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Lumbar Spine Surgery: Clinical Updates and Perspective

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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: 31 January 2025 | Viewed by 7092

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Dr. Vincent Challier

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Guest Editor

Hôpital Privé du Dos Francheville, 24000 Périgueux, France
Interests: spine surgery; spondylolisthesis; kyphosis; lumbar spine; low back pain; spine research

Special Issue Information

Dear Colleagues,

This Special Issue of the Journal of Clinical Medicine aims to provide a comprehensive overview of the latest developments in lumbar spine surgery, including both surgical techniques and emerging technologies, with a focus on improving patient outcomes and advancing our understanding of spinal disease. In addition to covering topics such as spinal alignment in degenerative lumbar spine, minimally invasive surgery, spinal fusion, and the use of new technologies like robotics and navigation systems, this Special Issue will explore patient expectations for performance and outcomes in lumbar spine surgery. The growing trend of lumbar endoscopy as a minimally invasive surgical technique will also be highlighted, with a focus on its benefits and limitations compared to traditional open surgery. The use of big data analytics, AI, and machine learning techniques are also discussed as emerging tools to improve outcomes in lumbar spine surgery. Overall, this Special Issue aims to provide insights into the latest advances in the field, emphasizing core problems to be solved and mobilizing efforts towards improving diagnosis, treatment, and prognosis in the setting of lumbar surgical care.

Dr. Vincent Challier
Guest Editor

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Keywords

lumbar spine surgery
clinical updates
surgical techniques
minimally invasive surgery
spinal fusion
prone lateral fusion
sagittal alignment
lumbar endoscopy
uniportal endoscopy
bipolar unilateral endoscopy
long-term outcomes

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Published Papers (7 papers)

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11 pages, 2308 KiB

Open AccessArticle

Return to Work Following Anterior Lumbar Interbody Fusion with Percutaneous Posterior Pedicle Fixation: A Retrospective Analysis from Two Academic Centers in Germany

by Bedjan Behmanesh, Helen Wempe, Fatma Kilinc, Daniel Dubinski, Sae-Yeon Won, Marcus Czabanka, Matthias Setzer, Patrick Schuss, Matthias Schneider, Thomas Freiman and Florian Gessler

J. Clin. Med. 2024, 13(18), 5636; https://doi.org/10.3390/jcm13185636 - 23 Sep 2024

Viewed by 602

Abstract

Objective: Return to work after spinal surgery is a crucial factor in the recovery process. It can contribute not only to physical rehabilitation but also to psychological well-being. This study aims to evaluate the rate of return to work following elective lumbar spine surgery and identify predictors that predict failure of return to work. Methods: Adult patients who underwent anterior lumbar interbody fusion at two medical centers were retrospectively identified. A standardized telephone interview was conducted for the final analysis to assess the clinical outcomes of these patients. Results: Out of a total of 159 patients, 104 were of working age at the time of the elective surgery. Data were missing for 35 patients, who were thus excluded from the analysis. All patients had a minimum follow-up period of one year. After surgery, 75% of the patients returned to work within a median time of 3 months. Quality of life, back pain, leg pain, and ODI scores, as well as self-reported satisfaction, were significantly better in patients who returned to work (p < 0.05). Tobacco use and previous musculoskeletal surgery were significant predictive factors of failure to return to work. None of the patients who were unemployed prior to surgery returned to work. Conclusions: Our study reveals that 75% of patients returned to work within three months after surgery. The most significant predictor of failure to return to work is being unemployed before surgery. Additionally, preoperative education about postoperative behavior and physical activity could potentially increase the rate. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Clinical Updates and Perspective)

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14 pages, 8401 KiB

Open AccessArticle

Distal Junctional Failure: A Feared Complication of Multilevel Posterior Spinal Fusions

by Soufiane Ghailane, Houssam Bouloussa, Manuel Fernandes Marques, Jean-Etienne Castelain, Vincent Challier, Matthieu Campana, Clément Jacquemin, Jean-Marc Vital and Olivier Gille

J. Clin. Med. 2024, 13(17), 4981; https://doi.org/10.3390/jcm13174981 - 23 Aug 2024

Viewed by 711

Abstract

Objectives: Distal junctional failure (DJF) is less commonly described than proximal junctional failure following posterior spinal fusion, and particularly adult spinal deformity (ASD) surgery. We describe a case series of patients with DJF, taking into account sagittal spinopelvic alignment, and suggest potential risk factors in light of the current literature. Methods: We performed a single-center, retrospective review of posterior spinal fusion patients with DJF who underwent subsequent revision surgery between June 2009 and January 2019. Demographics and surgical details were collected. Radiographical measurements included the following: preoperative and postoperative sagittal and coronal alignment for each index or revision surgery. The upper-instrumented vertebra (UIV), lower instrumented vertebra (LIV), and fusion length were recorded. Results: Nineteen cases (64.7 ± 13.5 years, 12 women, seven men) were included. The mean follow-up was 4.7 ± 2.4 years. The number of instrumented levels was 6.79 ± 2.97. Among the patients, 84.2% (n = 16) presented at least one known DJF risk factor. LIV was frequently L5 (n = 10) or S1 (n = 2). Six patients had an initial circumferential fusion at the distal end. Initial DJFs were vertebral fracture distal to the fusion (n = 5), screw pull-out (n = 9), spinal stenosis (n = 4), instability (n = 4), and one early DJK. The distal mechanical complications after a first revision included screw pull-out (n = 4), screw fracture (n = 3), non-union (n = 2), and an iatrogenic spondylolisthesis. Conclusions: In this case series, insufficient sagittal balance restoration, female gender, osteoporosis, L5 or S1 LIV in long constructs were associated with DJF. Restoring spinal balance and circumferentially fusing the base of constructs represent key steps to maintain correction and prevent revisions. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Clinical Updates and Perspective)

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13 pages, 6198 KiB

Open AccessArticle

Effects of the Severity of Stenosis on Clinical Outcomes of Indirect Decompression Using Oblique Lumbar Interbody Fusion

by Dong-Ho Kang, Jonghyuk Baek, Bong-Soon Chang, Hyoungmin Kim, Seong Hwa Hong and Sam Yeol Chang

J. Clin. Med. 2024, 13(15), 4421; https://doi.org/10.3390/jcm13154421 - 28 Jul 2024

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Abstract

Background: No consensus has been reached regarding the efficacy of indirect decompression through oblique lumbar interbody fusion (OLIF) in severe lumbar spinal stenosis (LSS). This study investigated the impact of preoperative magnetic resonance imaging (MRI)-based grading of central and foraminal stenosis on OLIF outcomes in LSS patients and identified risk factors for postoperative clinical dissatisfaction. Methods: We retrospectively reviewed LSS patients who underwent OLIF with a minimum 1-year follow-up. Clinical scores obtained preoperatively and at 3, 6, 12, and 24 months postoperatively were analyzed using the substantial clinical benefit (SCB) framework. The severity of central and foraminal stenosis in the initial MRI was assessed through qualitative grading systems. Results: Among the 145 patients, with a mean follow-up of 33.7 months, those with severe central stenosis showed a significantly higher proportion of patients achieving SCB in the visual analog scale for leg pain (94.5% versus 83.1%; p = 0.044) at one year postoperatively than those without. However, those with severe foraminal stenosis showed significantly higher Oswestry Disability Index (ODI) scores (p = 0.024), and lower walking ability scores in the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) (p = 0.004) at one year postoperatively than those without. The presence of a foraminal osteophyte of the superior articular process (SAP) was a significant risk factor responsible for not achieving SCB in ODI and walking ability in JOABPEQ at one year postoperatively (odds ratio: 0.20 and 0.22, respectively). Conclusions: After OLIF, patients with severe central stenosis showed clinical outcomes comparable to those without. The improvement in ODI and walking ability in JOABPEQ was limited in patients with severe foraminal stenosis. Surgeons should consider direct decompression in cases with the presence of foraminal osteophytes of SAP. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Clinical Updates and Perspective)

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10 pages, 967 KiB

Open AccessArticle

Defining Age-Adjusted PI–LL Targets for Surgical Realignment in Adult Degenerative Scoliosis: A Retrospective Cohort Study

by Haoran Zhang, Yuanpeng Zhu, Xiangjie Yin, Dihan Sun, Shengru Wang and Jianguo Zhang

J. Clin. Med. 2024, 13(13), 3643; https://doi.org/10.3390/jcm13133643 - 21 Jun 2024

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Abstract

Objectives: The purpose of this study was to investigate postoperative pelvic incidence minus lumbar lordosis mismatch (PI–LL) and health-related quality of life (HRQOL) outcomes to determine age-adjusted PI–LL targets. Method: The dataset encompassed a range of variables, including age, sex, body mass index, Charlson comorbidity index, presence of osteopenia, hospital stay, operative duration, blood loss, American Society of Anesthesiologists score, number of fusion levels, lumbar lordosis, sagittal vertical axis, pelvic incidence, and PI–LL. The non-linear relationship between PI–LL and clinical outcomes was examined using a curve analysis, with adjustments made for potential confounding variables. Upon identification of a non-linear relationship, a two-piecewise regression model was employed to determine the threshold effect. Results: A total of 280 patients were enrolled. In the fully adjusted model, the optimal PI–LL target for patients aged 45–54 years old was PI–LL < 10°, the optimal target for patients aged 55–74 was 10–20°, and the optimal target for patients older than 75 years was more suitable for PI–LL > 20°. In the curve-fitting graph, it could be seen that the relationship between PI–LL and HRQOL outcomes was not linear in each age group. The peaks of the curves within each group occurred at different locations. Higher and lower thresholds for optimal surgical goals were determined using the two-piecewise regression model from the SRS-22 score and the ODI score. Conclusions: This study showed that the optimal PI–LL after corrective surgery in adult degenerative scoliosis patients should be adjusted according to age. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Clinical Updates and Perspective)

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11 pages, 747 KiB

Open AccessArticle

New Axially Expandable Oblique Cage Designed for Anterior to Psoas (ATP) Approach: Indications-Surgical Technique and Clinical-Radiological Outcomes in Patients with Symptomatic Degenerative Disc Disease

by Massimo Miscusi, Sokol Trungu, Luca Ricciardi, Stefano Forcato, Antonella Mangraviti and Antonino Raco

J. Clin. Med. 2024, 13(12), 3444; https://doi.org/10.3390/jcm13123444 - 12 Jun 2024

Viewed by 842

Abstract

Background: Standard oblique cages cannot cover endplates side-to-side, which is an important biomechanical factor for reducing the risk of cage subsidence and for restoring correct segmental lordosis. The aim of this study is to evaluate the radiological and clinical results of a new oblique lumbar interbody fusion (OLIF) axially expandable cage. Methods: This is a prospective observational case–control study. From March 2018 to June 2020, 28 consecutive patients with lumbar degenerative disease underwent an ATP approach, with the insertion of a new axially expandable cage, which was used as a stand-alone procedure or followed by posterior percutaneous pedicle fixation. Results: Twenty-eight patients in both groups met the inclusion criteria. The mean follow-up time was 31.2 months (range of 13–37). The clinical results were not significantly different, although in the control group, two major intraoperative complications were recorded, and slight improvements in ODI and SF-36 scores were observed in the study group. The radiological results showed a less frequent incidence of subsidence and a higher rate of fusion in the study group compared to controls. Conclusions: The axially expandable oblique cage for lumbar inter body fusion, specifically designed for the ATP approach, represents an innovation and a technical improvement. The insertion and the axial expansion technique are safe and easy. The large footprint could obtain solid and effective arthrodesis, potentially reducing the risk of subsidence. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Clinical Updates and Perspective)

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14 pages, 7512 KiB

Open AccessArticle

Novel Screw Placement Method for Extremely Small Lumbar Pedicles in Scoliosis

by Chang-Ju Hwang, Joo-Young Lee, Dong-Ho Lee, Jae-Hwan Cho, Choon-Sung Lee, Mi-Young Lee and So-Jung Yoon

J. Clin. Med. 2024, 13(4), 1115; https://doi.org/10.3390/jcm13041115 - 16 Feb 2024

Viewed by 1068

Abstract

Study Design: Consecutive case series. Objective: To propose a screw placement method in patients with extremely small lumbar pedicles (ESLPs) (<2 mm) to maintain screw density and correction power, without relying on the O-arm navigation system. Summary of Background Data: In scoliosis surgery, ESLPs can hinder probe passage, resulting in exclusion or substitution of the pedicle screws with a hook. Screw density affects correction power, making it necessary to maximize the number of screw placements, especially in the lumbar curve. Limited studies provide technical guidelines for screw placement in patients with ESLPs, independent of the O-arm navigation system. Methods: We enrolled 19 patients who underwent scoliosis correction surgery using our novel screw placement method for ESLPs. Clinical, radiological, and surgical parameters were assessed. After posterior exposure of the spine, the C-arm fluoroscope was rotated to obtain a true posterior–anterior view and both pedicles were symmetrically visualized. An imaginary pedicle outline was presumed based on the elliptical or linear shadow from the pedicle. The screw entry point was established at a 2 (or 10) o’clock position in the presumed pedicle outline. After adjusting the gear-shift convergence, both cortices of the transverse process were penetrated and the tip was advanced towards the lateral vertebral body wall, where an extrapedicular screw was placed with tricortical fixation. Results: Out of 90 lumbar screws in 19 patients, 33 screws were inserted using our novel method, without correction loss or complications during an average follow-up period of 28.44 months, except radiological loosening of one screw. Conclusions: Our new extrapedicular screw placement method into the vertebral body provides an easy, accurate, and safe alternative for scoliosis patients with ESLPs without relying on the O-arm navigation system. Surgeons must consider utilizing this method to enhance correction power in scoliosis surgery, regardless of the small size of the lumbar pedicle. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Clinical Updates and Perspective)

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14 pages, 3514 KiB

Open AccessSystematic Review

Efficacy and Safety of the Extreme Lateral Interbody Fusion (XLIF) Technique in Spine Surgery: Meta-Analysis of 1409 Patients

by Pablo Palacios, Isabel Palacios, Ana Palacios, Juan Carlos Gutiérrez, Gonzalo Mariscal and Alejandro Lorente

J. Clin. Med. 2024, 13(4), 960; https://doi.org/10.3390/jcm13040960 - 7 Feb 2024

Viewed by 1361

Abstract

(1) Objectives: The objective of this study was to quantify the exact clinical-radiological efficacy and safety of the extreme lateral interbody fusion (XLIF) technique in spinal surgery; (2) Methods: A meta-analysis was performed using PubMed, Embase, Scopus, and Cochrane Collaboration Library. Studies focusing on patients surgically treated with XLIF were included. The outcomes were as follows: visual analog scale (VAS) and Oswestry disability index (ODI), radiological outcomes, and adverse events. Cohort studies and case series were also included. Clinical outcomes were assessed at 12 months of age. Data were combined using Review Manager 5.4 and WebPlotDigitizer 13.1.4; (3) Results: Nineteen studies with a pool of 1409 patients were included in this meta-analysis. Leg pain VAS and back pain VAS significantly improved at 12 months (SMD 2.75, 95% CI 0.59–4.90; SMD 4.54, 95% CI 1.39–7.69). ODI showed significant improvement (MD 32.51, 95% CI 24.01–41.00) at 12 months. Disc height increased significantly (SMD −2.73, 95% CI −3.58 to −1.88). Lumbar lordosis and segmental lordosis were significantly corrected postoperatively (MD −2.44, 95% CI −3.45 to −1.43; MD −2.55, 95% CI −3.61 to −1.48). The fusion rates at 12 months ranged from 85.0% to 93.3%. The most frequent complications were transient neurological conditions (2.2%), hardware failure (1.9%), and transient pain (1.8%). The most frequent serious complications were nerve root injury (1.0%), gastrointestinal impairment (0.7%), and vertebral fractures (0.6%); (4) Conclusions: This is the first meta-analysis of the specific use of XLIF in spinal surgery. This study demonstrates that the XLIF technique in spine surgery is associated with good clinical and radiological results and a low complication rate. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Clinical Updates and Perspective)

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