) cervical techniques has grown significantly. Advancements in surgical instrumentation have broadened the spectrum of available percutaneous interventions, thus providing viable alternative treatment options for patients with prolonged, conservative treatment-resistant ailments due to contained cervical disc herniation. The aim of this study was to perform a systematic review and meta-analysis in order to evaluate the effectiveness and safety of minimally invasive percutaneous (non-endoscopic) cervical techniques. Methods: A comprehensive literature search was conducted using the PubMed, Cochrane Library, and SCOPUS databases up to July 2024, in accordance with the PRISMA guidelines. Outcomes measured included Visual Analogue Scale (VAS) scores, the Neck Disability Index (NDI), and MacNab scores, assessing pain relief and functional recovery. The risk of bias was evaluated using the Cochrane risk of bias tool (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) tool, with statistical analyses conducted in R software (version 4.3.1). Results: Out of 847 records, 21 studies (covering 1580 patients) were included in the final analysis. Five different percutaneous minimally invasive cervical procedures were incorporated into this review: nucleoplasty (n = 973), discectomy (n = 311), a combination of nucleoplasty and discectomy (n = 98), annuloplasty (n = 33), and pulsed radiofrequency (n = 17). The mean patient age was 49.5, with a gender distribution of 47.7% male and 52.3% female. A meta-analysis of six studies on cervical nucleoplasty (400 patients) demonstrated a significant reduction in pain scores, with a standardized mean difference (SMD) of −4.68 (95% CI: −8.77; −0.59, p = 0.032). However, a high heterogeneity (I² = 98.8%, Q = 407.31, p < 0.001) was observed, indicating significant variability across studies. The reoperation rate among patients was 3.4%, with discitis and device-related complications being the most frequently reported adverse events. Conclusions: Minimally invasive percutaneous cervical interventions provide effective pain relief and functional improvement for patients with cervical disc herniation, as evidenced by reductions in VAS scores and positive MacNab outcomes. The choice of the most appropriate technique should be based on individual clinical scenarios, surgeon expertise, and patient preferences, as no single method demonstrates clear superiority according to clinical outcomes or complication rates. Full article

(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Current Advances and Future Options)

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16 pages, 671 KiB

Open AccessSystematic Review

Virtual Reality as a Therapeutic Tool in Spinal Cord Injury Rehabilitation: A Comprehensive Evaluation and Systematic Review

by Matteo Scalise, Tevfik Serhan Bora, Chiara Zancanella, Adrian Safa, Roberto Stefini and Delia Cannizzaro

J. Clin. Med. 2024, 13(18), 5429; https://doi.org/10.3390/jcm13185429 - 13 Sep 2024

Cited by 4 | Viewed by 3487

Abstract

Introduction: The spinal rehabilitation process plays a crucial role in SCI patients’ lives, and recent developments in VR have the potential to efficiently engage SCI patients in therapeutic activities and promote neuroplasticity. Objective: The primary objective of this study is to [...] Read more.

Introduction: The spinal rehabilitation process plays a crucial role in SCI patients’ lives, and recent developments in VR have the potential to efficiently engage SCI patients in therapeutic activities and promote neuroplasticity. Objective: The primary objective of this study is to assess a complete review of the extended impacts of VR-assisted training on spine rehabilitation in SCI patients. Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) through a single database search in PubMed/Medline between the dates 1 January 2010 and 1 February 2024. MESH terms and keywords were combined in the following search strategy: (Augmented Reality OR VR OR Virtual Reality) AND (Spine OR Spinal) AND Rehabilitation. Included articles were written in English, involved adults with SCI, included an intervention with VR, AR, or any mixed reality system, and assessed changes in outcomes after the intervention. Results: The search produced 257 articles, and 46 of them were allocated for data extraction to evaluate 652 patients. Both when VR training was analyzed and reviewed separately, and when compared to traditional training, the findings exhibited predominantly promising outcomes, reflecting a favorable trend in the study. VR technologies were used in different settings and customizations, and the medium total time of VR training among the studies was 60.46 h per patient. Conclusions: This auspicious outcome of the study further motivates the intervention of VR and AR in the rehabilitation of SCI patients along with ameliorating their overall holistic well-being. Full article

(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Current Advances and Future Options)

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