Surgical Management of Spinal and Paraspinal Degeneration: Innovative Approaches and Clinical Outcomes

Spinal degeneration remains one of the leading causes of chronic disability globally, with surgical management representing a critical but complex intervention across a spectrum of patient profiles. As the field advances, growing evidence highlights the interdependence between intervertebral disc pathology and paraspinal muscle integrity—a relationship with direct implications for surgical planning and long-term outcomes.Modern spinal biomechanics recognizes a pathogenic, bidirectional feedback loop between intervertebral disc degeneration (IVDD) and the degradation of the lumbar paraspinal muscles—specifically the multifidus, erector spinae, and psoas major. Rather than acting as passive bystanders to spinal aging, these muscles serve as critical dynamic stabilizers. When they undergo structural decay, they actively accelerate spinal instability, alter sagittal alignment, and compromise surgical outcomes. The deeply situated multifidus acts as the primary local segment stabilizer, while the superficial erector spinae acts as a global mobilizer controlling shear forces. The psoas major and quadratus lumborum provide essential structural equilibrium under axial and lateral loads.Severe muscle degeneration steers surgeons away from traditional open procedures—which strip muscles from bone and cause ischemic necrosis—toward minimally invasive surgery (MIS). Techniques like MIS-TLIF utilize inter-muscular corridors via the Wiltse approach, while LLIF/OLIF routes bypass the posterior tension band entirely to protect spinal alignment.Patients with advanced fatty infiltration face significantly higher risks of proximal junctional kyphosis (PJK), hardware failure, and chronic post-operative pain. Consequently, rehabilitation must avoid premature high-load extension, focusing instead on low-load motor control training to safely re-establish neuromuscular pathways. While structural stabilization via fusion can partially reverse fatty degeneration within 12 months, long-term targeted exercise is vital to protect adjacent segments and ensure lasting surgical success.This Research Topic welcomes original research, systematic reviews, case series, and clinical studies addressing the surgical management of spinal and paraspinal degeneration. We welcome submissions covering, but not limited to, the following themes:• The role of paraspinal muscle degeneration and fatty infiltration in spinal instability and sagittal balance• Imaging biomarkers and quantitative assessment of paraspinal muscle quality for surgical planning• Comparative outcomes of minimally invasive versus open approaches in degenerated spines• MIS-TLIF, LLIF, OLIF, and other muscle-sparing techniques: indications, outcomes, and complications• Predictors and prevention of proximal junctional kyphosis (PJK) and hardware failure• Strategies to preserve or restore paraspinal muscle function during and after surgery• Postoperative rehabilitation protocols and motor control training following spinal fusion• Reversibility of fatty degeneration and adjacent segment protection after stabilization• Patient-reported outcomes, chronic post-operative pain, and quality-of-life data• Emerging technologies, navigation, robotics, and biomechanical modeling in degenerative spine surgery• Role of artificial intelligence and machine learning for quantitative assessment of paraspinal muscles• Paraspinal muscle alterations in spine deformities Topic editors: Murat Şakir Ekşi, Emel Ece Özcan Ekşi, Uruj Zehra, Gaston Camino-Willhuber Source: https://www.frontiersin.org/research-topics/82980/surgical-management-of-spinal-and-paraspinal-degeneration-innovative-approaches-and-clinical-outcomes