North American Spine Society Journal最新文献

{"title":"Novel carbon fiber pedicle screw system for the treatment of lumbar degenerative disc disease: Results from a prospective, multicenter, FDA investigational device exemption study","authors":"Scot Dean Miller DO, MBA ,&nbsp;Rajiv V. Taliwal MD ,&nbsp;Kathleen Opsitnick MSN, APRN, ACNP-BC ,&nbsp;Brandy Mansfield MSN, APRN, ANP-BC ,&nbsp;Thomas Cha MD ,&nbsp;Mohamad Bydon MD ,&nbsp;Anders Jonathan Cohen MD ,&nbsp;Reuven Gepstein MD ,&nbsp;Itzhak Engel MD ,&nbsp;Joshef Leitner MD ,&nbsp;Ely Ashkenazi MD ,&nbsp;Michael Millgram MD ,&nbsp;Yoram Folman MD ,&nbsp;Carl Lauryssen MD","doi":"10.1016/j.xnsj.2025.100844","DOIUrl":"10.1016/j.xnsj.2025.100844","url":null,"abstract":"<div><h3>Background</h3><div>Standard titanium pedicle screw systems are widely used in spinal fusion but produce imaging artifacts and may have limitations in fatigue resistance. CarboClear carbon fiber-reinforced PEEK (CFR-PEEK) implants offer improved radiolucency and fatigue properties, and negligible artifacts in MRI and CT scans. The purpose of this study was to evaluate the safety and effectiveness of CarboClear CFR-PEEK pedicle screw system for patients with degenerative disc disease (DDD) undergoing 1 level lumbar spinal fusion.</div></div><div><h3>Methods</h3><div>A prospective, multicenter, FDA-regulated Investigational Device Exemption (IDE) clinical trial, including 55 patients with DDD at 1 level (L2 to S1). Patients received the CarboClear System and a PEEK interbody fusion device. They were evaluated preoperatively and postoperatively at 6 weeks, 3, 6, 12, and 24 months, and then annually until the last patient completed 24-month follow-up. Primary outcome measures included self-reporting Visual Analog Scale (VAS) pain scores and Oswestry Disability Index (ODI), radiographic fusion rate, and safety assessments. Secondary measures included self-reporting SF-12 Health Survey (SF-12) scores and patient satisfaction (VAS), and operative parameters. Results were compared to predefined literature control group.</div></div><div><h3>Results</h3><div>At 24 months, 90.0% of the patients had clinically meaningful pain improvement (VAS ≥ 20), and 78.0% had ODI improvement ≥15 points. Rigorously defined fusion was achieved in 85.71% of the patients at 24 months and in 94.59% at 36 months. The neurological success rate was 93.33%. No serious device-related adverse events occurred. The 24-month index-level reoperation rate was 7.14%, including 1 implant removal case (1.79%). Compared to the literature control, CarboClear device demonstrated superior imaging clarity and at least equivalent clinical outcomes.</div></div><div><h3>Conclusions</h3><div>The CarboClear System is a safe and effective alternative to titanium pedicle screws for lumbar fusion, providing improved imaging compatibility and fatigue resistance.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100844"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of National Institutes of Health funding for back pain research in the United States","authors":"Jason Silvestre MD,&nbsp;John C. Martin BS,&nbsp;Robert J. Ferdon MS,&nbsp;Warren Roth MD,&nbsp;James P. Lawrence MD,&nbsp;Kelley Banagan MD,&nbsp;Charles A. Reitman MD,&nbsp;Robert A. Ravinsky MDCM, MPH","doi":"10.1016/j.xnsj.2025.100832","DOIUrl":"10.1016/j.xnsj.2025.100832","url":null,"abstract":"<div><h3>Background</h3><div>There is a paucity of studies investigating the National Institutes of Health (NIH) funding priorities for back pain research. This study analyzed the portfolio of NIH research grants awarded for back pain in the United States.</div></div><div><h3>Methods</h3><div>NIH grant data were collected from the NIH RePORTER database (2016–2023). Principal investigator (PI) characteristics were collected from academic websites including sex, graduate degree, and academic rank. NIH funding was analyzed for twenty clinical areas and compound annual growth rates (CAGRs) were calculated over the study period. Nonparametric tests were used to compare NIH funding totals by PI characteristics.</div></div><div><h3>Results</h3><div>From 2016 to 2023, the NIH research budget increased from $31.5 to $45.0 billion (CAGR 5.2%). Annual NIH funding for back pain research increased from $23.3 to $69.0 million (CAGR 17.0%) and totaled $523 million over the study period. Dementia ($19.7 billion, CAGR 19.2%) and diabetes ($8.9 billion, CAGR 1.3%) had the most NIH funding. The National Institute of Neurological Disorders and Stroke (45.0%) was the top funding institute and the R01 was the top funded grant mechanism (32.8%). The clinical areas receiving the most NIH funding for back pain research were pathophysiology (20.2%), social determinants (19.6%), and clinical trial networks (16.3%). Several PI characteristics were associated with higher NIH funding totals for back pain research including PhD degree and full professor rank (p&lt;.001).</div></div><div><h3>Conclusions</h3><div>Annual NIH funding for back pain research increased over the study period yet remains superseded by other clinical areas. Future coordinated efforts may be needed to stimulate NIH grant funding for back pain research.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100832"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between perioperative patient-reported outcomes and upper extremity functional performance in degenerative cervical myelopathy","authors":"Harshit Arora MBBS,&nbsp;Hassan Darabi MD,&nbsp;Vishwajeet Singh MBBS, MS,&nbsp;Aysha Alsahlawi MBBS, MSc,&nbsp;Jared T. Wilcox MD, PhD,&nbsp;Francis Farhadi MD, PhD","doi":"10.1016/j.xnsj.2026.100854","DOIUrl":"10.1016/j.xnsj.2026.100854","url":null,"abstract":"<div><h3>Background</h3><div>Degenerative cervical myelopathy (DCM) is caused by chronic compression of the cervical spinal cord. Individuals usually present with a combination of upper extremity dysfunction, imbalance, and bladder dysfunction, which impact overall quality of life. Various questionnaires like mJOA, Nurick, NDI, and DCM-72 have been used for disease stratification. Our study aims to evaluate the clinical correlation between self-reported measures and objective upper extremity assessments and to derive the minimal clinically important difference (MCID) for individuals with DCM.</div></div><div><h3>Methods</h3><div>A prospective two-center study of consecutive patients diagnosed with DCM was undertaken. A comprehensive assessment of upper extremity functioning including dexterity, sensation, and muscle strength, as well as self-reported questionnaires were completed preoperatively, and at 6- and 12-months postoperative follow-up. Statistical analyses were conducted to evaluate the progression of self-reported measures postoperatively and to evaluate correlations with upper extremity functional assessments. A p-value &lt;.05 was deemed statistically significant.</div></div><div><h3>Results</h3><div>A total of 99 patients with DCM and 34 controls were followed up over a period of 12 months. Significant differences were observed in mJOA overall scores and subscores, NDI, Nurick, and PROMIS-10 Physical scores. Various upper extremity functional measures significantly correlated with the self-reported outcome measures, highlighting the correlation between functional impairment and diminished quality of life. Using mJOA at 6-months follow-up as an anchor, DCM-72 MCID values of 1.44, 3.20, and 6.92 were approximated for mild, moderate and severe DCM, respectively.</div></div><div><h3>Conclusions</h3><div>Individuals with DCM experience significant postoperative improvements in self-reported outcomes, and upper extremity functioning strongly correlates with these gains. The DCM-72 MCID values offer clinically relevant thresholds for composite upper extremity functional recovery.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100854"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diagnostic value of metagenomic next-generation sequencing versus traditional microbiological testing in native pyogenic spinal infections: A systematic review and meta-analysis","authors":"Othman Ibrahim BS ,&nbsp;Rewa Aboushaala ,&nbsp;Namrah Ahmed MS ,&nbsp;Andrew Savoia BS ,&nbsp;Sloane O. Ward BS ,&nbsp;Shriya N. Patel BS ,&nbsp;Gregory Lopez MD ,&nbsp;Sarah E. Sansom DO, MS ,&nbsp;Brett Williams MD ,&nbsp;Kern Singh MD ,&nbsp;Lena Al-Harthi PhD ,&nbsp;Khaled Aboushaala MD, MS, PhD","doi":"10.1016/j.xnsj.2025.100840","DOIUrl":"10.1016/j.xnsj.2025.100840","url":null,"abstract":"<div><h3>Background</h3><div>Native pyogenic spinal infections (PSIs), including spondylodiscitis and vertebral osteomyelitis, are challenging to diagnose due to low culture sensitivity and delayed results. Metagenomic next-generation sequencing (mNGS) has emerged as a promising diagnostic tool, but its comparative clinical utility remains uncertain. The purpose of this study is to systematically compare the diagnostic performance and clinical impact of mNGS versus conventional microbial culture in detecting pathogens responsible for native PSIs.</div></div><div><h3>Methods</h3><div>The current systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed across 6 major databases. Eligible studies directly compared mNGS with standard culture for native PSIs and reported diagnostic performance metrics. Data were extracted and analyzed using a random-effects model to produce pooled estimates. Study quality was assessed using the Newcastle-Ottawa Scale. Primary outcomes included pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Secondary outcomes assessed diagnostic yield, time to diagnosis, treatment modification, and false-positive or contamination events.</div></div><div><h3>Results</h3><div>A total of 1,227 patients from 12 studies were included, encompassing those with suspected or confirmed native PSIs. Pooled sensitivity and specificity of mNGS were 89.7% (95% CI: 85.6–93.1%) and 86.2% (95% CI: 80.5–91.0%), respectively. mNGS demonstrated a significantly higher diagnostic yield (69–90%) compared to culture (27.2–44.7%) and enabled faster diagnosis (range, 17.7–48 hours). mNGS informed antimicrobial selection in up to 70.3% of cases and detected a broader pathogen spectrum. The incidence of false positives was low (range, 1–5) but non-negligible, emphasizing the need for careful interpretation.</div></div><div><h3>Conclusions</h3><div>mNGS outperforms conventional culture in sensitivity, speed, and breadth of pathogen detection in native PSIs and supports more tailored antimicrobial therapy. However, careful interpretation is necessary due to potential false positives. These findings support the integration of mNGS into clinical workflows, particularly in complex or culture-negative infections.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100840"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for insufficient segmental lordosis at the fused level following posterior lumbar interbody fusion: Effect of change in segmental lordosis in the intraoperative prone position","authors":"Hiroyuki Ishiguro MD, PhD ,&nbsp;Shota Takenaka MD, DMSc ,&nbsp;Masanori Kaneko MD ,&nbsp;Hiroyuki Aono MD, PhD","doi":"10.1016/j.xnsj.2026.100850","DOIUrl":"10.1016/j.xnsj.2026.100850","url":null,"abstract":"<div><h3>Background</h3><div>A decrease in segmental lordosis (SL) at the fused level (ΔSL &lt; 0) following posterior lumbar interbody fusion (PLIF) has been identified as a contributing factor to early-onset adjacent segment disease. However, achieving sufficient SL can be challenging despite technical strategies such as optimized cage placement. This study aimed to identify risk factors for ΔSL &lt; 0 following PLIF, with a particular focus on intraoperative prone SL.</div></div><div><h3>Methods</h3><div>A total of 105 patients who underwent primary single-level PLIF at L4-5 for degenerative lumbar spondylolisthesis between 2017 and 2022 were included. Radiological evaluations included measurements of preoperative, intraoperative (prone position), and 1-week postoperative radiographs, as well as preoperative CT images. ΔSL-P was defined as the change in SL between preoperative standing and intraoperative prone positions. Patients were categorized into the ΔSL ≥ 0 and the ΔSL &lt; 0 group. Patient demographics, preoperative radiological parameters, intraoperative SL, ΔSL-P, cage configuration, and the cage height–disc height ratio were compared between the 2 groups.</div></div><div><h3>Results</h3><div>The ΔSL ≥ 0 group comprised 48 patients, while the ΔSL &lt; 0 group included 57. Multivariate analysis identified preoperative standing SL (OR 1.15, 95% CI 1.01–1.31, p = .033) and ΔSL-P (OR 0.66, 95% CI 0.53–0.82, p &lt; .001) as significant risk factors for ΔSL &lt; 0. Preoperative standing SL showed a significant negative correlation with ΔSL (<em>r</em> = −0.591, p &lt; .001), while ΔSL-P demonstrated a significant positive correlation with ΔSL (<em>r</em> = 0.661, p &lt; .001). Receiver operating characteristic curve analysis identified a ΔSL-P cutoff value of −1° for predicting ΔSL &lt; 0 (AUC 0.84), sensitivity of 91% and specificity of 58%.</div></div><div><h3>Conclusions</h3><div>ΔSL-P was identified as the most significant risk factor for ΔSL &lt; 0. A decrease in prone SL relative to the preoperative standing value may warrant careful attention.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100850"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147277313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of perioperative dexamethasone on postoperative complications in diabetic patients undergoing spine surgery","authors":"Michael S. Kim MD,&nbsp;Madison Brunette BS,&nbsp;Melissa Romoff MS,&nbsp;Hao-Hua Wu MD,&nbsp;Sohaib Hashmi MD,&nbsp;Don Y. Park MD,&nbsp;Yu-Po Lee MD,&nbsp;Nitin Bhatia MD,&nbsp;Emily Mills MD","doi":"10.1016/j.xnsj.2026.100847","DOIUrl":"10.1016/j.xnsj.2026.100847","url":null,"abstract":"<div><h3>Background</h3><div>Dexamethasone is commonly used perioperatively for analgesic and antiemetic benefit, however, the risk of postoperative hyperglycemia is concerning, particularly among diabetic patients undergoing spine surgery, where extensive tissue exposure and hardware implantation may increase risk of wound complications. The influence of baseline glycemic control and surgical approach on dexamethasone-associated risk remains poorly characterized.</div></div><div><h3>Methods</h3><div>A retrospective cohort study using the TriNetX United States Collaborative Network, a nationally representative database comprised of over 117 million unique patients, was conducted. Adults with diabetes mellitus who underwent spine surgery between 2014 and 2024 were identified and categorized into anterior cervical, posterior cervical, lumbar decompression, and lumbar decompression with fusion groups. Patients receiving perioperative dexamethasone were compared with matched controls who did not receive dexamethasone using 1:1 propensity score matching. Patients were stratified by preoperative hemoglobin A1c (&lt;7.5%, 7.5%–8.9%, ≥9.0%). Ninety-day postoperative outcomes included hyperglycemia, wound complications, infection, sepsis, cardiopulmonary events, renal failure, transfusion, and mortality.</div></div><div><h3>Results</h3><div>Among 154,469 patients with diabetes who underwent spine surgery during the study period, dexamethasone administration was associated with higher odds of postoperative hyperglycemia, wound dehiscence, wound infection, sepsis, acute kidney injury, transfusion, and respiratory failure. Effects varied by approach. In cervical procedures, dexamethasone increased hyperglycemia but was associated with lower rates of pneumonia, respiratory failure, and mortality. In lumbar procedures, dexamethasone was associated with increased wound infection, myocardial infarction, and transfusion risk. Glycemic control was found to be a significant risk modifier with increased risk of postoperative complications associated with increasing A1c.</div></div><div><h3>Conclusions</h3><div>Perioperative dexamethasone administration is associated with increased hyperglycemia and wound complications in diabetic patients undergoing spine surgery, with the highest risk in those with poor preoperative glycemic control and in lumbar procedures. These findings support dexamethasone administration tailored to surgical approach and preoperative A1c for diabetic patients undergoing spine surgery.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100847"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do GLP-1 agonists affect perioperative risk in spine surgery? A systematic review and meta-analysis","authors":"Favour C Ononogbu-Uche BA ,&nbsp;Felix Toussaint MD ,&nbsp;Abdullah W Saleh BS ,&nbsp;Afnan Hassab E Siddig MD ,&nbsp;Ramzy Ahmed BS ,&nbsp;Karim Akl BS ,&nbsp;Mostafa H Algabri MD ,&nbsp;Mohamed Alwadai MD ,&nbsp;Lauren Corliss BA ,&nbsp;Norah Foster MD ,&nbsp;Muhammad M Abd-El-Barr MD,PhD","doi":"10.1016/j.xnsj.2025.100835","DOIUrl":"10.1016/j.xnsj.2025.100835","url":null,"abstract":"<div><h3>Background</h3><div>Use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is increasing among patients presenting for spine surgery, but their perioperative safety and impact on surgical outcomes, particularly pseudoarthrosis, remain uncertain.</div></div><div><h3>Methods</h3><div>We conducted a PRISMA-compliant systematic review and meta-analysis (PROSPERO CRD420251111692) of comparative studies enrolling adults undergoing any spine surgery, comparing perioperative GLP-1 RA use with no GLP-1 RA. PubMed, Embase, Web of Science, and EBSCO were searched through August 1, 2025. Two reviewers independently screened, extracted data, and assessed risk of bias with ROBINS-I. Random-effects models were used for dichotomous outcomes, reported as odds ratios (OR) with 95% confidence intervals (CI). Meta-analyses were performed when at least 3 studies reported a given outcome, and outlier studies were excluded from sensitivity analyses.</div></div><div><h3>Results</h3><div>Thirteen retrospective cohort studies were included. Across cohorts, baseline characteristics were broadly similar between GLP-1 users (<em>n</em> = 13,754) and controls (<em>n</em> = 17,591): weighted mean age approximately 61 years, weighted mean BMI in the low-to-mid 30 s, and high prevalence of type 2 diabetes and hypertension. Seven studies evaluating pseudarthrosis showed much heterogeneity, but there was a lower risk with GLP-1 RA use (OR 0.74; 95% CI: 0.55–1.00; <em>p</em> = .049; I² = 91.7%). This finding was heterogeneous but represented sensitivity analysis (OR 0.64; 95% CI: 0.57–0.73; <em>p</em> &lt; .001; I² = 45.3%). Pooled analyses found no significant differences for other surgical and nonsurgical outcome measures. There was a nonsignificant trend toward higher nerve injury with GLP-1 exposure (OR 1.57; 95% CI: 0.99–2.48; <em>p</em> = .056; I² = 42.4%). Heterogeneity varied by outcome and was highest for reoperation and utilization endpoints.</div></div><div><h3>Conclusions</h3><div>In adults undergoing spine surgery, perioperative GLP-1 RA use appears safe and is associated with a nonrobust, lower risk of pseudarthrosis, with no consistent differences in infection, wound, neurologic, thromboembolic, pulmonary, or utilization outcomes. Given confounders and retrospective designs, prospective, agent-specific studies are needed to validate fusion benefits and refine perioperative management.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100835"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative complications after anterior cervical discectomy and fusion in patients with versus without carotid artery stenosis","authors":"Katie M. Zehner BS ,&nbsp;Julian Smith-Voudouris MS ,&nbsp;Joshua G. Sanchez BA ,&nbsp;Sahir S. Jabbouri MD ,&nbsp;Yoji Ogura MD, PhD ,&nbsp;Basar Atalay MD, PhD ,&nbsp;Jonathan N. Grauer MD ,&nbsp;Arya G. Varthi MD","doi":"10.1016/j.xnsj.2025.100838","DOIUrl":"10.1016/j.xnsj.2025.100838","url":null,"abstract":"<div><h3>Background</h3><div>Carotid artery stenosis (CS) may elevate risk of stroke related to anterior cervical discectomy and fusion (ACDF) due to manipulation of the carotid artery and alteration in flow dynamics. Prior studies assessing this potential association are limited by small sample size and assessment of in-hospital stroke only.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted to compare 90-day adverse events following ACDF in patients with versus without CS. Adult patients (age &gt;17 years) without a history of stroke who underwent isolated 1-3 level ACDF were identified in the 2010-2023 PearlDiver M170 database. Patients with CS were matched 1:4 to patients without CS based on age, sex, and Elixhauser comorbidity index (ECI). Adverse outcomes, emergency department (ED) visits, and readmissions in the 90 postoperative days were identified and compared between groups with univariable and multivariable analyses, the latter controlling for age, sex, and ECI. The timing of stroke following surgery was also plotted on a Kaplan-Meier survival curve and compared by log-rank test. A secondary analysis was conducted comparing CS patients with and without a history of revascularization procedure.</div></div><div><h3>Results</h3><div>Among patients in the database undergoing ACDF, 17,772 with and 423,401 without CS were identified. Following matching, final cohorts consisted of 16,888 CS patients and 67,355 matched controls. CS was associated with greater odds of cardiac events (OR=1.74, p&lt;.001) and stroke (OR=1.49, p&lt;.001), but not other assessed adverse outcomes. The incidence of stroke continued to diverge for the 2 groups out to 90-days postoperatively. Of the CS patients, 2.8% had prior carotid revascularization. These patients had no difference in odds of stroke when compared to patients who had not undergone revascularization (p=.522)</div></div><div><h3>Conclusions</h3><div>ACDF patients with CS were found to be at significantly elevated odds of cardiac events and stroke (adverse outcomes associated with atherosclerotic burden), but not other assessed adverse outcomes. Surveillance of related symptoms through the perioperative period is importantly considered.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100838"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of ChatGPT versus spine surgeons as an emergency department spine call consultant","authors":"Taha M. Taka MD ,&nbsp;Seena Sebt BA ,&nbsp;Sarah Meng BS ,&nbsp;Andrew Cabrera MD ,&nbsp;David Shin BS ,&nbsp;Vahe Yacoubian MD, MPH ,&nbsp;Weyjuin Chao MD ,&nbsp;Daniel Rossie MD ,&nbsp;Zhengle Xu MD ,&nbsp;Melissa Erickson MD ,&nbsp;Brett Rocos MD ,&nbsp;Khoi Than MD ,&nbsp;Elizabeth Yu MD ,&nbsp;Nicholas Ahn MD ,&nbsp;Christopher Bono MD ,&nbsp;Wayne Cheng MD ,&nbsp;Olumide Danisa MD","doi":"10.1016/j.xnsj.2025.100836","DOIUrl":"10.1016/j.xnsj.2025.100836","url":null,"abstract":"<div><h3>Background</h3><div>Large language models (LLMs) like ChatGPT are increasingly being recognized as credible tools for use across diverse healthcare settings. While artificial intelligence (AI) use has previously been evaluated in emergency medicine, its use in subspecialty care - particularly spine surgery - remains underexplored. This study evaluates the clinical accuracy, management appropriateness, completeness, helpfulness, and overall quality of ChatGPT responses compared to those of board-certified, spine surgeons in response to common emergency department (ED) consultations.</div></div><div><h3>Methods</h3><div>A 7-part questionnaire was developed based on common ED spine consultations (eg, Cauda Equina Syndrome, compression fracture in elderly patients, purulent drainage from surgical wound, acute lumbar disc herniation, incomplete spinal cord injury, epidural abscess, and metastatic spine disease). Each case included 3–4 questions pertaining to examination, diagnosis, management, and counseling. Responses from ChatGPT and 7 board-certified spine surgeons were restricted to 3–4 sentences per question. Three emergency medicine physicians rated each de-identified questionnaire response using a 5-point Likert scale. Statistical analysis was conducted using a 2-sample T-test with unequal variance. Inter-rater reliability was assessed using pairwise weighted Cohen’s kappa coefficient (κ).</div></div><div><h3>Results</h3><div>When comparing AI responses versus spine surgeon responses to proposed ED consultations, AI responses were rated to be superior across all 5 metrics of clinical accuracy, management appropriateness, completeness, helpfulness, and overall quality (p&lt;.05). Inter-rater reliability was assessed using the average pairwise weighted Cohen’s kappa coefficient which showed substantial agreement (κ=0.76).</div></div><div><h3>Conclusions</h3><div>ChatGPT responses to emergency department spine consultations were rated as significantly higher compared to board-certified spine surgeons by emergency medicine providers. Though further improvement and validation is warranted, these findings suggest that ChatGPT can be a useful clinical adjunct for spine-related emergency department consultations.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100836"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the letter to the editor regarding: “A call for dynamic guidelines: Incorporating AI ethics into social media best practices for spine professionals”","authors":"Zachary A. Cupler DC, MS ,&nbsp;Andrew Trontis MD, MS ,&nbsp;Brandon Lucke-Wold MD, PhD ,&nbsp;Samuel M. Schut DC ,&nbsp;Khoi D. Than MD ,&nbsp;James E. Eubanks MD, DC, MS ,&nbsp;Robert J. Butler DC ,&nbsp;Reem Elwy MRCS ,&nbsp;David Gendelberg MD","doi":"10.1016/j.xnsj.2026.100856","DOIUrl":"10.1016/j.xnsj.2026.100856","url":null,"abstract":"","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"25 ","pages":"Article 100856"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147537947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}