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Advances in Spine Surgery: Current Innovations and Future Directions
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Advances in Spine Surgery: Current Innovations and Future Directions

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

Deadline for manuscript submissions: 24 October 2026 | Viewed by 1998

Special Issue Editors

Dr. Gonzalo Mariscal

E-Mail Website
Guest Editor
Mediterranean Observatory for Clinical and Health Research, Calle Navellos 1, 46001 València, Spain
Interests: spine; clinical studies; robotics; minimally invasive; complications; patient-reported outcomes; reviews
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Jesús Burgos

E-Mail Website
Guest Editor
Spine Unit, Hospital Vithas Internacional, 28027 Madrid, Spain
Interests: spine; adolescent idiopathic scoliosis; fusionless; complications
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The Special Issue "Advances in Spine Surgery: Current Innovations and Future Directions" aims to capture the dynamic evolution and broad spectrum of research and clinical practice in spine surgery. Despite significant progress in techniques, technologies, and patient outcomes, key challenges remain, including improving minimally invasive approaches, enhancing spinal biomechanics understanding, optimizing regenerative therapies, integrating surgical robotics, and advancing personalized patient-centered care. This Special Issue welcomes original research, comprehensive reviews, and clinical studies addressing these and related topics. Its scope encompasses novel surgical methods, innovative instrumentation, technological integration, research bridging laboratory findings to clinical application, and studies exploring long-term outcomes and quality of life for patients with spinal disorders. The goal is to foster interdisciplinary dialogue and mobilize the community of researchers, surgeons, and allied health professionals to share insights, overcome persistent challenges, and shape the future landscape of spine surgery. Contributions from diverse perspectives and disciplines are strongly encouraged to advance understanding and innovation in this rapidly evolving field.

Dr. Gonzalo Mariscal
Prof. Dr. Jesús Burgos
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 250 words) can be sent to the Editorial Office for assessment.

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

  • spine
  • clinical studies
  • robotics
  • minimally invasive
  • complications
  • patient-reported outcomes
  • reviews

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Published Papers (3 papers)

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20 pages, 2909 KB  
Article
Combining Engineering Precision with Clinical Relevance: A Novel Dual Framework for Assessing Pedicle Screw Accuracy in Spine Surgery
by Arnaud Delafontaine, Olivier Cartiaux, Bernard G. Francq and Virginie Cordemans
J. Clin. Med. 2026, 15(6), 2328; https://doi.org/10.3390/jcm15062328 - 18 Mar 2026
Viewed by 289
Abstract
Background/Objectives: Accurate pedicle screw placement is critical in spine surgery, as malposition can cause neurological, vascular, or visceral injuries and compromise construct stability. The primary objective of this study was to develop and experimentally validate a dual quantitative framework for assessing pedicle screw [...] Read more.
Background/Objectives: Accurate pedicle screw placement is critical in spine surgery, as malposition can cause neurological, vascular, or visceral injuries and compromise construct stability. The primary objective of this study was to develop and experimentally validate a dual quantitative framework for assessing pedicle screw placement accuracy, combining (1) coaxiality, a standardized geometric metric of trajectory alignment, and (2) pedicle wall distance (dpw), a novel parameter defined as the minimal distance between the screw axis and the pedicle cortex providing surgeons with direct, millimetric, clinically actionable feedback. A secondary objective was to compare these parameters: dpw, coaxiality, entry point errors and orientation angle errors between senior surgeons and residents to evaluate the influence of surgical experience. We hypothesized that this framework would provide reproducible quantitative measurements, demonstrate strong agreement with established CBCT-based grading systems, and allow meaningful subgroup comparisons by experience level. Methods: Eight operators (four senior surgeons, four residents) performed 240 pedicle screw insertions on synthetic polyurethane lumbar spine models using freehand, CBCT-assisted, and navigation-assisted techniques. Predefined 3D trajectories were compared with actual screw positions digitized with sub-millimetric precision. Errors, coaxiality, and dpw were computed, and dpw was validated against CBCT-based Gertzbein and Heary classifications. Agreement and diagnostic performance metrics (Kappa, sensitivity, specificity) were calculated. Results: Of 236 analyzable screws, coaxiality correlated with entry point errors (ρ = 0.41), target point errors (ρ = 0.85), and orientation angle errors (ρ = 0.48), confirming its robustness as an engineering metric. dpw provided immediate, interpretable feedback and demonstrated near-perfect agreement with CBCT grading (Kappa = 0.86; sensitivity = 0.96; specificity = 0.97), detecting breaches missed by qualitative classifications. Subgroup analyses indicated small but significant differences between senior and junior surgeons for target point errors (p = 0.006), orientation angle errors (p = 0.025), and coaxiality (p = 0.023), whereas entry point errors (p = 0.201) and dpw (p = 0.163) did not differ significantly. Conclusions: This dual-metric framework bridges engineering rigor and intraoperative applicability. Coaxiality supports reproducible research assessment, while dpw enables actionable surgical feedback. The framework allows objective comparison across operators of different experience levels. Together, these metrics offer a standardized, clinically relevant, and quantitative method for evaluating pedicle screw placement, with potential to enhance surgical safety, education, and patient outcomes. Full article
(This article belongs to the Special Issue Advances in Spine Surgery: Current Innovations and Future Directions)
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15 pages, 1020 KB  
Article
Accuracy of Robotic-Guided Pedicular Screw Insertion in Thoracolumbar Spinal Surgery
by Ignacio Dominguez, Rafael Luque, Angela Carrascosa, Juan Pablo Castaño, Alicia Collado, Pedro Alonso Lera and Fernando Marco
J. Clin. Med. 2025, 14(23), 8425; https://doi.org/10.3390/jcm14238425 - 27 Nov 2025
Viewed by 801
Abstract
Background/Objectives: Screw placement accuracy with robotic guidance shows better results than freehand techniques, yet there is scant data for region-specific outcomes, fusion rates, and complication profiles in different populations. The purpose of this study is to assess and describe screw-rod accuracy, fusion [...] Read more.
Background/Objectives: Screw placement accuracy with robotic guidance shows better results than freehand techniques, yet there is scant data for region-specific outcomes, fusion rates, and complication profiles in different populations. The purpose of this study is to assess and describe screw-rod accuracy, fusion rates, and complications of robot-assisted pedicle screw placement in a Spanish cohort. Methods: Robotic-guided technique for thoracolumbar fusion in 115 patients (July 2020–January 2025) using ExcelsiusGPS® platform (Globus Medical Inc., Audubon, PA, USA). Inclusion criteria: adults (≥18 years) with postoperative CT to assess accuracy. Primary outcomes were screw accuracy (assessed on the Gertzbein–Robbins scale), fusion rates, and complications (infection, osteolysis, and subsidence). Jamovi 2.6 was employed for statistical analysis. Results: Of a total of 726 screws implanted, 590 screws (95 patients) were studied: 584 (99%) Grade A, 5 (0.8%) Grade B, and 1 (0.2%) Grade C. Fusion was achieved in 85 out of 95 patients (89.5%). Complications included superficial infections (3/115 patients, 2.6%) and asymptomatic osteolysis (8/95 patients, 8.4%, mostly at S1). There was no screw subsidence or removal. Conclusions: Robotic-guided pedicle screw placement demonstrated exceptional accuracy (99% Grade A), high fusion success (89.5%), and minimal complications in this Spanish cohort, supporting its clinical utility for spinal instrumentation. Full article
(This article belongs to the Special Issue Advances in Spine Surgery: Current Innovations and Future Directions)
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Other

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25 pages, 5345 KB  
Systematic Review
Radiation Exposure in Robotic-Assisted Versus Conventional and Navigation-Assisted Spine Surgery: A Systematic Review, Meta-Analysis, and Meta-Regression of 3205 Patients
by Víctor Rodríguez-Domínguez, Catalina Vivancos Sánchez, Mario Taravilla-Loma, María L. Gandía-González and Alberto Isla Guerrero
J. Clin. Med. 2026, 15(6), 2144; https://doi.org/10.3390/jcm15062144 - 11 Mar 2026
Viewed by 374
Abstract
Objectives: This systematic review and meta-analysis compared freehand and navigation-assisted spine surgery with robot-assisted techniques, focusing on radiation dose, fluoroscopy time, and factors influencing these outcomes. Methods: Following the PRISMA and PROSPERO protocols, we searched major databases for comparative studies on [...] Read more.
Objectives: This systematic review and meta-analysis compared freehand and navigation-assisted spine surgery with robot-assisted techniques, focusing on radiation dose, fluoroscopy time, and factors influencing these outcomes. Methods: Following the PRISMA and PROSPERO protocols, we searched major databases for comparative studies on radiation exposure or fluoroscopy duration. Non-comparative, cadaveric, and animal studies were excluded. Bias was assessed with RoB 2 and MINORS. The data were pooled using random-effects models, with subgroup, meta-regression, sensitivity, and publication-bias analyses. Results: Twenty-eight studies (3205 patients) were included. Compared with freehand surgery, robotic assistance did not significantly reduce radiation dose (SMD −0.81; p = 0.07) or fluoroscopy time (SMD −0.56; p = 0.06), with substantial heterogeneity. Subgroup analyses revealed lower exposure with specific robotic systems (e.g., Tianji®), in degenerative and trauma indications, and at cervical, lumbar, and thoracolumbar levels. No differences were observed between robotic-assisted and navigation-assisted techniques. A meta-regression showed increasing an fluoroscopy time and radiation dose in more recent freehand studies, while trends were stable in robotic cohorts. No publication bias was detected. Conclusions: Robotic-assisted surgery was not associated with statistically significant reductions in overall radiation dose or fluoroscopy time compared with freehand techniques. Effects may vary by robotic platform, indication, and anatomical level; however, substantial heterogeneity limits certainty. Further randomized controlled trails with standardized reporting are warranted. Full article
(This article belongs to the Special Issue Advances in Spine Surgery: Current Innovations and Future Directions)
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