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Clinical Progress of Spine Surgery
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Clinical Progress of Spine Surgery

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

Deadline for manuscript submissions: 20 August 2026 | Viewed by 7070

Special Issue Editors

Dr. Edoardo Mazzucchi

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Guest Editor
Department of Neurosurgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
Interests: neuro-oncology; degenerative spine surgery; functional neurosurgery; pain surgery; image-guided surgery; intraoperative imaging
Special Issues, Collections and Topics in MDPI journals
Dr. Gianluca Vadalà

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Guest Editor
Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
Interests: spine surgery; orthopedic surgery; intervertebral disk degeneration
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Spine surgery is continuously evolving, especially in the last few years. Recent technological advancement has greatly pushed this progress in patient selection, surgical planning, intra-operative imaging, operative room equipment and post-operative care. New and old techniques are being progressively improved over the years to provide less invasive and more efficient surgical treatments. On the other hand, the ageing population and the availability of new treatments for cancer patients have progressively broadened the number of patients who can benefit from surgery both for degenerative and neoplastic conditions, thus posing new challenges to clinicians and researchers. In this Special Issue, we welcome authors to submit papers regarding the progress in the management of spine patients. 

Dr. Edoardo Mazzucchi
Dr. Gianluca Vadalà
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 surgery
  • rehabilitation
  • robotic surgery
  • spinal endoscopy
  • spinal tumor
  • back pain
  • minimally invasive surgery
  • spinal fusion

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Published Papers (5 papers)

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Research

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18 pages, 1971 KB  
Article
Surgical Trauma Gradient as an Independent Predictor of Postoperative Pain, Functional Recovery, and Complication Risk After Spine Surgery: A 2 × 2 Invasiveness Model with Psychosocial Interaction
by Christian Riediger, Mark Ferl, Agnieszka Halm-Pozniak, Christoph H. Lohmann and Maria Schönrogge
J. Clin. Med. 2026, 15(9), 3189; https://doi.org/10.3390/jcm15093189 - 22 Apr 2026
Viewed by 372
Abstract
Background/Objective: Postoperative recovery after spine surgery varies substantially and cannot be fully explained by structural pathology alone. This study evaluates postoperative outcomes using a structured 2 × 2 Surgical Trauma Gradient integrating exposure-related invasiveness (minimally invasive vs. open) and biomechanical strategy (decompression vs. [...] Read more.
Background/Objective: Postoperative recovery after spine surgery varies substantially and cannot be fully explained by structural pathology alone. This study evaluates postoperative outcomes using a structured 2 × 2 Surgical Trauma Gradient integrating exposure-related invasiveness (minimally invasive vs. open) and biomechanical strategy (decompression vs. fusion), and examines the modifying role of Type-D personality. Methods: This observational cohort study included 200 patients undergoing elective spine surgery. Patients were stratified into four surgical subgroups: minimally invasive decompression, open decompression, minimally invasive fusion, and open fusion. Primary outcomes included pain intensity (Visual Analog Scale), functional disability (Oswestry Disability Index), patient satisfaction (Patient Satisfaction Index), and postoperative complications at 12-month follow-up. Surgical invasiveness was modeled both categorically and as an ordinal gradient. Multivariable regression, logistic regression, interaction analysis, and longitudinal mixed-effects models were applied. Results: Postoperative outcomes demonstrated a consistent gradient across increasing surgical burden. In multivariable models, higher surgical invasiveness independently predicted greater residual pain (β = 0.69; 95% CI 0.55–0.82; p < 0.001) and higher functional disability (β = 6.20; 95% CI 5.10–7.30; p < 0.001). Increasing invasiveness was also associated with lower patient satisfaction (β = −0.38; 95% CI −0.47 to −0.29; p < 0.001) and higher complication risk (OR = 1.64; 95% CI 1.12–2.41; p = 0.01). Type-D personality independently predicted worse postoperative pain (β = 0.41; p = 0.008) and significantly modified the association between surgical burden and pain (interaction β = 0.22; p = 0.012). Conclusions: Postoperative outcomes follow a structured Surgical Trauma Gradient influenced by both surgical burden and psychosocial vulnerability, particularly Type-D personality. Integrating these dimensions may improve perioperative risk stratification and support individualized treatment strategies. Full article
(This article belongs to the Special Issue Clinical Progress of Spine Surgery)
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18 pages, 2441 KB  
Article
Comparative Radiologic and Morphologic Analysis of Posterolateral Fusion and Percutaneous Pedicle Screw Fixation for Thoracolumbar Junction Burst Fractures
by Hyung-Rae Lee, Minseung Kang, Jae Min Park and Jae-Hyuk Yang
J. Clin. Med. 2025, 14(18), 6379; https://doi.org/10.3390/jcm14186379 - 10 Sep 2025
Viewed by 1026
Abstract
Background/Objectives: Thoracolumbar burst fractures often require surgical stabilization. Although posterolateral fusion (PLF) has been traditionally used, percutaneous posterior fixation (PPF) without fusion has emerged as a less invasive alternative. However, comparative data specifically addressing PPF and PLF are limited. This study aimed to [...] Read more.
Background/Objectives: Thoracolumbar burst fractures often require surgical stabilization. Although posterolateral fusion (PLF) has been traditionally used, percutaneous posterior fixation (PPF) without fusion has emerged as a less invasive alternative. However, comparative data specifically addressing PPF and PLF are limited. This study aimed to compare the radiological and perioperative outcomes of PPF and PLF for thoracolumbar burst fractures. Methods: This retrospective cohort study analyzed 61 patients with T11–L2 burst fractures (PPF, 28; PLF, 33). Radiological parameters included local and global sagittal alignment and vertebral height ratio. Fracture morphology was assessed using a structured grading system based on anterior height ratios. Perioperative variables were also assessed. Statistical significance was set at p < 0.05. Results: PPF demonstrated significant advantages in operative time (160.7 min vs. 205.8 min, p < 0.01) and blood loss (165 cc vs. 317 cc, p < 0.01), with a shorter hospitalization time. PPF achieved outcomes comparable to PLF in global alignment and anterior height restoration. The PLF group showed greater local kyphotic angle correction (−7.77° vs. −1.53°, p = 0.01), whereas the PPF group showed significantly higher postoperative posterior height ratio (p = 0.02). Changes in morphological grades, assessed using the anterior height ratio-based grading system, showed similar patterns of improvement in both groups. All implant removals were performed due to patient-reported discomfort. Conclusions: PPF yielded radiological outcomes comparable to PLF in the treatment of thoracolumbar burst fractures. The use of a morphological grading system provided a structured descriptive tool to evaluate surgical impact, though its utility remains exploratory and requires further validation. Full article
(This article belongs to the Special Issue Clinical Progress of Spine Surgery)
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13 pages, 1127 KB  
Article
Comparative Efficacy of Percutaneous Laser Disc Decompression (PLDD) and Conservative Therapy for Lumbar Disc Herniation: A Retrospective, Observational, Single-Center Study
by Domenico Policicchio, Benedetta Boniferro, Erica Lo Turco, Giuseppe Mauro, Antonio Veraldi, Virginia Vescio, Giuseppe Vescio and Giosuè Dipellegrini
J. Clin. Med. 2025, 14(12), 4235; https://doi.org/10.3390/jcm14124235 - 14 Jun 2025
Cited by 2 | Viewed by 4051
Abstract
Background: Although percutaneous laser disc decompression (PLDD) has been proposed as an alternative to conventional surgery for lumbar disc herniation (LDH), we specifically propose it for patients with contained herniations where standard surgical intervention is not the first option. This study evaluates PLDD [...] Read more.
Background: Although percutaneous laser disc decompression (PLDD) has been proposed as an alternative to conventional surgery for lumbar disc herniation (LDH), we specifically propose it for patients with contained herniations where standard surgical intervention is not the first option. This study evaluates PLDD compared to conservative therapy as an early treatment alternative. Methods: This retrospective observational study compared PLDD to conservative treatment in adult patients with contained LDH. All patients underwent 3 months of standard conservative therapy. Those who remained dissatisfied according to the Visual Analog Scale (VAS) and/or Macnab criteria were then treated with PLDD. We analyzed outcomes from both treatment phases using the Wilcoxon signed-rank test and the Mann–Whitney U test. Results: 121 patients underwent outpatient evaluation for LDH and received an average of 90 days of conservative therapy. Of these 103 patients, dissatisfied with the outcomes of conservative treatment, subsequently underwent PLDD. Following conservative treatment, the average VAS score reduction was 4.1%. Six months after PLDD, the VAS scores demonstrated a significant reduction, with an average decrease of 30% (p < 0.0001). In terms of functional outcomes assessed by the Macnab criteria, 39.8% of patients treated with PLDD achieved ‘Excellent’ or ‘Good’ outcomes, compared to only 11.4% after conservative treatment. Conclusions: PLDD appears to be a viable alternative to conservative therapy for this subgroup of patients with contained LDH. It may be beneficial to propose PLDD early in the therapeutic regimen to accelerate short term clinical improvement. Further studies are required to evaluate the long term efficacy of this treatment approach. Full article
(This article belongs to the Special Issue Clinical Progress of Spine Surgery)
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Other

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13 pages, 1138 KB  
Systematic Review
Open Anterolateral Cordotomy for Cancer Pain: Indication, Efficacy, and Safety: A Systematic Literature Review
by Edoardo Mazzucchi, Gianluca Galieri, Giuseppe La Rocca, Stefano Telera, Ilaria Monteferrante, Claudia Claroni, Domenico Policicchio, Adelina Amalia Ardelean, Giovanni Sabatino and Andrei Brinzeu
J. Clin. Med. 2026, 15(6), 2111; https://doi.org/10.3390/jcm15062111 - 10 Mar 2026
Viewed by 418
Abstract
Background/Objectives: Open anterolateral cordotomy (OALC) is a surgical intervention that has been performed to treat patients with persistent pain for more than a century. In recent decades, its application has been reduced in favor of other less invasive treatments. The present article [...] Read more.
Background/Objectives: Open anterolateral cordotomy (OALC) is a surgical intervention that has been performed to treat patients with persistent pain for more than a century. In recent decades, its application has been reduced in favor of other less invasive treatments. The present article aims to define indications, safety, and the efficacy profile of this procedure for the contemporary neurosurgeon. Methods: A systematic review of articles published from 2010 to 2025 has been performed. Only patients who underwent OALC for cancer pain were included. Results: Eleven articles were included in the systematic review for a total of 33 patients. Adequate pain response was obtained in 87.9% of cases. In 21.2% of patients, some kind of complication was reported, but they persisted only in three patients (9%). A single case of mirror pain was described. Conclusions: OALC is a procedure still performed in selected cases of persistent cancer pain with a favorable safety and efficacy profile. Full article
(This article belongs to the Special Issue Clinical Progress of Spine Surgery)
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15 pages, 668 KB  
Systematic Review
Critical Assessment of Evidence Quality of Meta-Analyses Comparing Sacral 2 Alar–Iliac Fixation with Iliac Screws for Adult Spinal Deformity: An Umbrella Review with Emphasis on Methodological Limitations
by Ali Haider Bangash, Ananth S. Eleswarapu, Mitchell S. Fourman, Yaroslav Gelfand, Saikiran G. Murthy, Jaime A. Gomez, C. Rory Goodwin, Peter G. Passias, Reza Yassari and Rafael De la Garza Ramos
J. Clin. Med. 2026, 15(2), 753; https://doi.org/10.3390/jcm15020753 - 16 Jan 2026
Viewed by 489
Abstract
Background/Objectives: Adult spinal deformity (ASD) management often requires pelvic fixation, with S2 alar–iliac (S2AI) screws emerging as an alternative to traditional iliac screws. Despite multiple meta-analyses comparing these techniques, the methodological quality of these syntheses and technical heterogeneity across primary studies significantly [...] Read more.
Background/Objectives: Adult spinal deformity (ASD) management often requires pelvic fixation, with S2 alar–iliac (S2AI) screws emerging as an alternative to traditional iliac screws. Despite multiple meta-analyses comparing these techniques, the methodological quality of these syntheses and technical heterogeneity across primary studies significantly impact their conclusions and subsequent clinical decision-making. This systematic review evaluates the evidence quality of meta-analyses comparing S2AI with traditional iliac screws for ASD management, focusing on methodological rigor, primary study overlap, and clinical heterogeneity. Methods: PubMed, Cochrane, and Epistemonikos were searched for meta-analyses comparing S2AI with iliac screws for patients with ASD. The Quality of Reporting of Meta-analyses (QUOROM) checklist and the revised Assessment of Multiple Systematic Reviews (AMSTAR 2) tool were adopted to assess the methodological quality. Primary study overlap was evaluated using the Corrected Covered Area (CCA) method. Clinical heterogeneity was assessed by examining characteristics of studies included in ≥67% of meta-analyses. Results: From a total of 29 publications, six meta-analyses met the inclusion criteria (4807 patients; mean age: 59 years; 33% female). All included meta-analyses exhibited critically low methodological quality per AMSTAR-2, with common flaws including failure to provide lists of excluded studies and lack of a priori protocols. Very high primary study overlap was observed (CCA: 31%), with only 11% (2 of 19) primary studies included in all meta-analyses, whereas 42% (8 of 19) primary studies were included by only a single meta-analysis. Substantial clinical heterogeneity existed regarding patient characteristics, surgical techniques, and outcome definitions. Conclusions: This systematic review of meta-analyses identified critically low methodological quality, high primary study overlap, and substantial clinical heterogeneity in the existing evidence comparing pelvic fixation techniques for ASD. While published meta-analyses generally favor S2AI screws, these significant limitations prevent drawing definitive conclusions about superiority. Future research should prioritize high-quality prospective studies with standardized reporting to generate more reliable evidence for improving surgical outcomes in ASD management. Full article
(This article belongs to the Special Issue Clinical Progress of Spine Surgery)
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