An International Delphi Consensus on Defining the Optimal Surgical Composite Outcome in Metastatic Spine Disease (OSCO-M).

Study Design: Delphi Consensus.

Objective: To define an optimal surgical composite outcome measure in patients with metastatic spine disease (OSCO-M) through international consensus among key opinion leaders.

Methods: Members of the AO Spine Knowledge Forum Tumor, an international group of dedicated spine oncology surgeons and oncologists, participated in a modified Delphi process between March 2023 and November 2024.

The Spinal Chordoma Patient Reported Outcome Survey (spCPROS): a patient-centered, disease-specific tool for assessing quality of life in spinal chordoma patients.

Purpose: Chordomas present most frequently in the lumbosacral spine. Spinal chordomas and treatment sequelae significantly affect quality of life (QOL) due to proximity of major neurovascular structures and the aggressive management required. However, since there are no validated instruments for this population, we aimed to develop a novel QOL metric for spinal chordoma patients.

Evaluation of Adverse Events and the Impact on Health-Related Outcomes in Patients Undergoing Surgery for Metastatic Spine Tumors: Analysis of the Metastatic Tumor Research and Outcomes Network (MTRON) Registry Dataset.

Study DesignThis study is part of the AO Spine Metastatic Tumor Research and Outcomes Network [MTRON], an international multicenter prospective observational registry including patients with spinal metastases.ObjectivesThis study aims to elucidate the incidence of surgical complications, their risk factors and consequent effects on survival outcomes, hospital length of stay, and overall health-related quality of life (HRQOL) parameters in a large cohort of patients affected by spinal metastases who were surgically treated.MethodsAvailable data from February 2017 to July 2023 were analyzed.

An Appraisal of the Quality of Development and Reporting of Predictive Models in Spine Surgery.

Study DesignLiterature review.ObjectiveThe Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) statement was developed to improve the generalizability of predictive models. This study systematically evaluated the quality of predictive models related to spine procedures and assessed their compliance with the TRIPOD guidelines.

ROCK-dependent mechanotransduction of macroscale forces drives fibrosis in degenerative spinal disease.

Chronic repetitive forces on the spinal column promote the development of degenerative spinal disease. Yet the mechanisms linking such macroscale mechanical forces to tissue hypertrophy remain unknown. Here we show that fibrotic regions in human ligamentum flavum naturally exposed to high stress display elevated Rho-associated kinase (ROCK) signalling and an increased density of myofibroblasts expressing smooth muscle actin α.

The impact of semaglutide use for weight loss on transforaminal lumbar interbody fusion outcomes.

Introduction: While glucagon-like peptides 1 receptor agonists (GLP-1RAs) grow in popularity, their potential for presurgical weight optimization in spine surgery remains unclear. We examined the influence of semaglutide prescription on one- to three-level transforaminal lumbar interbody fusion (TLIF) outcomes.

Methods: Retrospective analysis of obese, non-diabetic patients was conducted from 2018 to 2022.

AtlasGPT: a language model grounded in neurosurgery with domain-specific data and document retrieval.

Objective: Large language models (LLMs) have shown promising performance on medical licensing examinations, but their ability to excel in subspecialty domains and their robustness under adversarial conditions remain unclear. Herein, the authors present AtlasGPT, a subspecialty-focused LLM for neurosurgery, and evaluate its performance on a benchmark multiple-choice question bank and under adversarial testing, as well as its ability to generate high-quality explanations.

Methods: AtlasGPT was built by fine-tuning GPT-4 architecture and retrieval-augmented generation from neurosurgical knowledge sources.

The utilization of hypoalbuminemia as a prognostic metric in patients with spinal metastases: A scoping review.

Introduction: Hypoalbuminemia is associated with poor outcomes in cancer patients, but its role in spinal metastases remains unclear.

Research Question: This study aimed to identify albumin cutoff values defining hypoalbuminemia and describe the association between serum albumin and outcomes in patients with spinal metastases.

Material And Methods: A narrative review of articles up to December 2022 was conducted using PubMed/Medline, EMBASE, and Web of Science databases.

Comparison of Outcomes Between Staged and Same-Day Circumferential Spinal Fusion for Adult Spinal Deformity: Systematic Review and Meta-Analysis.

Background: Adult spinal deformity (ASD) is a prevalent condition often treated with circumferential spinal fusion (CF), which can be performed as staged or same-day procedures. However, evidence guiding the choice between these approaches is lacking.

Objective: This study aims to compare patient outcomes following staged and same-day CF for ASD.

Surgical Adverse Events for Primary Tumors of the Spine and Their Impact on Outcomes: An Observational Study From the Primary Tumors Research and Outcomes Network.

Background And Objectives: Aggressive resection for primary tumors of the spine are associated with a high rate of adverse events (AEs), but the impact of AEs on patient-reported outcomes (PROs) remains unknown and is critical to the shared decision-making. Our primary objective was to assess the impact of surgical AEs on PROs using an international registry. Assessing the impact on clinical outcomes and identifying risk factors for AEs were our secondary objectives.

The effect of time to balloon kyphoplasty on osteoporotic vertebral compression fractures: a systematic review with meta-analysis.

Background: Vertebral compression fractures (VCFs) cause significant morbidity in the elderly population. This study aimed to determine the difference in pain-related outcomes in the elderly population who suffered vertebral body fractures, treated with balloon kyphoplasty at "early" (<4 weeks) and "late" (>4 weeks) stages. To the best of our knowledge, this has not been previously evaluated in a meta-analysis.

Unmasking Racial, Ethnic, and Socioeconomic Disparities in United States Chordoma Clinical Trials: Systematic Review.

Background: Chordoma is a rare bone cancer with limited treatment options. Clinical trials are crucial for developing effective therapies, but their success depends on including diverse patient populations. The objective of this study was to systematically evaluate the reporting of racial, ethnic, and socioeconomic diversity in United States clinical trials exploring treatment for chordoma.

Malnutrition in Spine Oncology: Where Are We and What Are We Measuring?

Study Design: Scoping review.

Objective: To identify which markers are used as surrogates for malnutrition in metastatic spine disease and which are the most studied outcomes associated with it.

Methods: A scoping review was performed by searching the PubMed/Medline, EMBASE, and Web of Science databases up to July 2022.

Appropriate use criteria for neoplastic compression fractures.

Background Context: Clinical outcomes are directly related to patient selection and treatment indications for improved quality of life. With emphasis on quality and value, it is essential that treatment recommendations are optimized.

Purpose: The purpose of the North American Spine Society (NASS) Appropriate Use Criteria (AUC) is to determine the appropriate (ie, reasonable) multidisciplinary treatment recommendations for patients with metastatic neoplastic vertebral fractures across a spectrum of more common clinical scenarios.

Overview of Molecular Prognostication for Common Solid Tumor Histologies - What the Surgeon Should Know.

Study Design: Narrative Literature review.

Objective: To provide a general overview of important molecular markers and targeted therapies for the most common neoplasms (lung, breast, prostate and melanoma) that metastasize to the spine and offer guidance on how to best incorporate them in the clinical setting.

Methods: A narrative review of the literature was performed using PubMed, Google Scholar, Medline databases, as well as the histology-specific National Comprehensive Cancer Network guidelines to identify relevant articles limited to the English language.

Prevention and Management of Posterior Wound Complications Following Oncologic Spine Surgery: Narrative Review of Available Evidence and Proposed Clinical Decision-Making Algorithm.

Study Design: Narrative Review.

Objective: Contextualized by a narrative review of recent literature, we propose a wound complication prevention and management algorithm for spinal oncology patients. We highlight available strategies and motivate future research to identify optimal and individualized wound management for this population.

What is the Optimal Management of Metastatic Spine Patients With Intermediate Spinal Instability Neoplastic Scores: To Operate or Not to Operate?

Study Design: Systematic review.

Objective: In patients with extradural metastatic spine disease, we sought to systematically review the outcomes and complications of patients with intermediate Spinal Instability Neoplastic Score (SINS) lesions undergoing radiation therapy, percutaneous interventions, minimally invasive surgeries, or open spinal surgeries.

Methods: Following PRISMA guidelines for systematic reviews, MEDLINE, EMBASE, Web of Science, the Cochrane Database of Systematic Reviews and the Cochrane Center Register of Controlled Trials were queried for studies that reported on SINS intermediate patients who underwent: 1) radiotherapy, 2) percutaneous intervention, 3) minimally invasive, or 4) open surgery.

The literacy barrier in clinical trial consents: a retrospective analysis.

Background: Historically, the readability of consent forms in medicine have been above the average reading level of patients. This can create challenges in obtaining truly informed consent, but the implications on clinical trial participant retention are not fully explored. To address this gap, we seek to analyze clinical trial consent forms by determining their readability and relationship with the associated trial's participant dropout rate.

Assessing the prognostic impact of body composition phenotypes on surgical outcomes and survival in patients with spinal metastasis: a deep learning approach to preoperative CT analysis.

Objective: The prognostic significance of body composition phenotypes for survival in patients undergoing surgical intervention for spinal metastases has not yet been elucidated. This study aimed to elucidate the impact of body composition phenotypes on surgical outcomes and 5-year survival.

Methods: The records of patients treated surgically for spinal metastases between 2010 and 2020 were retrospectively evaluated.

Comparative Analysis of Surgical Outcomes in Separation Surgery Versus Anterior Reconstruction for Metastatic Epidural Spinal Cord Compression.

Study Design: Retrospectively matched case-control study.

Objective: To compare intraoperative and postoperative outcomes between separation surgery and corpectomy with anterior reconstruction for patients with metastatic epidural spinal cord compression (MESCC).

Summary Of Background Data: The primary goal of surgery for MESCC is to preserve and improve neurological function.

Surgical Outcomes After Preoperative Embolization in Hypervascular Spinal Metastases: A Propensity Scored Study of 191 Patients.

Study Design: Retrospective propensity-score matched, case-control study at 2 academic tertiary care centers.

Objective: To assess the effect of preoperative embolization (PE) on (1) intraoperative blood loss, defined as conventional estimates of blood loss (EBL) and hemoglobin mass loss; and (2) secondary outcomes in patients with spinal metastases from hypervascular histologies.

Background Context: PE intends to reduce blood loss during surgery for spinal metastases of hypervascular tumors such as renal cell carcinoma.

Semaglutide exposure and its association with adverse outcomes in diabetic patients undergoing transforaminal lumbar interbody fusion for lumbar degenerative disc disease.

Objective: Semaglutide, a novel glucagon-like peptide-1 receptor agonist, has transformed the therapeutic landscape for type 2 diabetes mellitus. However, its effect on osteoclast activity and its potential to induce weight-related muscle loss raises concerns about its impact on spine surgery outcomes. As such, evaluating semaglutide's influence on transforaminal lumbar interbody fusion (TLIF) is imperative, given the procedure's reliance on successful bony fusion to prevent postoperative instability and further interventions.

Exploring the energetic and conformational properties of the sequence space connecting naturally occurring RNA tetraloop receptor motifs.

Folded RNAs contain tertiary contact motifs whose structures and energetics are conserved across different RNAs. The transferable properties of RNA motifs simplify the RNA folding problem, but measuring energetic and conformational properties of many motifs remains a challenge. Here, we use a high-throughput thermodynamic approach to investigate how sequence changes alter the binding properties of naturally occurring motifs, the GAAA tetraloop • tetraloop receptor (TLR) interactions.