From the Editor-in-Chief: Featured Articles in the March 2024 Issue

Inbo Han

doi:10.14245/ns.2448218.109

Among the papers published in the March issue of Neurospine, the featured articles selected by editors are as follows.

“A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Methods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques” by Hwang et al. [1].

This study assessed robotic versus conventional pedicle screw fixation for lumbar degenerative disease, demonstrating robotic surgery’s higher accuracy with no significant difference in clinical and radiological outcomes. With 162 patients over a 2.2-year follow-up, it found robotic surgery, especially when paired with minimally invasive approaches, reduces tissue damage without compromising effectiveness, highlighted by better Gertzbein-Robbins and Babu scores in the robotic group.

“Advancements and Challenges in Robot-Assisted Bone Processing in Neurosurgical Procedures” by Kitahama et al. [2].

This study explored the use of neurosurgical robots for nerve decompression, focusing on automating bone grinding—a critical aspect of neurosurgery. By integrating an endoscope with a robotic manipulator, the research team conducted precision bone machining with a drill, measuring grinding resistance in 3 axes during linear (e.g., laminectomy) and cylindrical (e.g., foraminotomy) tasks. Results indicated a proportional increase in resistance during linear grinding, suggesting the usefulness of resistance measurements for assessing cortical penetration depth. However, a 10% error in cylindrical grinding highlighted challenges such as tool efficiency and robotic arm deflection. Despite these issues, robotic assistance achieved processing speeds double those of manual surgery, albeit with a -10% error margin in simulated foraminotomy conditions.

“TomoRay: Generating Synthetic Computed Tomography of the Spine From Biplanar Radiographs” by Zanier et al. [3].

This study tested the feasibility of creating synthetic spinal computed tomography (CT) images from biplanar radiographs, addressing CT imaging’s logistical, cost, and radiation issues. Utilizing a dataset of 209 spinal CT scans, researchers trained a generative adversarial model to transform 2-dimensional images into 3-dimensional synthetic CT scans, evaluating its performance with internal and external validation sets. Despite the challenges in accurately replicating three-dimensional spinal structures from two-dimensional x-rays, the model showed promising results, suggesting further investigation into this technology could be beneficial for enhancing spinal assessment and intervention planning with reduced logistical and health risks.

“Use of ChatGPT for Determining Clinical and Surgical Treatment of Lumbar Disc Herniation With Radiculopathy: A North American Spine Society Guideline Comparison” by Mejia et al. [4].

This study evaluated chat generative pre-trained transformer (ChatGPT) versions 3.5 and 4.0 against the North American Spine Society’s 2012 guidelines for Lumbar Disk Herniation with Radiculopathy, focusing on their accuracy in providing medical information. ChatGPT-3.5 accurately aligned with the guidelines in 52% of cases, while version 4.0 improved accuracy to 59%. Both versions added supplementary information but also included over-conclusive recommendations and occasionally omitted essential guideline details. Despite these limitations, ChatGPT shows potential for assisting in clinical decision-making, underscoring the need for careful consideration and further research to ensure its safe application in medical settings.

“Clinical Characteristics, Surgical Outcomes, and Risk Factors for Emergency Surgery in Patients With Spinal Metastases: A Prospective Cohort Study” by Kanda et al. [5].

This study analyzed 216 patients with spinal metastases who underwent surgery, comparing outcomes between emergency and nonemergency procedures. Patients undergoing emergency surgery (within 48 hours of diagnosis) exhibited worse pre-and postoperative health statuses and shorter median survival times compared to those with planned surgeries. Multivariate analysis identified spinal metastases at T3–10 and lower Frankel grades (A–C) as significant risk factors for necessitating emergency surgery. The findings suggest that outcomes are poorer for emergency surgeries, highlighting the need for vigilant monitoring of patients with specific risk factors to improve prognosis and quality of life.

From the Editor-in-Chief: Featured Articles in the March 2024 Issue

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