Global Spine Journal最新文献

{"title":"The Role of Frailty and Sarcopenia in Predicting Major Adverse Events, Length of Stay and Reoperation Following <i>En Bloc</i> Resection of Primary Tumours of the Spine.","authors":"Eryck Moskven, Oliver Lasry, Supriya Singh, Alana M Flexman, John T Street, Nicolas Dea, Charles G Fisher, Tamir Ailon, Marcel F Dvorak, Brian K Kwon, Scott J Paquette, Raphaële Charest-Morin","doi":"10.1177/21925682231173360","DOIUrl":"10.1177/21925682231173360","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational cohort study.</p><p><strong>Objective: </strong><i>En bloc</i> resection for primary tumours of the spine is associated with a high rate of adverse events (AEs). The objective was to explore the relationship between frailty/sarcopenia and major perioperative AEs, length of stay (LOS), and unplanned reoperation following <i>en bloc</i> resection of primary spinal tumours.</p><p><strong>Methods: </strong>This is a unicentre study consisting of adult patients undergoing <i>en bloc</i> resection for a primary spine tumor. Frailty was calculated with the modified frailty index (mFI) and spine tumour frailty index (STFI). Sarcopenia was quantified with the total psoas area/vertebral body area ratio (TPA/VB) at L3 and L4. Univariable regression analysis was used to quantify the association between frailty/sarcopenia and major perioperative AEs, LOS and unplanned reoperation.</p><p><strong>Results: </strong>95 patients met the inclusion criteria. The mFI and STFI identified a frailty prevalence of 3% and 18%. Mean CT TPA/VB ratios were 1.47 (SD ± .05) and 1.83 (SD ± .06) at L3 and L4. Inter-observer reliability was .93 and .99 for CT and MRI L3 and L4 TPA/VB ratios. Unadjusted analysis demonstrated sarcopenia and mFI did not predict perioperative AEs, LOS or unplanned reoperation. Frailty defined by an STFI score ≥2 predicted unplanned reoperation for surgical site infection (SSI) (<i>P</i> < .05).</p><p><strong>Conclusions: </strong>The STFI was only associated with unplanned reoperation for SSI on unadjusted analysis, while the mFI and sarcopenia were not predictive of any outcome. Further studies are needed to investigate the relationship between frailty, sarcopenia and perioperative outcomes following <i>en bloc</i> resection of primary spinal tumors.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9360180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Coronal Malalignment in Degenerative Lumbar Scoliosis and Priority-Matching Correction Technique to Prevent Postoperative Coronal Decompensation.","authors":"Shibao Lu, Weiguo Zhu, Ashish D Diwan, Jeffrey C Wang, Guoguang Zhao, Zorica Buser, Dongfan Wang, Peng Cui, Yu Wang, Chao Kong, Wei Wang, Xiaolong Chen","doi":"10.1177/21925682231178202","DOIUrl":"10.1177/21925682231178202","url":null,"abstract":"<p><strong>Study design: </strong>A prospective case-control study.</p><p><strong>Objective: </strong>To analyze global coronal malalignment (GCM) in degenerative lumbar scoliosis (DLS) and to prospectively investigate the performance of priority-matching correction technique on preventing postoperative coronal imbalance.</p><p><strong>Methods: </strong>A total of 444 DLS inpatients and outpatients were recruited. GCMs were classified into 2 types: Type 1, GCM with thoracolumbar (TL/L) curve as the main contribution on coronal imbalance; Type 2, GCM with lumbosacral (LS) curve as the main contribution on coronal imbalance. Patients receiving priority-matching correction were assigned to Group P-M and receiving traditional correction were assigned to Group T form August 2020. The fundamental principle of priority-matching technique was to first correct the key curve contributing to coronal imbalance rather than the curve with greater magnitude.</p><p><strong>Results: </strong>Type 1 GCM accounted for 45% and Type 2 GCM accounted for 55% of patients. Type 2 GCM was detected to have greater LS Cobb angle and L4 tilt. At 1-year follow-up, 29.8% of patients with Type 2 GCM, whereas 11.7% of patients with Type 1 GCM were observed to have postoperative coronal decompensation. Patients with postoperative imbalance were revealed to have greater preoperative LS Cobb angle and L4 tilt and smaller correction extent of LS curve and L4 tilt. 6.25% of patients developed postoperative coronal imbalance in Group P-M, whereas 40.5% developed in Group T.</p><p><strong>Conclusion: </strong>Highlighting priority and aggressive correction of the key curve to coronal imbalance, priority-matching technique was proved to be able to limit the development of postoperative coronal decompensation.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9560145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causes of Intraoperative Neuromonitoring Events in Adult Spine Deformity Surgery: A Systematic Review.","authors":"Chloe Cottone, David Kim, Christopher Lucasti, Maxwell M Scott, Benjamin C Graham, Nell Aronoff, Bilal Hasanspahic, David Kowalski, Justin Bird, Dil Patel","doi":"10.1177/21925682241242693","DOIUrl":"10.1177/21925682241242693","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objectives: </strong>Intraoperative neuromonitoring (IOMN) has become a standard practice in the detection and prevention of nerve damage and postoperative deficit. While multicenter studies have addressed this inquiry, there have been no systematic reviews to date. This systematic review identifies the leading causes of IONM alerts during adult spinal deformity (ASD) surgeries.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a literature search was performed in PubMed and Embase. IONM alert causes were grouped by equivalent terms used across different studies and binned into larger categories, including surgical maneuver, Changes in blood pressure/temperature, Oxygenation, Anesthesia, Patient position, and Unknown.</p><p><strong>Results: </strong>Inclusion criteria were studies on adult patients receiving ASD correction surgery using IONM with documented alert causes. 1544 references were included in abstract review, 128 in full text review, and 16 studies qualified for data extraction. From those studies, there was a total of 3945 adult patients with 299 IONM alerts. Surgical maneuver led the alert causes (258 alerts/86.3%), with signal loss most commonly occurring at correction or osteotomy (101/33.8% and 95/31.8% respectively). Pedicle screw placement caused 35 alerts (11.7%). Changes in temperature and blood pressure were the third largest category (34/11.4%).</p><p><strong>Conclusions: </strong>The most frequent causes of IONM alerts in ASD surgery were surgical maneuvers such as correction, osteotomy, and pedicle screw placement. This information provides spine surgeons with a quantitative perspective on the causes of IONM changes and show that most occur at predictable times during ASD surgery.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140293345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Affecting the Surgical Outcomes of Patients Treated With \"de-tension\" Surgical Strategy for Multilevel Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine: A Minimum 2-year Follow-Up Study of 83 Patients in a Single Center.","authors":"Guanghui Chen, Tianqi Fan, Zhongqiang Chen, Weishi Li, Qiang Qi, Zhaoqing Guo, Woquan Zhong, Yu Jiang, Chunli Song, Chuiguo Sun","doi":"10.1177/21925682231174194","DOIUrl":"10.1177/21925682231174194","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>To describe the clinical characteristics and surgical outcomes of patients with multilevel-ossification of the posterior longitudinal ligament (mT-OPLL), and to identify risk factors for unfavorable outcomes.</p><p><strong>Methods: </strong>Patients who were diagnosed with mT-OPLL and underwent one-stage thoracic posterior laminectomy combined with selective OPLL resection, spinal cord de-tension, and fusion surgery between August 2012 and October 2020 were recruited. Patients' demographic-, surgical- and radiological-related parameters were collected and analyzed. Neurological status was evaluated with mJOA score, and recovery rate (RR) was calculated using the Hirabayashi formula. According to RR, patients were divided into a favorable outcome group (FOG, RR ≥50%) and an unfavorable outcome group (UOG, RR <50%). Univariate and multivariate analyses were used to compare the difference between the 2 groups and to identify risk factors for unfavorable outcomes.</p><p><strong>Results: </strong>A total of 83 patients were included, with an average age of 50.6 ± 8.3 years. Cerebrospinal fluid leakage (60.2%) and transient neurological deterioration (9.6%) were the most common complications. The average mJOA score improved from preoperative 4.3 ± 2.2 to 9.0 ± 2.4 at the last follow-up, and the mean RR was 74.9 ± 26.3%. Disease duration, preoperative nonambulatory status, and the number of decompressed levels were identified as potential risk factors by Univariate analysis (all P < .05). Multivariate analysis showed that the preoperative disease duration and nonambulatory status were independent risk factors for unfavorable outcomes.</p><p><strong>Conclusions: </strong>Long disease duration and nonambulatory status before surgery were independent risk factors for unfavorable outcomes.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9767845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Significance of Odontoid Incidence in Patients With Cervical Spondylotic Myelopathy.","authors":"Hongyu Qin, Weiyou Chen, Longao Huang, Xin Xiao, Qinghua Yang, Hua Jiang","doi":"10.1177/21925682231182342","DOIUrl":"10.1177/21925682231182342","url":null,"abstract":"<p><strong>Study design: </strong>Observational study.</p><p><strong>Objective: </strong>To analyze the cervical sagittal parameters for standing Digital radiography (DR) and supine Magnetic resonance imaging (MRI), and to further clarify the relationship between odontoid incidence (OI) and cervical spondylotic myelopathy (CSM).</p><p><strong>Methods: </strong>52 CSM patients aged 54.46 ± 2.89 years underwent both standing DR and supine MRI scans of cervical spine between November 2021 and November 2022. OI, odontoid tilt (OT), C2 slope (C2S), T1 slope (T1S), C0-2 angle, C2-7 angle (cervical lordosis [CL]), and T1S-CL were measured in both DR and MRI images using Surgimap (<i>Version 2.3.2.1</i>). Pearson correlation and linear regression were used to compare these parameters between the two modalities.</p><p><strong>Results: </strong>Cervical sagittal parameters, including OI, OT, C2S, C0-2 angle, T1S, C2-7 angle (CL) and T1S-CL, showed no significant differences in the measurements between the two modalities. Based on the DR images, OI was related to OT (r = .386, P < .01), C2S (r = .505, P < .01), CL (r = -.412, P < .01), and T1S-CL (r = .320, P < .05), and OI was matched with CL (r2 = .170) and T1S-CL (r2 = .102). Based on MRI images, OI was related to OT (r = .433, P < .01), C2S (r = .516, P < .01), CL (r = -.355, P < .01), and T1S-CL (r = .271, P < .05), and OI matched with C2-7 (r2 = .126) and T1S-CL (r2 = .073).</p><p><strong>Conclusion: </strong>OI is an independent parameter related to cervical anatomy and its measurement is unaffected by external factors. In patients with CSM, odontoid parameters may effectively describe the sagittal alignment of the cervical spine on DR and MRI images.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9948256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study on Accuracy of Intra-Operative Computed Tomography-Navigation Based Pedicle Screw Placement With Skin vs Bone Fixed Dynamic Reference Frame in Minimally Invasive Transforaminal Lumbar Interbody Fusion.","authors":"Devanand Degulmadi, Bharat R Dave, Vikrant Chauhan, Ajay Krishnan, Shivanand C Mayi, Ravi Rai, Mirant Bharat Dave, Shivkumar Bali, Pranav Charde, Abhijith Anil","doi":"10.1177/21925682231181884","DOIUrl":"10.1177/21925682231181884","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective comparative study.</p><p><strong>Objective: </strong>To compare the accuracy of intra-operative navigation-assisted percutaneous pedicle screw insertion between bone fixed and skin fixed dynamic reference frame (DRF) in Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).</p><p><strong>Methods: </strong>Between October 2018 and September 2022, patients who underwent MIS-TLIF were included in this study with DRF fixed either on bone (group B) or skin (group S). Pedicle screws were inserted under the guidance of intra-operative Cone bean Computed tomography (cbCT) based navigation. Accuracy of pedicle screw placement was immediately checked by a final intra-operative cbCT Spin.</p><p><strong>Results: </strong>Among 170 patients, group B included 91 patients and group S included 79 patients. Out of total 680 screws, 364 screws (group B) and 316 screws (group S) were placed. Patient's demographic data and distribution of screws showed no statistically significant difference. The accuracy showed no significant difference between both the groups (94.5% in group B and 94.3% in group S).</p><p><strong>Conclusion: </strong>Skin fixed DRF can serve as an alternate way for placement and avoids extra incision with similar accuracy in pedicle screw insertions with bone fixed DRF using intra-operative CT guided navigation in MIS TLIF.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9940516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GPT-4 as a Source of Patient Information for Anterior Cervical Discectomy and Fusion: A Comparative Analysis Against Google Web Search.","authors":"Paul G Mastrokostas, Leonidas E Mastrokostas, Ahmed K Emara, Ian J Wellington, Elizabeth Ginalis, John K Houten, Amrit S Khalsa, Ahmed Saleh, Afshin E Razi, Mitchell K Ng","doi":"10.1177/21925682241241241","DOIUrl":"10.1177/21925682241241241","url":null,"abstract":"<p><strong>Study design: </strong>Comparative study.</p><p><strong>Objectives: </strong>This study aims to compare Google and GPT-4 in terms of (1) question types, (2) response readability, (3) source quality, and (4) numerical response accuracy for the top 10 most frequently asked questions (FAQs) about anterior cervical discectomy and fusion (ACDF).</p><p><strong>Methods: </strong>\"Anterior cervical discectomy and fusion\" was searched on Google and GPT-4 on December 18, 2023. Top 10 FAQs were classified according to the Rothwell system. Source quality was evaluated using <i>JAMA</i> benchmark criteria and readability was assessed using Flesch Reading Ease and Flesch-Kincaid grade level. Differences in <i>JAMA</i> scores, Flesch-Kincaid grade level, Flesch Reading Ease, and word count between platforms were analyzed using Student's t-tests. Statistical significance was set at the .05 level.</p><p><strong>Results: </strong>Frequently asked questions from Google were varied, while GPT-4 focused on technical details and indications/management. GPT-4 showed a higher Flesch-Kincaid grade level (12.96 vs 9.28, <i>P</i> = .003), lower Flesch Reading Ease score (37.07 vs 54.85, <i>P</i> = .005), and higher <i>JAMA</i> scores for source quality (3.333 vs 1.800, <i>P</i> = .016). Numerically, 6 out of 10 responses varied between platforms, with GPT-4 providing broader recovery timelines for ACDF.</p><p><strong>Conclusions: </strong>This study demonstrates GPT-4's ability to elevate patient education by providing high-quality, diverse information tailored to those with advanced literacy levels. As AI technology evolves, refining these tools for accuracy and user-friendliness remains crucial, catering to patients' varying literacy levels and information needs in spine surgery.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140184156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Palliative Surgical Treatment for Spinal Metastases on the Patient's Quality of Life With a Focus on the Segment of the Metastasis: A Prospective Multicenter Study.","authors":"Naoki Segi, Hiroaki Nakashima, Sadayuki Ito, Jun Ouchida, Yuki Shiratani, Takaki Shimizu, Akinobu Suzuki, Hidetomi Terai, Kenichiro Kakutani, Yutaro Kanda, Hiroyuki Tominaga, Ichiro Kawamura, Masayuki Ishihara, Masaaki Paku, Yohei Takahashi, Masahiro Funaba, Toru Funayama, Hideaki Nakajima, Koji Akeda, Takashi Hirai, Hirokazu Inoue, Kazuo Nakanishi, Haruki Funao, Tsutomu Oshigiri, Bungo Otsuki, Kazu Kobayakawa, Shinji Tanishima, Ko Hashimoto, Takuya Iimura, Hirokatsu Sawada, Koji Uotani, Hiroaki Manabe, Chizuo Iwai, Daisuke Yamabe, Akihiko Hiyama, Shoji Seki, Yuta Goto, Masashi Miyazaki, Kazuyuki Watanabe, Toshio Nakamae, Takashi Kaito, Narihito Nagoshi, Satoshi Kato, Kota Watanabe, Shiro Imagama, Gen Inoue, Takeo Furuya","doi":"10.1177/21925682241297948","DOIUrl":"10.1177/21925682241297948","url":null,"abstract":"<p><strong>Study design: </strong>Prospective multicenter study.</p><p><strong>Objectives: </strong>Palliative surgery is crucial for maintaining the quality of life (QOL) in patients with spinal metastases. This study aimed to compare the short-term outcomes of QOL after palliative surgery between patients with metastatic spinal tumors at different segments.</p><p><strong>Methods: </strong>We prospectively compared the data of 203 patients with spinal metastases at 2-3 consecutive segments who were divided into the following three groups: cervical, patients with cervical spine lesions; thoracic, patients with upper-middle thoracic spine lesions; and TL/L/S, patients with lesions at the thoracolumbar junction and lumbar and sacral regions. Preoperative and postoperative EuroQol 5-dimension (EQ5D) 5-level were compared.</p><p><strong>Results: </strong>All groups exhibited improvement in the Frankel grade, performance status, pain, Barthel index, EQ5D health state utility value (HSUV), and EQ5D visual analog scale (VAS) postoperatively. Although preoperative EQ5D HSUVs did not significantly differ between the groups (cervical, 0.461 ± 0.291; thoracic, 0.321 ± 0.292; and TL/L/S, 0.376 ± 0.272), the thoracic group exhibited significantly lower postoperative EQ5D HSUVs than the other two groups (cervical, 0.653 ± 0.233; thoracic, 0.513 ± 0.252; and TL/L/S, 0.624 ± 0.232). However, postoperative EQ5D VAS was not significantly different between the groups (cervical, 63.4 ± 25.8; thoracic, 54.7 ± 24.5; and TL/L/S, 61.7 ± 21.9).</p><p><strong>Conclusions: </strong>Palliative surgery for metastatic spinal tumors provided comparable QOL improvement, irrespective of the spinal segment involved. Patients with upper and middle thoracic spinal metastases had poorer QOL outcomes than those with metastases in other segments; however, sufficient QOL improvement was achieved.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar Spinal Stenosis Grading in Multiple Level Magnetic Resonance Imaging Using Deep Convolutional Neural Networks.","authors":"Dongkyu Won, Hyun-Joo Lee, Suk-Joong Lee, Sang Hyun Park","doi":"10.1177/21925682241299332","DOIUrl":"10.1177/21925682241299332","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective magnetic resonance imaging grading with comparison between experts and deep convolutional neural networks (CNNs).</p><p><strong>Objective: </strong>The application of deep learning to clinical diagnosis has gained popularity. This approach can accelerate image interpretation and serve as a screening tool to help doctors.</p><p><strong>Methods: </strong>A comparison was conducted between retrospective magnetic resonance imaging (MRI) grading performed by experts and grading obtained using CNN classifiers. Data were collected from the lumbar axial dataset in the DICOM format. Two experts labeled the sampled images using the same diagnostic tools: localization of patches near the spinal canal, rootlet leveling, and stenosis grading. Comprehensive comparisons were presented for both rootlet cord classification and stenosis grading.</p><p><strong>Results: </strong>Rootlet-cord classification for the two analyzers was 90.3% and the F1 score was 86.6%. The agreement of Analyzers-Classifiers was 92.7% and 96.8% for data with 90.6% and 95.6% F1 scores, respectively. For stenosis grading, there was an agreement of 89.2% between the two analyzers, resulting in an F1 score of 76.5%. The grades of the Analyzers-Classifiers agreed on 91.5/89.4% of the data, with an F1 score of 78.4/75.7%. Analyzer1 and Analyzer2 classified >74% as grade A (78.8% and 74.4%, respectively), 15.4% and 18.6% as grade B, 4.2% and 6.0% as grade C, and 1.6% and 2.0% as grade D, respectively.</p><p><strong>Conclusions: </strong>The fully automated deep learning model showed competitive results in stenosis grade diagnosis and rootlet cord classification under similar anatomical conditions. However, abrupt anatomical changes can lead to a puzzle diagnosis based only on images.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of C5 Palsy: An International Survey of Peripheral Nerve Surgeons.","authors":"Daniel Lubelski, Andrew M Hersh, James Feghali, Daniel M Sciubba, Timothy Witham, Ali Bydon, Nicholas Theodore, Allan J Belzberg","doi":"10.1177/21925682231171853","DOIUrl":"10.1177/21925682231171853","url":null,"abstract":"<p><strong>Study design: </strong>International survey.</p><p><strong>Objectives: </strong>C5 palsy (C5P) is a neurological complication affecting 5-10% of patients after cervical decompression surgery. Most cases improve with conservative treatment; however, nearly 20% of patients may be left with residual deficits. Guidelines are lacking on C5P management and timing of surgical intervention. Therefore, we sought to survey peripheral nerve surgeons on their management of C5P.</p><p><strong>Methods: </strong>An online survey was distributed centered around a patient with C5P after posterior cervical decompression and fusion. Questions included surgeon demographics, diagnostic modalities, and timing and choice of operation. Responses were summarized and the chi-squared and Kruskal-Wallis H tests were used to examine differences across specialties.</p><p><strong>Results: </strong>A total of 154 surgeons responded to the survey, of which 59 (38%) indicated that they manage C5P cases. Average time prior to operating was 4.5 ± 2.2 months for complete injuries and 6.6 ± 3.2 months for partial injuries, with neurosurgeons significantly more likely to wait longer periods for complete (<i>P</i> = .01) and partial injuries (<i>P</i> = .03). Foraminotomies were selected by 19% of surgeons, while 92% selected nerve transfers. Transfer of the ulnar nerve to the musculocutaneous nerve was the most common choice (81%), followed by transfer of the radial nerve to the axillary nerve (58%).</p><p><strong>Conclusion: </strong>Consensus exists among peripheral nerve surgeons on the use of nerve transfers for surgical treatment in cases with severe motor weakness failing to improve. Most surgeons advocate for early intervention in complete injuries. Disagreement concerns the type of nerve transfer employed, timing of surgery, and efficacy of foraminotomy.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9375219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}