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Current Progress and Future Directions of Spine Surgery
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Current Progress and Future Directions of Spine Surgery

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

Deadline for manuscript submissions: 20 September 2025 | Viewed by 10381

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 (10 papers)

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10 pages, 470 KiB  
Article
Comparing Clinical Outcomes of Microdiscectomy, Interspinous Device Implantation, and Full-Endoscopic Discectomy for Simple Lumbar Disc Herniation
by Chien-Ching Lee, Ruey-Mo Lin, Wei-Sheng Juan, Hao-Yu Chuang, Hung-Lin Lin, Cheng-Hsin Cheng and Chun-Hsu Yao
J. Clin. Med. 2025, 14(6), 1925; https://doi.org/10.3390/jcm14061925 - 13 Mar 2025
Viewed by 469
Abstract
Background/Objectives: The treatment for lumbar disc herniation (LDH) is surgical discectomy. This surgery may enhance spinal instability and exacerbate disc degeneration. The most common treatment options include microdiscectomy (MD), interspinous process device (IPD) implantation, and percutaneous endoscopic lumbar discectomy (PELD). As few [...] Read more.
Background/Objectives: The treatment for lumbar disc herniation (LDH) is surgical discectomy. This surgery may enhance spinal instability and exacerbate disc degeneration. The most common treatment options include microdiscectomy (MD), interspinous process device (IPD) implantation, and percutaneous endoscopic lumbar discectomy (PELD). As few studies have compared these three procedures, this study focused on collecting data on the clinical, functional, and imaging outcomes of surgery for symptomatic LDH. Methods: This is a retrospective, transverse, and analytical study, with a total of 383 patients who received operations for symptomatic LDH between 2018 and 2022. Medical information from the charts of these patients was collected. The results were followed up on for a minimum of one year by collecting responses from several questionnaires and clinical data, including patients’ scores on the visual analogue scale (VAS), Oswestry Disability Index (ODI), and symptomatic improvement score (SIS), as well as wound size, blood loss, hospital stay, postoperative disc change, and complications. Results: At the end of data collection, the VAS and ODI scores all showed significant improvement following these three procedures (p < 0.01). The SISs were all ranked as good (8.1, 8.5, and 7.9) post-surgery. PELD was a minimally invasive procedure that resulted in the smallest wound size (0.82 cm), minimal blood loss (21 mL), and a short hospital stay (4.2 days). A substantial pre-/postoperative change in disc height was noted in the MD (−17%) and PELD (−15%) groups. The complication rates were similar among the three groups (3%, 5%, and 5.6%). Conclusions: IPD implantation and PELD yielded outcomes comparable to those of conventional MD for symptomatic relief and functional recovery. Although the complication rates were similar, the postoperative complications were quite different from those of the other procedures. PELD resulted in rapid recovery and minimal invasion, and IPD implantation showed a good ability to preserve disc height and spinal stability; however, the clinical relevance of these findings in disc degeneration remains controversial. Full article
(This article belongs to the Special Issue Current Progress and Future Directions of Spine Surgery)
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19 pages, 3922 KiB  
Article
Evaluation of Cancellous Bone Density from C3 to L5 in 11 Body Donors: CT Versus Micro-CT Measurements
by Guido Schröder, Estelle Akl, Justus Hillebrand, Andreas Götz, Thomas Mittlmeier, Steffi S. I. Falk, Laura Hiepe, Julian Ramin Andresen, Reimer Andresen, Dirk Flachsmeyer-Blank, Hans-Christof Schober and Änne Glass
J. Clin. Med. 2025, 14(4), 1059; https://doi.org/10.3390/jcm14041059 - 7 Feb 2025
Viewed by 641
Abstract
Introduction: Comparative studies on Hounsfield units (HU) and bone volume fraction (BVF%) for the demonstration of cancellous bone density in the entire spine and in the various intravertebral regions are rare. The aim of the present study was to determine HU in various [...] Read more.
Introduction: Comparative studies on Hounsfield units (HU) and bone volume fraction (BVF%) for the demonstration of cancellous bone density in the entire spine and in the various intravertebral regions are rare. The aim of the present study was to determine HU in various segments and sectional planes (sagittal, axial, coronary) of the spine and their description in the context of bone density measurement on micro-CT, as well as the significance of the values for bone loss and fracture risk. Materials/Methods: The spines of 11 body donors were analyzed by means of high-resolution spiral CT and micro-CT. Vertebral deformities were identified on sagittal reformations and classified. Cancellous bone density in the individual vertebrae from C3 to L5, expressed in HU, was measured on CT images (in all 242 vertebral bodies). For this purpose, a manually positioned ROI was established in mid-vertebral cancellous bone in the axial, sagittal, and coronary planes. Using a Jamshidi® needle, we obtained 726 specimens from prepared vertebrae extracted from three quadrants (QI: right-sided edge, QII: central, QIII: left-sided edge) and analyzed these on a micro-CT device (SKYSCAN 1172, RJL Micro & Analytic GmbH, Germany). The study design with multiple measurements was reflected by a General Linear Model Repeated Measures. The model was adjusted to the bone density values of both procedures (HU, BVF%) in the viewed sectional planes and quadrants for 22 vertebrae, with the predictors gender and fracture status, controlled for age and body mass index (BMI). Analysis of variance provided estimations of density values and comparisons of several subgroups. Results: All spines were osteoporotic. Both procedures revealed a significant reduction in cancellous bone density from C3 to L5 (p ≤ 0.018). Gender (p = 0.002) and fracture status (p = 0.001) have an impact on bone density: men have higher bone density values than women; cases with fewer fractures also have higher bone density values. CT revealed both effects (p = 0.002 for each) with greater clarity. HU on CT measurements in the axial plane showed higher density values than in the sagittal or coronary planes. CT measurement profiles along the spine as well as along the individual profiles of the 11 body donors were independent of the measured quadrants, but the micro-CT measurements were not. Discussion: The craniocaudal reduction in bone density was demonstrated in different degrees of clarity by the two procedures. Likewise, the procedure-related visualization of differences in cancellous bone density between genders, fracture groups, sectional planes, and quadrants indicates the need for a better understanding of the advantages of each procedure for patient-oriented approaches to the diagnosis of osteoporosis. Future research should be focused on the determination of standard values and their clinical application for the prevention and treatment of osteoporosis. Full article
(This article belongs to the Special Issue Current Progress and Future Directions of Spine Surgery)
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13 pages, 1210 KiB  
Article
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 1054
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 [...] Read more.
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  
Article
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 821
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 [...] Read more.
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  
Article
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
Viewed by 910
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 [...] Read more.
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  
Article
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
Cited by 1 | Viewed by 1959
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 [...] Read more.
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  
Article
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 820
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 [...] Read more.
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  
Article
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 897
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 [...] Read more.
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  
Article
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 1439
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 [...] Read more.
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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9 pages, 20033 KiB  
Technical Note
Lumbopelvic Fixation: How to Be Less Invasive When You Cannot Be Minimally Invasive—A New Subcutaneous Supra-Fascial Approach to Minimize Open Iliac Screwing
by Carlo Brembilla, Emanuele Stucchi, Mario De Robertis, Giorgio Cracchiolo, Ali Baram, Gabriele Capo, Zefferino Rossini, Andrea Franzini, Marco Riva, Federico Pessina and Maurizio Fornari
J. Clin. Med. 2025, 14(5), 1600; https://doi.org/10.3390/jcm14051600 - 27 Feb 2025
Viewed by 428
Abstract
Background/Objectives: Lumbopelvic fixation (LPF) is essential for stabilizing the lumbosacral junction (LSJ) in cases of trauma, tumors, and other pathologies. While minimally invasive percutaneous techniques are preferred when feasible, open LPF remains necessary when direct sacral access is required. This study describes a [...] Read more.
Background/Objectives: Lumbopelvic fixation (LPF) is essential for stabilizing the lumbosacral junction (LSJ) in cases of trauma, tumors, and other pathologies. While minimally invasive percutaneous techniques are preferred when feasible, open LPF remains necessary when direct sacral access is required. This study describes a modified open LPF technique designed to minimize invasiveness while maintaining effective stabilization. Methods: We present a case of sacral metastasis requiring LPF. The surgical technique involves a linear midline incision, meticulous subfascial dissection to preserve the Longissimus thoracis and Iliocostalis lumborum muscles, and a subcutaneous supra-fascial approach for iliac screw placement guided by intraoperative CT navigation. A U-shaped cross-link is used for final construct stability. The case illustrates the application of this technique in a 56-year-old female patient with metastatic breast carcinoma involving the sacrum, complicated by nerve compression and urinary retention. Results: The patient underwent successful LPF with nerve root decompression and partial tumor resection. Postoperatively, she experienced no new neurological deficits and demonstrated progressive improvement in sphincter function. The described surgical approach minimized soft tissue disruption, blood loss, and potential complications associated with more extensive dissection. Six-month follow-up CT scans confirmed the stability of the LPF construct and the residual lesion. Conclusions: When open LPF is unavoidable, the described subcutaneous supra-fascial approach for iliac screw placement, combined with muscle preservation and a U-shaped cross-link, offers a less invasive alternative that minimizes soft tissue trauma, reduces potential complications, and facilitates faster patient recovery. This technique can be particularly beneficial in patients with sacral metastases requiring nerve decompression and tumor resection. Full article
(This article belongs to the Special Issue Current Progress and Future Directions of Spine Surgery)
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