Asian Spine Journal最新文献

{"title":"A comprehensive review of risk factors and prevention strategies: how to minimize mechanical complications in corrective surgery for adult spinal deformity.","authors":"Jin-Sung Park, Hyun-Jun Kim, Se-Jun Park, Dong-Ho Kang, Chong-Suh Lee","doi":"10.31616/asj.2024.0505","DOIUrl":"https://doi.org/10.31616/asj.2024.0505","url":null,"abstract":"<p><p>Adult spinal deformity (ASD) surgery aims to correct abnormal spinal alignment in both the sagittal and coronal planes to alleviate pain and improve functional activities of daily living. Despite the advancements in surgical techniques that have led to better clinical outcomes, postoperative mechanical complications remain. These complications include instrumentation failure, with proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and rod fractures (RFs) being the most common. Such complications deteriorate clinical outcomes and often require revision surgery, which can be more burdensome for surgeons and patients, than index surgery. Thus, the risk factors for mechanical complications must be identified, and effective preventive strategies established. Therefore, this study aimed to review the risk factors for mechanical complications, focusing on PJK, PJF, and RF, and explore prevention strategies for these complications in ASD surgery, drawing upon recent literature.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539995","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":"More postoperative complications and revision surgery after occipitocervical fusion than after atlantoaxial fusion: a retrospective multicenter cohort study.","authors":"Koji Uotani, Angel Oscar Paz Flores, Masato Tanaka, Shashank J Ekade, Shinya Arataki, Tadashi Komatsubara, Yoshiaki Oda, Kensuke Shinohara, Toshifumi Ozaki","doi":"10.31616/asj.2024.0374","DOIUrl":"https://doi.org/10.31616/asj.2024.0374","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective multicenter cohort study.</p><p><strong>Purpose: </strong>We sought to determine whether occipitocervical (OC) fusion is followed by more postoperative complications and revision surgery than is atlantoaxial (AA) fusion. We aim to compare postoperative complications and revision surgery associated with OC fusion and AA fusion.</p><p><strong>Overview of literature: </strong>OC and AA fusion are established techniques for restoring upper cervical stability. However, the outcomes of the two methods have not been compared.</p><p><strong>Methods: </strong>This study included 90 patients who underwent upper spinal fusion surgery for mechanical instability, performed by three surgeons in two hospitals from 2011 to 2023; OC fusion was indicated for irreducible AA subluxation, os odontoideum, and severe upper C1 fracture. Of the patients, 38 (mean age, 58.7 years) underwent OC fusion, and 52 (mean age, 62.8 years) underwent AA fusion. To evaluate surgical outcomes, we documented surgical time, intraoperative blood loss, postoperative complications, and the rate of revision surgery. Radiographs were obtained to identify screw malposition, rod breakage, and nonunion. To compare the outcomes of the two techniques, we used the Mann-Whitney U test for continuous variables and the chi-square or Fisher's exact test for dichotomous variables.</p><p><strong>Results: </strong>OC fusion took significantly longer (175.4 minutes) than AA fusion (150.7 minutes, p=0.020) and had a higher complication rate (39.5% vs. 11.5%, p <0.0001). The reoperation rate was 23.7% (9/38) after OC fusion and 3.8% (2/52) after AA fusion; the difference was statistically significant (p=0.0073). Average amounts of blood loss were 224 mL during OC fusion and 224 mL during AA fusion; the difference was not significant (p=0.947).</p><p><strong>Conclusions: </strong>Although OC fusion is indispensable for certain conditions, particularly basilar invagination, it entails more risk than dose AA fusion; the choice of technique thus warrants careful consideration.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540003","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":"Decompression and fusion for lumbar degenerative spondylolisthesis is associated with higher early morbidity rates and risk of perioperative complications compared with decompression alone: a retrospective study in the United States.","authors":"Abhinav Sharma, Paramveer Birring, Nischal Acharya, Manaav Mehta, Nicole Liu Goldenhersh, Michael Steinhaus, Hao-Hua Wu, Sohaib Hashmi, Don Young Park, Yu-Po Lee, Nitin Bhatia","doi":"10.31616/asj.2024.0279","DOIUrl":"https://doi.org/10.31616/asj.2024.0279","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Purpose: </strong>To assess differences in 30-day morbidity and mortality and postoperative complications between two surgical treatment options.</p><p><strong>Overview of literature: </strong>The choice of decompression with fusion or decompression alone for the management of degenerative spondylolisthesis (DS) is controversial.</p><p><strong>Methods: </strong>The American College of Surgeons National Quality Improvement Program database was queried for laminectomy or laminotomy with and without fusion from 2015 to 2020. The estimated 30-day mortality and morbidity, 30-day complications, and American Society of Anesthesiologist (ASA) classification were evaluated through chi-square and analysis of variance tests, with the results further stratified according to the ASA classification.</p><p><strong>Results: </strong>Of the 4,120 patients, 2,384 (58%) underwent a laminectomy or laminotomy without fusion and 1,736 (42%) underwent a laminectomy or laminotomy with fusion. Patients undergoing decompression with fusion had higher mean mortality (estimated probability 0.0034 vs. 0.0027, p<0.001), mean morbidity (estimated probability 0.053 vs. 0.048, p<0.001), mean length of stay (3.62±3.4 days vs. 3.15±4.3 days, p<0.001), and bleeding risk necessitating transfusion (9.5% vs. 7.6%, p =0.038). There was a higher rate of overall 30-day postoperative complications associated with an increasing ASA score for both cohorts.</p><p><strong>Conclusions: </strong>Decompression with fusion was associated with higher estimated mortality, morbidity, and 30-day complications. Decompression alone is an appealing treatment option for lumbar DS, particularly for patients with higher ASA scores and those at higher risk.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540035","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":"Estimation of proximal junctional failure and associated risk factors in adult spine deformity surgery: an observational study from a single institution.","authors":"Vishwajeet Singh, Marcelo Oppermann, Nathan Evaniew, Alexandra Soroceanu, Fred Nicholls, Bradley Jacobs, Kenneth Thomas, Ganesh Swamy","doi":"10.31616/asj.2024.0405","DOIUrl":"https://doi.org/10.31616/asj.2024.0405","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective observational cohort study.</p><p><strong>Purpose: </strong>To estimate the proximal junctional failure (PJF) rate and identify associated factors.</p><p><strong>Overview of literature: </strong>Proximal junctional pathologies are challenging and common complications of adult spine deformity (ASD) surgery. However, the PJF rate was not accurately defined within the ASD cohort. A correct estimate of PJF incidence and associated factors will inform clinicians on reoperation risk and prevention strategies.</p><p><strong>Methods: </strong>This retrospective observational study included patients with degenerative or adult idiopathic thoracolumbar deformity, extended instrumentation, sacropelvic fixation, and more than 2 years of follow-up. Patients with post-traumatic or iatrogenic sagittal malalignment were excluded. Demographic and operative data were obtained from the electronic medical records. Preoperative and followup scoliosis radiographs were reviewed to calculate the spinal alignment parameters. Patients were categorized into the PJF and non- PJF groups using the modified Hart-ISSG criteria, and their demographic, surgical, and radiographic parameters were compared using descriptive statistics. Multivariable logistic regression models were fitted to estimate the association measures of PJF occurrence, and their odds ratios (ORs) were reported with corresponding 95% confidence intervals (CI).</p><p><strong>Results: </strong>Of the eligible 157 patients who underwent surgery between 2011 and 2018, 130 were included. The mean age was 64.6±8 years, and 73% of the patients were female. Moreover, 42 (32%) and 88 patients (68%) were allocated to the PJF and non-PJF groups, respectively. The mean change in the proximal junctional angle (△PJA) in the PJF group was 26°±8.2°, and 33 patients (79%) had a final PJA >20°, 4 (10%) had an additional upper instrumented vertebra (UIV)/UIV+1 fracture, and 5 (12%) had an additional screw dislodgement or fixation failure. Postoperative changes in PJA (OR, 1.23; 95% CI, 1.12-1.37; p <0.001), thoracic kyphosis (TK; OR, 1.06; 95% CI, 1.02-1.11; p =0.004), and the use of a proximal tether (OR, 0.22; 95% CI, 0.04-0.82; p =0.03) were associated with PJF.</p><p><strong>Conclusions: </strong>In this study, the PJF rate was 32%, of which 67% of the patients underwent reoperation. Postoperative PJA and TK changes and the use of proximal tethers were significantly associated with PJF.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539992","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":"Evaluating the effect of early balloon kyphoplasty on adjacent vertebral fracture risk in osteoporotic vertebral fracture management: a retrospective study.","authors":"Masatoshi Yamamoto, Koji Ohta, Daisuke Hirano, Maki Noguchi, Shuhei Ayukawa, Keigo Shirasaki, Kenya Ishizu, Tetsuya Watanabe, Keiichiro Iida","doi":"10.31616/asj.2024.0494","DOIUrl":"https://doi.org/10.31616/asj.2024.0494","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>To evaluate whether the timing of balloon kyphoplasty (BKP) affects the risk of adjacent vertebral fractures (AVFs) in the management of osteoporotic vertebral fractures.</p><p><strong>Overview of literature: </strong>Osteoporotic vertebral fractures are usually managed conservatively; however, complications such as nonunion, neurologic deficits, and high-grade kyphosis can arise. BKP, a minimally invasive procedure for pain relief, has been associated with AVF risk. Although meta-analyses suggest no significant difference in AVF rates between BKP and conservative treatment, retrospective studies report higher AVF rates after BKP. Many of these cases involve patients resistant to conservative treatment, which implies that differences in the incidence of AVF may be influenced by the delay before performing BKP.</p><p><strong>Methods: </strong>We retrospectively analyzed 189 patients who underwent BKP between 2012 and 2023, excluding those with pathological fractures. The incidence of AVF was assessed at 3 months after BKP. Risk factors, including age, sex, fracture site, prior vertebral fractures, bone mineral density, kyphosis angle, endplate damage, signal changes in the fractured vertebral body on magnetic resonance imaging, vertebral instability, and timing of BKP, were evaluated.</p><p><strong>Results: </strong>The overall incidence of AVFs was 29%. The AVF rate was 21% in patients treated with BKP within 30 days, as compared with 32% in those treated later; however, this difference was not statistically significant (p =0.15). Multivariate analysis identified vertebral instability as the only significant risk factor for AVF (odds ratio, 2.73; p =0.01), whereas the timing of BKP showed no significant association with AVF risk.</p><p><strong>Conclusions: </strong>Early BKP does not significantly reduce the risk of AVF. The findings suggest that the management of osteoporotic vertebral fractures should focus on vertebral stability rather than intervention timing.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539953","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":"To Zoom or not to Zoom? A retrospective comparative study to assess the validity of video versus face-to-face consultations and examinations for diagnosing lower back pain in Wales.","authors":"Megan Havard, Ronan McKeogh, Abi Goodier, Gemma Johns, Sashin Ahuja","doi":"10.31616/asj.2024.0344","DOIUrl":"https://doi.org/10.31616/asj.2024.0344","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective comparative study.</p><p><strong>Purpose: </strong>To evaluate the accuracy of examination findings and diagnoses established after initial spinal consultations for low back pain conducted virtually in comparison with face-to-face (F2F) consultations.</p><p><strong>Overview of literature: </strong>The COVID-19 pandemic required a shift from F2F to virtual consultations in healthcare, with documented benefits such as reduced costs, CO2 emissions, and time. However, the diagnostic accuracy of telemedicine for conditions requiring physical examinations, such as low back pain, remains underexplored. Although studies have highlighted the feasibility and high satisfaction of virtual spinal assessments, they have not thoroughly investigated their diagnostic accuracy.</p><p><strong>Methods: </strong>This study included 154 new patients with degenerative lumbar spine problems who were assessed via virtual consultations (VCs) (n=77) or F2F (n=77) by a single orthopedic spinal surgeon between May 2020 and January 2021. Patients were matched by age and sex, and examinations followed the \"telemedicine musculoskeletal examination\" protocol by the Mayo Clinic. Diagnostic changes from initial to definitive diagnoses were recorded and compared between the two groups.</p><p><strong>Results: </strong>The diagnostic accuracy of VCs was comparable with that of F2F examinations, with no significant difference in the rate of diagnostic changes between the groups (p=0.814 for any change; p=0.405 for more significant changes). Motor deficits were the only examination component with significant false-positive rates in the VC group (p=0.023).</p><p><strong>Conclusions: </strong>The study findings indicate that the initial spinal VCs and examinations are effective, safe, and beneficial in the evaluation of low back pain, providing the same diagnostic accuracy as initial F2F consultations. All erroneous motor deficit findings were false positive, which means that no serious pathology was missed during the initial VC evaluation. Future research should focus on refining virtual examination techniques, particularly for assessing motor deficits.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540057","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":"Bone density comparison between the normal pedicle trajectory, cortical bone trajectory, and modified cortical bone trajectory using computed tomography: a cross-sectional study.","authors":"Bikash Parajuli, Dipak Shrestha, Kuniyoshi Abumi, Sabik Kayastha, Jagadish Thapa, Sanjay Sharma, Suman Lamichhane, Christian Deininger","doi":"10.31616/asj.2024.0377","DOIUrl":"https://doi.org/10.31616/asj.2024.0377","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Purpose: </strong>To compare bone density by computed tomography Hounsfield unit (CTHU) between the original pedicle trajectory (OPT), cortical bone trajectory (CBT), and modified cortical bone trajectory (MCBT).</p><p><strong>Overview of literature: </strong>The significant pullout strength in CBT is believed to be due to increased screw-cortical bone contact; however, it allows for shorter/less-diameter screw placement, and the fixation is limited to the posterior one-third of the vertebral body, compromising the screw anchorage in the anterior vertebra.</p><p><strong>Methods: </strong>Computed tomography transverse sections of the L1-L5 (1,000 vertebrae) of 200 patients were cut into three planes: (1) horizontal to the pedicle, representing the plane for OPT; (2) in the caudocranial plane in the sagittal plane and divergent in the transverse plane representing the CBT; and (3) the caudocranial plane in the sagittal plane and parallel in the transverse plane representing the MCBT. For each trajectory, the CTHU of four points, namely, posterior cortex, mid-pedicle, midbody, and anterior cortex, were compared within the area of screw insertion.</p><p><strong>Results: </strong>The mean CTHUs of OPT, CBT, and MCBT were 354.2±70 HU, 529.9±75 HU, and 457.3±90 HU, respectively (p <0.01). The CTHU of the posterior cortex in MCBT was 65.6% higher than that in OPT and 14.9% lower than that in CBT. A comparable decline in CTHU with age was noted in CBT and MCBT (Pearson's r : -0.20 vs. -0.22; adjusted R 2: 0.040 vs. 0.047). However, a higher decline in CTHU with age was observed in OPT (Pearson's r =-0.38, adjusted R 2=0.14).</p><p><strong>Conclusions: </strong>MCBT has a significantly higher CTHU than OPT. The density in the posterior cortex in MCBT is comparable to that in the CBT trajectory. MCBT appears to be an alternative trajectory for lumbar spine fixation.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539999","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":"Predictors of hospitalization for longer than one day following elective single-level anterior cervical discectomy and fusion: a retrospective case-control database study.","authors":"Sam Han Jiang, James W Nie, Nauman Shaukat Chaudhry, Saavan Patel, Darius Ansari, Ashwin Ganesh, Jeffrey Z Nie, Jaimin Patel, Ankit Indravadan Mehta","doi":"10.31616/asj.2024.0321","DOIUrl":"https://doi.org/10.31616/asj.2024.0321","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective case-control study.</p><p><strong>Purpose: </strong>To understand the risk factors for prolonged hospitalization following anterior cervical discectomy and fusion (ACDF) to reduce postoperative complications and better identify optimal candidates for elective ACDF.</p><p><strong>Overview of literature: </strong>Despite the proven safety of ACDF, many patients may experience prolonged postoperative hospitalization.</p><p><strong>Methods: </strong>Data were collected from the American College of Surgeons National Surgical Quality Improvement Program dataset spanning 2017-2019. The primary outcome of interest was the length of stay (LOS). The study population was divided into two cohorts: those with LOS ≤1 day and those with LOS >1 day. Univariate and multivariate analyses were performed to identify predictors of LOS >1 day. Propensity score matching and group comparisons were used to evaluate pre- and post-discharge complication rates between the cohorts.</p><p><strong>Results: </strong>A total of 12,906 patients with ACDF were identified in the database and considered eligible for the study. Of these patients, 69.5% had LOS ≤1 day and 30.5% had LOS >1 day. Factors associated with LOS >1 day included age ≥65 years, female sex, non-White race, American Society of Anesthesiologists classification 3, dependent functional status, and operation length of 120-150 minutes and >150 minutes. Patients with LOS >1 day were more likely to undergo intraoperative or postoperative blood transfusions (0.1% vs. 0.7%, p<0.001), unplanned reoperations (0% vs. 1.7%, p<0.001), and develop pneumonia during hospitalization (0% vs. 0.7%, p<0.001). These patients were also more likely to be readmitted (2.7% vs. 4.3%, p<0.001).</p><p><strong>Conclusions: </strong>Older patients, those with poorer functional status, and those who undergo longer operative times are more likely to experience prolonged postoperative hospitalization. These patients are also at increased risk of complications such as pneumonia, blood transfusions, reoperation, and readmission. Careful patient selection for ACDF is essential to reduce the risk of prolonged hospitalization and associated complications.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540021","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 sarcopenia on outcomes following vertebral augmentation for osteoporotic vertebral compression fracture: a systematic review and meta-analysis.","authors":"Bao Tu Thai Nguyen, Tan Thanh Nguyen, Yi-Jie Kuo, Yu-Pin Chen","doi":"10.31616/asj.2024.0467","DOIUrl":"https://doi.org/10.31616/asj.2024.0467","url":null,"abstract":"<p><p>Vertebral augmentation is a safe and effective treatment for osteoporotic vertebral compression fractures (OVCFs) in elderly patients. The impact of sarcopenia on post-procedure outcomes has been debated. This meta-analysis examined its effect on outcomes following vertebral augmentation in OVCF patients. Several electronic databases were searched until August 2024 for studies that compared patients with and without sarcopenia after kyphoplasty or vertebroplasty for OVCFs. The outcomes of interest were the rates of vertebral refracture and residual back pain (RBP), clinical outcomes, length of hospital stay, and mortality rate. The pooled results are presented as odds ratios (ORs) or mean differences with corresponding 95% confidence intervals (CIs). Fourteen studies involving 2197 patients with OVCF treated with vertebral augmentation were included. Of these patients, 813 had sarcopenia and 1384 did not, with a mean age of 73.06. Patients with sarcopenia exhibited a higher prevalence of refracture than those without sarcopenia (OR, 2.92; 95% CI, 1.34-6.34; p =0.007). Patients without sarcopenia had a 64% lower risk of RBP than those with sarcopenia (OR, 0.36; 95% CI, 0.23-0.56; p <0.001). Additionally, patients with sarcopenia demonstrated worse postoperative clinical outcomes, longer hospital stays, and a significantly higher risk of mortality. Sarcopenia adversely affects patients undergoing vertebral augmentation for OVCFs. Early diagnosis of sarcopenia in patients with OVCF and the adoption of comprehensive management strategies to improve and maintain muscle health are recommended (PROSPERO registry number: CRD42024578202).</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539959","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":"Can generative artificial intelligence provide accurate medical advice?: a case of ChatGPT versus Congress of Neurological Surgeons management of acute cervical spine and spinal cord injuries clinical guidelines.","authors":"Michael Saturno, Mateo Restrepo Mejia, Wasil Ahmed, Alexander Yu, Akiro Duey, Bashar Zaidat, Fady Hijji, Jonathan Markowitz, Jun Kim, Samuel Cho","doi":"10.31616/asj.2024.0301","DOIUrl":"https://doi.org/10.31616/asj.2024.0301","url":null,"abstract":"<p><strong>Study design: </strong>An experimental study.</p><p><strong>Purpose: </strong>To explore the concordance of ChatGPT responses with established national guidelines for the management of cervical spine and spinal cord injuries.</p><p><strong>Overview of literature: </strong>ChatGPT-4.0 is an artificial intelligence model that can synthesize large volumes of data and may provide surgeons with recommendations for the management of spinal cord injuries. However, no available literature has quantified ChatGPT's capacity to provide accurate recommendations for the management of cervical spine and spinal cord injuries.</p><p><strong>Methods: </strong>Referencing the \"Management of acute cervical spine and spinal cord injuries\" guidelines published by the Congress of Neurological Surgeons (CNS), a total of 36 questions were formulated. Questions were stratified into therapeutic, diagnostic, or clinical assessment categories as seen in the guidelines. Questions were secondarily grouped according to whether the corresponding recommendation contained level I evidence (highest quality) versus only level II/III evidence (moderate and low quality). ChatGPT-4.0 was prompted with each question, and its responses were assessed by two independent reviewers as \"concordant\" or \"nonconcordant\" with the CNS clinical guidelines. \"Nonconcordant\" responses were rationalized into \"insufficient\" and \"contradictory\" categories.</p><p><strong>Results: </strong>In this study, 22/36 (61.1%) of ChatGPT's responses were concordant with the CNS guidelines. ChatGPT's responses aligned with 17/24 (70.8%) therapeutic questions and 4/7 (57.1%) diagnostic questions. ChatGPT's response aligned with only one of the five clinical assessment questions. Notably, the recommendations supported by level I evidence were the least likely to be replicated by ChatGPT. ChatGPT's responses agreed with 80.8% of the recommendations supported exclusively by level II/III evidence.</p><p><strong>Conclusions: </strong>ChatGPT-4 was moderately accurate when generating recommendations that aligned with the clinical guidelines. The model frequently aligned with low evidence and therapeutic recommendations but exhibited inferior performance on topics that contained high-quality evidence or pertained to diagnostic and clinical assessment strategies. Medical practitioners should monitor its usage until further models can be rigorously trained on medical data.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540011","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}