Assessment of Multimodal Natural Language Processing in Ascertaining Perioperative Safety Indicators From Preoperative Notes in Spine Surgery.

Introduction: Standard spine surgery machine learning (ML) models often rely on structured clinical data, overlooking nuanced free text, such as preoperative surgical notes. The aims of this work were to develop a multimodal ML model combining structured electronic health record (EHR) data with natural language-processed unstructured clinical narratives.

Methods: After testing against Convolutional Neural Network, Support Vector Machine, LightGBM, and Random Forest algorithms, the XGBoost algorithm was selected for model development.

Multimodal machine learning for risk-stratified bundled payments in spinal surgery.

Accurate prediction of financial metrics in spine surgery is crucial as healthcare transitions to value-based care. While bundled payment models have succeeded in other orthopedic procedures, the heterogeneity of spinal surgery complicates their adoption. We develop the first preoperative risk-stratified multimodal machine learning model that integrates structured clinical data and unstructured surgeon notes using natural language processing to predict financial parameters.

The characterization of frailty in spine surgery: a systematic review of frailty indices.

Purpose: Frailty is a key predictor of postoperative outcomes in spine surgery, yet its definition varies widely across studies. Most research relies on comorbidity-based indices like the modified frailty index (mFI), overlooking the multidimensional nature of frailty. The purpose of this systematic review is to identify the frailty indices in use, assess their prevalence, and evaluate their association with clinical outcomes.

Spinal cord stimulator utilization trends and predictors of unsuccessful trial-to-implant conversion.

Background: Spinal cord stimulators (SCS) are neuromodulatory devices that may be considered for refractory back or neurologic pain. Trends in SCS utilization and factors associated with failure of trial-to-implant conversion are not well defined.

Methods: Using the 2010 - 2022 PearlDiver Mariner Patient Claims Database, adults who underwent SCS trial were identified and categorized into those who did or did not undergo conversion to permanent SCS implantation.

Safety and efficacy of tranexamic acid in oncologic surgery for spinal metastases: A systematic review.

Background: Tranexamic acid (TXA) has shown efficacy in reducing blood loss in various surgical specialties without increasing thromboembolic risks, but its role in metastatic spinal tumor surgery (MSTS) remains unclear. This systematic review synthesized evidence on the safety and efficacy of TXA in MSTS.

Methods: PubMed, Cochrane, and Epistemonikos were searched from inception to February 1, 2025 for studies reporting on TXA use in MSTS.

Are hospital experience scores correlated with patient-reported outcome measures following elective spine surgery?

Objective: Patient experience scores are hospital-centric metrics, which are becoming increasingly important in healthcare quality assessment; however, the factors that influence these scores are poorly defined. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a nationally administered, publicly reported patient experience survey that exerts a major influence on hospital reimbursement by the Centers for Medicare and Medicaid Services (CMS). The purpose of this study was to investigate the correlation between HCAHPS scores and postoperative patient-reported outcome measures (PROMs) up to 5 years after elective cervical and thoracolumbar spine surgery.

Glucagon-like peptide-1 receptor agonist use prior to spinal surgery results in reduced postoperative length of stay: A propensity-score matched analysis.

Background: While glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated benefits in reducing complications following total knee and hip arthroplasty, their effects in spinal surgery remain unclear. Prior studies have reported mixed results across select spinal fusion procedures, and the impact of GLP-1 RAs on perioperative outcomes has not been well-defined. This study evaluates the association between preoperative GLP-1 RA use and key perioperative outcomes in spinal surgery.

Return to Activities of Daily Living After Fusion to the Pelvis for Adult Spinal Deformity.

Study Design: Cross-sectional survey and retrospective review of prospectively collected data.

Objective: To investigate return to activities among patients with adult spinal deformity (ASD) after long-segment fusion to the pelvis.

Background: No prior studies have assessed the extent and timing of return to employment, driving, and walking among a single cohort of patients with ASD.

Projections of single-level indirect lumbar interbody fusion volume and associated costs for Medicare patients to 2050.

Background: Anterior, Oblique, and Lateral Lumbar Interbody Fusions (ALIF/OLIF/LLIF) are powerful modalities for achieving indirect decompression of lumbar foraminal stenosis while providing a large fusion surface and preserving the posterior vertebral structures. This study aimed to project future trends in the implementation rates and associated costs of ALIF/OLIF/LLIF in Medicare patients aged >65 in the US.

Methods: Data was acquired from the Centers for Medicare and Medicaid Services (CMS) from January 1, 2000 to December 31, 2022, using CPT codes to identify ALIF/OLIF/LLIF procedures.

Zero-Profile Stand-Alone Cages Versus Traditional Cage-and-Plate Constructs in Single and Multi-Level Anterior Cervical Discectomy and Fusion: A Propensity-Matched Analysis Using Validated Fusion Assessment Methods.

ObjectivesStand-alone (SA) and anterior cage-and-plate (ACP) have been studied in anterior cervical discectomy and fusion (ACDF). However, fusion assessment methods vary and existing studies are not propensitymatched and often lack patient-reported outcomes (PROMs). We compare fusion rates between propensity-matched single- and multi-level SA versus ACP using a method validated by intraoperative motion testing during revision surgery.

Multimodal machine learning for predicting perioperative safety indicators in spinal surgery.

Background Context: Machine learning (ML) algorithms can utilize the large amount of tabular data in electronic health records (EHRs) to predict perioperative safety indicators. Integrating unstructured free-text inputs via natural language processing (NLP) may further enhance predictive accuracy.

Purpose: To design and validate a preoperative multimodal ML architecture that integrates structured EHR data (patient demographics, comorbidities, and clinical covariates) with unstructured free-text inputs (past medical and surgical history, medications, and problem lists) via NLP.

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.

Impact of Single-Level Minimally Invasive Versus Open L4-L5 and L5-S1 Transforaminal Lumbar Interbody Fusion on Postoperative Distal and Lumbar Lordosis.

Study Design: Retrospective cohort study.

Objective: To compare distal lordosis (DL) and lumbar lordosis (LL) generated by single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and open TLIF at L4-L5 and L5-S1.

Summary Of Background Data: Restoring or maintaining L4-S1 DL and LL is an important component of TLIF surgery.

Diagnosis and treatment of postoperative voice complications following anterior cervical discectomy and fusion: a systematic review.

Background: There is a wide discrepancy in the literature regarding the incidence of postoperative dysphonia following ACDF. How postoperative dysphonia is measured is also inconsistent, with many studies relying on patient-reported outcomes rather than diagnostic laryngoscopy. The purpose of this study was to consolidate information regarding dysphonia after ACDF to improve diagnosis and management.

Racial, ethnic, and socioeconomic disparities in clinical trial reporting for metastatic spine tumors: An exploration of North American studies.

Purpose: The objective of this study was to evaluate the reporting of racial, ethnic, and socioeconomic data in clinical trials exploring the management of metastatic spine disease (MSD).

Methods: We undertook a cross-sectional analysis of North American completed and published clinical trials registered on ClinicalTrials.gov exploring the management of patients with MSD.

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.

Immunologic and Targeted Molecular Therapies for Chordomas: A Narrative Review.

Chordomas are rare sarcomas arising from notochordal tissue and occur most commonly in the spine. The standard of care for chordomas without evidence of metastatic disease generally consists of en bloc resection followed by adjuvant radiotherapy. However, long-term (20-year) survival rates are approximately 30%.

Off-Label Bone Morphogenetic Protein 2 Use Results in Successful Posterolateral Lumbar Fusion in a Veteran Population.

Introduction: Patients within the US Veterans Health Administration (VA) system have higher rates of comorbidities and chronic pain, increasing risks of complications/poor outcomes following spine surgery. Although the use of bone morphogenetic protein 2 (BMP-2) is established for anterior lumbar interbody fusion, its indications for off-label use in posterolateral fusion are unclear. The objective of this study was to evaluate safety and utility of BMP-2 in posterolateral fusion through a 15-year experience at the VA.

Racial Disparities in Patients with Metastatic Tumors of the Spine: A Systematic Review.

Objective: Disparities in access and delivery of care have been shown to disproportionately affect certain racial groups. Studies have been conducted to assess these disparities within the spinal metastasis population, but the extent of their effects in the setting of other socioeconomic measures remains unclear. The purpose of this study was to perform a systematic review to understand the effect of racial disparities on outcomes in patients with metastatic spine disease.

Predictors of Clavien-Dindo Grade III-IV or Grade V Complications after Metastatic Spinal Tumor Surgery: An Analysis of Sociodemographic, Socioeconomic, Clinical, Oncologic, and Operative Parameters.

The rate of major complications and 30-day mortality after surgery for metastatic spinal tumors is relatively high. While most studies have focused on baseline comorbid conditions and operative parameters as risk factors, there is limited data on the influence of other parameters such as sociodemographic or socioeconomic data on outcomes. We retrospectively analyzed data from 165 patients who underwent surgery for spinal metastases between 2012-2023.

Total Shoulder Arthroplasty is associated With Less Pain and Better Functional Outcomes, but Humeral Head Resurfacing may be Preferred in Younger, Higher Demand Patients: A Short-Term Outcomes Study in Patients with Glenohumeral Osteoarthritis.

Objectives: This study aimed to compare short-term outcomes following Total Shoulder Arthroplasty (TSA) and Humeral Head Resurfacing (HHR) in patients with glenohumeral osteoarthritis (GHOA).

Methods: A retrospective analysis included patients who had undergone either TSA or HHR for GHOA at a single institution. Baseline demographics, complications, range of motion (active forward flexion, FF and active external rotation, ER), visual analog scores (VAS), and Subjective Shoulder Values (SSV) were collected.

Return to sporting activities following long fusions to the pelvis in adult spinal deformity.

Background Context: Returning to recreational sporting activities after adult spinal deformity (ASD) correction may significantly impact the patient's perceived quality of life.

Purpose: This study sought to characterize participation in sporting activities before and after ASD surgery, and to identify factors associated with impaired return to sports.

Study Design: Cross-sectional survey and retrospective review of prospectively collected data.

Area Socioeconomic Status is Associated with Refusal of Recommended Surgery in Patients with Metastatic Bone and Joint Disease.

Background: This study sought to identify associations between the Yost Index, a geocoded area neighborhood socioeconomic status (nSES) score, and race/ethnicity with patient refusal of recommended surgery for metastatic bone disease.

Methods: Patients with metastatic bone disease were extracted from the Surveillance, Epidemiology, and End Results database. The Yost Index was geocoded using factor analysis and categorized into quintiles using census tract-level American Community Service (ACS) 5-year estimates and seven nSES measures.