Advances in Lumbar Spine Surgery

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

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 8951

Special Issue Editors

Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
Interests: degenerative lumbar spine surgery; minimally invasive spine surgery; endoscopic spine surgery; osteoporosis; spine tumor; mixed reality; medical twin
Department of Orthopaedic Surgery, Spine Center, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Chuncheon, Republic of Korea
Interests: endoscopic spine surgery; minimal invasive lumbar fusion surgery; robotic spine surgery

Special Issue Information

Dear Colleagues,

In the modern day, patients' expectations are growing, and adequate spinal decompression and the removal of spinal pathology are no longer sufficient to meet their needs. Patients today desire minimal soft tissue injury, rapid return to work, and spinal stability maintenance. Minimally invasive surgeries, such as endoscopy (uniportal and biportal) and lateral access surgery, are also often used, and several cutting-edge surgical techniques, such as robotic or augmented reality surgery, are being developed. In addition, a variety of biological substances are commonly employed to boost the union rate. Spine surgeons are developing an interest in these techniques.

This special issue, titled "Advances in Lumbar Spine Surgery", intends to publish research on the clinical application of modern technologies in lumbar spine surgery in as broad a context as possible to provide the readers with a comprehensive overview of the latest developments.

Clinical, radiographical, and experimental, basic science research, in terms of the clinical applications of modern technologies in lumbar spine surgery, is welcome. Papers on preoperative imaging, new and innovative surgical approaches and techniques, as well as the application of various novel technologies, devices, and surgical concepts are of interest.

Case reports, retrospective and prospective case series and studies, operative videos, technical notes, literature reviews, opinions, and clinical and basic science research are all welcome.

Dr. Sang-Min Park
Dr. Hyun-Jin Park
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 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 disease
  • fracture
  • tumor
  • interbody fusion
  • laminectomy
  • discectomy
  • endoscopy
  • minimal invasive surgery
  • 3D print
  • mixed reality
  • interventions

Published Papers (8 papers)

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Research

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10 pages, 661 KiB  
Article
Correlation between Preoperative MRI Parameters and Oswestry Disability Index in Patients with Lumbar Spinal Stenosis: A Retrospective Study
Medicina 2023, 59(11), 2000; https://doi.org/10.3390/medicina59112000 - 14 Nov 2023
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Abstract
Background and Objectives: Lumbar spinal stenosis (LSS) is a degenerative condition posing significant challenges in clinical management. Despite the use of radiological parameters and patient-reported outcome measures like the Oswestry Disability Index (ODI) for evaluation, there is limited understanding of their interrelationship. [...] Read more.
Background and Objectives: Lumbar spinal stenosis (LSS) is a degenerative condition posing significant challenges in clinical management. Despite the use of radiological parameters and patient-reported outcome measures like the Oswestry Disability Index (ODI) for evaluation, there is limited understanding of their interrelationship. This study aimed to investigate the correlation between preoperative MRI parameters and ODI scores in patients with LSS undergoing surgical treatment. Materials and Methods: A retrospective analysis was conducted on 86 patients diagnosed with LSS over a 5-year period. Preoperative MRI measurements, including the cross-sectional area of the psoas muscle, lumbar canal stenosis, neural foramina area, and facet joint osteoarthritis, were assessed. ODI scores were collected preoperatively and at a 1-year follow-up. Statistical analyses were performed using IBM SPSS Statistics software (version 26). Results: Weak to moderate correlations were observed between certain MRI parameters and ODI scores. The initial ODI score had a weak positive correlation with the severity of lumbar canal stenosis according to Schizas criteria (rho = 0.327, p = 0.010) and a moderate negative correlation with the relative cross-sectional area of the psoas muscle (rho = −0.498, p = 0.000). At 1-year follow-up, the ODI had a weak negative correlation with the relative cross-sectional area of the psoas muscle (rho = −0.284, p = 0.026). Conclusions: While the severity of LSS showed a weak correlation with initial ODI, it was not a predictor of 1-year postoperative ODI. Furthermore, although the cross-sectional area of the thecal sac, the sagittal area of the neural foramen, and the grade of facet joint osteoarthritis influence the imagistic severity, none of them correlate with ODI. These findings underscore the need for a comprehensive model that integrates multiple imaging and clinical parameters for a holistic understanding of LSS and its functional outcomes. Full article
(This article belongs to the Special Issue Advances in Lumbar Spine Surgery)
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9 pages, 2508 KiB  
Article
A Randomized Controlled Trial of Vertebral Body Decompression Procedure Versus Conservative Treatment for Painful Vertebral Compression Fracture
Medicina 2023, 59(10), 1848; https://doi.org/10.3390/medicina59101848 - 17 Oct 2023
Viewed by 1262
Abstract
Background: Traditional treatment modalities for vertebral compression fractures (VCFs) include bed rest, pain medications, muscle relaxants, back braces, and physical therapy. In cases where conservative treatment proves ineffective, a new procedure called core decompression of the vertebral body is explored. Core decompression of [...] Read more.
Background: Traditional treatment modalities for vertebral compression fractures (VCFs) include bed rest, pain medications, muscle relaxants, back braces, and physical therapy. In cases where conservative treatment proves ineffective, a new procedure called core decompression of the vertebral body is explored. Core decompression of the vertebral body has the potential to lower and stabilize the intraosseous pressure, resulting in enhanced blood circulation, which contributes to pain reduction. In this trial, we evaluated the efficacy of core decompression of the vertebral body in patients with painful VCFs compared with conventional conservative treatment. Methods: This prospective randomized controlled trial was conducted at a tertiary education hospital between June 2017 and May 2020. The participants were randomly assigned in a 1:1 ratio to one of two treatment groups: the core decompression group and the conservative treatment group. The primary outcome measure was the visual analog scale (VAS) pain score of the back 3 months after the procedure. Secondary outcome measures included the Oswestry Disability Index (ODI) for lumbar disabilities, the European Quality of Life-5 Dimensions (EQ-5D) score for quality of life, and radiographic outcomes such as changes in compression rate. Results: All patients underwent the assigned intervention (48 core decompression and 50 conservative treatments). At both 1 month and 3 months, there were no significant differences between the core decompression group and conservative treatment group in VAS pain score (adjusted treatment effect: −0.1 and 2.0; 95% confidence interval [CI]: −7.5 to 7.3 and −5.6 to 9.6; p = 0.970 and p = 0.601, respectively). In addition, there were no significant inter-group differences in ODI and EQ-5D scores throughout the follow-up period (p = 0.917 and 0.704, respectively). Conclusion: Core decompression of the vertebral body did not demonstrate any significant improvement in pain and disability compared to conventional conservative treatment. Full article
(This article belongs to the Special Issue Advances in Lumbar Spine Surgery)
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6 pages, 269 KiB  
Article
Evaluating the Efficacy of Water-Soluble Bone Wax (Tableau Wax) in Reducing Blood Loss in Spinal Fusion Surgery: A Randomized, Controlled, Pilot Study
Medicina 2023, 59(9), 1545; https://doi.org/10.3390/medicina59091545 - 25 Aug 2023
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Abstract
Background and Objectives: Lumbar decompression with fusion surgery is an effective treatment for spinal stenosis, but critical postoperative hematoma is a concern. Bone wax has been widely used to control bone bleeding but it has some drawbacks. This study aimed to evaluate [...] Read more.
Background and Objectives: Lumbar decompression with fusion surgery is an effective treatment for spinal stenosis, but critical postoperative hematoma is a concern. Bone wax has been widely used to control bone bleeding but it has some drawbacks. This study aimed to evaluate the efficacy of Tableau wax, a bioabsorbable hemostatic material, in patients undergoing spinal fusion surgery through a pilot study design. Materials and Methods: A total of 31 patients were enrolled in this single-surgeon, single-institution study. The participants underwent transforaminal lumbar interbody fusion surgery and were randomly assigned to the control group (Bone wax) or test group (Tableau wax). Demographic data, pre- and post-operative hemoglobin levels, blood loss volume, surgical time, Oswestry Disability Index, and EQ-5D scores were recorded. Results: The study showed no significant difference in preoperative and postoperative hemoglobin levels, Oswestry Disability Index, and EQ-5D scores between the groups. However, the Tableau wax group had a significantly lower reduction in hemoglobin levels (1.3 ± 1.0 g/dL) and blood loss (438.2 mL) compared to the Bone wax group (2.2 ± 0.9 g/dL and 663.1 mL, respectively; p = 0.018 and p = 0.022). Full article
(This article belongs to the Special Issue Advances in Lumbar Spine Surgery)
10 pages, 946 KiB  
Article
Efficacy of Aceclofenac and Ilaprazole Combination Therapy versus Celecoxib Monotherapy for Treating NSAID-Induced Dyspepsia in Lumbar Spinal Stenosis Patients
Medicina 2023, 59(7), 1307; https://doi.org/10.3390/medicina59071307 - 14 Jul 2023
Cited by 1 | Viewed by 1310
Abstract
Background and Objectives: Dyspepsia is a common adverse event associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with lumbar spinal stenosis. Although proton pump and cyclooxygenase-2 inhibitors are potential treatment options, the optimal strategy remains unclear. This study aimed [...] Read more.
Background and Objectives: Dyspepsia is a common adverse event associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with lumbar spinal stenosis. Although proton pump and cyclooxygenase-2 inhibitors are potential treatment options, the optimal strategy remains unclear. This study aimed to compare the efficacy and safety of combination therapy with aceclofenac and ilaprazole versus celecoxib monotherapy for the treatment of dyspepsia caused by NSAID use in patients with lumbar spinal stenosis. Materials and Methods: This prospective, double-blind, randomized, actively controlled study was conducted at Seoul National University Bundang Hospital in South Korea from July 2020 to September 2021. The participants were randomized into one of two treatment groups: celecoxib monotherapy (control group) and combination therapy with aceclofenac and ilaprazole (test group). The primary efficacy endpoint was the mean change in the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) scores from baseline to treatment week 8. The secondary efficacy endpoint was the mean change in Short-Form-12 (SF-12) scores from baseline (week 0) to treatment week 8. Results: The study enrolled 140 patients who were randomly assigned to receive combination therapy with aceclofenac and, ilaprazole or celecoxib. In the per protocol set, the mean change in SF-LDQ scores from week 0 to week 8 was −0.51 ± 4.78 and 1.85 ± 6.70 in the combination therapy and celecoxib group, respectively (p = 0.054). SF-12 scores did not differ significantly between the two groups. Adverse events were reported in both groups, but there was no significant difference in incidence. Conclusions: Combination therapy with aceclofenac and ilaprazole can be a treatment option for NSAID-induced dyspepsia in some situations. Full article
(This article belongs to the Special Issue Advances in Lumbar Spine Surgery)
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11 pages, 3133 KiB  
Article
Radiographic Outcomes of Conservative and Operative Treatment in Isolated L1 Fractures
Medicina 2023, 59(4), 695; https://doi.org/10.3390/medicina59040695 - 01 Apr 2023
Viewed by 1064
Abstract
Background and Objectives: The adequate therapy of thoracolumbar fractures in the elderly population is still controversially discussed. The aim of this study was to evaluate and compare the results of conservatively and surgically treated younger (≤60a) and elderly patients (>60a) with fractures [...] Read more.
Background and Objectives: The adequate therapy of thoracolumbar fractures in the elderly population is still controversially discussed. The aim of this study was to evaluate and compare the results of conservatively and surgically treated younger (≤60a) and elderly patients (>60a) with fractures of L1. Materials and Methods: Patients (231) with isolated L1 fractures were included and treated at the University Clinic of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, during the observation period of 2012–2018. Results: Conservative treatment led to a significant increase in the vertebral and bi-segmental kyphosis angle in both age groups (young vertebral: p = 0.007; young bi-segmental: p = 0.044; old vertebral: p = 0.0001; old bis-segmental: p = 0.0001). A significant reduction in the vertebral angle in both age groups was achieved after operative treatment (young: p = 0.003, old: p = 0.007). The bi-segmental angle did not significantly improve after surgery in both age groups (≤60a: p = 0.07; >60a: p = 1.0). Conclusions: The study shows that conservative treatment does not seem to be sufficient for a correction of radiological parameters in young and elderly patients. In contrast, operative treatment led to a significant improvement of the vertebral kyphosis angle, without changing the bi-segmental kyphosis angle. These results suggest a greater benefit from operative treatment in patients ≤ 60a than in older patients. Full article
(This article belongs to the Special Issue Advances in Lumbar Spine Surgery)
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12 pages, 4919 KiB  
Article
Marker Screw Utilization for Minimally Invasive Transforaminal Lumbar Interbody Fusion (MS-MIS TLIF): Promises and Advantages
Medicina 2023, 59(3), 585; https://doi.org/10.3390/medicina59030585 - 16 Mar 2023
Cited by 1 | Viewed by 1189
Abstract
Background and Objective: Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) has been investigated and shown excellent short- and long-term outcomes. In this paper, we describe a new MIS-TLIF technique and pedicle screw insertion using a marker screw as a guidance method. Moreover, [...] Read more.
Background and Objective: Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) has been investigated and shown excellent short- and long-term outcomes. In this paper, we describe a new MIS-TLIF technique and pedicle screw insertion using a marker screw as a guidance method. Moreover, we report perioperative, postoperative, and patient-related outcomes. In addition, this paper outlines major differences in radiation exposure, cost effectiveness and accuracy of Marker Screw Minimally Invasive Transforaminal Interbody Fusion (MS-MIS TLIF) compared to other techniques. We report our technique to share our knowledge and experience with the aim of achieving a better MIS-TLIF that would help both surgeons and patients. Materials and Methods: A prospective case series was conducted between October 2018 and February 2021. Patients undergoing MS-MIS TLIF with marker screws were consecutively included. The surgery did not exceed two levels. The patients’ medical records were reviewed, and the included patients were asked to complete two outcome-questionnaires before surgery and at the six-month visit. The surgical technique is described in this paper. Results: A total of 37 patients were recruited. The mean age was 57.35 ± 12.8 years, and more than half of the patients were females. The most common indications for surgery were degenerative disc disease and spondylolisthesis, with the typical level at L4–5. The operative time was 3.02 ± 0.83 h, while the estimated blood loss was 127.7 ± 71.1 mL. The average time for ambulation and hospitalization was 1 ± 1.1 and 2.84 ± 1.4 days, respectively. The patients described significant improvement in both questionnaires. No screw-related complications or screw revisions were needed up to two years of follow-up. Conclusions: The use of marker screws for pedicle screw placement through a minimally invasive fashion is shown to be a promising technique that can overcome many drawbacks, including cost, operative time, and radiation exposure. Performing MS-MIS TLIF can achieve a 360- degree fusion compared to percutaneous MIS-TLIF. Full article
(This article belongs to the Special Issue Advances in Lumbar Spine Surgery)
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Review

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22 pages, 2471 KiB  
Review
The Evolution of Lateral Lumbar Interbody Fusion: A Journey from Past to Present
Medicina 2024, 60(3), 378; https://doi.org/10.3390/medicina60030378 - 23 Feb 2024
Viewed by 462
Abstract
Lumbar interbody fusion procedures have seen a significant evolution over the years, with various approaches being developed to address spinal pathologies and instability, including posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and lateral lumbar interbody [...] Read more.
Lumbar interbody fusion procedures have seen a significant evolution over the years, with various approaches being developed to address spinal pathologies and instability, including posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and lateral lumbar interbody fusion (LLIF). LLIF, a pivotal technique in the field, initially emerged as extreme/direct lateral interbody fusion (XLIF/DLIF) before the development of oblique lumbar interbody fusion (OLIF). To ensure comprehensive circumferential stability, LLIF procedures are often combined with posterior stabilization (PS) using pedicle screws. However, achieving this required repositioning of the patient during the surgical procedure. The advent of single-position surgery (SPS) has revolutionized the procedure by eliminating the need for patient repositioning. With SPS, LLIF along with PS can be performed either in the lateral or prone position, resulting in significantly reduced operative time. Ongoing research endeavors are dedicated to further enhancing LLIF procedures making them even safer and easier. Notably, the integration of robotic technology into SPS has emerged as a game-changer, simplifying surgical processes and positioning itself as a vital asset for the future of spinal fusion surgery. This literature review aims to provide a succinct summary of the evolutionary trajectory of lumbar interbody fusion techniques, with a specific emphasis on its recent advancements. Full article
(This article belongs to the Special Issue Advances in Lumbar Spine Surgery)
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23 pages, 664 KiB  
Review
Factors Predisposing to The Formation of Degenerative Spondylolisthesis—A Narrative Review
Medicina 2023, 59(8), 1430; https://doi.org/10.3390/medicina59081430 - 07 Aug 2023
Cited by 2 | Viewed by 1388
Abstract
The relationship between various factors predisposing to the formation of spondylolisthesis, including degenerative spondylolisthesis, has been analyzed by many authors. However, not all observations are consistent. In this review, we identified factors whose impact on the prevalence of spondylolisthesis was most often mentioned [...] Read more.
The relationship between various factors predisposing to the formation of spondylolisthesis, including degenerative spondylolisthesis, has been analyzed by many authors. However, not all observations are consistent. In this review, we identified factors whose impact on the prevalence of spondylolisthesis was most often mentioned in the literature. These included gender, age, bone mineral density, ethnic origin, and oophorectomy. The results were inclusive in terms of physical activity, pregnancy status, and use of hormone replacement therapy. Associations between diabetes and smoking were very poorly marked. The literature so far has identified a number of factors significantly affecting the incidence of degenerative spondylolisthesis. These include age, gender, body weight, ethnic origin, bone mineral density, and hormonal balance. Radiological parameters, which include iliac crest, pelvic tilt, pelvic incidence, sacral slope, and lumbar lordosis, may also be of great importance for assessing changes in the occurrence and progression. However, the authors do not agree on the real significance of individual factors. The aim of this review was to identify the factors predisposing to the formation of degenerative spondylolisthesis, the importance of which has been suggested in the current literature. The systematization of knowledge in this field can allow a more accurate adjustment of the treatment plan for each patient affected by this condition. Full article
(This article belongs to the Special Issue Advances in Lumbar Spine Surgery)
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