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Spine Surgery: Current Practice and Future Directions
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Spine Surgery: Current Practice and Future Directions

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

Deadline for manuscript submissions: closed (20 April 2026) | Viewed by 7428

Special Issue Editors

Dr. Claudio Bernucci

E-Mail Website
Guest Editor
Neurosurgery Unit, ASL Nuoro, Nuoro, Italy
Interests: neuroradiology; endoscopic neurosurgery; microneurosurgery; cervical spine; neuro-oncology; spine surgery; intervertebral disc arthroplasty; spine
Dr. Francesco Costa

E-Mail
Guest Editor
Spine Surgery Unit (NCH4), Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
Interests: spine surgery; imaging; spinal surgery; spinal cord injury; neuro-oncology; tumors; computed tomography; navigation; economic analysis; biomechanics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The progress of knowledge and technology in the diagnosis and treatment of the diseases affecting the spine has been remarkable in the last years. New instrumentation devices coupled with intraoperative imaging acquisition systems and dedicated ancillaries has allowed surgeons to reduce surgical trauma and obtain better results and faster recoveries. Therapeutic indications still remain unchanged, but new procedures have emerged in order to alleviate the symptoms complained of by the patients without reducing the mobility and the functions of the spine. Spine endoscopy, robot-assisted surgery, and moreover, regenerative therapies are the new frontiers for the coming years.

In this Special Issue, we welcome authors to submit papers on the clinical advance of spine surgery regarding different pathologies (trauma, tumor, degenerative, and deformity) in terms of both diagnosis and treatment.

Dr. Claudio Bernucci
Dr. Francesco Costa
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

  • degenerative
  • spinal trauma
  • spine tumors
  • neurosurgery
  • spine surgery
  • spinal deformity
  • scoliosis
  • robotics surgery
  • spinal cord injury
  • clinical practices
  • regenerative therapies

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Published Papers (3 papers)

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Research

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24 pages, 1025 KB  
Article
Bone Optimization for Perioperative Spine Patients: A Multidisciplinary Approach at a Single Academic Center
by Maria Valentina Suarez-Nieto, Karen Malacon, Andrea Fox, Mary Carmen Lopez Isidro, Harsh Wadhwa, Serena S. Hu and Corinna C. Zygourakis
J. Clin. Med. 2025, 14(24), 8866; https://doi.org/10.3390/jcm14248866 - 15 Dec 2025
Cited by 1 | Viewed by 1890
Abstract
Background: Osteoporosis and low bone mineral density are highly prevalent among patients undergoing spinal fusion, contributing to higher rates of hardware failure, revision surgery, and poor postoperative outcomes. Despite clear risks, perioperative screening and treatment for osteoporosis remain inconsistent. Bone Health Clinics [...] Read more.
Background: Osteoporosis and low bone mineral density are highly prevalent among patients undergoing spinal fusion, contributing to higher rates of hardware failure, revision surgery, and poor postoperative outcomes. Despite clear risks, perioperative screening and treatment for osteoporosis remain inconsistent. Bone Health Clinics (BHCs) and Fracture Liaison Services (FLSs) have emerged as multidisciplinary models to address this care gap. We describe the implementation of a dedicated BHC at a single academic center and evaluate perioperative pharmacotherapy patterns, treatment barriers, and surgical outcomes among spine patients. Methods: We retrospectively reviewed 174 consecutive perioperative spine patients referred to our institutional BHC between October 2019 and April 2024. Demographics, surgical characteristics, bone health status, laboratory and DXA results, pharmacologic management, contraindications, insurance-related barriers, and medication sequencing were collected. Surgical outcomes included hardware failure and revision surgery. Bone health response was assessed by follow-up DXA scans. Results: The cohort was predominantly female (78.2%) with a mean age of 71.9 years. Most patients were referred by neurosurgery (53.4%) or orthopedics (41.4%). Based on DXA and fragility fracture history, 27.0% had osteopenia, 56.3% osteoporosis, and 13.8% severe osteoporosis. Pharmacotherapy was prescribed in 146 patients (83.9%), most commonly romosozumab (32.9%), denosumab (22.6%), and abaloparatide (21.2%). Twenty-eight patients (16.1%) did not receive medication, primarily due to contraindications. Insurance-related barriers disproportionately affected anabolic agents, whereas denosumab had the lowest denial rate (15.2%, p = 0.0124). Sequential therapy was common (32.1%), most frequently romosozumab followed by denosumab. Hardware failure occurred in 11.5% of patients, with 5.7% requiring revision surgery. Among the 80 patients (46.0%) with follow-up DXA, 60% demonstrated improved bone mineral density, with an average T-score gain of 0.6 ± 0.5. Conclusions: Integration of a multidisciplinary BHC into perioperative spine care was feasible, associated with high rates of pharmacotherapy initiation, and demonstrated favorable early surgical outcomes compared to published complication rates in this population. Insurance and contraindications remain key barriers to anabolic therapy access, driving prescribing toward denosumab. Prospective studies are needed to confirm the impact of perioperative bone optimization on surgical durability, cost-effectiveness, and patient-centered outcomes. Full article
(This article belongs to the Special Issue Spine Surgery: Current Practice and Future Directions)
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14 pages, 690 KB  
Article
Spinal Anesthesia Results in Lower Costs Compared to General Anesthesia for Patients Undergoing Lumbar Fusion—A Matched Cohort Study
by Favour C. Ononogbu-Uche, Abdullah Wael Saleh, Felix Toussaint, Taylor Wallace, Joshua Woo, Matthew T. Morris, Christopher I. Shaffrey, William M. Bullock, Nicole R. Guinn and Muhammad M. Abd-El-Barr
J. Clin. Med. 2025, 14(11), 3851; https://doi.org/10.3390/jcm14113851 - 30 May 2025
Viewed by 4148
Abstract
Background/Objectives: Degenerative lumbar spine disease (DLSD) is increasingly managed with minimally invasive surgery (MIS) and evolving anesthesia methods. While general anesthesia (GA) remains standard, spinal anesthesia (SA) may offer faster recovery and fewer side effects. This study compares the clinical and economic [...] Read more.
Background/Objectives: Degenerative lumbar spine disease (DLSD) is increasingly managed with minimally invasive surgery (MIS) and evolving anesthesia methods. While general anesthesia (GA) remains standard, spinal anesthesia (SA) may offer faster recovery and fewer side effects. This study compares the clinical and economic outcomes of GA versus SA in transforaminal lumbar interbody fusion (TLIF). Methods: A retrospective review of 18 TLIF patients (2018–2022) was performed, with 9 patients in each cohort. Patients were matched by demographics and procedure type. Data collected included operative time, blood loss, complications, postoperative opioid utilization, and 30-day readmissions. Costs were analyzed in categories: anesthesia, implants, inpatient care, operating room (OR) supplies, OR time, and PACU fees, using Wilcoxon Rank T-tests and Pearson Chi-Squared tests. Results: Clinical outcomes such as blood loss, and operative time were similar between groups. However, SA patients had significantly shorter LOS compared to GA (SA: 12 h vs. GA: 84 h, % difference: −150%, p = 0.04). Additionally, SA patients had lower total direct costs ($27,881.85 vs. $35,669.01; p = 0.027). Significant cost reductions with SA were noted in OR supplies/medications ($7367.93 vs. $10,879.46; p = 0.039) and inpatient costs ($621.65 vs. $3092.66; p = 0.027). Within these categories, reductions were observed for intravenous solutions, sedatives/anesthetics, pressure management, labs, imaging, evaluations, hospital care, and medications. Although costs for implants, anesthesia care, OR time, and PACU fees were lower with SA, these differences did not reach statistical significance. Conclusions: In TLIF for DLSD, SA provides significant economic advantages over GA while yielding comparable clinical outcomes. These results support SA as a cost-effective alternative, warranting further prospective studies to confirm these findings. Full article
(This article belongs to the Special Issue Spine Surgery: Current Practice and Future Directions)
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Review

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18 pages, 535 KB  
Review
Artificial Intelligence in Intraoperative Imaging and Navigation for Spine Surgery: A Narrative Review
by Mina Girgis, Allison Kelliher, Michael S. Pheasant, Alex Tang, Siddharth Badve and Tan Chen
J. Clin. Med. 2026, 15(7), 2779; https://doi.org/10.3390/jcm15072779 - 7 Apr 2026
Viewed by 794
Abstract
Artificial intelligence (AI) is increasingly transforming spine surgery, with expanding applications in diagnostics, intraoperative imaging, and surgical navigation. As the field advances toward greater precision and safety, machine learning (ML) and deep learning technologies are being integrated to augment surgeon expertise and optimize [...] Read more.
Artificial intelligence (AI) is increasingly transforming spine surgery, with expanding applications in diagnostics, intraoperative imaging, and surgical navigation. As the field advances toward greater precision and safety, machine learning (ML) and deep learning technologies are being integrated to augment surgeon expertise and optimize operative workflows. In particular, AI-driven innovations in image acquisition and navigation are reshaping intraoperative decision-making and technical execution. This narrative review provides an overview of AI applications relevant to intraoperative imaging and navigation in spine surgery. We begin by defining key concepts in AI, ML, and deep learning and briefly outline the historical evolution of AI within spine practice. We then examine current capabilities in image recognition and automated pathology detection, emphasizing their clinical relevance. Given the central role of imaging accuracy in modern navigation-assisted procedures, we review conventional acquisition platforms, including intraoperative computed tomography (CT) systems (e.g., O-arm, GE, Airo), surface-based registration to preoperative CT (Stryker, Medtronic), and optical surface mapping technologies (e.g., 7D Surgical). Emerging AI-optimized advancements are subsequently discussed, including low-dose intraoperative CT protocols, expanded scan windows, metal artifact reduction algorithms, integration of 2D fluoroscopy with preoperative CT datasets, and 3D reconstruction derived from 2D imaging. These developments aim to improve image quality, reduce radiation exposure, and enhance navigational accuracy. By synthesizing current evidence and technological progress, this review highlights how AI-enhanced imaging systems are redefining intraoperative spine surgery and shaping the future of precision-based care. The primary purpose of this review is to outline the applications of AI and its potential for perioperative and intraoperative optimization, including radiation exposure reduction, workflow streamlining, preoperative planning, robot-assisted surgery, and navigation. The secondary purpose is to define AI, machine learning, and deep learning within the medical context, describe image and pathology recognition, and provide a historical overview of AI in orthopedic spine surgery. Full article
(This article belongs to the Special Issue Spine Surgery: Current Practice and Future Directions)
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