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Advances and Challenges in Spine Surgery
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Advances and Challenges in 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: 25 August 2024 | Viewed by 10914

Special Issue Editors

Dr. Yi Lu

E-Mail Website
Guest Editor
Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Interests: spinal cord injury; low back pain; disc degeneration; minimally invasive spine surgery; spinal deformity; traumatic brain injury
Prof. Dr. Micheal Wang

E-Mail Website
Guest Editor
Department of Neurosurgery and Rehab Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
Interests: minimally invasive spine surgery; awake spine surgery; ERAS (enhanced recovery after surgery); endoscopic spine surgery; spinal deformity; robotics; spinal cord injury biomarkers

Special Issue Information

Dear Colleagues,

Spine surgery has undergone tremendous advancement in the past several decades. We have gained a much deeper understanding of how to approach the spine while minimizing trauma to the normal tissue, how to stabilize the spine respecting the natural spine biomechanics, and how to maintain or restore optimal spine alignment when performing reconstructive spine surgeries. Significant technological advancements have reshaped how we treat spinal ailments. Modern segmental fixation and hardware technologies have allowed more secure and stable spinal fixation. The refinement of spinal navigation has helped spine surgeons place hardware more safely and with greater accuracy. The innovations in biological material technology have greatly facilitated successful bony healing and fusion after spine surgery.

We have started to gain a better understanding of the pathophysiology of the origin of back pain. In addition, we have also begun to understand the molecular changes occurring after spinal cord injury and the basic molecular process involved in spinal axon regeneration. 

There are still plenty of challenges facing us in spine surgery. How to decrease the rate of disc degeneration and minimize discogenic back pain, how to accurately determine the etiologies of various kinds of back pain, how to preserve spinal motion and physiological flexibility with spinal instrumentation, how to avoid adjacent level disease with spinal fusion, and how to minimize delayed iatrogenic spinal instability with spinal decompression are all examples of the issues facing spine surgeons on a daily basis. In addition, spinal cord injury remains one of the most challenging and unresolved issues in modern neuroscience. We have yet to find an effective treatment to reverse the functional loss for patients suffering from severe spinal cord injury. 

The current Special Issue will present the most up-to-date advances in spine surgery, discuss our new understanding of the pathophysiology of the spine and spinal cord biology, and introduce the challenges that remain to be solved in spine surgery.

Dr. Yi Lu
Prof. Dr. Micheal Wang
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

  • spinal surgery
  • low back pain
  • spinal biomechanics
  • spinal surgical anatomy
  • minimally invasive spine surgery
  • spinal deformity
  • spinal cord injury
  • spinal trauma
  • spinal oncology

Published Papers (6 papers)

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Research

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12 pages, 2428 KiB  
Article
Early Experience with Prone Lateral Interbody Fusion in Deformity Correction: A Single-Institution Experience
by Alyssa M. Bartlett, Christopher F. Dibble, David A. W. Sykes, Peter N. Drossopoulos, Timothy Y. Wang, Clifford L. Crutcher, Khoi D. Than, Deb A. Bhomwick, Christopher I. Shaffrey and Muhammad M. Abd-El-Barr
J. Clin. Med. 2024, 13(8), 2279; https://doi.org/10.3390/jcm13082279 - 15 Apr 2024
Viewed by 380
Abstract
Background/Objectives: Lateral spine surgery offers effective minimally invasive deformity correction, but traditional approaches often involve separate anterior, lateral, and posterior procedures. The prone lateral technique streamlines this process by allowing single-position access for lateral and posterior surgery, potentially benefiting from the lordosing effect [...] Read more.
Background/Objectives: Lateral spine surgery offers effective minimally invasive deformity correction, but traditional approaches often involve separate anterior, lateral, and posterior procedures. The prone lateral technique streamlines this process by allowing single-position access for lateral and posterior surgery, potentially benefiting from the lordosing effect of prone positioning. While previous studies have compared prone lateral to direct lateral for adult degenerative diseases, this retrospective review focuses on the outcomes of adult deformity patients undergoing prone lateral interbody fusion. Methods: Ten adult patients underwent single-position prone lateral surgery for spine deformity correction, with a mean follow-up of 18 months. Results: Results showed significant improvements: sagittal vertical axis decreased by 2.4 cm, lumbar lordosis increased by 9.1°, pelvic tilt improved by 3.3°, segmental lordosis across the fusion construct increased by 12.2°, and coronal Cobb angle improved by 6.3°. These benefits remained consistent over the follow-up period. Correlational analysis showed a positive association between improvements in PROs and SVA and SL. When compared to hybrid approaches, prone lateral yielded greater improvements in SVA. Conclusions: Prone lateral surgery demonstrated favorable outcomes with reasonable perioperative risks. However, further research comparing this technique with standard minimally invasive lateral approaches, hybrid, and open approaches is warranted for a comprehensive evaluation. Full article
(This article belongs to the Special Issue Advances and Challenges in Spine Surgery)
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Review

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15 pages, 1664 KiB  
Review
Evolution of Cervical Endoscopic Spine Surgery: Current Progress and Future Directions—A Narrative Review
by Chuan-Ching Huang, Jamal Fitts, David Huie, Deb A. Bhowmick and Muhammad M. Abd-El-Barr
J. Clin. Med. 2024, 13(7), 2122; https://doi.org/10.3390/jcm13072122 - 06 Apr 2024
Viewed by 393
Abstract
Cervical endoscopic spine surgery is rapidly evolving and gaining popularity for the treatment of cervical radiculopathy and myelopathy. This approach significantly reduces muscular damage and blood loss by minimizing soft tissue stripping, leading to less postoperative pain and a faster postoperative recovery. As [...] Read more.
Cervical endoscopic spine surgery is rapidly evolving and gaining popularity for the treatment of cervical radiculopathy and myelopathy. This approach significantly reduces muscular damage and blood loss by minimizing soft tissue stripping, leading to less postoperative pain and a faster postoperative recovery. As scientific evidence accumulates, the efficacy and safety of cervical endoscopic spine surgery are continually affirmed. Both anterior and posterior endoscopic approaches have surfaced as viable alternative treatments for various cervical spine pathologies. Newer techniques, such as endoscopic-assisted fusion, the anterior transcorporeal approach, and unilateral laminotomy for bilateral decompression, have been developed to enhance clinical outcomes and broaden surgical indications. Despite its advantages, this approach faces challenges, including a steep learning curve, increased radiation exposure for both surgeons and patients, and a relative limitation in addressing multi-level pathologies. However, the future of cervical endoscopic spine surgery is promising, with potential enhancements in clinical outcomes and safety on the horizon. This progress is fueled by integrating advanced imaging and navigation technologies, applying regional anesthesia for improved and facilitated postoperative recovery, and incorporating cutting-edge technologies, such as augmented reality. With these advancements, cervical endoscopic spine surgery is poised to broaden its scope in treating cervical spine pathologies while maintaining the benefits of minimized tissue damage and rapid recovery. Full article
(This article belongs to the Special Issue Advances and Challenges in Spine Surgery)
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14 pages, 1101 KiB  
Review
Advances and Challenges of Endoscopic Spine Surgery
by Daniel Burkett and Nathaniel Brooks
J. Clin. Med. 2024, 13(5), 1439; https://doi.org/10.3390/jcm13051439 - 01 Mar 2024
Viewed by 687
Abstract
The purpose of this paper is to review the data supporting current endoscopic surgical techniques for the spine and the potential challenges and future of the field. The origins of endoscopic spine surgery can be traced back many decades, with many important innovations [...] Read more.
The purpose of this paper is to review the data supporting current endoscopic surgical techniques for the spine and the potential challenges and future of the field. The origins of endoscopic spine surgery can be traced back many decades, with many important innovations throughout its development. It can be applied to all levels of the spine, with many robust trials supporting its clinical outcomes. Continued clinical research is needed to explore its expanding indications. Although the limitations of starting an endoscopic program can be justified by its cost effectiveness and positive societal impact, challenges facing its widespread adoption are still present. As more residency and fellowship programs include endoscopy as part of their spine training, it will become more prevalent in hospitals in the United States. Technological advancements in spine surgery will further propel and enhance endoscopic techniques as they become an integral part of a spine surgeon’s repertoire. Full article
(This article belongs to the Special Issue Advances and Challenges in Spine Surgery)
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22 pages, 2021 KiB  
Review
Updates on Pathophysiology of Discogenic Back Pain
by Rohan Jha, Joshua D. Bernstock, Joshua I. Chalif, Samantha E. Hoffman, Saksham Gupta, Hong Guo and Yi Lu
J. Clin. Med. 2023, 12(21), 6907; https://doi.org/10.3390/jcm12216907 - 02 Nov 2023
Cited by 2 | Viewed by 6049
Abstract
Discogenic back pain, a subset of chronic back pain, is caused by intervertebral disc (IVD) degeneration, and imparts a notable socioeconomic health burden on the population. However, degeneration by itself does not necessarily imply discogenic pain. In this review, we highlight the existing [...] Read more.
Discogenic back pain, a subset of chronic back pain, is caused by intervertebral disc (IVD) degeneration, and imparts a notable socioeconomic health burden on the population. However, degeneration by itself does not necessarily imply discogenic pain. In this review, we highlight the existing literature on the pathophysiology of discogenic back pain, focusing on the biomechanical and biochemical steps that lead to pain in the setting of IVD degeneration. Though the pathophysiology is incompletely characterized, the current evidence favors a framework where degeneration leads to IVD inflammation, and subsequent immune milieu recruitment. Chronic inflammation serves as a basis of penetrating neovascularization and neoinnervation into the IVD. Hence, nociceptive sensitization emerges, which manifests as discogenic back pain. Recent studies also highlight the complimentary roles of low virulence infections and central nervous system (CNS) metabolic state alteration. Targeted therapies that seek to disrupt inflammation, angiogenesis, and neurogenic pathways are being investigated. Regenerative therapy in the form of gene therapy and cell-based therapy are also being explored. Full article
(This article belongs to the Special Issue Advances and Challenges in Spine Surgery)
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20 pages, 2241 KiB  
Review
Advances and Evolving Challenges in Spinal Deformity Surgery
by Ruchit V. Patel, Alexander G. Yearley, Hannah Isaac, Eric J. Chalif, Joshua I. Chalif and Hasan A. Zaidi
J. Clin. Med. 2023, 12(19), 6386; https://doi.org/10.3390/jcm12196386 - 06 Oct 2023
Viewed by 1165
Abstract
Background: Surgical intervention is a critical tool to address adult spinal deformity (ASD). Given the evolution of spinal surgical techniques, we sought to characterize developments in ASD correction and barriers impacting clinical outcomes. Methods: We conducted a literature review utilizing PubMed, Embase, Web [...] Read more.
Background: Surgical intervention is a critical tool to address adult spinal deformity (ASD). Given the evolution of spinal surgical techniques, we sought to characterize developments in ASD correction and barriers impacting clinical outcomes. Methods: We conducted a literature review utilizing PubMed, Embase, Web of Science, and Google Scholar to examine advances in ASD surgical correction and ongoing challenges from patient and clinician perspectives. ASD procedures were examined across pre-, intra-, and post-operative phases. Results: Several factors influence the effectiveness of ASD correction. Standardized radiographic parameters and three-dimensional modeling have been used to guide operative planning. Complex minimally invasive procedures, targeted corrections, and staged procedures can tailor surgical approaches while minimizing operative time. Further, improvements in osteotomy technique, intraoperative navigation, and enhanced hardware have increased patient safety. However, challenges remain. Variability in patient selection and deformity undercorrection have resulted in heterogenous clinical responses. Surgical complications, including blood loss, infection, hardware failure, proximal junction kyphosis/failure, and pseudarthroses, pose barriers. Although minimally invasive approaches are being utilized more often, clinical validation is needed. Conclusions: The growing prevalence of ASD requires surgical solutions that can lead to sustained symptom resolution. Leveraging computational and imaging advances will be necessary as we seek to provide comprehensive treatment plans for patients. Full article
(This article belongs to the Special Issue Advances and Challenges in Spine Surgery)
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Other

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35 pages, 1283 KiB  
Systematic Review
Epidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review
by J. I. Chalif, V. S. Chavarro, E. Mensah, B. Johnston, D. P. Fields, E. J. Chalif, M. Chiang, O. Sutton, R. Yong, R. Trumbower and Y. Lu
J. Clin. Med. 2024, 13(4), 1090; https://doi.org/10.3390/jcm13041090 - 14 Feb 2024
Viewed by 1592
Abstract
(1) Background: Spinal cord injury (SCI) represents a major health challenge, often leading to significant and permanent sensorimotor and autonomic dysfunctions. This study reviews the evolving role of epidural spinal cord stimulation (eSCS) in treating chronic SCI, focusing on its efficacy and safety. [...] Read more.
(1) Background: Spinal cord injury (SCI) represents a major health challenge, often leading to significant and permanent sensorimotor and autonomic dysfunctions. This study reviews the evolving role of epidural spinal cord stimulation (eSCS) in treating chronic SCI, focusing on its efficacy and safety. The objective was to analyze how eSCS contributes to the recovery of neurological functions in SCI patients. (2) Methods: We utilized the PRISMA guidelines and performed a comprehensive search across MEDLINE/PubMed, Embase, Web of Science, and IEEE Xplore databases up until September 2023. We identified studies relevant to eSCS in SCI and extracted assessments of locomotor, cardiovascular, pulmonary, and genitourinary functions. (3) Results: A total of 64 studies encompassing 306 patients were identified. Studies investigated various stimulation devices, parameters, and rehabilitation methods. Results indicated significant improvements in motor function: 44% of patients achieved assisted or independent stepping or standing; 87% showed enhanced muscle activity; 65% experienced faster walking speeds; and 80% improved in overground walking. Additionally, eSCS led to better autonomic function, evidenced by improvements in bladder and sexual functions, airway pressures, and bowel movements. Notable adverse effects included device migration, infections, and post-implant autonomic dysreflexia, although these were infrequent. (4) Conclusion: Epidural spinal cord stimulation is emerging as an effective and generally safe treatment for chronic SCI, particularly when combined with intensive physical rehabilitation. Future research on standardized stimulation parameters and well-defined therapy regimens will optimize benefits for specific patient populations. Full article
(This article belongs to the Special Issue Advances and Challenges in Spine Surgery)
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