Enhancing Magnetic Resonance Imaging (MRI) Report Comprehension in Spinal Trauma: Readability Analysis of AI-Generated Explanations for Thoracolumbar Fractures.

Background: Magnetic resonance imaging (MRI) reports are challenging for patients to interpret and may subject patients to unnecessary anxiety. The advent of advanced artificial intelligence (AI) large language models (LLMs), such as GPT-4o, hold promise for translating complex medical information into layman terms.

Objective: This paper aims to evaluate the accuracy, helpfulness, and readability of GPT-4o in explaining MRI reports of patients with thoracolumbar fractures.

Comparing Three and Four-Rod Constructs in Adult Spinal Deformity Patients With Long Fusions to the Pelvis: Is There a Difference in Rod Fractures and Revision Rates at Minimum 2-Year Follow-up?

Study Design: Single-center retrospective cohort study.

Objective: To determine if the 4-rod construct (4RC) is protective against the occurrence of rod fractures when compared with the 3-rod construct (3RC) in adult spinal deformity (ASD) patients with long fusions to the sacrum.

Summary Of Background Data: Past studies have explored the different outcomes in subjects with dual-rod versus multirod constructs.

Vitality of global alignment following adult spinal deformity surgery to long-term improvement of patient-reported outcomes regardless of regional alignment.

Objective: The objective of this study was to discern whether patients who achieve a cranial sagittal vertical axis to the hip (CrSVA-H) < 2 cm at 2 years of follow-up, regardless of mismatch between pelvic incidence and lumbar lordosis (PI-LL), have a greater improvement in patient-reported outcome measures (PROMs).

Methods: This was a retrospective analysis of a prospectively collected single-center database of adult spinal deformity (ASD) patients who underwent corrective surgery with a minimum follow-up of 2 years. Patient demographics, perioperative data, radiographic parameters, and PROMs were collected at baseline and follow-up.

The Efficacy of Prophylactic Vancomycin in Decreasing Surgical Site Infections in Adolescent Idiopathic Scoliosis Patients: A Large Multicenter Cohort Study.

Background: The use of vancomycin powder in spine surgery has been supported in adult populations, however, its efficacy in preventing postoperative surgical site infections in AIS patients is yet to be determined.

Methods: A multi-center review was conducted from June 2010 to February 2019, using ICD and CPT codes to identify AIS patients who underwent primary PSF. The patients were divided into two groups: the vancomycin cohort (receiving local vancomycin powder prior to wound closure) and the non-vancomycin cohort.

Maintaining stability at the lumbosacral-pelvic region in adult spinal deformity surgery without sacroiliac joint fusion: are 4 pelvic screws superior to 2 pelvic screws?

Objective: The objective of this study was to compare a multiple pelvic screw fixation strategy (dual bilateral 4 pelvic screw fixation [4PvS]) with the use of single bilateral 2 pelvic screw fixation (2PvS), with the aim of addressing lumbosacral junction stability.

Methods: This analysis is a single-center, retrospective review of ASD patients treated between 2015 and 2021. All patients had a minimum 2-year follow-up and spinal fusion to the sacrum without sacroiliac fusion and met at least one radiographic and procedural criterion: pelvic incidence-lumbar lordosis ≥ 20°, T1 pelvic angle ≥ 20°, sagittal vertical axis ≥ 7.

Incidental dural tears during pediatric posterior spinal fusions.

Purpose: To characterize the frequency of incidental dural tears in pediatric spine surgery, their treatment, complications, and results of long-term follow-up.

Methods: A retrospective review of all pediatric patients who underwent a posterior spinal fusion (PSF) between 2004-2019 at a tertiary children's hospital was conducted. Electronic medical records were reviewed for patient demographics, intra-operative data, presence of an incidental dural tear, repair method, and patient outcomes.

Revision of Harrington rod constructs: a single-center's experience with this homogenous adult spinal deformity population at a minimum 2-year follow-up.

Purpose: To evaluate radiographic and clinical outcomes following revision surgery after HRC fusions.

Methods: Single-institution, retrospective study of patients revised following HRC with minimum 2-year follow-up post-revision. Demographics, perioperative information, radiographic parameters, complications, and Oswestry disability index (ODI) scores were collected.

Knee flexion compensation in postoperative adult spinal deformity patients: implications for sagittal balance and clinical outcomes.

Purpose: To determine whether maintaining good sagittal balance with significant knee flexion (KF) constitutes a suboptimal outcome after adult spinal deformity (ASD) correction.

Methods: This single-center, single-surgeon retrospective study, assessed ASD patients who underwent posterior spinal fusion between 2014 and 2020. Inclusion criteria included meeting at least one of the following: PI-LL ≥ 25°, T1PA ≥ 20°, or CrSVA-H ≥ 2 cm.

Is neck pain treatable with surgery?

Introduction: Neck pain is one of the most common complaints in clinical practice and can be caused by a wide variety of conditions. While cervical spine surgery is a well-accepted option for radicular pain and myelopathy, surgery for isolated neck pain is controversial. The identification of the source of pain is challenging and subtle, and misdiagnosis can lead to inappropriate treatment.

Intervertebral disc human nucleus pulposus cells associated with back pain trigger neurite outgrowth in vitro and pain behaviors in rats.

Low back pain (LBP) is often associated with the degeneration of human intervertebral discs (IVDs). However, the pain-inducing mechanism in degenerating discs remains to be elucidated. Here, we identified a subtype of locally residing human nucleus pulposus cells (NPCs), generated by certain conditions in degenerating discs, that was associated with the onset of discogenic back pain.

Do adult spinal deformity patients who achieve and maintain PI-LL < 10 have better patient-reported and clinical outcomes compared to patients with PI-LL ≥ 10? A propensity score-matched analysis.

Purpose: To investigate whether patients with spinopelvic mismatch (PI-LL ≥ 10) report worse patient-reported outcomes (PROs) compared to patients who achieve PI-LL < 10 at 2-year postop.

Methods: In this retrospective study, propensity score matching (PSM) was used to analyze patients who underwent posterior spinal fusion due to deformity, as defined by one or more of the following criteria: PI-LL ≥ 25°, T1 pelvic angle ≥ 30°, sagittal vertical axis ≥ 15 cm, thoracic scoliosis ≥ 70°, thoracolumbar scoliosis ≥ 50°, coronal malalignment ≥ 7 cm, or those who underwent a three-column osteotomy or fusion with ≥ 12 levels. Key outcomes were total Scoliosis Research Society-22r, Oswestry Disability Index (PROs), and reoperation at 1- and 2-year postop.

Adult spinal deformity patients revised for pseudarthrosis have comparable two-year outcomes to those not undergoing any revision surgery.

Purpose: This study aimed to evaluate whether adult spinal deformity patients undergoing revision for symptomatic pseudarthrosis have comparable two-year outcomes as patients who do not experience pseudarthrosis.

Methods: Patients whose indexed procedure was revision for pseudarthrosis (pseudo) were compared with patients who underwent a primary procedure and did not have pseudarthrosis by 2Y post-op (non-pseudo). Patients were propensity-matched (PSM) based on baseline (BL) sagittal alignment, specifically C7SVA and CrSVA-Hip.

Outcomes and reoperation rates of adult spinal deformity patients with baseline sagittal malalignment based on the cranial axis to the hip at 2 years postoperatively.

Objective: The aim of this study was to discern whether patients with a cranial sagittal vertical axis to the hip (CrSVA-H) > 2 cm at 2 years postoperatively exhibit significantly worse patient-reported outcomes (PROs) and clinical outcomes compared with patients with CrSVA-H < 2 cm.

Methods: This was a retrospective, 1:1 propensity score-matched (PSM) study of patients who underwent posterior spinal fusion for adult spinal deformity. All patients had a baseline sagittal imbalance of CrSVA-H > 30 mm.

Adjacent Segment Impingement: A New Type of Adjacent Segment Disease?: A Report of 3 Cases.

Case: We present 3 cases in which spinal rods extending beyond the intended level of fusion caused injury to adjacent structures, which we term "adjacent segment impingement." All cases presented as back pain with no neurological symptoms, with a minimum 6 years of follow-up from the initial procedure. Treatment consisted of extending the fusion to include the affected adjacent segment.

Rate and risk factors for pediatric cervical spine fusion pseudarthrosis: opportunity for improvement.

Purpose: Although the pediatric population typically has a high union rate, the cervical spine has a reputation for frequent pseduarthrosis, as high as 38% in some prior series. Our purpose was to examine the rate and risk factors for pseudarthrosis in pediatric cervical spine fusions.

Methods: Retrospective review of all patients with ≥ 2 years follow-up undergoing cervical spinal fusion between January 2004 and December 2019 at a tertiary pediatric hospital.

Chronic Warfarin Anticoagulation in Hip Fracture Patients Delays Surgery and Is Associated With Increased Risk of Postoperative Complications: A Multicenter Propensity-Score-Matched Analysis.

Objective: To evaluate the effect of warfarin on blood transfusion and postoperative complications in a low-energy hip fracture population compared with a non-anticoagulated comparison group.

Design: Multicenter Retrospective Cohort.

Setting: Three Urban Level I Academic Trauma Centers.

Think and Talk Like You Went to Business School.

Most orthopaedic surgeons do not have formal training in business education. We have learned that success comes to those who study hard, choose the correct answer on multiple-choice tests, and focus on patient care and operating. In contrast, business school graduates learned that success comes to those who apply interpersonal skills to build relationships and trust, in addition to taking risks.

Outpatient Versus Inpatient Anterior Lumbar Spine Surgery: A Multisite, Comparative Analysis of Patient Safety Measures.

Background: The frequency and complexity of spinal surgery performed in an ambulatory surgery center (ASC) is increasing. However, safety and efficacy data of most spinal procedures adapted to the ASC are sparse and have focused on anterior cervical surgery. The purpose of this study was to compare the 90-day complication and readmission rates of anterior lumbar spine surgery performed in an ASC or inpatient setting.

Delayed Surgery Does Not Reduce Transfusion Rates in Low-Energy Hip Fractures on Direct Oral Anticoagulants.

Objectives: To compare transfusion rates in patients on direct oral anticoagulants (DOACs) with nonanticoagulated patients undergoing hip fracture surgery and, secondarily, to determine whether time to surgery or complications differ between these groups.

Design: Multicenter retrospective cohort.

Setting: Three tertiary care, academic, Level I trauma centers.

Stem Cells and Spinal Fusion.

Background: This manuscript is a review of the literature investigating the use of mesenchymal stem cells (MSCs) being applied in the setting of spinal fusion surgery. We mention the rates of pseudarthrosis, discuss current bone grafting options, and examine the preclinical and clinical outcomes of utilizing MSCs to assist in successfully fusing the spine.

Methods: A thorough literature review was conducted to look at current and previous preclinical and clinical studies using stem cells for spinal fusion augmentation.

Surgical Site Infection Following Neuromuscular Posterior Spinal Fusion Fell 72% After Adopting the 2013 Best Practice Guidelines.

Study Design: Retrospective cohort study.

Objective: The purpose of this study is to investigate the incidence of surgical site infection in neuromuscular scoliosis (NMS) patients at a tertiary children's hospital before and after the implementation of strategies mentioned in the 2013 Best Practice Guideline.

Summary Of Background Data: Patients with NMS are at high risk for surgical site infection following spine surgery.

C1-C2 Distraction Ligamentous Injury Treated with Halo-Vest Application: A Case Report.

Case: There is a paucity of literature regarding pediatric upper cervical spine traumatic instability, atlanto-occipital dislocations, and fractures, with no clear treatment algorithm. We present a 12-year-old girl with significant posterior C1-C2 distraction and resultant ligamentous injury after a motor vehicle collision who was treated with a halo vest for 3 months. At 8-month follow-up, follow-up magnetic resonance imaging demonstrated complete ligamentous healing without instability on dynamic radiographs, and at 18-month follow-up, the patient made a full recovery.

Severe Chin-on-Chest Cervical Spine Deformity in the Setting of Stiff-Person Syndrome: A Case Report.

Case: Stiff-person syndrome (SPS) presents with progressive muscle rigidity, postural instability, and periodic debilitating spasms. Reports of axial hyperextension exist, but kyphotic deformities have not been described. We surgically treated a patient with debilitating SPS and severe cervicothoracic hyperkyphosis with posterior spinal fusion and instrumentation.

Advanced Glycation End Product Inhibitor Pyridoxamine Attenuates IVD Degeneration in Type 2 Diabetic Rats.

Type 2 diabetes mellitus (T2DM) is associated with advanced glycation end product (AGE) enrichment and considered a risk factor for intervertebral disc (IVD) degeneration. We hypothesized that systemic AGE inhibition, achieved using pyridoxamine (PM), attenuates IVD degeneration in T2DM rats. To induce IVD degeneration, lumbar disc injury or sham surgery was performed on Zucker Diabetic Sprague Dawley (ZDSD) or control Sprague Dawley (SD) rats.