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Current Progress and Future Directions of Spine Surgery

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

Deadline for manuscript submissions: 23 March 2025 | Viewed by 7106

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Special Issue Editors

Prof. Dr. Dong-Gune Chang

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Guest Editor

Department of Orthopedic Surgery, College of Medicine, Inje Univeristy Sanggye Paik Hospital, Inje University, Seoul 01757, Republic of Korea
Interests: spinal deformity; adult spinal deformity; pediatric spinal deformity; adult degenerative spine; minimally invasive surgery; osteoporosis; spinal fusion; osteobiologic

Dr. Sam Yeol Chang

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Guest Editor

Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
Interests: minimally-invasive fusion techniques; navigation-assisted spine surgery; robot-assisted spine surgery; osteobiologics; adult spinal deformity; pediatric spinal deformity; spinal tumors; separation surgery

Special Issue Information

Dear Colleagues,

This Special Issue of The Journal of Clinical Medicine aims to provide a comprehensive overview of the present and future of spine surgery. Recent developments and advancements in surgical techniques and novel technologies for spine surgery have markedly improved clinical outcomes in patients with spinal diseases and deformities. Examining the current progress and anticipating the future direction of the evolution of spine surgery will expand our horizons and deepen our understanding of this challenging field. This Special Issue will cover the clinical outcomes of emerging surgical techniques and technologies, from navigation and robotic-assisted spine surgery to osteobiologics, surface technologies, and expandable interbody cages. This Special Issue will also explore how machine learning algorithms and artificial intelligence can reshape our clinical practice for patients with spinal diseases and deformities.

This Special Issue welcomes both original research and review articles on the present and future of spine surgery, from endoscopic spine surgery to adult and pediatric deformity corrections.

Prof. Dr. Dong-Gune Chang
Dr. Sam Yeol Chang
Guest Editors

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Keywords

minimally invasive surgery
navigation-assisted spine surgery
robotic-assisted spine surgery
deformity correction
spinal fusion
osteobiologic
surface technology
expandable cage
artificial intelligence
machine learning algorithms

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Published Papers (7 papers)

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Research

13 pages, 1210 KiB

Open AccessArticle

Multidisciplinary Digital Therapeutics for Chronic Low Back Pain Versus In-Person Therapeutic Exercise with Education: A Randomized Controlled Pilot Study

by Dong-Ho Kang, Jae Hyeon Park, Chan Yoon, Chi-Hyun Choi, Sanghee Lee, Tae Hyun Park, Sam Yeol Chang and Seong-Ho Jang

J. Clin. Med. 2024, 13(23), 7377; https://doi.org/10.3390/jcm13237377 - 4 Dec 2024

Viewed by 722

Abstract

Background: Chronic lower back pain (CLBP) is a global health issue leading to significant disability and socioeconomic burden. Traditional treatments, including exercise and cognitive behavioral therapy (CBT), are often limited by physical and temporal constraints. This study aimed to evaluate the efficacy of multidisciplinary digital therapeutics (MORA Cure LBP) compared to conventional treatments. Methods: This multicenter, randomized, controlled pilot study enrolled 46 participants. Participants were randomly assigned in a 1:1 ratio to either a MORA Cure LBP group or control group, which received conventional treatment. Results: At eight weeks, both groups demonstrated improvements compared to baseline. No statistically significant differences were observed between the MORA Cure LBP and control groups in reductions in usual pain intensity (MORA Cure LBP: 3.1 ± 1.9 vs. control: 3.0 ± 1.5, p = 0.809), worst pain intensity (MORA Cure LBP: 5.00 ± 2.18 vs. control: 4.27 ± 1.83, p = 0.247), and functional disability (ODI, MORA Cure LBP: 15.6 ± 9.6 vs. control: 15.6 ± 10.0, p > 0.999). Compliance was significantly higher in the MORA Cure LBP group during the first 4 weeks (MORA Cure LBP: 74.7% ± 27.4 vs. control: 53.1% ± 28.6, p < 0.001). Conclusions: Both multidisciplinary digital therapeutics (MORA Cure LBP) and conventional treatments were effective in reducing pain and functional disability in patients with CLBP, with no significant differences between the two groups. Digital therapeutics, particularly those that integrate CBT and exercise, offer promising alternatives to conventional therapies by improving accessibility and potentially enhancing patient engagement. Full article

(This article belongs to the Special Issue Current Progress and Future Directions of Spine Surgery)

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12 pages, 1346 KiB

Open AccessArticle

Cervical Open-Door Laminoplasty for Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament: Correlation Between Spinal Canal Expansion and Clinical Outcomes

by Young-Il Ko, Young-Hoon Kim, Jorge Barraza, Myung-Sup Ko, Chungwon Bang, Byung Jun Hwang, Sang-Il Kim and Hyung-Youl Park

J. Clin. Med. 2024, 13(22), 6904; https://doi.org/10.3390/jcm13226904 - 16 Nov 2024

Viewed by 610

Abstract

Background/Objectives: This study investigated the relationship between spinal canal expansion and clinical outcomes in patients with myelopathy due to ossification of the posterior longitudinal ligament (OPLL) who underwent cervical open-door laminoplasty. Methods: A retrospective study was conducted on 36 OPLL patients who underwent open-door laminoplasty between 2009 and 2021. Preoperative and two-year postoperative radiologic parameters, including bony canal area (BCA) and spinal canal area (SCA), were measured. Clinical outcomes were assessed using the Numerical Rating Scale (NRS) for neck pain and radicular pain, the Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores. Results: The mean expansion of BCA was 112.1 mm² (47%) and SCA was 100.5 mm² (64%). All clinical outcomes improved after surgery, although not statistically significant. JOA scores improved significantly in the severe group, while NDI and NRS-neck scores improved in the mild to moderate group. Significant correlations were found between improvements in NRS-neck and expansions of BCA (r = 0.533, p = 0.001) and SCA (r = 0.537, p = 0.001). NDI improvement was also associated with BCA expansion. No significant correlations were found between canal expansion and NRS-R, NRS-L, or JOA scores. Conclusions: Cervical open-door laminoplasty effectively increased the bony and spinal canal areas in patients with OPLL and myelopathy. In addition to improving myelopathy symptoms, this procedure may also improve neck pain and disability. Further research is needed to assess the long-term outcomes and to better understand these clinical improvements. Full article

(This article belongs to the Special Issue Current Progress and Future Directions of Spine Surgery)

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9 pages, 1417 KiB

Open AccessArticle

Vertebral Body Morphology in Neuromuscular Scoliosis with Spastic Quadriplegic Cerebral Palsy

by Göker Utku Değer, Heon Jung Park, Kyeong-Hyeon Park, Hoon Park, Mohammed Salman Alhassan, Hyun Woo Kim and Kun-Bo Park

J. Clin. Med. 2024, 13(20), 6289; https://doi.org/10.3390/jcm13206289 - 21 Oct 2024

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Abstract

Background/Objectives: The distorted vertebral body has been studied in scoliosis; however, there is little knowledge about the difference between neuromuscular and idiopathic scoliosis. This study aimed to investigate the vertebral body morphology in patients with spastic quadriplegic cerebral palsy and scoliosis (CP scoliosis) and compare them with those of apex- and Cobb angle-matched patients with adolescent idiopathic scoliosis (AIS). Methods: Thirty-four patients with CP scoliosis and thirty-two patients with AIS were included. The pedicle diameter, chord length, and vertebral body rotation were evaluated at one level above the apex, one level below the apex, and at the apex using a reconstructed computed tomography scan. The apex of the curve and Cobb angle were too diverse between patients with CP scoliosis or AIS. Eighteen patients were matched in each group according to the apex and Cobb angle (within 5-degree differences) of the major curve, and compared between matched groups (mCPscoliosis vs. mAIS). Results: In the comparison of the apex and Cobb angle-matched groups, there was no statistical difference in the Cobb angle between mCPscoliosis (80.7 ± 13.8 degrees) and mAIS (78.6 ± 13.6 degrees, p = 0.426), and the vertebral body rotation (25.4 ± 15.4° in mCPscoliosis vs. 24.4 ± 6.5° in mAIS, p = 0.594). There was no difference in the pedicle diameters of either the convex (3.6 ± 1.1 mm in mCPscoliosis vs. 3.3 ± 1.2 mm in mAIS, p = 0.24) or concave side (3.1 ± 1.2 mm in mCPscoliosis vs. 2.7 ± 1.6 mm in mAIS, p = 0.127). However, the patients in the mCPscoliosis group were younger (12.7 ± 2.5 years vs. 14.6 ± 2.4 years, p = 0.001), and the chord length was shorter on the convex (38.0 ± 5.0 mm vs. 40.4 ± 4.9 mm, p = 0.025) and concave (37.7 ± 5.2 mm vs. 40.3 ± 4.7 mm, p = 0.014) sides compared with those of the mAIS group. Conclusions: With a similar apex and Cobb angle, the vertebral body rotation and pedicle diameter in patients with CP scoliosis were comparable to those with AIS; however, the chord length was shorter in CP scoliosis. For the selection of the pedicle screw in CP scoliosis, the length of the pedicle screw should be more considered than the diameter. Full article

(This article belongs to the Special Issue Current Progress and Future Directions of Spine Surgery)

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13 pages, 727 KiB

Open AccessArticle

Enhanced Recovery After Surgery Protocols in One- or Two-Level Posterior Lumbar Fusion: Improving Postoperative Outcomes

by Ji Uk Choi, Tae-Hong Kee, Dong-Ho Lee, Chang Ju Hwang, Sehan Park and Jae Hwan Cho

J. Clin. Med. 2024, 13(20), 6285; https://doi.org/10.3390/jcm13206285 - 21 Oct 2024

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Abstract

Background/Objectives: Enhanced recovery after surgery (ERAS) protocols optimize perioperative care and improve recovery. This study evaluated the effectiveness of ERAS in one- or two-level posterior lumbar fusion surgeries, focusing on perioperative medication use, pain management, and functional outcomes. Methods: Eighty-eight patients undergoing lumbar fusion surgery between March 2021 and February 2022 were allocated into pre-ERAS (n = 41) and post-ERAS (n = 47) groups. Outcomes included opioid and antiemetic consumption, pain scores (numerical rating scale (NRS)), functional recovery (Oswestry Disability Index (ODI) and EuroQol 5 Dimension (EQ-5D)), and complication rates. Pain was assessed daily for the first four postoperative days and at 6 months. Linear Mixed Effects Model analysis evaluated pain trajectories. Results: The post-ERAS group showed significantly lower opioid (p = 0.005) and antiemetic (p < 0.001) use. No significant differences were observed in NRS pain scores in the first 4 postoperative days. At 6 months, the post-ERAS group reported significantly lower leg pain (p = 0.002). The time:group interaction was not significant for back (p = 0.848) or leg (p = 0.503) pain. Functional outcomes at 6 months, particularly ODI and EQ-5D scores, showed significant improvement in the post-ERAS group. Complication rates were lower in the post-ERAS group (4.3% vs. 19.5%, p = 0.024), while hospital stay and fusion rates remained similar. Conclusions: The ERAS protocol significantly reduced opioid and antiemetic use, improved long-term pain management and functional recovery, and lowered complication rates in lumbar fusion patients. These findings support the implementation of ERAS protocols in spinal surgery, emphasizing their role in enhancing postoperative care. Full article

(This article belongs to the Special Issue Current Progress and Future Directions of Spine Surgery)

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10 pages, 3412 KiB

Open AccessArticle

Comparison of Revision Techniques for Rod Fracture after Adult Spinal Deformity Surgery: Rod Replacement Alone or Coupled with Lateral Lumbar Interbody Fusions or Accessory Rods

by Ki Young Lee, Jung-Hee Lee, Gil Han, Cheol-Hyun Jung and Hong Sik Park

J. Clin. Med. 2024, 13(20), 6203; https://doi.org/10.3390/jcm13206203 - 18 Oct 2024

Viewed by 689

Abstract

Background: Rod fracture (RF) is the most common cause of revision in adult spinal deformity (ASD) surgery, and various treatment strategies for preventing RF are reported in the literature. This retrospective study, involving 139 ASD patients (aged ≥65 years and a minimum 2-year follow-up) who underwent long-segment fixation from T10 to sacrum with pedicle subtraction osteotomy (PSO), analyzed long-term results, including radiographical parameters and the incidence of recurrent RF (re-RF), to determine the most effective revision method for preventing RF. Methods: Patients were classified into three groups according to the revision method performed for RF: simple rod replacement (RR group, n = 17), lateral lumbar interbody fusion around the PSO site (RR + LLIF group, n = 8), and accessory rod insertion (RR + AR group, n = 22). Baseline characteristics and radiographical and clinical parameters were analyzed. Results: RF occurred in 47 patients (34%) at an average of 28 months following primary deformity correction. Re-RF occurred in six patients (13%) at an average of 37 months. Re-RF occurred most commonly in the RR group (p = 0.048). Every re-RF in the RR group occurred at the PSO site; none occurred in the RR + LLIF group, and one in the RR + AR group occurred near the L4–5. After both primary deformity correction and revision surgery, spinopelvic parameters had shown favorable results, and clinical outcomes had improved in all three groups without significant intergroup differences. Conclusions: Accessory rod insertion or an additional LLIF around the PSO site seems to provide greater strength and stability to the previously fused segments than a simple rod replacement, which demonstrates the need for additional support in revision surgery for RF after a PSO. Full article

(This article belongs to the Special Issue Current Progress and Future Directions of Spine Surgery)

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13 pages, 724 KiB

Open AccessArticle

Characterization of Patients with Poor Clinical Outcome after Adult Spinal Deformity Surgery: A Multivariate Analysis of Mean 8-Year Follow-Up Data

by Se-Jun Park, Hyun-Jun Kim, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung and Chong-Suh Lee

J. Clin. Med. 2024, 13(19), 6000; https://doi.org/10.3390/jcm13196000 - 8 Oct 2024

Viewed by 786

Abstract

Background/Objective: Limited data exist regarding the long-term clinical outcomes and related factors after adult spinal deformity (ASD) surgery. This study aims to characterize patients who experienced poor clinical outcomes during long-term follow-up after ASD surgery. Methods: Patients who underwent ASD surgery with ≥5-vertebra fusion including the sacrum and ≥5-year follow-up were included. They were divided into two groups according to the Oswestry Disability Index (ODI) at the last follow-up: group P (poor outcome, ODI > 40) and group NP (non-poor outcome, ODI ≤ 40). Clinical variables, including patient factors, surgical factors, radiographic parameters, and mechanical complications (proximal junctional kyphosis [PJK] and rod fracture), were compared between the groups. Results: A total of 105 patients were evaluated, with a mean follow-up of 100.6 months. The mean age was 66.3 years, and 94 patients (89.5%) were women. There were 52 patients in group P and 53 patients in group NP. Univariate analysis showed that low T-score, postoperative correction relative to age-adjusted pelvic incidence-lumbar lordosis, T1 pelvic angle (TPA) at last follow-up, and PJK development were significant factors for poor clinical outcomes. Multivariate analysis identified PJK as the single independent risk factor (odds ratio [OR] = 3.957 for PJK development relative to no PJK, OR = 21.141 for revision surgery for PJK relative to no PJK). Conclusions: PJK development was the single independent factor affecting poor clinical outcomes in long-term follow-up. Therefore, PJK prevention appears crucial for achieving long-term success after ASD surgery. Full article

(This article belongs to the Special Issue Current Progress and Future Directions of Spine Surgery)

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14 pages, 1894 KiB

Open AccessFeature PaperArticle

Impact of the Disc Vacuum Phenomenon on Surgical Outcomes in Lumbar Spinal Stenosis: A Comparative Study between Endoscopic Decompression and Minimally Invasive Oblique Lateral Interbody Fusion

by Hyung Rae Lee, Kun Joon Lee, Seung Yup Lee and Jae Hyuk Yang

J. Clin. Med. 2024, 13(19), 5827; https://doi.org/10.3390/jcm13195827 - 29 Sep 2024

Viewed by 1236

Abstract

Objective: This study investigated the influence of the vacuum phenomenon (VP) on surgical outcomes in patients with lumbar spinal stenosis, comparing minimally invasive oblique lateral interbody fusion (MIS OLIF) and endoscopic decompression. Methods: A cohort of 110 patients diagnosed with lumbar spinal stenosis underwent either endoscopic decompression or MIS OLIF. Patients were classified into two groups based on the presence or absence of the VP on preoperative CT scans, non-VP (n = 42) and VP (n = 68). Radiologic and clinical outcomes, including back and leg pain assessed using the visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the EuroQol-5 Dimension (Eq5D), were compared pre- and postoperatively over a 2-year follow-up period. Results: Preoperatively, the VP group exhibited significantly greater leg pain (p = 0.010), while no significant differences were observed in back pain or the ODI between the groups. In the non-VP group, decompression and fusion yielded similar outcomes, with decompression showing a better ODI score at 1 month (p = 0.018). In contrast, in the VP group, patients who underwent fusion showed significantly improved long-term leg pain outcomes compared to those who underwent decompression at both 1-year (p = 0.042) and 2-year (p = 0.017) follow-ups. Conclusions: The VP may indicate segmental instability and may play a role in the persistence of radiculopathy. Fusion surgery appears to offer better long-term relief in patients with the VP, whereas decompression alone is a viable option in non-VP cases. These findings suggest that the VP may be a useful factor in guiding surgical decision-making. Full article

(This article belongs to the Special Issue Current Progress and Future Directions of Spine Surgery)

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