Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
5.2
3.3
Journals
JCM
Special Issues
Surgical Management of Complex Spinal Pathologies: Challenges and Innovations
jcm-logo
Submit to JCM Review for JCM Propose a Special Issue

Journal Menu

► Journal Menu

Journal Browser

► Journal Browser
share announcement

Surgical Management of Complex Spinal Pathologies: Challenges and Innovations

A Special Issue of Journal of Clinical Medicine (ISSN 2077-0383) belonging to the section "Orthopedics".

Deadline for manuscript submissions: closed (20 May 2026) | Viewed by 6212

Editor

Dr. Spyridon Komaitis

E-Mail
Guest Editor
Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, UK
Interests: minimally invasive spinal surgery; adult spinal deformity; spinal surgery; degenerative disease of the spine; spine disorders
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The surgical management of complex spinal pathologies continues to evolve rapidly with the development of advanced techniques, minimally invasive approaches, and novel technologies. Despite significant progress, these conditions—ranging from adult spinal deformity and complex degenerative conditions to revision surgery, spinal oncology, and spinal infection—remain among the most demanding challenges for spine surgeons worldwide. This Special Issue of Journal of Clinical Medicine aims to highlight surgical strategies, complication management, clinical outcomes, and decision-making frameworks in the treatment of complex spinal disorders. Original research and systematic reviews are welcome. Particular emphasis will be placed on complex surgical techniques, comparative studies of minimally invasive versus open approaches, the role of navigation and robotics, perioperative management, and long-term functional outcomes. By bringing together international expertise, this Special Issue seeks to provide an updated perspective that will enhance clinical practice and guide future research in the surgical treatment of complex spinal pathologies.

Dr. Spyridon Komaitis
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

  • complex spinal surgery
  • adult spinal deformity
  • complex degenerative pathologies
  • revision spine surgery
  • spinal oncology
  • robotics
  • navigation
  • surgical outcomes

Benefits of Publishing in a Special Issue

  • Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
  • Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
  • Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
  • External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
  • Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

Download All Papers
Order results
Result details
Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:

Research

Jump to: Review

12 pages, 1368 KB  
Article
The Efficacy of Prone Single-Position Lateral Lumbar Interbody Fusion for Symptomatic Cranial Adjacent Segment Degeneration
by Dong Hun Kim, Sang Don Kim, Jung-Woo Hur, Jin Young Kim and Jae Taek Hong
J. Clin. Med. 2026, 15(2), 895; https://doi.org/10.3390/jcm15020895 - 22 Jan 2026
Cited by 1 | Viewed by 684
Abstract
Background/Objectives: Following lumbar fusion procedures, adjacent segment degeneration (ASD) at cranial levels presents as a well-documented long-term complication, manifesting through recurrent pain, neurological deficits, and progressive functional decline. The prone single-position technique for lateral lumbar interbody fusion (PSP-LLIF) streamlines surgical workflow by [...] Read more.
Background/Objectives: Following lumbar fusion procedures, adjacent segment degeneration (ASD) at cranial levels presents as a well-documented long-term complication, manifesting through recurrent pain, neurological deficits, and progressive functional decline. The prone single-position technique for lateral lumbar interbody fusion (PSP-LLIF) streamlines surgical workflow by eliminating the need for intraoperative patient repositioning; however, comprehensive evidence supporting its clinical and radiological effectiveness in managing cranial ASD remains insufficient. Material and Methods: This retrospective cohort study examined 30 consecutive patients presenting with symptomatic cranial adjacent segment disease who were treated with PSP-LLIF at a single institution. Patient-reported outcome measures included visual analog scale (VAS) assessments for axial and radicular pain, alongside the Oswestry Disability Index (ODI) for functional status evaluation. Radiological parameters included overall and segmental lumbar lordotic measurements, anterior and posterior disk height, fusion status, and instrumentation-related complications. Results: At 12-month postoperative evaluation, substantial clinical improvements were demonstrated. Mean VAS reductions measured 4.7 points for axial pain and 6.5 points for radicular pain, while ODI decreased by 28.5 points (p < 0.05). Radiological assessment demonstrated mean increases of 6.3° in lumbar lordosis and 5.1° in segmental lordosis, along with significant gains in both anterior and posterior disk height (p < 0.05). Solid fusion was radiographically confirmed at all instrumented levels. Temporary postoperative neurological symptoms developed in several patients but resolved spontaneously without requiring revision surgery. Conclusions: PSP-LLIF yields substantial clinical benefit and reliable radiological correction in patients with symptomatic cranial ASD. Optimal outcomes necessitate rigorous adherence to position-specific technical modifications, particularly maintenance of perpendicular fluoroscopic trajectories and implementation of continuous neural monitoring to account for prone-induced anatomical shifts. This approach represents a viable treatment strategy for patients with symptomatic cranial ASD. Full article
(This article belongs to the Special Issue Surgical Management of Complex Spinal Pathologies: Challenges and Innovations)
►▼ Show Figures

Graphical abstract

Review

Jump to: Research

17 pages, 304 KB  
Review
Traumatic Spinal Cord Injury: A Contemporary Review of Classification, Evaluation, and Acute Management
by John Carlos McDearman, John Attelah and Ali Nourbakhsh
J. Clin. Med. 2026, 15(16), 6175; https://doi.org/10.3390/jcm15166175 - 10 Aug 2026
Viewed by 879
Abstract
Traumatic spinal cord injury (SCI) is a catastrophic condition associated with profound neurologic disability, psychosocial disruption, high long-term healthcare utilization, and reduced life expectancy. Globally, SCI remains a major cause of morbidity, most commonly resulting from traumatic mechanisms such as motor vehicle collisions [...] Read more.
Traumatic spinal cord injury (SCI) is a catastrophic condition associated with profound neurologic disability, psychosocial disruption, high long-term healthcare utilization, and reduced life expectancy. Globally, SCI remains a major cause of morbidity, most commonly resulting from traumatic mechanisms such as motor vehicle collisions and falls, with a bimodal age distribution affecting both younger adults and older individuals. This narrative review provides a comprehensive, clinically oriented overview of SCIs with emphasis on classification, initial evaluation, imaging, and contemporary management strategies. The review highlights the dual-phase pathophysiology of SCIs—primary mechanical insult followed by secondary injury cascades—underscoring the rationale for rapid stabilization and timely, injury-specific interventions. Initial care is framed around immobilization and trauma resuscitation principles, with cervical spine clearance guided by validated decision tools and early, appropriate imaging acquisition. We discuss adjunctive imaging considerations and address the ongoing debate regarding MRI use in obtunded patients with negative initial studies. Acute inpatient management priorities include prevention of secondary complications, hemodynamic optimization, respiratory support, and vigilant surveillance for autonomic dysfunction. Pharmacologic neuroprotection with high-dose methylprednisolone remains controversial; current guideline recommendations are reviewed. Finally, we outline operative decision-making and evidence supporting early decompression in selected patients, as well as common surgical approaches and their indications. This review consolidates foundational concepts and current standards to support practical, evidence-informed SCI evaluation and management. Full article
(This article belongs to the Special Issue Surgical Management of Complex Spinal Pathologies: Challenges and Innovations)
13 pages, 668 KB  
Review
Growth-Based Decision-Making in Congenital Scoliosis with Multiple Vertebral Anomalies
by Seidali Abdaliyev, Daniyar Yestay, Dina Saginova, Alexander Chsherbina, Daulet Baitov and Serik Serikov
J. Clin. Med. 2026, 15(6), 2198; https://doi.org/10.3390/jcm15062198 - 13 Mar 2026
Viewed by 907
Abstract
Background: Congenital scoliosis (CS) associated with multiple vertebral anomalies (MVAs) represents a biologically dynamic deformity in which cumulative segmental asymmetry, residual growth potential, and mechanobiological modulation interact to drive progression. Unlike isolated congenital lesions, MVAs exhibit growth-dependent and configuration-specific behavior, complicating risk [...] Read more.
Background: Congenital scoliosis (CS) associated with multiple vertebral anomalies (MVAs) represents a biologically dynamic deformity in which cumulative segmental asymmetry, residual growth potential, and mechanobiological modulation interact to drive progression. Unlike isolated congenital lesions, MVAs exhibit growth-dependent and configuration-specific behavior, complicating risk stratification and timing of intervention. Despite extensive literature on congenital deformities, an integrated growth-oriented decision framework for this subgroup remains lacking. Methods: This narrative review synthesizes embryological, biomechanical, and clinical evidence related to vertebral growth potential, anomaly configuration, progression patterns, and age-dependent treatment strategies in CS with MVAs. A structured literature search of major databases was performed, and findings were analyzed thematically to propose a biologically grounded growth-based decision framework. Results: Across the literature, three interdependent determinants of progression consistently emerge: anomaly configuration, residual segmental growth capacity, and mechanobiological amplification during growth. High-risk configurations—particularly mixed formation–segmentation defects and fully segmented hemivertebrae with contralateral growth arrest—demonstrate rapid and often non-linear progression. Thoracic involvement further modifies clinical urgency due to its impact on pulmonary development. Integration of developmental biology and mechanobiological principles supports a structured, growth-informed approach to surveillance and intervention timing. Conclusions: MVAs should be conceptualized as dynamic growth systems rather than static structural defects. A shift from angle-driven to growth-informed decision-making may enhance early identification of high-risk patterns while minimizing unnecessary premature fusion in lower-risk cases. Adoption of a structured growth-based framework provides a biologically coherent foundation for individualized management and long-term optimization of spinal and thoracic development. Full article
(This article belongs to the Special Issue Surgical Management of Complex Spinal Pathologies: Challenges and Innovations)
►▼ Show Figures

Figure 1

11 pages, 217 KB  
Review
Nonoperative Treatment of Adult Spinal Deformity: A Comprehensive Narrative Review
by Christos G. Zlatanos, Mohamed A. Hassanin, Ahmed Aly, Khalid M. Salem and Nasir A. Quraishi
J. Clin. Med. 2025, 14(24), 8864; https://doi.org/10.3390/jcm14248864 - 15 Dec 2025
Cited by 2 | Viewed by 1611
Abstract
Background/Objectives: Adult spinal deformity (ASD) is increasingly prevalent due to an ageing population and is associated with significant pain, disability, and reduced quality of life. While surgery is often considered for severe deformities, many patients are either unsuitable for major corrective procedures [...] Read more.
Background/Objectives: Adult spinal deformity (ASD) is increasingly prevalent due to an ageing population and is associated with significant pain, disability, and reduced quality of life. While surgery is often considered for severe deformities, many patients are either unsuitable for major corrective procedures or prefer conservative care. This narrative review synthesizes the current evidence on nonoperative management strategies for ASD. Methods: A literature search on the PubMed and Cochrane databases identified relevant studies published up to 25 October 2025. Medical Subject Headings and keywords related to nonsurgical ASD management were used. Eligible studies included nonsurgical series with a minimum of 12 months’ follow-up, while case reports were excluded. Results: Seven studies met our inclusion criteria: three on bracing, three on physiotherapy and combined physical and cognitive rehabilitation programmes, and one on transforaminal epidural steroid injections (ESIs). Bracing was effective in slowing the curve progression rate. One study showed that the progression rate decreased from 1.47°/year to 0.24° for degenerative scoliosis (p < 0.0001) and from 0.70°/year to 0.24° for idiopathic scoliosis (p = 0.03). Another study showed that there was no statistically significant difference in the Cobb angle or anticipated worsening when comparing the initial measurement with the final control after treatment (p = 0.973). Finally, a third study reported reduced back pain, with Roland–Morris scores improving from 3.3 to 2.0 (p < 0.001) at 18 months. Physiotherapy and multidisciplinary rehabilitation programmes appeared to be effective in significantly reducing pain and disability levels. One study found that Oswestry Disability Index (ODI) scores improved from 39.5 to 31.8 (p < 0.001), while back pain, measured using the Numeric Pain Rating Scale (NPRS), improved from 58.4 to 42.1 (p < 0.001), with 51% achieving minimal clinically important change (MCIC). Another study reported ODI reductions from 38 to 17.6 and pain scores from 6.5 to 2.2 (p < 0.001), while in a third study, the “Koshimagari Exercise” programme yielded MCIDs in the ODI for 42% of patients. Finally, ESIs provided significant pain relief for at least a month in over half of the patients with degenerative scoliosis and radiculopathy, with diminishing effects throughout the first 2 years. More specifically, 37.2% of patients had a successful outcome at one year post-injection and 27.3% at 2 years (p < 0.01). Conclusions: Our study suggests that bracing, physiotherapy, and multidisciplinary rehabilitation programmes, as well as ESIs, can serve as effective short term alternatives for patients with ASD who are either unsuitable for surgery or do not wish to pursue it. As such, this review provides valuable evidence-based insights that can guide clinicians in developing a treatment plan and lay the foundations for establishing a novel pathway for this specific subgroup of patients with ASD. Full article
(This article belongs to the Special Issue Surgical Management of Complex Spinal Pathologies: Challenges and Innovations)
13 pages, 10187 KB  
Review
Transpedicular Transdural Approach for Calcified Thoracic Disc Herniations: Technical Commentary, Case Series, and Review of the Literature
by Spyridon Komaitis, Elie Najjar, Dritan Pasku, Konstantinos Zygogiannis, Daniel D’Aquino and Khalid M Salem
J. Clin. Med. 2025, 14(21), 7741; https://doi.org/10.3390/jcm14217741 - 31 Oct 2025
Cited by 4 | Viewed by 1601
Abstract
Background/Objectives: Calcified thoracic disc herniations are a formidable surgical challenge due to their proximity to the spinal cord and the heightened risk of iatrogenic neurological injury. Traditional anterior and posterolateral approaches, while effective in select scenarios, may not provide adequate exposure for [...] Read more.
Background/Objectives: Calcified thoracic disc herniations are a formidable surgical challenge due to their proximity to the spinal cord and the heightened risk of iatrogenic neurological injury. Traditional anterior and posterolateral approaches, while effective in select scenarios, may not provide adequate exposure for large, centrally located calcified discs. Methods: We performed a narrative review of the literature and retrospective case series of seven patients who underwent transpedicular–transdural thoracic discectomy for central or centrolateral calcified disc herniations at our institution in recent years. All patients were followed clinically for a minimum of three months postoperatively. Surgical technique and intraoperative nuances were also documented. Results: The transdural approach enabled direct access to the ventral thoracic spine, allowing for the effective decompression of calcified herniations in all cases. Six out of seven patients (86%) demonstrated clinical improvement or neurological stability at three-month follow-up, while one out of seven patients (14%) who presented with severe preoperative neurological deficits had persisting neurological deterioration postoperatively. The technical aspects of the microsurgical approach were critical to minimizing risk. Conclusions: The transpedicular–transdural approach is a viable and effective surgical option for select cases of central or centrolateral calcified thoracic disc herniation. When executed with a precise microsurgical technique, it offers safe decompression with favourable short-term outcomes. Full article
(This article belongs to the Special Issue Surgical Management of Complex Spinal Pathologies: Challenges and Innovations)
►▼ Show Figures

Figure 1

Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:
 
Displaying articles 1-5
Back to TopTop