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Spine Surgery: Current Challenges and Opportunities
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Spine Surgery: Current Challenges and Opportunities

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

Deadline for manuscript submissions: 20 January 2027 | Viewed by 1598

Editor

Dr. Kambiz Sarahrudi

E-Mail Website
Guest Editor
1. Department Medicine, Danube Private University, 3500 Krems an der Donau, Austria
2. Department of Traumatology and Orthopedics, Division of Trauma Surgery, Medical University of Wiener Neustadt, 2700 Wiener Neustadt, Austria
Interests: trauma surgery; spinal surgery; vertebral fractures; difficult bone fracture healing

Special Issue Information

Dear Colleagues,

Spine surgery has progressed greatly in recent decades, driven by a deeper understanding of spinal function and advances in technology. Surgeons now approach the spine with less trauma to surrounding tissue, stabilize it while preserving natural biomechanics, and restore alignment during reconstruction. Modern fixation systems and hardware provide more secure stabilization, while spinal navigation improves safety and accuracy. Biological innovations have also enhanced bone healing and fusion outcomes.

Beyond surgical techniques, research has expanded knowledge of back pain origins, spinal cord injury mechanisms, and axonal regeneration. Despite these achievements, major challenges remain. These include preventing disk degeneration, identifying precise causes of back pain, preserving spinal motion, and avoiding complications such as adjacent-level disease or instability after decompression. Spinal cord injury, in particular, continues to lack effective treatments to restore lost function.

This Special Issue highlights the latest advances in spine surgery, new biological insights, and the unresolved challenges shaping the field’s future.

Dr. Kambiz Sarahrudi
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 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-anonymized 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

  • vertebral fracture
  • spine trauma
  • spinal cord injury
  • adjacent segment degeneration
  • infection
  • spondylodiscitis
  • verte-bral metastasis
  • osteoporotic fracture
  • fracture of sacrum
  • disk degeneration
  • degenerative spine surgery
  • minimally invasive spine surgery

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Published Papers (3 papers)

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Research

20 pages, 2353 KB  
Article
Examining the Role of Pre-Operative Retrolisthesis in Single-Level Lumbar Fusion: Impact on Reoperation Rates
by Hershil Alkesh Patel, Rohan I. Suresh, Sapan Patel, Abel K. Lindley, Ethan Yang, Gerald Kidd, Evan Honig, Ryan Curto, Usman Zareef, Hans Prakash, Amil Sahai, Husni Alasadi, Alexander Padovano, Louis J. Bivona, Daniel Cavanaugh, Eugene Y. Koh, Steven C. Ludwig and Julio J. Jauregui
J. Clin. Med. 2026, 15(11), 4063; https://doi.org/10.3390/jcm15114063 - 24 May 2026
Viewed by 274
Abstract
Background/Objectives: Lumbar fusion for degenerative pathology is increasingly common, yet revision surgery, often due to adjacent segment disease, remains a major concern. While sagittal alignment has been widely studied, the role of preoperative lumbar retrolisthesis is less clear. This study evaluated the prevalence, [...] Read more.
Background/Objectives: Lumbar fusion for degenerative pathology is increasingly common, yet revision surgery, often due to adjacent segment disease, remains a major concern. While sagittal alignment has been widely studied, the role of preoperative lumbar retrolisthesis is less clear. This study evaluated the prevalence, distribution, and clinical significance of preoperative retrolisthesis in patients undergoing single-level L4–L5 fusion, with a focus on its association with revision surgery. Materials and Methods: A retrospective cohort study of 116 adult patients undergoing single-level L4–L5 posterior fusion with multilevel decompression from 2018 to 2022 was performed. Retrolisthesis was defined as posterior translation ≥ 2 mm and assessed across lumbar levels. Patients were stratified by revision status. Statistical comparisons and Cox proportional hazards models were used to evaluate associations between retrolisthesis burden, radiographic parameters, and revision risk. Results: Preoperative retrolisthesis was present in 78.4% of patients, most commonly at L3–L4 and L2–L3, and frequently involved multiple levels. Presence of retrolisthesis alone was not associated with revision (85.7% vs. 77.5%, p = 0.73). However, patients with ≥3 retrolisthesis levels demonstrated reduced revision-free survival, with a higher hazard of revision on univariate analysis (HR 3.65, p = 0.055). In multivariate analysis, ≥3 levels (HR 5.50, p = 0.018) and greater absolute L4–S1 lordosis change (HR 1.09 per degree, p = 0.031) were independent predictors of revision. Conclusions: Retrolisthesis is highly prevalent in patients undergoing L4–L5 fusion but is not predictive of revision when considered alone. A greater multilevel retrolisthesis burden, particularly when combined with larger segmental lordosis change, may represent a mechanically vulnerable spine phenotype associated with increased revision risk. These findings should be interpreted as exploratory and require validation in larger cohorts. Full article
(This article belongs to the Special Issue Spine Surgery: Current Challenges and Opportunities)
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9 pages, 1271 KB  
Article
Accuracy of CT- vs. Fluoroscopic-Guided Biopsy in Spinal Lesions
by Sebastian G. Walter, Joline S. Schwan, Thaer Ali, Lioba Bürvenich, Vincent J. Heck, Philipp Rauen, Wolfram Weschenfelder, Sonja Häckel and Nikolaus Kernich
J. Clin. Med. 2026, 15(10), 3727; https://doi.org/10.3390/jcm15103727 - 12 May 2026
Viewed by 424
Abstract
Background: The rising incidence of vertebral body fractures, vertebral infections and metastatic disease increases the need for diagnostic modalities with high specificity. Biopsy remains essential, yet comparative data on CT-guided versus intraoperative percutaneous fluoroscopy-guided biopsy are limited. Methods: This retrospective study [...] Read more.
Background: The rising incidence of vertebral body fractures, vertebral infections and metastatic disease increases the need for diagnostic modalities with high specificity. Biopsy remains essential, yet comparative data on CT-guided versus intraoperative percutaneous fluoroscopy-guided biopsy are limited. Methods: This retrospective study compared two cohorts biopsied for spinal lesions between April 2015 and April 2024: CT-guided biopsy (n = 62), and intraoperative percutaneous biopsy (n = 154). Groups were analyzed for demographic and clinical characteristics, and diagnostic yield was defined by the conclusiveness of the primary biopsy; statistical comparisons were performed using Fisher’s exact test. Results: CT-guided biopsy yielded conclusive results in 46 of 62 cases (74.2%), whereas intraoperative, fluoroscopy-guided biopsy was conclusive in 41 of 154 cases (26.6%), representing a statistically significant difference (p < 0.001). In analogy, propensity score matching (1:1) resulted in similar significant (p < 0.001) results (CT-guided group vs. intraoperative, fluoroscopy-guided group: 86.7% vs. 35.6%) Conclusions: CT-guided biopsy demonstrated a substantially higher rate of conclusive results compared with intraoperative biopsy in this cohort. Further studies with larger and more balanced cohorts are needed to strengthen clinical recommendations. Full article
(This article belongs to the Special Issue Spine Surgery: Current Challenges and Opportunities)
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11 pages, 566 KB  
Article
Surgical Site Infection Following Surgery for Spine Trauma
by Matthias Zolda-Neugebauer, Georgios Gkourlias, Ulrike Wittig, Arastoo Nia and Kambiz Sarahrudi
J. Clin. Med. 2026, 15(8), 3109; https://doi.org/10.3390/jcm15083109 - 19 Apr 2026
Viewed by 406
Abstract
Background/Objectives: Traumatic spinal fractures are common injuries, and a proportion of these cases require surgical stabilization using various operative systems. This study aimed to analyze the epidemiology of surgical site infections (SSIs) following exclusively trauma-related spinal surgery and to identify potential risk [...] Read more.
Background/Objectives: Traumatic spinal fractures are common injuries, and a proportion of these cases require surgical stabilization using various operative systems. This study aimed to analyze the epidemiology of surgical site infections (SSIs) following exclusively trauma-related spinal surgery and to identify potential risk factors for their occurrence, as there is a lack of studies focusing on non-elective trauma-related spinal surgeries and SSI in the literature. Methods: This retrospective single-center analysis examined 710 patients with traumatic spinal injuries treated surgically between 2012 and 2022 at the Level I Trauma Center at the Department of Orthopedics and Trauma Surgery of the University Hospital Wiener Neustadt, Austria. To investigate SSI risk factors, comparative statistical analyses and logistic regression were used, with a level of statistical significance of α = 0.05. Results: In total, 28 cases (with an incidence of 3.94%) developed SSI, and these cases were characterized by a significantly higher body weight/BMI, longer operative times, and more stabilized segments and implanted hardware. They were also more likely to have undergone open surgery, laminectomy in combination with dorsal stabilization, intensive care treatment, or to present with neurological deficits or ankylosing spondylitis. SSIs occurred most frequently in the thoracolumbar and cervicothoracic junctions, and were predominantly caused by Staphylococcus epidermidis, Staphylococcus aureus, and Cutibacterium acnes. As independent risk factors, a higher BMI (OR = 1.188) and the use of cross-connectors (OR = 4.948) were identified, whereas other initially significant variables did not remain significant after adjustment. Conclusions: There are surgery-related and potentially modifiable variables and non-modifiable patient-related risk factors for the occurrence of SSI. Patients with SSIs stayed an average of 25.3 days in hospital and had a mortality rate of 17.9%. Full article
(This article belongs to the Special Issue Spine Surgery: Current Challenges and Opportunities)
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