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Use of ChatGPT for Determining Clinical and Surgical Treatment of Lumbar Disc Herniation With Radiculopathy: A North American Spine Society Guideline Comparison. 使用 ChatGPT 确定腰椎间盘突出症伴根性病变的临床和手术治疗:NASS 指南比较。
IF 3.2 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-03-01 Epub Date: 2024-01-31 DOI: 10.14245/ns.2347052.526
Mateo Restrepo Mejia, Juan Sebastian Arroyave, Michael Saturno, Laura Chelsea Mazudie Ndjonko, Bashar Zaidat, Rami Rajjoub, Wasil Ahmed, Ivan Zapolsky, Samuel K Cho

Objective: Large language models like chat generative pre-trained transformer (ChatGPT) have found success in various sectors, but their application in the medical field remains limited. This study aimed to assess the feasibility of using ChatGPT to provide accurate medical information to patients, specifically evaluating how well ChatGPT versions 3.5 and 4 aligned with the 2012 North American Spine Society (NASS) guidelines for lumbar disk herniation with radiculopathy.

Methods: ChatGPT's responses to questions based on the NASS guidelines were analyzed for accuracy. Three new categories-overconclusiveness, supplementary information, and incompleteness-were introduced to deepen the analysis. Overconclusiveness referred to recommendations not mentioned in the NASS guidelines, supplementary information denoted additional relevant details, and incompleteness indicated omitted crucial information from the NASS guidelines.

Results: Out of 29 clinical guidelines evaluated, ChatGPT-3.5 demonstrated accuracy in 15 responses (52%), while ChatGPT-4 achieved accuracy in 17 responses (59%). ChatGPT-3.5 was overconclusive in 14 responses (48%), while ChatGPT-4 exhibited overconclusiveness in 13 responses (45%). Additionally, ChatGPT-3.5 provided supplementary information in 24 responses (83%), and ChatGPT-4 provided supplemental information in 27 responses (93%). In terms of incompleteness, ChatGPT-3.5 displayed this in 11 responses (38%), while ChatGPT-4 showed incompleteness in 8 responses (23%).

Conclusion: ChatGPT shows promise for clinical decision-making, but both patients and healthcare providers should exercise caution to ensure safety and quality of care. While these results are encouraging, further research is necessary to validate the use of large language models in clinical settings.

背景:像 ChatGPT 这样的大型语言模型在各行各业都取得了成功,但在医疗领域的应用仍然有限。本研究旨在评估使用 ChatGPT 向患者提供准确医疗信息的可行性,特别是评估 ChatGPT 3.5 和 4.0 版本与 2012 年北美脊柱协会(NASS)腰椎间盘突出症伴有放射性病变指南的一致性:对 ChatGPT 根据 NASS 指南回答问题的准确性进行了分析。为了深化分析,引入了三个新的类别--过度结论、补充信息和不完整。过度结论性指的是NASS指南中未提及的建议,补充信息指的是更多相关细节,不完整性指的是NASS指南中遗漏的关键信息:在所评估的 29 份临床指南中,ChatGPT 3.5 在 15 份(52%)回复中显示了准确性,而 ChatGPT 4.0 在 17 份(59%)回复中实现了准确性。ChatGPT 3.5 在 14 个(48%)回复中显示出过度结论,而 ChatGPT 4.0 在 13 个(45%)回复中显示出过度结论。此外,ChatGPT 3.5 在 24 个(83%)回复中提供了补充信息,而 ChatGPT 4.0 在 27 个(93%)回复中提供了补充信息。就不完整性而言,ChatGPT 3.5 在 11 个(38%)回复中显示出不完整性,而 ChatGPT 4.0 在 8 个(23%)回复中显示出不完整性:结论:ChatGPT 为临床决策带来了希望,但患者和医疗服务提供者都应谨慎行事,以确保医疗安全和质量。虽然这些结果令人鼓舞,但仍需进一步研究,以验证大型语言模型在临床环境中的应用。
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引用次数: 0
Does Sacral Slanting Affect Postoperative Shoulder Balance in Patients With Lenke Type 2A Adolescent Idiopathic Scoliosis? 骶骨倾斜是否会影响伦克 2A 型青少年特发性脊柱侧凸患者术后的肩部平衡?
IF 3.2 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-03-01 Epub Date: 2024-01-31 DOI: 10.14245/ns.2347072.536
Chang Ju Hwang, Hyung Rae Lee, Suk Kyu Lee, Sang Yun Seok, Jae Hwan Cho, Dong-Ho Lee, Choon Sung Lee

Objective: Even minor sacral slanting can influence T1 tilt and shoulder balance. Yet, the relationship between sacral slanting and postoperative shoulder imbalance (PSI) has not been previously explored. To determine risk factors for PSI in Lenke 2A adolescent idiopathic scoliosis (AIS) patients, with an emphasis on sacral slanting.

Methods: The study encompassed 96 consecutive patients who had undergone posterior correction and fusion surgery for Lenke type 2A AIS. Patients were grouped into PSI(+) and PSI(-) based on postoperative outcomes. Additionally, they were classified into left-sided slanting, no slanting, and right-sided slanting groups according to the degree of sacral slanting. Various radiological measures were compared.

Results: Patients in the PSI(+) group exhibited a smaller preoperative proximal thoracic curve and a higher main thoracic curve correction rate than those in the PSI(-) group. The presence or absence of sacral slanting did not exhibit a significant variation in PSI occurrence. However, the right-sided sacral slanting group showed a larger delta radiologic shoulder height compared to the other 2 groups (7.1 mm vs. 1.5 & 3.3 mm).

Conclusion: Sacral slanting was not directly linked to the development of PSI. Despite the common postoperative elevation of the left shoulder, the shoulder height differences decreased over the follow-up period. Especially in cases with a right-sided tilted sacrum, the PSI demonstrated progressive improvement, with an associated increase in the rightward distal wedging angle, leading to distal adding-on.

目的:即使是轻微的骶骨倾斜也会影响 T1 倾斜和肩部平衡。然而,骶骨斜度与术后肩部不平衡(PSI)之间的关系尚未得到探讨。目的:确定Lenke 2A青少年特发性脊柱侧凸(AIS)患者出现PSI的风险因素,重点是骶骨倾斜:研究对象包括96名连续接受过Lenke 2A型AIS后路矫正和融合手术的患者。根据术后结果将患者分为 PSI(+)和 PSI(-)两组。此外,根据骶骨倾斜的程度将患者分为左侧倾斜组、无倾斜组和右侧倾斜组。对各种放射学指标进行了比较:结果:与 PSI(-)组相比,PSI(+)组患者术前近端胸廓曲线较小,主胸廓曲线矫正率较高。骶骨是否倾斜在 PSI 发生率上没有显著差异。然而,与其他两组相比,右侧骶骨倾斜组显示出更大的Delta RSH(7.1毫米 vs. 1.5和3.3毫米):结论:骶骨倾斜与 PSI 的发生没有直接联系。尽管术后左肩普遍抬高,但肩高差异在随访期间有所缩小。特别是在骶骨右侧倾斜的病例中,PSI表现出逐渐改善的趋势,与之相关的是远端楔角(DWA)向右增加,导致远端增高。
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引用次数: 0
Quantitative Analysis of the Effect of Stereotactic Radiosurgery for Postoperative Residual Cervical Dumbbell Tumors: A Multicenter Retrospective Cohort Study. 立体定向放射外科治疗术后残留颈椎哑铃状肿瘤效果的定量分析:一项多中心回顾性队列研究。
IF 3.2 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-03-01 Epub Date: 2024-01-31 DOI: 10.14245/ns.2347070.535
Sang Hyub Lee, Sun Woo Jang, Hong Kyung Shin, Jeoung Hee Kim, Danbi Park, Chang-Min Ha, Sun-Ho Lee, Dong Ho Kang, Young Hyun Cho, Sang Ryong Jeon, Sung Woo Roh, Jin Hoon Park

Objective: Stereotactic radiosurgery (SRS) has been performed for spinal tumors. However, the quantitative effect of SRS on postoperative residual cervical dumbbell tumors remains unknown. This study aimed to quantitatively evaluate the efficacy of SRS for treating postoperative residual cervical dumbbell tumors.

Methods: We retrospectively reviewed cases of postoperative residual cervical dumbbell tumors from 1995 to 2020 in 2 tertiary institutions. Residual tumors underwent SRS (SRS group) or were observed with clinical and magnetic resonance imaging (MRI) follow-up (observation group). Tumor regrowth rates were compared between the SRS and observation groups. Additionally, risk factors for tumor regrowth were analyzed.

Results: A total of 28 cervical dumbbell tumors were incompletely resected. Eight patients were in the SRS group, and 20 in the observation group. The mean regrowth rate was not significantly lower (p = 0.784) in the SRS group (0.18 ± 0.29 mm/mo) than in the observation group (0.33 ± 0.40 mm/mo). In the multivariable Cox regression analysis, SRS was not a significant variable (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.18-1.79; p = 0.336).

Conclusion: SRS did not significantly decrease the tumor regrowth rate in our study. We believe that achieving maximal resection during the initial operation is more important than postoperative adjuvant SRS.

目的:立体定向放射手术(SRS)已被用于治疗脊柱肿瘤。然而,SRS 对术后残余颈椎哑铃状肿瘤的定量效果仍不清楚。本研究旨在定量评估 SRS 治疗术后残余颈椎哑铃状肿瘤的疗效:我们回顾性分析了两家三级医疗机构1995年至2020年的术后残留颈椎哑铃状肿瘤病例。残留肿瘤接受了 SRS(SRS 组)或通过临床和磁共振成像(MRI)随访观察(观察组)。比较了 SRS 组和观察组的肿瘤再生长率。此外,还分析了肿瘤再生的风险因素:结果:共有 28 例颈椎哑铃状肿瘤未完全切除。结果:共有 28 例颈椎哑铃状肿瘤未完全切除,其中 8 例为 SRS 组,20 例为观察组。SRS组(0.18 ± 0.29 mm/月)的平均再生率(P=0.784)并不明显低于观察组(0.33 ± 0.40 mm/月)。在多变量 Cox 回归分析中,SRS 不是一个显著变量(危险比 1.03,95% 置信区间 [0.34-3.06],P = 0.962)。术后首次核磁共振成像显示的残留肿瘤直径是唯一显著的变量(危险比 0.92,95% 置信区间 [0.84-1.00],P = 0.037):结论:在我们的研究中,SRS并未明显降低肿瘤的再生率。结论:在我们的研究中,SRS 并未明显降低肿瘤的再生率,术后首次 MRI 检查的残留肿瘤直径是降低肿瘤再生率的唯一重要变量。因此,我们认为在初次手术中实现最大切除比术后辅助 SRS 更为重要。
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引用次数: 0
Relationship Between Types of Warming Devices and Surgical Site Infection in Patients Who Underwent Posterior Fusion Surgery Based on National Data. 基于全国数据的保温设备类型与后路融合手术患者手术部位感染的关系。
IF 3.2 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2023-12-01 Epub Date: 2023-12-31 DOI: 10.14245/ns.2346846.423
Seung Hoon Kim, Yonghan Cha, Sang Yun Seok, Jae Hwan Cho, Bo-Yeon Kim, Hyo-Jung Lee, Gui-Ok Kim

Objective: Perioperative hypothermia can lead to various complications. Although various warming techniques have been used to prevent perioperative hypothermia, the effect of these techniques on surgical site infection (SSI) during posterior fusion surgery is unclear. The effects of warming devices on SSI rates were therefore analyzed using data complied by the Health Insurance and Review Assessment (HIRA) Service in Korea.

Methods: This study included 5,406 patients in the HIRA Service database who underwent posterior fusion surgery during the years 2014, 2015, and 2017. Factors related to SSI in these patients, including warming devices, antibiotics, and transfusion, were analyzed.

Results: The incidence of SSI was higher in patients who underwent forced air warming than in those who did not undergo active warming (odds ratio [OR], 1.73; p = 0.039), especially above 70 years old (OR, 4.11; p = 0.014). By contrast, the incidence of SSI was not significantly higher in patients who underwent device using conduction. Infection rates were higher in patients who received prophylactic antibiotics within 20 minutes before incision, than within 21 to 60 minutes (OR, 2.07; p = 0.001) and who received more blood transfusions (1 pint < volume ≤ 2 pint; OR, 1.75; p = 0.008, > 2 pint; OR, 2.73; p = 0.004).

Conclusion: SSI rates were higher in patients who underwent warming with forced air devices than with devices using conduction, as well as being higher in patients who older age, received blood transfusions and administered antibiotics within 20 minutes before incision. Devices using conduction have more advantages in preventing SSI than forced air warming device. In addition, the reduction of other risk factors for SSI may improve postoperative results.

目的:围手术期低温可导致各种并发症。虽然各种加温技术已被用于预防围术期低体温,但这些技术对后路融合手术中手术部位感染(SSI)的影响尚不明确。因此,我们利用韩国健康保险和审查评估(HIRA)服务机构提供的数据分析了保暖设备对 SSI 感染率的影响:本研究纳入了 HIRA 服务数据库中 2014、2015 和 2017 年期间接受后路融合手术的 5406 名患者。分析了这些患者中与 SSI 相关的因素,包括加温设备、抗生素和输血:接受强制空气加温的患者的 SSI 发生率高于未接受主动加温的患者(几率比 [OR],1.73;P = 0.039),尤其是 70 岁以上的患者(OR,4.11;P = 0.014)。相比之下,使用传导装置的患者的 SSI 发生率并没有明显增加。在切口前 20 分钟内接受预防性抗生素治疗的患者感染率高于在 21 至 60 分钟内接受预防性抗生素治疗的患者(OR,2.07;P = 0.001),接受输血较多的患者感染率也较高(1 品脱 < 容量 ≤ 2 品脱;OR,1.75;P = 0.008,> 2 品脱;OR,2.73;P = 0.004):使用强制空气设备加温的患者的 SSI 感染率高于使用传导设备的患者,年龄较大、接受过输血和在切口前 20 分钟内使用过抗生素的患者的 SSI 感染率也更高。在预防 SSI 方面,传导式设备比强制空气加温设备更具优势。此外,减少 SSI 的其他风险因素也可改善术后效果。
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引用次数: 0
Cellular Basis for Sequencing of Antiresorptive and Anabolic Therapies for Bone: Commentary on "Bone Remodeling and Modeling: Cellular Targets for Antiresorptive and Anabolic Treatments, Including Approaches Through the Parathyroid Hormone (PTH)/PTH-Related Protein Pathway". 骨质抗吸收和同化疗法排序的细胞基础:"骨质重塑和建模 "评论:抗骨质吸收和合成代谢疗法的细胞靶点,包括通过甲状旁腺激素 (PTH)/PTH 相关蛋白途径的方法 "的评论。
IF 3.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2023-12-01 Epub Date: 2023-12-31 DOI: 10.14245/ns.2347242.621
Natalie A Sims
{"title":"Cellular Basis for Sequencing of Antiresorptive and Anabolic Therapies for Bone: Commentary on \"Bone Remodeling and Modeling: Cellular Targets for Antiresorptive and Anabolic Treatments, Including Approaches Through the Parathyroid Hormone (PTH)/PTH-Related Protein Pathway\".","authors":"Natalie A Sims","doi":"10.14245/ns.2347242.621","DOIUrl":"10.14245/ns.2347242.621","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"20 4","pages":"1110-1111"},"PeriodicalIF":3.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10762422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139087847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Commentary on "Simultaneous Single-Position Oblique Lateral Interbody Fusion Combined With Unilateral Percutaneous Pedicle Screw Fixation for Single-Level Lumbar Tuberculosis: A 3-Year Retrospective Comparative Study". 关于 "单侧经皮椎弓根螺钉固定治疗单侧腰椎结核的同时单位置斜侧椎体间融合术:一项为期 3 年的回顾性比较研究"。
IF 3.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2023-12-01 Epub Date: 2023-12-31 DOI: 10.14245/ns.2347288.644
Chao-Hung Kuo, Tsung-Hsi Tu
{"title":"Commentary on \"Simultaneous Single-Position Oblique Lateral Interbody Fusion Combined With Unilateral Percutaneous Pedicle Screw Fixation for Single-Level Lumbar Tuberculosis: A 3-Year Retrospective Comparative Study\".","authors":"Chao-Hung Kuo, Tsung-Hsi Tu","doi":"10.14245/ns.2347288.644","DOIUrl":"10.14245/ns.2347288.644","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"20 4","pages":"1319-1320"},"PeriodicalIF":3.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10762404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139087850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quality of Spine Surgery Information on Social Media: A DISCERN Analysis of TikTok Videos. 社交媒体上脊柱手术信息的质量:TikTok 视频的 DISCERN 分析。
IF 3.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2023-12-01 Epub Date: 2023-12-31 DOI: 10.14245/ns.2346700.350
Tejas Subramanian, Kasra Araghi, Izzet Akosman, Olivia Tuma, Amier Hassan, Ali Lahooti, Anthony Pajak, Pratyush Shahi, Robert Merrill, Omri Maayan, Evan Sheha, James Dowdell, Sravisht Iyer, Sheeraz Qureshi

Objective: The use of social media applications to disseminate information has substantially risen in recent decades. Spine and back pain-related hashtags have garnered several billion views on TikTok. As such, these videos, which share experiences, offer entertainment, and educate users about spinal surgery, have become increasingly influential. Herein, we assess the quality of spine surgery content TikTok from providers and patients.

Methods: Fifty hashtags encompassing spine surgery ("#spinalfusion," "#scoliosissurgery," and "#spinaldecompression") were searched using TikTok's algorithm and included. Two independent reviewers rated the quality of each video via the DISCERN questionnaire. Video metadata (likes, shares, comments, views, length) were all collected; type of content creator (musculoskeletal, layperson) and content category (educational, patient experience, entertainment) were determined.

Results: The overall DISCERN score was, on average, 24.4. #Spinalfusion videos demonstrated greater engagement, higher average likes (p = 0.02), and more comments (p < 0.001) compared to #spinaldecompression and #scoliosissurgery. #Spinaldecompression had the highest DISCERN score (p < 0.001), likely explained by the higher percentage of videos that were educational (p < 0.001) and created by musculoskeletal (MSK) professionals (p < 0.001). Compared to laypersons, MSK professionals had significantly higher quality videos (p < 0.001). Similarly, the educational category demonstrated higher quality videos (p < 0.001). Video interaction trended lower with MSK videos and educational videos had the lowest interaction of the content categories (likes: p = 0.023, comments: p = 0.005).

Conclusion: The quality of spine surgery videos on TikTok is low. As the influence of the new social media landscape governs how the average person consumes information, MSK providers should participate in disseminating high-quality content.

目的:近几十年来,使用社交媒体应用程序传播信息的情况大幅增加。在 TikTok 上,与脊柱和背痛相关的标签已经获得了数十亿的浏览量。因此,这些分享经验、提供娱乐和教育用户有关脊柱手术知识的视频变得越来越有影响力。在此,我们对来自医疗机构和患者的 TikTok 脊柱手术内容的质量进行了评估:我们使用 TikTok 的算法搜索了 50 个与脊柱手术有关的标签("#spinalfusion"、"#scoliosissurgery "和 "#spinaldecompression"),并将其收录其中。两名独立审查员通过 DISCERN 问卷对每个视频的质量进行评分。视频元数据(赞、分享、评论、浏览量、长度)均被收集;内容创作者类型(肌肉骨骼、非专业人士)和内容类别(教育、患者体验、娱乐)也被确定:结果:DISCERN 总分平均为 24.4 分。与#spinaldecompression和#scoliosissurgery相比,#Spinalfusion视频的参与度更高,平均点赞数更高(p = 0.02),评论更多(p < 0.001)。#Spinaldecompression 的 DISCERN 得分最高(p < 0.001),这可能是因为教育性视频(p < 0.001)和由肌肉骨骼(MSK)专业人士制作的视频(p < 0.001)所占比例较高。与普通人相比,MSK 专业人员的视频质量明显更高(p < 0.001)。同样,教育类视频的质量也更高(p < 0.001)。在内容类别中,MSK 视频和教育类视频的交互性呈下降趋势(喜欢:p = 0.023,评论:p = 0.005):结论:TikTok 上脊柱手术视频的质量较低。结论:TikTok 上的脊柱手术视频质量较低。由于新的社交媒体环境影响着普通人的信息消费方式,因此 MSK 医疗机构应参与传播高质量的内容。
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引用次数: 0
The Combined Effects of RhBMP-2 and Systemic RANKL Inhibitor in Patients With Bone Density Loss Undergoing Posterior Lumbar Interbody Fusion: A Retrospective Observational Analysis With Propensity Score Matching. RhBMP-2和全身RANKL抑制剂对腰椎后路椎体间融合术骨密度丧失患者的联合作用:倾向评分匹配的回顾性观察分析
IF 3.2 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2023-12-01 Epub Date: 2023-12-31 DOI: 10.14245/ns.2346702.351
Seungjun Ryu, Seon-Jin Yoon, Chang Kyu Lee, Seong Yi, Keung-Nyun Kim, Yoon Ha, Dong Ah Shin

Objective: The risks of nonunion and subsidence are high in patients with bone density loss undergoing spinal fusion surgery. The internal application of recombinant human bone morphogenic protein 2 (rhBMP-2) in an interbody cage improves spinal fusion; however, related complications have been reported. Denosumab, a human monoclonal antibody targeting the receptor activator of nuclear factor kappa B ligand (RANKL), hinders osteoblast differentiation and function. Therefore, this study aimed to observe the combined effect of the local application of rhBMP-2 in a lumbar cage and systemic RANKL inhibition on postoperative spinal fusion in patients with bone density loss undergoing posterior lumbar interbody fusion (PLIF).

Methods: This retrospective observational study included 251 consecutive patients with spinal stenosis who underwent PLIF at a single center between 2017 and 2021. Clinical outcomes were assessed, and radiographic evaluations included lumbar flexion, extension, range of motion, and subsidence. Statistical analyses were conducted to identify the combined effect of the treatment and the subsidence and spinal fusion status.

Results: One hundred patients were included in the final analysis. Denosumab treatment significantly reduced the rate of osteolysis (p = 0.013). When denosumab was administered in combination with rhBMP-2, the fusion status remained similar; however, the incidences of postoperative osteolysis and postoperative oozing day decreased.

Conclusion: The combined use of rhBMP-2 and RANKL inhibition in patients with bone density loss can enhance bone formation after PLIF with fewer complications than rhBMP-2 alone.

目的:接受脊柱融合手术的骨密度丧失患者发生骨不连和下沉的风险很高。将重组人骨形态发生蛋白 2(rhBMP-2)内置于椎间笼中可改善脊柱融合,但也有相关并发症的报道。地诺单抗是一种靶向核因子卡巴B配体受体激活剂(RANKL)的人类单克隆抗体,会阻碍成骨细胞的分化和功能。因此,本研究旨在观察在腰椎笼中局部应用 rhBMP-2 和全身 RANKL 抑制剂对接受后路腰椎椎间融合术(PLIF)的骨密度丧失患者术后脊柱融合的联合影响:这项回顾性观察研究纳入了2017年至2021年间在一个中心接受PLIF手术的251例连续性椎管狭窄患者。对临床结果进行了评估,放射学评估包括腰椎屈曲、伸展、活动范围和下沉。研究人员进行了统计分析,以确定治疗与下沉和脊柱融合状态的综合影响:结果:100 名患者被纳入最终分析。地诺单抗治疗明显降低了骨溶解率(p = 0.013)。当 Denosumab 与 rhBMP-2 联合使用时,脊柱融合情况保持相似;但术后溶骨和术后渗液日的发生率有所下降:结论:与单独使用 rhBMP-2 相比,在骨密度丧失患者中联合使用 rhBMP-2 和 RANKL 抑制剂可增强 PLIF 术后的骨形成,且并发症较少。
{"title":"The Combined Effects of RhBMP-2 and Systemic RANKL Inhibitor in Patients With Bone Density Loss Undergoing Posterior Lumbar Interbody Fusion: A Retrospective Observational Analysis With Propensity Score Matching.","authors":"Seungjun Ryu, Seon-Jin Yoon, Chang Kyu Lee, Seong Yi, Keung-Nyun Kim, Yoon Ha, Dong Ah Shin","doi":"10.14245/ns.2346702.351","DOIUrl":"10.14245/ns.2346702.351","url":null,"abstract":"<p><strong>Objective: </strong>The risks of nonunion and subsidence are high in patients with bone density loss undergoing spinal fusion surgery. The internal application of recombinant human bone morphogenic protein 2 (rhBMP-2) in an interbody cage improves spinal fusion; however, related complications have been reported. Denosumab, a human monoclonal antibody targeting the receptor activator of nuclear factor kappa B ligand (RANKL), hinders osteoblast differentiation and function. Therefore, this study aimed to observe the combined effect of the local application of rhBMP-2 in a lumbar cage and systemic RANKL inhibition on postoperative spinal fusion in patients with bone density loss undergoing posterior lumbar interbody fusion (PLIF).</p><p><strong>Methods: </strong>This retrospective observational study included 251 consecutive patients with spinal stenosis who underwent PLIF at a single center between 2017 and 2021. Clinical outcomes were assessed, and radiographic evaluations included lumbar flexion, extension, range of motion, and subsidence. Statistical analyses were conducted to identify the combined effect of the treatment and the subsidence and spinal fusion status.</p><p><strong>Results: </strong>One hundred patients were included in the final analysis. Denosumab treatment significantly reduced the rate of osteolysis (p = 0.013). When denosumab was administered in combination with rhBMP-2, the fusion status remained similar; however, the incidences of postoperative osteolysis and postoperative oozing day decreased.</p><p><strong>Conclusion: </strong>The combined use of rhBMP-2 and RANKL inhibition in patients with bone density loss can enhance bone formation after PLIF with fewer complications than rhBMP-2 alone.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"20 4","pages":"1186-1192"},"PeriodicalIF":3.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10762388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139087791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Computer Vision in Osteoporotic Vertebral Fracture Risk Prediction: A Systematic Review. 计算机视觉在骨质疏松性椎体骨折风险预测中的应用:系统综述。
IF 3.2 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2023-12-01 Epub Date: 2023-12-31 DOI: 10.14245/ns.2347022.511
Anthony K Allam, Adrish Anand, Alex R Flores, Alexander E Ropper

Osteoporotic vertebral fractures (OVFs) are a significant health concern linked to increased morbidity, mortality, and diminished quality of life. Traditional OVF risk assessment tools like bone mineral density (BMD) only capture a fraction of the risk profile. Artificial intelligence, specifically computer vision, has revolutionized other fields of medicine through analysis of videos, histopathology slides and radiological scans. In this review, we provide an overview of computer vision algorithms and current computer vision models used in predicting OVF risk. We highlight the clinical applications, future directions and limitations of computer vision in OVF risk prediction.

骨质疏松性脊椎骨折(OVFs)是一个重大的健康问题,与发病率、死亡率和生活质量下降有关。传统的椎体骨质疏松性骨折风险评估工具,如骨矿物质密度(BMD),只能捕捉到风险概况的一小部分。人工智能,特别是计算机视觉,通过对视频、组织病理学切片和放射扫描的分析,已经在其他医学领域掀起了一场革命。在这篇综述中,我们概述了计算机视觉算法和目前用于预测 OVF 风险的计算机视觉模型。我们重点介绍了计算机视觉在 OVF 风险预测中的临床应用、未来发展方向和局限性。
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引用次数: 0
Fusion Assessment of Oblique Lumbar Interbody Fusion Using Demineralized Bone Matrix: A 2-Year Prospective Study. 使用脱矿物质骨基质进行斜腰椎椎间融合术的融合评估:一项为期两年的前瞻性研究
IF 3.2 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2023-12-01 Epub Date: 2023-12-31 DOI: 10.14245/ns.2347032.516
Sangseok Lee, Jin Woo Jung, Sang-Woo Lee, Kyoung-Tae Kim, Heum-Dai Kwon, Subum Lee, Young San Ko, Pius Kim, Dae-Chul Cho

Objective: Although several studies have reported successful fusion rates after oblique lumbar interbody fusion (OLIF) using allografts or dimerized bone matrix (DBM) instead of autografts, whether OLIF can achieve satisfactory solid fusion without the use of autografts remains unclear. This study investigated the real fusion rates after OLIF using allografts and DBM, which were evaluated using both dynamic radiographs and computed tomography scans.

Methods: We enrolled 79 consecutive patients who underwent minimally invasive OLIF followed by percutaneous pedicle screw fixation. All patients were treated with OLIF between L2 and L5 and underwent radiographic and clinical follow-ups at 12, 18, and 24 months after surgery. Radiographic assessment of fusion was performed using the modified BrantigaSteffee-Fraser (mBSF) scale, which was categorized as follows: grades I (radiographic pseudoarthrosis), II (indeterminate fusion), and III (solid radiographic fusion). Other radiologic and clinical outcomes were evaluated using the following parameters: vertebral slippage distance, disc height, subsidence, Oswestry Disability Index (ODI), and visual analogue scale (VAS).

Results: Clinical outcomes demonstrated significant improvements in the VAS scores for back pain, leg pain, and ODI after surgery. Subsidence was present in 34 cases (35.4%) at 12 months postoperatively, which increased to 47.9% and reached 50.0% at 1.5 years and 2 years after surgery, respectively. The solid fusion rate after OLIF was 32.3% at 1 year, increased to 58.3% at 1.5 years, and reached 72.9% at 2 years. Radiographic pseudoarthrosis was 24.0% at 1 year, which decreased to 6.3% at 1.5 years and 3.1% at 2 years.

Conclusion: OLIF is a safe and effective surgical procedure for the treatment of degenerative lumbar diseases. The mBSF scale, which simultaneously evaluates both dynamic angles and bone bridge formation, offers great reliability for the radiological assessment of fusion. Moreover, OLIF using allografts and DBM, which is performed on one or 2 levels at L2-5, can achieve satisfactory fusion rates within 2 years after surgery.

目的:尽管有多项研究报道了使用异体移植物或二聚体骨基质(DBM)替代自体移植物进行斜腰椎椎体间融合术(OLIF)后的成功融合率,但不使用自体移植物的OLIF能否实现令人满意的实体融合仍不清楚。本研究调查了使用同种异体骨和二聚体骨基质进行 OLIF 后的实际融合率,并使用动态 X 光片和计算机断层扫描进行了评估:我们连续收治了79例接受微创OLIF术后经皮椎弓根螺钉固定的患者。所有患者均接受了 L2 和 L5 之间的 OLIF 治疗,并在术后 12、18 和 24 个月接受了放射学和临床随访。融合的放射学评估采用改良的Brantiga-Steffee-Fraser(mBSF)量表,分为以下等级:I级(放射学假关节)、II级(融合不确定)和III级(放射学融合牢固)。其他放射学和临床结果通过以下参数进行评估:椎体滑移距离、椎间盘高度、沉降、Oswestry 失能指数(ODI)和视觉模拟量表(VAS):结果:临床结果显示,术后背痛、腿痛和 ODI 的 VAS 评分均有明显改善。术后12个月有34例(35.4%)出现下沉,术后1.5年和2年分别增至47.9%和50.0%。OLIF 术后 1 年的实体融合率为 32.3%,1.5 年时增至 58.3%,2 年时达到 72.9%。影像学假关节在1年时为24.0%,1.5年时降至6.3%,2年时降至3.1%:OLIF是治疗腰椎退行性疾病的一种安全有效的手术方法。mBSF 量表可同时评估动态角度和骨桥的形成,为融合的放射学评估提供了极大的可靠性。此外,使用同种异体材料和 DBM 在 L2-5 的一个或两个水平上进行 OLIF,可在术后两年内达到满意的融合率。
{"title":"Fusion Assessment of Oblique Lumbar Interbody Fusion Using Demineralized Bone Matrix: A 2-Year Prospective Study.","authors":"Sangseok Lee, Jin Woo Jung, Sang-Woo Lee, Kyoung-Tae Kim, Heum-Dai Kwon, Subum Lee, Young San Ko, Pius Kim, Dae-Chul Cho","doi":"10.14245/ns.2347032.516","DOIUrl":"10.14245/ns.2347032.516","url":null,"abstract":"<p><strong>Objective: </strong>Although several studies have reported successful fusion rates after oblique lumbar interbody fusion (OLIF) using allografts or dimerized bone matrix (DBM) instead of autografts, whether OLIF can achieve satisfactory solid fusion without the use of autografts remains unclear. This study investigated the real fusion rates after OLIF using allografts and DBM, which were evaluated using both dynamic radiographs and computed tomography scans.</p><p><strong>Methods: </strong>We enrolled 79 consecutive patients who underwent minimally invasive OLIF followed by percutaneous pedicle screw fixation. All patients were treated with OLIF between L2 and L5 and underwent radiographic and clinical follow-ups at 12, 18, and 24 months after surgery. Radiographic assessment of fusion was performed using the modified BrantigaSteffee-Fraser (mBSF) scale, which was categorized as follows: grades I (radiographic pseudoarthrosis), II (indeterminate fusion), and III (solid radiographic fusion). Other radiologic and clinical outcomes were evaluated using the following parameters: vertebral slippage distance, disc height, subsidence, Oswestry Disability Index (ODI), and visual analogue scale (VAS).</p><p><strong>Results: </strong>Clinical outcomes demonstrated significant improvements in the VAS scores for back pain, leg pain, and ODI after surgery. Subsidence was present in 34 cases (35.4%) at 12 months postoperatively, which increased to 47.9% and reached 50.0% at 1.5 years and 2 years after surgery, respectively. The solid fusion rate after OLIF was 32.3% at 1 year, increased to 58.3% at 1.5 years, and reached 72.9% at 2 years. Radiographic pseudoarthrosis was 24.0% at 1 year, which decreased to 6.3% at 1.5 years and 3.1% at 2 years.</p><p><strong>Conclusion: </strong>OLIF is a safe and effective surgical procedure for the treatment of degenerative lumbar diseases. The mBSF scale, which simultaneously evaluates both dynamic angles and bone bridge formation, offers great reliability for the radiological assessment of fusion. Moreover, OLIF using allografts and DBM, which is performed on one or 2 levels at L2-5, can achieve satisfactory fusion rates within 2 years after surgery.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"20 4","pages":"1205-1216"},"PeriodicalIF":3.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10762405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139087860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Neurospine
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