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Clinical Advances in Orthopaedic Treatment of Lumbar and Spine Diseases
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Clinical Advances in Orthopaedic Treatment of Lumbar and Spine Diseases

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

Deadline for manuscript submissions: closed (14 October 2024) | Viewed by 11169

Special Issue Editors

Dr. Micheal Raad

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Guest Editor
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
Interests: spine surgery; lumbar fusion; knee surgery; spine research; hip arthroplasty
Dr. Nissim Ohana

E-Mail Website
Guest Editor
Orthopedic Department, Meir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 4428164, Israel
Interests: spine surgery; orthopedic surgery; lumbar spine surgery; spine diseases; osteoporotic fractures
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The field of orthopaedic surgery is constantly evolving, driven by advancements in medical technology, surgical techniques, and our understanding of diseases and conditions affecting the lumbar spine. Lumbar spine surgery plays a pivotal role in addressing a wide range of conditions, including degenerative disc disease, spinal stenosis, herniated discs, trauma, neoplastic spine diseases and spinal deformities.

As we strive for improved patient outcomes and enhanced quality of life, it is essential to embrace and disseminate the latest clinical advances in this field.

This special issue of our journal focuses on the clinical advances in orthopaedic treatment of lumbar and spine diseases. We invite researchers, clinicians, and experts in the field to contribute their valuable insights, innovative research, and novel treatment approaches. By sharing your knowledge and experiences, we can collectively push the boundaries of our understanding and improve the standard of care for patients with lumbar spine conditions.

The topics of interest for this special issue include, but are not limited to:

  1. Minimally invasive surgical techniques for lumbar spine disorders
  2. Navigation-assisted and robotic-assisted spine surgery
  3. Biologics and regenerative therapies in the treatment of lumbar spine diseases
  4. Advances in spinal fusion techniques and implants
  5. Patient-specific approaches in the management of spinal deformities
  6. Rehabilitation and postoperative care in lumbar spine surgery
  7. Outcomes research and quality improvement initiatives in spine surgery
  8. Neurosurgical perspectives on lumbar spine surgery

We encourage authors to submit original research articles, review articles that contribute to the body of knowledge in this field. Our aim is to foster collaboration, exchange ideas, and promote the adoption of evidence-based practices in the management of lumbar and spine diseases.

Together, let us propel the field of orthopaedic surgery forward, improving patient outcomes, enhancing quality of life, and shaping the future of lumbar spine surgery. We look forward to receiving your valuable contributions.

Dr. Micheal Raad
Dr. Nissim Ohana
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 100 words) can be sent to the Editorial Office for announcement on this website.

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

  • lumbar spine surgery
  • spine surgery
  • robotic-assisted spine surgery
  • spinal fusion
  • minimally invasive surgical
  • spinal deformities

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Related Special Issue

Published Papers (6 papers)

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Research

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9 pages, 2004 KiB  
Article
Dual-Fluoroscopy vs. Single-Fluoroscopy in Balloon Kyphoplasty: A Study of Efficiency and Safety
by Roy Romem, Itzhak Engel, David Segal, Refael Behrbalk, David Schleifer, Jonathan EJ Koch, Nissim Ohana and Yuval Baruch
J. Clin. Med. 2024, 13(21), 6608; https://doi.org/10.3390/jcm13216608 - 3 Nov 2024
Viewed by 1014
Abstract
Background: Vertebral compression fractures (VCFs) are the most prevalent type of osteoporotic fractures, often causing significant pain, morbidity, and mortality. Vertebral augmentation procedures like balloon kyphoplasty (BK) are effective in treating VCFs. These procedures are typically performed using a single fluoroscopy machine (SF) [...] Read more.
Background: Vertebral compression fractures (VCFs) are the most prevalent type of osteoporotic fractures, often causing significant pain, morbidity, and mortality. Vertebral augmentation procedures like balloon kyphoplasty (BK) are effective in treating VCFs. These procedures are typically performed using a single fluoroscopy machine (SF) for anteroposterior (AP) and lateral views. We have implemented a dual-fluoroscopy (DF) technique to reduce procedure time and radiation exposure. The goal of this study was to determine whether dual-fluoroscopy could optimize surgical efficiency without compromising safety, offering a more effective alternative to traditional single-fluoroscopy methods. Methods: This retrospective study included 126 patients who underwent BK with either SF (n = 74, 58.7%) or DF (n = 52, 41.3%) between 2020 and 2024. We collected data on procedure duration per pedicle (PDPP), radiation exposure (reference air kerma and dose-area product [DAP]), and radiation duration. A sub-analysis of post-learning phase cases was performed. Results: A learning curve was identified for the first 24 cases and 15 cases using the SF technique and DF technique, respectively, which was followed by a stabilization in procedure duration per pedicle (Levene’s statistic = 10.623, p = 0.002 for SD difference, p < 0.001 for mean PDPP difference). After the completion of the learning phase for both techniques, the DF group demonstrated a significantly shorter PDPP (11.83 ± 4.3 vs. 14.03 ± 5.57 min, p = 0.049). No significant differences were found in radiation exposure, including radiation duration (p = 0.577), reference air kerma, or DAP. Conclusions: Dual-fluoroscopy significantly reduces procedure time after the learning curve is overcome, improving efficiency without increasing radiation exposure. This technique holds promise for optimizing kyphoplasty workflow and safety, supporting broader clinical adoption. Full article
(This article belongs to the Special Issue Clinical Advances in Orthopaedic Treatment of Lumbar and Spine Diseases)
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12 pages, 3146 KiB  
Article
Cerebrospinal Fluid Dynamics Analysis Using Time-Spatial Labeling Inversion Pulse (Time-SLIP) Magnetic Resonance Imaging in Mice
by Yusuke Tomita, Mitsuru Yagi, Fumiko Seki, Yuji Komaki, Morio Matsumoto and Masaya Nakamura
J. Clin. Med. 2024, 13(15), 4550; https://doi.org/10.3390/jcm13154550 - 4 Aug 2024
Viewed by 1149
Abstract
Background/Objectives: Abnormalities in cerebrospinal fluid (CSF) dynamics cause diverse conditions, such as hydrocephalus, but the underlying mechanism is still unknown. Methods to study CSF dynamics in small animals have not been established due to the lack of an evaluation system. Therefore, the purpose [...] Read more.
Background/Objectives: Abnormalities in cerebrospinal fluid (CSF) dynamics cause diverse conditions, such as hydrocephalus, but the underlying mechanism is still unknown. Methods to study CSF dynamics in small animals have not been established due to the lack of an evaluation system. Therefore, the purpose of this research study is to establish the time-spatial labeling inversion pulse (Time-SLIP) MRI technique for the evaluation of CSF dynamics in mice. Methods: We performed the Time-SLIP technique on 10 wild-type mice and 20 Tiptoe-walking Yoshimura (TWY) mice, a mouse model of ossification of the posterior longitudinal ligament (OPLL). We defined the stir distance as the distance of CSF stirring and calculated the mean ± standard deviation. The intraclass correlation coefficient of intraobserver reliability was also calculated. Furthermore, in TWY mice, the correlation coefficient between stir distance and canal stenosis ratio (CSR) was calculated. Results: The stir distance was significantly lower in TWY mice at 12 weeks and 17 weeks of age (1.20 ± 0.16, 1.21 ± 0.06, and 1.21 ± 0.15 mm at 12 weeks and 1.32 ± 0.21, 1.28 ± 0.23, and 1.38 ± 0.31 mm at 17 weeks for examiners A, B, and C). The intrarater reliability of the three examiners was excellent (>0.90) and there was a strongly negative correlation between stir distance and CSR in TWY mice (>−0.80). Conclusions: In this study, we established the Time-SLIP technique in experimental mice. This technique allows for a better understanding of CSF dynamics in small laboratory animals. Full article
(This article belongs to the Special Issue Clinical Advances in Orthopaedic Treatment of Lumbar and Spine Diseases)
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12 pages, 3851 KiB  
Article
Efficacy and Complication Rates of Percutaneous Vertebroplasty and Kyphoplasty in the Treatment of Vertebral Compression Fractures: A Retrospective Analysis of 280 Patients
by Jan Cerny, Jan Soukup, Kadzhik Petrosian, Lucie Loukotova and Tomas Novotny
J. Clin. Med. 2024, 13(5), 1495; https://doi.org/10.3390/jcm13051495 - 5 Mar 2024
Cited by 3 | Viewed by 1915
Abstract
Background: Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are established methods in the treatment of vertebral compression fractures (VCFs). In our manuscript, the target was to evaluate the efficacy of PVPs/PKPs and to determine the implications of potential periprocedural complications. Methods: 280 [...] Read more.
Background: Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are established methods in the treatment of vertebral compression fractures (VCFs). In our manuscript, the target was to evaluate the efficacy of PVPs/PKPs and to determine the implications of potential periprocedural complications. Methods: 280 patients, specifically 194 women (69.3%) and 86 men (30.7%), were enrolled. We used the AO spine fractures classification and the Yeom classification to determine the subtype of cement leakage. Only single-level VCFs of the thoracic or lumbar spine were included. Visual analogue scale (VAS) was assessed preoperatively and regularly after the surgery. Vertebral compression ratio (VBCR) was used to determine postoperative vertebral body collapse. Results: We recorded 54 cases (19.3%) of cement leakage. There was a significant decrease in mean VAS scores (6.82–0.76 in PVPs, 7.15–0.81 in PKPs). The decrease in VBCR was greater in the VP group (4.39%; 84.21–79.82) compared to the KP group (1.95%; 74.36–72.41). Conclusions: No significant difference in the risk of cement leakage when comparing KPs and VPs was found. VPs and KPs provide rapid and significant pain relief in patients with VCFs. Clinically relevant complications of VPs and KPs are rare. Kyphoplasties prevent further vertebral body collapse more effectively compared to vertebroplasties. Full article
(This article belongs to the Special Issue Clinical Advances in Orthopaedic Treatment of Lumbar and Spine Diseases)
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11 pages, 723 KiB  
Article
Inadequate Annotation and Its Impact on Pelvic Tilt Measurement in Clinical Practice
by Yuan Chai, Vincent Maes, A. Mounir Boudali, Brooke Rackel and William L. Walter
J. Clin. Med. 2024, 13(5), 1394; https://doi.org/10.3390/jcm13051394 - 28 Feb 2024
Cited by 5 | Viewed by 1302
Abstract
Background: Accurate pre-surgical templating of the pelvic tilt (PT) angle is essential for hip and spine surgeries, yet the reliability of PT annotations is often compromised by human error, inherent subjectivity, and variations in radiographic quality. This study aims to identify challenges leading [...] Read more.
Background: Accurate pre-surgical templating of the pelvic tilt (PT) angle is essential for hip and spine surgeries, yet the reliability of PT annotations is often compromised by human error, inherent subjectivity, and variations in radiographic quality. This study aims to identify challenges leading to inadequate annotations at a landmark dimension and evaluating their impact on PT. Methods: We retrospectively collected 115 consecutive sagittal radiographs for the measurement of PT based on two definitions: the anterior pelvic plane and a line connecting the femoral head’s centre to the sacral plate’s midpoint. Five annotators engaged in the measurement, followed by a secondary review to assess the adequacy of the annotations across all the annotators. Results: The outcomes indicated that over 60% images had at least one landmark considered inadequate by the majority of the reviewers, with poor image quality, outliers, and unrecognized anomalies being the primary causes. Such inadequacies led to discrepancies in the PT measurements, ranging from −2° to 2°. Conclusion: This study highlights that landmarks annotated from clear anatomical references were more reliable than those estimated. It also underscores the prevalence of suboptimal annotations in PT measurements, which extends beyond the scope of traditional statistical analysis and could result in significant deviations in individual cases, potentially impacting clinical outcomes. Full article
(This article belongs to the Special Issue Clinical Advances in Orthopaedic Treatment of Lumbar and Spine Diseases)
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Review

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19 pages, 689 KiB  
Review
Discogenic Low Back Pain: Anatomic and Pathophysiologic Characterization, Clinical Evaluation, Biomarkers, AI, and Treatment Options
by Matteo De Simone, Anis Choucha, Elena Ciaglia, Valeria Conti, Giuseppina Pecoraro, Alessandro Santurro, Annibale Alessandro Puca, Marco Cascella and Giorgio Iaconetta
J. Clin. Med. 2024, 13(19), 5915; https://doi.org/10.3390/jcm13195915 - 3 Oct 2024
Cited by 12 | Viewed by 3372
Abstract
Discogenic low back pain (LBP) is a significant clinical condition arising from degeneration of the intervertebral disc, a common yet complex cause of chronic pain, defined by fissuring in the annulus fibrosus resulting in vascularization of growing granulation tissue and growth of nociceptive [...] Read more.
Discogenic low back pain (LBP) is a significant clinical condition arising from degeneration of the intervertebral disc, a common yet complex cause of chronic pain, defined by fissuring in the annulus fibrosus resulting in vascularization of growing granulation tissue and growth of nociceptive nerve fibers along the laceration area. This paper delves into the anatomical and pathophysiological underpinnings of discogenic LBP, emphasizing the role of intervertebral disc degeneration in the onset of pain. The pathogenesis is multifactorial, involving processes like mitochondrial dysfunction, accumulation of advanced glycation end products, and pyroptosis, all contributing to disc degeneration and subsequent pain. Despite its prevalence, diagnosing discogenic LBP is challenging due to the overlapping symptoms with other forms of LBP and the absence of definitive diagnostic criteria. Current diagnostic approaches include clinical evaluations, imaging techniques, and the exploration of potential biomarkers. Treatment strategies range from conservative management, such as physical therapy and pharmacological interventions, to more invasive procedures such as spinal injections and surgery. Emerging therapies targeting molecular pathways involved in disc degeneration are under investigation and hold potential for future clinical application. This paper highlights the necessity of a multidisciplinary approach combining clinical, imaging, and molecular data to enhance the accuracy of diagnosis and the effectiveness of treatment for discogenic LBP, ultimately aiming to improve patient outcomes. Full article
(This article belongs to the Special Issue Clinical Advances in Orthopaedic Treatment of Lumbar and Spine Diseases)
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Other

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19 pages, 7832 KiB  
Systematic Review
Effectiveness of Interspinous Process Devices in Managing Adjacent Segment Degeneration Following Lumbar Spinal Fusion: A Systematic Review and Meta-Analysis
by Harris Mangal, David Felzensztein Recher, Roozbeh Shafafy and Eyal Itshayek
J. Clin. Med. 2024, 13(17), 5160; https://doi.org/10.3390/jcm13175160 - 30 Aug 2024
Cited by 1 | Viewed by 1614
Abstract
Background: Adjacent segment degeneration (ASD) is a significant complication following lumbar spinal fusion, often necessitating further surgical interventions and impairing patient outcomes. Interspinous process devices were introduced as an alternative treatment for spinal stenosis and degenerative spondylolisthesis and can potentially reduce the incidence [...] Read more.
Background: Adjacent segment degeneration (ASD) is a significant complication following lumbar spinal fusion, often necessitating further surgical interventions and impairing patient outcomes. Interspinous process devices were introduced as an alternative treatment for spinal stenosis and degenerative spondylolisthesis and can potentially reduce the incidence of ASDd. This systematic review and meta-analysis aims to evaluate the effectiveness of interspinous process devices or IPDs in managing ASD following a previous spinal fusion compared to traditional fusion techniques. Methods: Electronic databases, including PubMed, Embase, and the Cochrane Library, were queried for studies assessing IPDs against traditional lumbar fusion methods for managing ASD after previous lumbar fusion, which had been published between January 2014 and the present. Statistical analysis was conducted using Review Manager 5.4. Results: Seven retrospective cohort studies involving 546 patients met the inclusion criteria. The analysis revealed that IPDs were associated with a statistically significant reduction in the incidence of ASD (OR = 0.28, 95% CI: 0.16 to 0.51, p < 0.0001, and I2 = 0% after excluding outliers). The ODI demonstrated a non-significant trend towards improved outcomes with IPDs at the 2-year follow-up (SMD = −3.94; 95% CI: −11.72 to 3.85). Range of motion (ROM) was better preserved with IPDs compared to fusion (SMD = 0.00, 95% CI: −0.41 to 0.41, p = 1.00, I2 = 60%). The visual analogue scale or VAS lower back pain scores were significantly reduced at the 2-year follow-up (SMD = −0.69, 95% CI: −1.18 to −0.19, p = 0.006, and I2 = 74%). VAS leg pain showed consistent improvements (SMD = −0.29; 95% CI: −0.63 to 0.04). Intraoperative blood loss was significantly lower with IPDs (SMD = −2.07; 95% CI: −3.27 to −0.87, p = 0.0007, and I2 = 95%), and operation times were shorter (SMD = −2.22, 95% CI: −3.31 to −1.12, p < 0.0001, and I2 = 94%). Conclusions: The judicious use of IPDs might benefit a subset of patients, particularly those who are not suitable candidates for major corrective surgery. Full article
(This article belongs to the Special Issue Clinical Advances in Orthopaedic Treatment of Lumbar and Spine Diseases)
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