Fehlings Michael G, Ahuja Christopher S, Mroz Thomas, Hsu Wellington, Harrop James
Krembil Research Institute, Toronto Western Hospital, Toronto, Canada.
Departments of Orthopaedic and Neurological Surgery, The Cleveland Clinic, Cleveland, Ohio.
Neurosurgery. 2017 Mar 1;80(3S):S1-S8. doi: 10.1093/neuros/nyw112.
This focus issue highlights state-of-the-art techniques, equipment, and practices in the modern era of spine surgery while providing a glimpse into the next generation of patient care. A broad range of topics are presented to cover the full spectrum of the field. Degenerative diseases are discussed in a series of 3 articles on (1) pathophysiology, management, and surgical approaches to degenerative cervical myelopathy; (2) novel approaches to degenerative thoracolumbar disease (eg, interspinous process spacers, minimally invasive/endoscopic approaches); and (3) animal models and emerging therapeutics in degenerative disk disease. Also included is a unique study aiming to establish the critically important cost-benefit relationship for spine procedures with perspectives on how value is defined and how to address variability.Primary and metastatic spine oncology are reviewed with a focus on upcoming targeted biologics, subspecialized radiotherapy (eg, proton-beam, carbon-ion, stereotactic radiosurgery), genetic profiling to stratify risk, and morbidity-reducing surgical approaches (eg, minimally invasive/endoscopic resections, percutaneous instrumentation). Trauma is discussed in 2 high-quality papers on controversies in spinal trauma and neuroprotective/neuroregenerative interventions for traumatic spinal cord injury. A stimulating article on cervical, thoracolumbar, and pediatric deformity highlights the rapid evolution of deformity surgery with a look at innovative tools (eg, high-fidelity 3-dimensional reconstructions, magnetically controlled growing rods) and their impact on quality of life. Additionally, a must-read article on surgical site infections discusses key risk factors and evidence-based preventative techniques to remain aware of. Finally, cutting-edge technologies, including computer-assisted navigation, shared-control robotics, neuromodulation, novel osteobiologics, and biomaterials, are covered in detail in a series of 3 fascinating papers on the next generation of the field.Each section intends to highlight the salient literature and afford insights from multiple key thought leaders in an effort to minimize bias and provide varied perspectives. Overall, we hope this issue provides high-quality, evidence-based data relevant to trainees and practicing surgeons while also stimulating excitement about the future of spine surgery.
本期重点专题突出了脊柱外科现代时代的先进技术、设备和实践，同时让读者得以一瞥下一代患者护理的情况。文中呈现了广泛的主题，涵盖了该领域的各个方面。关于退行性疾病的内容在一系列3篇文章中进行了讨论，分别是：（1）退行性颈椎脊髓病的病理生理学、管理及手术方法；（2）退行性胸腰椎疾病的新方法（如棘突间撑开器、微创/内镜手术方法）；以及（3）退行性椎间盘疾病的动物模型和新兴治疗方法。此外，还包括一项独特的研究，旨在确立脊柱手术至关重要的成本效益关系，并探讨价值如何定义以及如何应对变异性。原发性和转移性脊柱肿瘤学也进行了综述，重点关注即将出现的靶向生物制剂、专科放疗（如质子束、碳离子、立体定向放射外科）、用于风险分层的基因分析以及降低发病率的手术方法（如微创/内镜切除术、经皮器械置入）。创伤方面在2篇高质量论文中进行了讨论，分别涉及脊柱创伤的争议以及创伤性脊髓损伤的神经保护/神经再生干预。一篇关于颈椎、胸腰椎和小儿脊柱畸形的精彩文章突出了畸形手术的快速发展，介绍了创新工具（如高保真三维重建、磁控生长棒）及其对生活质量的影响。此外，一篇必读的关于手术部位感染的文章讨论了关键风险因素和循证预防技术，值得关注。最后，包括计算机辅助导航、共享控制机器人技术、神经调节、新型骨生物制剂和生物材料在内的前沿技术，在一系列3篇引人入胜的关于该领域下一代发展的论文中进行了详细阐述。每个部分都旨在突出重要文献，并提供多位关键思想领袖的见解，以尽量减少偏见并提供多样的观点。总体而言，我们希望本期能为实习医生和执业外科医生提供高质量、循证的数据，同时也激发人们对脊柱外科未来发展的热情。
