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Medicina
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New Frontiers in Spine Surgery and Spine Disorders
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New Frontiers in Spine Surgery and Spine Disorders

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 20 November 2026 | Viewed by 7821

Editor

Prof. Dr. Shinjiro Kaneko

E-Mail Website
Guest Editor
Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake 470-1192, Japan
Interests: spinal deformity; spinal cord injury; cervical spine diseases; lumbar spine diseases; thoracic spine diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In recent years, we have been observing great progress in the field of treatment for spine disorders.

Lateral lumbar interbody fusion (LLIF) has emerged as a novel option for lumbar interbody fusion procedures. LLIF has also been widely used in the surgical treatment of adult spinal deformity (ASD). There are various advantages of applying LLIF to the surgical treatment of ASD. Meanwhile, several new issues remain unsolved.

The main aim of this Special Issue of Medicina is to deliver new advances in the field of spine surgery and spine disorders.

This Special Issue is open to studies on surgical strategies, clinical outcomes, etiology, systematic reviews, etc.

We invite authors to submit articles related to all the areas of spine and spinal cord surgery.

The paper types can be either of original articles, review articles, technical notes, or case reports.

Dr. Shinjiro Kaneko

Prof. Dr. Shinjiro Kaneko
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. Medicina is an international peer-reviewed open access monthly 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 2200 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 disorders
  • spine surgery
  • adult spinal deformity
  • pediatric spinal deformity
  • cervical spine diseases
  • upper cervical spine diseases, lumbar spine diseases
  • thoracic spine diseases
  • spinal cord injury
  • spine and spinal cord tumor

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Published Papers (7 papers)

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Research

12 pages, 4537 KB  
Article
Multipack Versus Single-Sterile Implant Supply in Spine Surgery: A Hospital-Based Health Technology Assessment
by Frederic Bludau, Franz Dally, Johannes Vogel, Sascha Gravius, Joe Mehanna, Viktoria Salopiata, Peter Fennema and Steffen Schulz
Medicina 2026, 62(7), 1242; https://doi.org/10.3390/medicina62071242 - 26 Jun 2026
Viewed by 270
Abstract
Background: Implant supply strategy in spine surgery affects operative workflow, resource utilization, and packaging-related material use, yet has received limited systematic investigation. This study evaluates single-sterile implants versus multipack implants using a hospital-based Health Technology Assessment (HB-HTA) framework. Methods: A non-randomized, [...] Read more.
Background: Implant supply strategy in spine surgery affects operative workflow, resource utilization, and packaging-related material use, yet has received limited systematic investigation. This study evaluates single-sterile implants versus multipack implants using a hospital-based Health Technology Assessment (HB-HTA) framework. Methods: A non-randomized, mixed-methods comparative study was conducted at a tertiary academic spine center. Time measurements were recorded during eight posterior fusion procedures (four per supply type; n = 18 single-pack screws, n = 20 multipack screws) across three process steps: implant retrieval, sterile transfer, and instrument preparation. Time measurements were recorded per packaging unit; per-implant comparisons were additionally derived for operational interpretation. Packaging volume, weight, and packaging-related CO2-equivalent estimates were calculated per implant. Standardized questionnaires were distributed to operating-room (OR) nurses (n = 14/21; 66.7%) and institutional surgeons (n = 11/11; 100%). Manufacturer-provided descriptive process and cost data were analyzed. Results: Multipack implants were associated with consistently shorter handling times across all measured process steps. Mean retrieval time per packaging unit was 25.4 s (multipack) versus 58.7 s (single-pack); retrieval time was significantly shorter for multipack units on the Mann–Whitney U test (p = 0.004), a result that was robust to supply-related outlier events (p = 0.001 after their post hoc exclusion). Packaging-normalized sterile-transfer burden per implant was reduced by a factor of 4.76. Instrument preparation was faster with multipack systems (15.6 s vs. 25.2 s). Packaging volume per implant was reduced by a factor of 5.6, and packaging weight by a factor of 2. Packaging-related CO2-equivalent estimates were lower for multipack implants (0.017 kg vs. 0.026 kg per implant). Survey responses indicated predominantly positive evaluations of workflow and handling efficiency. A trade-off was identified regarding the potential disposal of unused implants (noted by 73% of institutional surgeons). Manufacturer-provided descriptive data suggested scale effects in packaging and sterilization processes. Conclusions: Under high-volume academic conditions, multipack implants were associated with shorter implant-handling process times, favorable staff perceptions, and reduced packaging-related material burden while introducing trade-offs that require local evaluation. These exploratory findings suggest that the implant supply strategy is an underexplored but potentially relevant dimension of surgical process optimization in spine surgery. Full article
(This article belongs to the Special Issue New Frontiers in Spine Surgery and Spine Disorders)
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11 pages, 1636 KB  
Article
Preoperative 3D-Planned S1 Corridors Transferred into 2D Fluoroscopy Allow for Safe Intraoperative Large-Diameter Implant Placement: Description of a Novel Sacroiliac Fixation Technique and Proof of Concept in 137 Implantations
by Frederic Bludau, Steffen Heinrich Schulz, Sascha Gravius, Peter Fennema, Marcus Rickert, Johannes Vogel and Franz-Joseph Dally
Medicina 2026, 62(6), 1100; https://doi.org/10.3390/medicina62061100 - 5 Jun 2026
Viewed by 372
Abstract
Background and Objectives: Percutaneous iliosacral screw fixation is a standard treatment for posterior pelvic ring instability and sacral insufficiency fractures. However, conventional transsacral S1 screw fixation is associated with notable complication rates, most commonly implant loosening; dysmorphic sacral anatomy increases the risk [...] Read more.
Background and Objectives: Percutaneous iliosacral screw fixation is a standard treatment for posterior pelvic ring instability and sacral insufficiency fractures. However, conventional transsacral S1 screw fixation is associated with notable complication rates, most commonly implant loosening; dysmorphic sacral anatomy increases the risk of iatrogenic L5 or S1 nerve root injury. This study presents a modified S1 trajectory to engage the high-density bone of the anterior and cranial S1 vertebral body (promontory) by transferring preoperative 3D planning to intraoperative 2D fluoroscopy. Materials and Methods: This retrospective study analyzed implant placements for posterior pelvic ring instability, including high-velocity trauma and fragility fractures of the pelvis (FFPs). Preoperative computed tomography (CT) multiplanar reconstruction defined a modified corridor from a posterior-caudal iliac entry point directed cranially and ventrally into the S1 promontory. The 3D trajectory was transferred intraoperatively using standard 2D fluoroscopy (lateral, anteroposterior, inlet, and outlet views) with the patient prone. In cases of reduced bone quality or intended sacroiliac fusion, 3D-printed titanium implants (triangular or cylindrical threaded, 10.0–13.5 mm outer diameter) were selected over 7.5 mm cannulated screws. Results: Overall, 137 implants were placed in 71 patients: 13 cannulated screws in high-velocity pelvic ring trauma, 72 triangular titanium sacroiliac fusion implants (iFuse Implant System®, SI-Bone), and 52 threaded titanium fusion implants (iFuse TORQ®, SI-Bone) in patients with FFP. The modified trajectory consistently engaged the anterior and cranial S1 vertebral body. Postoperative 3D CT confirmed accurate placement of all implants. No iatrogenic nerve injuries or revisions for implant malposition occurred. Mean follow-up was 12 ± 9 months. Conclusions: Preoperative 3D CT planning combined with standard 2D fluoroscopy guided a modified S1 trajectory toward the cranial S1 vertebral body. Accurate and safe implant placement was achieved in the prone position without navigation systems, providing a practical alternative when standard transverse trajectories are limited by narrow bony corridors or sacral or pelvic dysmorphy. Full article
(This article belongs to the Special Issue New Frontiers in Spine Surgery and Spine Disorders)
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10 pages, 420 KB  
Article
Whole-Spine MRI Reveals High Prevalence of Multifocal Spondylodiscitis and Identifies a High-Risk Subgroup: A Retrospective Cohort Study of 274 Patients
by Steffen Heinrich Schulz, Franz-Joseph Dally, Johannes Vogel, Peter Fennema, Moritz Kolster and Frederic Bludau
Medicina 2026, 62(5), 989; https://doi.org/10.3390/medicina62050989 - 19 May 2026
Viewed by 274
Abstract
Background and Objectives: Spondylodiscitis is a severe spinal infection associated with substantial mortality. Standard diagnostic imaging is often limited to the symptomatic spinal segment, which may fail to detect infection foci in other spinal regions. The prevalence and prognostic significance of multifocal [...] Read more.
Background and Objectives: Spondylodiscitis is a severe spinal infection associated with substantial mortality. Standard diagnostic imaging is often limited to the symptomatic spinal segment, which may fail to detect infection foci in other spinal regions. The prevalence and prognostic significance of multifocal spondylodiscitis remain insufficiently characterized. Materials and Methods: A retrospective single-center cohort study was conducted at the University Medical Center Mannheim, Germany. All patients with a first diagnosis of imaging-confirmed infectious spondylodiscitis treated between 2008 and 2017 were included (n = 274). Disease distribution was classified as monosegmental, multisegmental unifocal, or multifocal. The study evaluated the detection rate of multifocal disease stratified by imaging modality (whole-spine MRI vs. segmental MRI) and assessed in-hospital mortality according to disease distribution, comorbidity burden, and pathogen type. Results: Among the 139 patients who underwent whole-spine MRI, multifocal spondylodiscitis was identified in 25 (18.0%) compared with 2 out of 116 patients (1.7%) who received segmental MRI. Overall in-hospital mortality was 16.9% (46/272). Mortality was substantially higher in patients with multifocal disease (40.0%) than in those with monosegmental (13.7%) or multisegmental unifocal involvement (15.6%, p = 0.002). Increasing comorbidity burden (7.5% with no comorbidities to 27.1% with three or more; p = 0.008) and Staphylococcus aureus infection (26.2% vs. 11.0%; p = 0.010) were also significantly associated with mortality. Conclusions: Multifocal spondylodiscitis was more frequently detected with whole-spine MRI and was associated with substantially increased in-hospital mortality. These findings support consideration of a low threshold for whole-spine MRI in the primary diagnostic workup of suspected spondylodiscitis. Further prospective studies are required to confirm these findings. Full article
(This article belongs to the Special Issue New Frontiers in Spine Surgery and Spine Disorders)
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13 pages, 11628 KB  
Article
Unilateral Posterior Stabilization in Adult Spinal Pathologies: Comparative Clinical, Radiological, and Complication Outcomes of Dynamic Versus Rigid Systems
by Uzay Erdogan, Ege Anil Ucar, Feride Bulgur Balay, Gurkan Berikol, Ibrahim Taha Albas, Mehmet Yigit Akgun, Tunc Oktenoglu, Ali Fahir Ozer and Ozkan Ates
Medicina 2025, 61(11), 1958; https://doi.org/10.3390/medicina61111958 - 31 Oct 2025
Viewed by 872
Abstract
Background and Objectives: Unilateral spinal stabilization has emerged as a less invasive alternative to bilateral fixation in the management of lateralized spinal pathologies. While both rigid and dynamic systems are utilized, comparative data regarding their clinical efficacy, radiological outcomes, and complication profiles—particularly [...] Read more.
Background and Objectives: Unilateral spinal stabilization has emerged as a less invasive alternative to bilateral fixation in the management of lateralized spinal pathologies. While both rigid and dynamic systems are utilized, comparative data regarding their clinical efficacy, radiological outcomes, and complication profiles—particularly in multilevel applications—remain limited. Materials and Methods: A retrospective, two-center analysis was conducted on 113 patients who underwent unilateral posterior spinal stabilization between 2019 and 2023. Patients were divided into unilateral rigid stabilization (URS, n = 41) and unilateral dynamic stabilization (UDS, n = 72) groups. Pathologies of the patients include disc herniations, foraminal and spinal stenosis, tumoral lesions and spondylolisthesis. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) over a 24-month follow-up. Radiological parameters included fusion status, superior adjacent disc height, and foraminal height index. Complication rates, including adjacent segment degeneration (ASD), pseudoarthrosis, and screw loosening, were analyzed according to type-of-stabilization and construct length (two, three, or four levels). Results: Both URS and UDS groups demonstrated significant VAS improvement at final follow-up, with no significant differences between groups (p < 0.001). Fusion rates were significantly higher in the URS group (85.37% vs. 27.78%, p < 0.001), while pseudoarthrosis (39.02% vs. 16.62%, p = 0.081) were more frequent in URS. No cases of rod fracture or infection were observed. Complication rates, particularly ASD, increased with longer constructs (6.56%, 21.21%, vs. 31.58% p = 0.01), independent of stabilization type. Conclusions: Unilateral stabilization—whether rigid or dynamic—offers effective symptom relief with reduced surgical morbidity. However, dynamic systems may provide biomechanical advantages by preserving motion and minimizing adjacent segment stress. While rigid constructs yield higher fusion rates, they are associated with increased complications. These findings support the use of dynamic stabilization, particularly in multilevel constructs, and highlight the need for patient-specific surgical strategies to optimize outcomes and mitigate long-term complications. Full article
(This article belongs to the Special Issue New Frontiers in Spine Surgery and Spine Disorders)
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11 pages, 843 KB  
Article
Association of CT HU Values with Adjacent Vertebral Fractures After Balloon Kyphoplasty
by Hiromitsu Takano, Hidetoshi Nojiri, Shota Tamagawa, Arihisa Shimura, Juri Teramoto, Hisashi Ishibashi, Yuta Sugawara, Kazuki Nakai and Muneaki Ishijima
Medicina 2025, 61(9), 1517; https://doi.org/10.3390/medicina61091517 - 23 Aug 2025
Cited by 1 | Viewed by 1197
Abstract
Background and Objectives: Although adjacent vertebral fractures (AVF) frequently occur after balloon kyphoplasty (BKP), their risk factors remain unclear. This retrospective study aimed to identify risk factors for AVF and evaluate the utility of Hounsfield unit (HU) values on preoperative vertebral computed [...] Read more.
Background and Objectives: Although adjacent vertebral fractures (AVF) frequently occur after balloon kyphoplasty (BKP), their risk factors remain unclear. This retrospective study aimed to identify risk factors for AVF and evaluate the utility of Hounsfield unit (HU) values on preoperative vertebral computed tomography (CT) scans as predictors of its occurrence. Materials and Methods: We retrospectively evaluated 180 patients (46 male and 134 female individuals; mean age: 80.3 years; range: 60–94 years) who underwent BKP for osteoporotic vertebral fractures (OVFs) between 2021 and 2023 with at least 6 months of follow-up. The patients were categorized into the AVF (n = 31) and non-AVF (n = 149) groups. Analyzed variables included patient characteristics, fracture level, prior fractures, posterior wall injury, intravertebral cleft, vacuum phenomenon in adjacent intervertebral discs, injury-to-surgery interval, cement volume, kyphosis angles, wedge ratios, and HU values. HU values were measured at three levels on preoperative CT scans in the vertebrae above and below the treated segment. Cutoff HU values predictive of AVF were determined using receiver operating characteristic (ROC) curve analysis. Results: AVF incidence was 17.2% (31/180), with 71.0% occurring in the vertebrae above the treated level. HU values in all measured slices were significantly lower in the AVF group. The mean HU values in the upper vertebra were 61.1 ± 6.03 (AVF) and 84.7 ± 2.75 (non-AVF), and in the lower vertebra, 51.5 ± 8.44 and 81.0 ± 3.85, respectively. ROC analysis showed cutoff HU values of 79.3 and 61.0 for the upper and lower vertebrae, respectively. HU values were identified as independent AVF risk factors. Conclusions: Preoperative vertebral HU values are independent AVF predictors. Values below 79.3 in the upper or 61.0 in the lower vertebrae were linked to higher AVF risk, suggesting HU measurement is a simple, useful tool for preoperative risk assessment. Full article
(This article belongs to the Special Issue New Frontiers in Spine Surgery and Spine Disorders)
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11 pages, 943 KB  
Article
Comparing Frailty Status Among Clusters Identified Based on EQ-5D-5L Dimensions in Older Patients with Chronic Low Back Pain
by Hee Jung Kim, Hyeon Chang Kim, Jisung Hwang and Shin Hyung Kim
Medicina 2025, 61(7), 1217; https://doi.org/10.3390/medicina61071217 - 3 Jul 2025
Cited by 1 | Viewed by 1292
Abstract
Background and Objectives: In the present study, distinct subgroups of older adults with chronic low back pain (LBP) were identified using cluster analysis based on the five dimensions of the EQ-5D-5L. Using detailed profiles of how chronic LBP affects various facets of [...] Read more.
Background and Objectives: In the present study, distinct subgroups of older adults with chronic low back pain (LBP) were identified using cluster analysis based on the five dimensions of the EQ-5D-5L. Using detailed profiles of how chronic LBP affects various facets of health-related quality of life (HRQoL), differences in frailty levels across these subgroups were investigated in this study. Materials and Methods: This retrospective study included patients ≥ 60 years of age who visited the pain clinic at a tertiary hospital between March 2022 and February 2023. HRQoL was assessed using the EQ-5D-5L, and frailty was evaluated via the Frailty Phenotype Questionnaire. Hierarchical cluster analysis using the WARD method with squared Euclidean distance was conducted on the EQ-5D-5L dimensions to identify subgroups. Differences in frailty, demographics, and clinical data across clusters were analyzed. Results: Among 837 older adults with chronic LBP, four distinct clusters were identified based on a cluster analysis of the EQ-5D-5L dimensions. Cluster 1 exhibited high levels of pain/discomfort and anxiety/depression, and cluster 2 had severe mobility limitations and pain/discomfort but low anxiety/depression. Cluster 3 showed balanced scores across all dimensions, and cluster 4 had severe pain/discomfort but good mobility. Significant differences were observed among the clusters in pain intensity, EQ Visual Analogue Scale (EQ-VAS) and EQ-5D-5L index scores, and frailty status. Cluster 1 had the highest pain scores and lowest EQ-VAS, and frailty was most prevalent in cluster 2 (28.5%) and least in cluster 4 (13.3%). Conclusions: The results of the present study emphasize the complexity of chronic LBP in older adults by identifying distinct clusters. Cluster analysis identified four unique profiles, with significant frailty differences across the clusters. These findings emphasize the importance of personalized management strategies tailored to specific patient profiles to enhance treatment effectiveness and improve frailty status. Full article
(This article belongs to the Special Issue New Frontiers in Spine Surgery and Spine Disorders)
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10 pages, 3278 KB  
Article
Augmented Reality in Scoliosis Correction Surgery: Efficiency and Accuracy in Pedicle Screw Instrumentation
by Chia-Ning Chang, Chi-Ruei Li, Sian-Siang Liao, Chiung-Chyi Shen, Kai-Yuan Chen, Chung-Hsin Lee and Meng-Yin Yang
Medicina 2025, 61(4), 576; https://doi.org/10.3390/medicina61040576 - 24 Mar 2025
Cited by 6 | Viewed by 2511
Abstract
Background and Objectives: Recent advancements in spinal navigation methodologies, particularly augmented reality (AR) techniques, have significantly enhanced the precision of spinal instrumentation procedures. This study aimed to evaluate the efficacy of AR-assisted navigation in spinal instrumentation surgery for thoracolumbar scoliosis. Materials and [...] Read more.
Background and Objectives: Recent advancements in spinal navigation methodologies, particularly augmented reality (AR) techniques, have significantly enhanced the precision of spinal instrumentation procedures. This study aimed to evaluate the efficacy of AR-assisted navigation in spinal instrumentation surgery for thoracolumbar scoliosis. Materials and Methods: This retrospective observational study included 10 patients with thoracolumbar scoliosis who met specific inclusion criteria and were recruited at a single medical center. Two neurosurgeons and one neuroradiologist used the Gertzbein–Robbins scale (GRS) for radiological evaluation. Preoperative and postoperative Cobb angles were measured to assess the correction of scoliosis. Overall, 257 screws were placed using the AR-assisted navigation system during thoracic and lumbar spinal deformity surgeries. Results: Among the 257 screws, 197 were placed in the thoracic spine and 60 in the lumbar spine, achieving an overall instrumentation accuracy of 98%. The preoperative Cobb angle of 69.5 ± 22.2° significantly improved to 10.1 ± 4.1° postoperatively. Regarding first-attempt screw placement accuracy, 97.4% of the screws in the thoracic spine (graded as GRS A or B) and 100% in the lumbar spine were placed with precision. Five grade C thoracic screws were identified, one of which required re-instrumentation. Conclusions: The AR navigation technique substantially improved the precision of spinal deformity surgery, with a high screw placement accuracy rate and significant scoliosis correction. The benefits of reduced attention diversion and an intuitive surgical experience suggest that AR technology could significantly improve spinal surgery practices and training programs, indicating potential for broader applicability in the future. Full article
(This article belongs to the Special Issue New Frontiers in Spine Surgery and Spine Disorders)
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