Lumbar Spinal Fusion: Established Surgical Techniques and Innovative Approaches

TOPICAL COLLECTIONS

Guest Editor

Guglielmo Iess

ICCS Istituto Clinico Città Studi Milano

Dr. Guglielmo Less is a neurosurgeon at the department of vertebral surgery at ICCS Istituto Clinico Città Studi Milano, Italy. He obtained his medical degree cum laude in 2016 at the University of Rome “Tor Vergata” and completed his residency in neurosurgery at the University of Milan in January 2023. His dissertation focused on a novel mini-invasive technique for lumbar fusion called “the facet wedge”. During the same year he received ECFMG certification (the standard for evaluating the qualifications of international medical graduates in the U.S.). His current research areas include identifying predictive factors of favorable clinical outcome in lumbar surgery and implementing surgical techniques to prevent adjacent segment disease secondary to lumbar arthrodesis. He is an author of 15 peer-reviewed publications in the last 3 years and a peer reviewer for several indexed journals (World Neurosurgery, Surgical Neurology International, Frontiers in Oncology).

Collection Overview

Lumbar fusion (also known as arthrodesis) is a surgical procedure used to join two or more vertebrae by promoting the growth of intervertebral bony bridges. Depending on the vertebrae elements being fused, it can be divided into three categories: (1) Interbody, (2) Posterolateral, and (3) Articular. Since the description of the first cases carried out by Dr. Russell A. Hibbs in 1911 and subsequently by Dr. Fred H. Albee for tuberculosis, lumbar fusion has become one of the most routinely performed surgical procedures. Its indications have extended to encompass a wide range of lumbar pathologies, including degenerative spondylolisthesis, trauma, infection, and neoplasia.

In recent years, significant effort has been devoted to developing novel approaches, innovative surgical techniques, and technologies to enhance patient outcomes, reduce surgical complications, and shorten recovery times. Alongside well-established traditional approaches (PLIF, ALIF, TLIF), less invasive tissue-sparing strategies such as minimally invasive TLIF, LLIF, OLIF, and endoscopic approaches are rapidly gaining prominence in lumbar arthrodesis. The latest advancements in spinal instrumentation hardware (e.g., cortical pedicle screws, facet wedge fixation, biological substances to increase union rate) and the utilization of modern technologies (e.g., robotics) have also significantly expanded the spinal surgeon's toolbox.

This Methods Collection aims to present both well-established surgical techniques and innovative approaches, providing insights into the current state of lumbar fusion and its promising prospects.