Assessing the Reproducibility of the Structured Abstracts Generated by ChatGPT and Bard Compared to Human-Written Abstracts in the Field of Spine Surgery: Comparative Analysis.

BACKGROUND: Due to recent advances in artificial intelligence (AI), language model applications can generate logical text output that is difficult to distinguish from human writing. ChatGPT (OpenAI) and Bard (subsequently rebranded as "Gemini"; Google AI) were developed using distinct approaches, but little has been studied about the difference in their capability to generate the abstract. The use of AI to write scientific abstracts in the field of spine surgery is the center of much debate and controversy. OBJECTIVE: The objective of this study is to assess the reproducibility of the structured abstracts generated by ChatGPT and Bard compared to human-written abstracts in the field of spine surgery. METHODS: In total, 60 abstracts dealing with spine sections were randomly selected from 7 reputable journals and used as ChatGPT and Bard input statements to generate abstracts based on supplied paper titles. A total of 174 abstracts, divided into human-written abstracts, ChatGPT-generated abstracts, and Bard-generated abstracts, were evaluated for compliance with the structured format of journal guidelines and consistency of content. The likelihood of plagiarism and AI output was assessed using the iThenticate and ZeroGPT programs, respectively. A total of 8 reviewers in the spinal field evaluated 30 randomly extracted abstracts to determine whether they were produced by AI or human authors. RESULTS: The proportion of abstracts that met journal formatting guidelines was greater among ChatGPT abstracts (34/60, 56.6%) compared with those generated by Bard (6/54, 11.1%; P<.001). However, a higher proportion of Bard abstracts (49/54, 90.7%) had word counts that met journal guidelines compared with ChatGPT abstracts (30/60, 50%; P<.001). The similarity index was significantly lower among ChatGPT-generated abstracts (20.7%) compared with Bard-generated abstracts (32.1%; P<.001). The AI-detection program predicted that 21.7% (13/60) of the human group, 63.3% (38/60) of the ChatGPT group, and 87% (47/54) of the Bard group were possibly generated by AI, with an area under the curve value of 0.863 (P<.001). The mean detection rate by human reviewers was 53.8% (SD 11.2%), achieving a sensitivity of 56.3% and a specificity of 48.4%. A total of 56.3% (63/112) of the actual human-written abstracts and 55.9% (62/128) of AI-generated abstracts were recognized as human-written and AI-generated by human reviewers, respectively. CONCLUSIONS: Both ChatGPT and Bard can be used to help write abstracts, but most AI-generated abstracts are currently considered unethical due to high plagiarism and AI-detection rates. ChatGPT-generated abstracts appear to be superior to Bard-generated abstracts in meeting journal formatting guidelines. Because humans are unable to accurately distinguish abstracts written by humans from those produced by AI programs, it is crucial to exercise special caution and examine the ethical boundaries of using AI programs, including ChatGPT and Bard.

Significance of paraspinal muscle quality in risk between single and multiple osteoporotic vertebral fractures.

PURPOSE: To compare paraspinal muscle quality between patients with single and multiple osteoporotic vertebral fractures (OVFs) and evaluate the role of the paraspinal muscles in OVFs. METHODS: A total of 262 consecutive patients with OVFs were retrospectively analyzed in two groups: those with single OVF (n = 173) and those with multiple OVFs (n = 89). The cross-sectional area (CSA) and fatty degeneration of the paraspinal muscles were calculated from axial T2-weighted magnetic resonance imaging at the level of the L4 upper endplate by manual tracing in ImageJ software. Pearson's correlation analysis was performed to analyze correlations of paraspinal muscle quality to multiple OVFs. RESULTS: FD in all the paraspinal muscles was significantly higher in the multiple OVF group than the single OVF group (all p < 0.005). The functional CSA (fCSA) of the paraspinal muscles was significantly lower in the multiple OVF group than the single OVF group (all Ps < 0.001), except for the erector spine (p = 0.304). The Pearson's correlation analysis showed significant positive inter-correlations for the fCSAs of all the paraspinal muscles and the occurrence of multiple OVFs. CONCLUSIONS: The pure muscle volumes of the multifidus, psoas major, and quadratus lumborum were lower in patients with multiple OVFs than in those with a single OVF. Furthermore, the inter-correlation among all the paraspinal muscles indicate that the muscle-bone crosstalk profoundly existed in vertebral fracture cascade. Therefore, special attention to paraspinal muscle quality is needed to prevent progression to multiple OVFs.

Fusion rates based on type of bone graft substitute using minimally invasive scoliosis surgery for adolescent idiopathic scoliosis.

BACKGROUND: Minimally invasive scoliosis surgery (MISS) is currently introduced on novel technique for surgical treatment of adolescent idiopathic scoliosis (AIS). This study is aimed to evaluate the efficacy of facet fusion in MISS compared to posterior fusion in conventional open scoliosis surgery (COSS) and compare facet fusion rates based on three bone graft substitutes in MISS for adolescent idiopathic scoliosis (AIS). METHODS: Eighty six AIS patients who underwent scoliosis surgery were divided into two groups: the COSS group and the MISS group. COSS was performed through posterior fusion with allograft. MISS was applied via facet fusion with three bone graft substitutes. The MISS group was further divided into three subgroups based on graft substitute: Group A (allograft), Group B (demineralized bone matrix [DBM]), and group C (demineralized cancellous bone chips). Fusion rate was measured using conventional radiographs to visualize loss of correction > 10°, presence of lysis around implants, breaks in fusion mass, and abnormal mobility of the fused segment. RESULTS: The fusion rates showed no significant difference in COSS and MISS groups (p = 0.070). In the MISS group, the fusion rates were 85, 100, and 100% in groups A, B, and C, respectively, with no significant difference (p = 0.221). There were no statistical differences between groups A, B, and C in terms of correction rate, fusion rate, and SRS-22 scores (p > 0.05). CONCLUSIONS: The facet fusion in MISS showed comparable to posterior fusion in COSS with regard to radiological and clinical outcomes. Furthermore, the type of graft substitute among allograft, DBM, and demineralized cancellous bone chips did not affect facet fusion rate or clinical outcomes in MISS. Therefore, MISS showed comparable fusion rate (with no influences on the type of graft substitute) and clinical outcomes to those of COSS in the surgical treatment of AIS.

Comparison of Denosumab and Zoledronic Acid in Postmenopausal Women With Osteoporosis: Bone Mineral Density (BMD) and Trabecular Bone Score (TBS).

BACKGROUND: Denosumab (DEN) and zoledronic acid (ZOL) currently represent the most potent antiresorptive agents for the treatment of osteoporosis. Despite similar effects on bone resorption, these agents have distinct mechanisms of action. The objective of this study was to compare the effect of DEN and ZOL after two-year administration on bone mineral density (BMD), trabecular bone score (TBS), bone turnover markers, and persistence. METHODS: A total of 585 postmenopausal women with osteoporosis who did not use osteoporosis medications were retrospectively reviewed. 290 patients were administered 60 mg DEN subcutaneously every 6 months from 2017 to 2018, and 295 patients were treated with 5 mg ZOL intravenously yearly from 2015 to 2017. BMD, TBS, and C-terminal cross-linking telopeptide of type 1 collagen (CTX) measurements were obtained at baseline and two-year after DEN injection or ZOL infusion. RESULTS: After two-year follow-up, 188 patients in the DEN group and 183 patients in the ZOL group were compared. BMD change from baseline at two years was significantly greater in the DEN group compared with the ZOL group (P < 0.001). The changes of TBS in the DEN group were statistically significant compared with baseline (P < 0.001) and the ZOL group (P < 0.001). The DEN group led to significantly greater reduction of CTX compared with ZOL group (P = 0.041). CONCLUSION: In postmenopausal women with osteoporosis, DEN was associated with greater BMD increase at all measured skeletal sites, greater increase of TBS, and greater inhibition of bone remodeling compared with ZOL.

Relationship between degree of separation of endplate cartilage and severity of intervertebral disc herniation.

Degeneration of intervertebral disc and fissures in the anulus was caused by compression and distraction, which lead to nucleus pulposus herniation. However, controversy remains regarding the exact mechanism behind disc herniation. The aim of this study is to analyze histologically the differences between the three types of disc herniations in an attempt to infer the underlying mechanism. Disc samples extracted from 49 patients who underwent discectomy of the lumbar region were studied by histological analysis. The severity of disc herniation was classified as bulging, protrusion, extrusion, or sequestration based on preoperative magnetic resonance imaging measurements. For comparative analysis of sequestration characteristics, 49 patients were classified into either the sequestration or the non-sequestration group (i.e., protrusion and extrusion) according to disc herniation type. Forty of the 49 patients had cartilage present in their disc samples upon histological analysis. The endplate cartilage-containing samples included two of four (50%) protruded disc patients, 22 of 29 (75.9%) extruded disc patients, and 16 of 16 (100%) sequestrated disc patients and had statistical significance (p = 0.019). There were no significant differences in age, sex, body mass index, length of hospital stays, injection history, surgical methods, and Visual Analog Scale between the sequestration and non-sequestration group (all p > 0.05). Separation of endplate cartilage increased with the severity of disc herniation. Therefore, the mechanism of disc herniation should consider the connection with endplate cartilage as an initiating link in the mechanical failure of intervertebral discs.

Safety and effectiveness of minimally invasive scoliosis surgery for adolescent idiopathic scoliosis: a retrospective case series of 84 patients.

PURPOSE: The aim of this study was to retrospectively evaluate a prospective series of patients with adolescent idiopathic scoliosis (AIS) who were treated with minimally invasive scoliosis surgery (MISS) technique with a minimum follow-up more than 1 year. MATERIALS AND METHODS: We retrospectively analyzed the prospectively collected data of 84 patients with AIS treated with MIS technique using two or three coin hole size incisions and a muscle-splitting approach. The clinical and radiological data such as the correction of deformity, coronal and sagittal profile and record of the perioperative morbidity of the patients were analyzed. RESULTS: The mean primary Cobb angle was corrected from 59.8° preoperatively to 18.6° postoperatively with a mean correction of 68.9% (p < 0.001). The mean kyphosis at T2 to T12 was maintained within normal range with an increase from 31.2° preoperatively to 35.3° postoperatively (p < 0.001). The 30-day perioperative complication rate was 7.14% with one deep infection and five cases of hemothorax. The mean operation time was 312.8 min; mean estimated blood loss was 846.6 ml (range 420-2800); and mean length of stay was 8.5 days (range 5 to 14). All data of postoperative SRS-22 questionnaire were significantly improved (p < 0.001). CONCLUSION: MISS used for AIS provides adequate correction in both planes and acceptable rate of perioperative complications, with a low estimated blood loss and short length of stay. Considering all the positives, the application of MISS technique for AIS seems meaningful and can become a valid alternative to posterior approach in the routine use. These slides can be retrieved under Electronic Supplementary Material.

Delayed presentation of infected common iliac artery pseudoaneurysm caused by malpositioned pedicle screw after minimally invasive scoliosis surgery.

PURPOSE: To report delayed onset common iliac artery perforation and infected pseudoaneurysm caused by malpositioned pedicle screw after minimally invasive scoliosis surgery (MISS). METHODS: A 21-year-old female was referred to our hospital with a 1-week history of abrupt right-sided low back pain, lower abdominal pain, and fever with a history of MISS using cannulated pedicle screws 18 months earlier. Paravertebral arterial erosion with pseudoaneurysm and retroperitoneal and paraspinal abscess were suspected. RESULTS: We performed resection of the pseudoaneurysm, vascular repair of right common iliac artery by angioplasty with a bovine patch and removal of implant. At 6 months after the last surgery, she had no limitations or problems in her daily activities with no recurrence of low back pain, abdominal pain, or fever as well as without loss of deformity. CONCLUSIONS: Our case showed that misplaced pedicle screws can cause potentially fatal complications, such as infected pseudoaneurysm, even in the late postoperative period.

Analysis of sensory system aspects of postural stability during quiet standing in adolescent idiopathic scoliosis patients.

BACKGROUND: The aim of this study was to quantitatively analyze quite standing postural stability of adolescent idiopathic scoliosis (AIS) patients in respect to three sensory systems (visual, vestibular, and somatosensory). METHOD: In this study, we analyzed the anterior-posterior center of pressure (CoP) signal using discrete wavelet transform (DWT) between AIS patients (n = 32) and normal controls (n = 25) during quiet standing. RESULT: The energy rate (∆E EYE %) of the CoP signal was significantly higher in the AIS group than that in the control group at levels corresponding to vestibular and somatosensory systems (p < 0.01). CONCLUSIONS: This implies that AIS patients use strategies to compensate for possible head position changes and spinal asymmetry caused by morphological deformations of the spine through vestibular and somatosensory systems. This could be interpreted that such compensation could help them maintain postural stability during quiet standing. The interpretation of CoP signal during quiet standing in AIS patients will improve our understanding of changes in physical exercise ability due to morphological deformity of the spine. This result is useful for evaluating postural stability before and after treatments (spinal fusion, bracing, rehabilitation, and so on).

Long-term management of congenital lordoscoliosis of the thoracic spine.

PURPOSE: The objective of this study is to report the progression of congenital hyperlordoscoliosis in a 2-year-old patient and the use of multiple surgical interventions in the treatment of hyperlordoscoliosis of the thoracic spine. METHODS: A 2-year-old patient with thoracic hyperlordosis underwent observation for 1 year. To halt the progression of hyperlordosis, a posterior laminectomy was carried out to remove all the fused segments. Despite surgery, lordosis progressed via spontaneous autofusion with development of scoliosis with unilateral unsegmented bar. At the age of 9 years, the patient underwent posterior osteotomy at the fused segments, which was unsuccessful in the correction of hyperlordosis, but was successful in the correction of scoliosis. At the age of 12 years, the patient complained of mild breathing difficulties resulting from hyperlordosis of the thoracic spine, and underwent posterior multilevel vertebral osteotomy (PMVO) again to correct lordoscoliosis. RESULTS: Follow-up in the 3 years after PMVO showed that correction of the deformity was well maintained, with a good clinical outcome and a well-balanced spine. CONCLUSIONS: PMVO is a potential intervention to manage rigid and severe congenital lordoscoliosis of the thoracic spine.

A prospective randomized comparative study of postoperative pain control using an epidural catheter in patients undergoing posterior lumbar interbody fusion.

PURPOSE: To assess the efficacy of continuous epidural infusion analgesia (ED) with 0.2 % Ropivacaine versus IV PCA (Fentanyl) in spinal fusion surgery patients. METHOD: A prospective randomized comparative clinical trial. Patients were randomized into one of two groups-the epidural group (ED-51 patients) and the IV PCA group (IV-43 patients). The epidural catheter tip was placed one level cephalad to the level of the PLIF in patients in the ED group. Patients were assessed by determining the pain score, cumulative opioid requirement, adverse effects, and satisfaction. RESULTS: Pain score comparisons between the ED group and the IV group, respectively, were as follows: immediate postoperative status: 2.1 ± 1.5 vs. 7.2 ± 2.1, p = 0.01; postoperative day 1: 2.3 ± 1.9 vs. 6.8 ± 2.3, p = 0.02; postoperative day 2: 1.9 ± 1.8 vs. 5.4 ± 2.1, p = 0.02; postoperative day 3: 1.5 ± 1.6 vs. 3.9 ± 1.9, p = 0.03; postoperative day 4: 3.8 ± 2.1 vs. 3.1 ± 1.9, p = 0.4. Lower levels of opioids were required in the ED group, and fewer opioid-related complications developed in the patients in this group. Complications related to the use of epidural catheters were comparable between the two groups. Patient satisfaction with postoperative pain control was higher in the ED group. CONCLUSION: In comparison with the use of IV PCA only, continuous epidural infusion of Ropivacaine resulted in lower pain scores and opioid consumption and higher patient satisfaction levels after posterior lumbar interbody fusion.

Analysis of coordination between thoracic and pelvic kinematic movements during gait in adolescents with idiopathic scoliosis.

PURPOSE: In this research, we investigated the coordination pattern and consistency of coordination between the thorax and pelvis during gait in patients with idiopathic scoliosis. METHODS: Across the study, 69 adolescent girls (controls: 30, patients: 39) participated. All participants were asked to walk 10 m barefoot at a self-selected speed. The walking speed, stride length, and range of motion of the pelvic and thoracic angles were collected using a three-dimensional optical motion analysis system, and the thorax-pelvis coordination was quantified using a vector coding technique. The frequency of four different patterns of coordination (in-phase, anti-phase, pelvis only, and thorax only) and the consistency of coordination including direction and magnitude during the gait cycle of the two groups were investigated. Independent-sample t tests were performed to examine differences between the two groups with regard to coordination patterns and consistency. RESULTS: The patients with idiopathic scoliosis showed significantly higher in-phase and relatively lower anti-phase in the transverse plane compared to controls. Additionally, the pelvis only in the transverse, frontal, and sagittal planes was significantly lower in patients. The consistency of coordination in patients was significantly lower than in controls in direction and magnitude on the transverse and frontal planes. CONCLUSION: From viewpoint of the thorax-pelvis coordination, patients with IS had less gait stability in the trunk than controls.

Kinematic relationship between rotation of lumbar spine and hip joints during golf swing in professional golfers.

BACKGROUND: Understanding the kinematics of the lumbar spine and hip joints during a golf swing is a basic step for identifying swing-specific factors associated with low back pain. The objective of this study was to examine the kinematic relationship between rotational movement of the lumbar spine and hip joints during a golf swing. METHODS: Fifteen professional golfers participated in this study with employment of six infrared cameras to record their golf swings. Anatomical reference system of the upper torso, pelvis and thigh segments, and the location of each hip and knee joint were defined by the protocols of the kinematic model of previous studies. Lumbar spine and hip joint rotational angle was calculated utilizing the Euler angle method. Cross-correlation and angle-angle plot was used to examine the degree of kinematic relationship between joints. RESULTS: A fairly strong coupling relationship was shown between the lumbar spine and hip rotational movements with an average correlation of 0.81. Leading hip contribution to overall rotation was markedly high in the early stage of the downswing, while the lumbar spine contributed greater towards the end of the downswing; however, the relative contributions of the trailing hip and lumbar spine were nearly equal during the entire downswing. CONCLUSIONS: Most of the professional golfers participated in this study used a similar coordination strategy when moving their hips and lumbar spine during golf swings. The rotation of hips was observed to be more efficient in producing the overall rotation during the downswing when compared to the backswing. These results provide quantitative information to better understand the lumbar spine and hip joint kinematic characteristics of professional golfers. This study will have great potential to be used as a normal control data for the comparison with kinematic information among golfers with low back pain and for further investigation of golf swing-specific factors associated with injury.

Optimal condition of heparin-conjugated fibrin with bone morphogenetic protein-2 for spinal fusion in a rabbit model.

BACKGROUND AIMS: Heparin-conjugated fibrin (HCF) is a carrier for long-term release of bone morphogenetic protein-2 (BMP-2) and has been shown to promote bone formation in animal models. We performed an experimental study to determine the optimal dose of BMP-2 with an HCF carrier that promotes bone formation comparable to that of autograft while minimizing complications in spinal fusion. METHODS: Twenty-four rabbits underwent posterolateral fusion of the L5-6 spinal segments. Different concentrations of HCF BMP-2 (1/10, 1/20, 1/30 or 1/40) were implanted in the spines of experimental rabbits, and autograft or INFUSE was implanted in the spines of control animals. Eight weeks after treatment, spinal fusion efficacy was evaluated by plain radiography, micro-computed tomography (micro-CT), mechanical testing and histomorphometry. RESULTS: Similar to autograft, the 1/40 HCF BMP-2 showed significant bone formation on micro-CT and histomorphometry with mechanical stability. However, the other HCF BMP-2 concentrations did not show significant bone formation compared with autograft. Although conventional BMP-2 (INFUSE) led to higher bone formation and stability, it also led to excessive ectopic bone and fibrous tissue formation. CONCLUSIONS: This study suggests the optimal concentration of BMP-2 using HCF for spinal fusion, which may decrease the complications of high-dose conventional BMP-2.

Multiaxial high-modularity spinopelvis (HMSP) fixation device in neuromuscular scoliosis: a comparative study.

PURPOSE: To compare radiological and clinical results in patients operated for neuromuscular scoliosis with pelvic fixation using high-modularity spinopelvic screw (HMSP) designed by authors. METHODS: Of 54 patients with neuromuscular scoliosis, group 1 comprised of 27 patients with conventional pelvic fixation; and group 2 comprised of 27 patients using HMSP. Results were evaluated radiologically and functionally. We compared preoperative and postoperative complications, especially the loosening or breakage of spinopelvis fixation device, failure of fixation, and the change of shadow around the spinopelvis fixation device. RESULTS: There was no difference of correctional power, preoperative average Cobb's angle of each group was 79.8 and 75 to postoperative 30.2 and 28.3 (P < 0.05). Pelvic obliquity improved from average 18.3°-8.9° in group I and average 24.3°-12.5° in group II (P < 0.05). However, there was no difference between two groups (P > 0.05). Average blood loss was 2,698 ml in group 1 and 2,414.8 ml in group 2 (P > 0.05). Average operative time was 360 min in group 1 and 332 min in group 2 (P = 0.30). There was no difference found between two groups regarding gait and functional evaluation. On the all cases of group 1 and 2, the change of shadow around the spinopelvis fixation device was observed. There was one case of the fracture of spinopelvis fixation device in group I. CONCLUSION: There was no difference of Cobb's angle and correctional power between the groups using HMSP when compared with the group using standard spinopelvis fixation device. Therefore, HMSP can be used more effectively in case of neuromuscular scoliosis.

Does delaying surgery in immature adolescent idiopathic scoliosis patients with progressive curve, lead to addition of fusion levels?

PURPOSE: To analyze the changes in the curve extent, pattern and the fusion level in adolescent idiopathic scoliosis (AIS) patients who undergo delayed surgery instead of early surgery. METHODS: Thirty-five immature AIS patients whose radiographs demonstrated an initial primary curve of more than 40° with a subsequent increase of 10° before attaining skeletal maturity with brace were enrolled. The initial and the final radiographs taken before surgery were compared to assess the changes in curve extent, pattern and the fusion levels as recommended by King's, Lenke's and Suk's guidelines. RESULTS: The average age of 35 AIS patients was 12.7 ± 1.6 years. The time interval between initial and final radiography was 39.3 ± 20.2 months and the degree of progress of the primary curve was 13 ± 9.7°. Fusion levels changed in 33 (94.2%), 33 (94.2%) and 32 (91.4%) patients according to King's, Lenke's and Suk's guidelines, respectively. Curve pattern was changed in 2 (5.7%), 12 (34.3%) and 10 (28.6) patients by King's, Lenke's and Suk's guidelines. The mean number of levels requiring fusion increased from 9.4 ± 2.1 at initial visit to 11.1 ± 1.8 at the final follow-up using King's guidelines, 9.7 ± 2.2-11.6 ± 2.0 as per Lenke's guidelines and 9.1 ± 2.0-11.5 ± 2.3 when fusion was planned using Suk's guidelines (p < 0.001 in all guidelines). CONCLUSIONS: Delay of surgery in immature AIS patients whose Cobb's angle exceed 40° initially and showing subsequent progression of the curve, of more than 10° can lead to alterations in the curve pattern and the need for increase in fusion levels.

Short apical rib resections thoracoplasty compared to conventional thoracoplasty in adolescent idiopathic scoliosis surgery.

PURPOSE: To introduce a modified technique of thoracoplasty (short apical rib resection thoracoplasty (SARRT)) and compare its clinical, functional radiological outcomes and postoperative lung functions with conventional thoracoplasty (CT) in scoliosis surgery. METHODS: Retrospectively review of adolescent idiopathic scoliosis patients who underwent corrective surgery with thoracoplasty from 2006 to 2010 was performed. Thoracoplasty was performed in 58 patients (CT in 31 and SARRT in 27 patients). 21 patients who underwent deformity correction only, without thoracoplasty were taken as control group (non-thoracoplasty, NT). To evaluate the outcome of SARRT, radiological parameters, pulmonary functions and clinical outcomes were compared among all the three groups. RESULTS: Age, sex and scoliosis types were evenly distributed between 3 groups (p = 0.66, 0.92, 0.31). Number of levels fused, change in Cobb angle, lordosis, kyphosis, coronal balance, sagittal balance, coronal translation and sagittal translation were not significantly different among the three groups (p > 0.05 for all). There was 38.6% improvement in rib hump in NT, 44.04% in CT and 60.9% correction in SARRT group. Pulmonary complications were significantly higher in the CT group, especially in view of pleural rupture, pulmonary effusion and intercostal neuralgia (p = 0.041, 0.029, 0.049). There was no difference among three groups in postoperative pulmonary function but the score of satisfaction as sub-category in SRS-22 questionnaire was decreased in CT groups (p = 0.046). CONCLUSIONS: SAART is effective in correcting the rib deformity without altering the pulmonary functions and SAART has less number of pulmonary complications as compared to CT.

Changes in the spinopelvic parameters of elite weight lifters.

OBJECTIVE: To describe the changes in the spinopelvic parameters in weight lifters and evaluate the factors leading to spinal anatomical changes (eg, spondylolysis and listhesis). DESIGN: Case-control study. SETTING: Tertiary, institutional. PARTICIPANTS: The study group participants were practicing weight lifters in the athletes' village of the 2012 London Olympics. A total of 21 elite weight lifters were enrolled. Their data were compared with those of 45 healthy volunteers in the control group. INTERVENTIONS: Comparative radiological evaluations were performed among the 21 elite weight lifters. Spinopelvic parameters (radiographic analysis), including total (TLL), upper (ULL), and lower (LLL) lumbar lordoses, sacral slope, pelvic tilt (PT) and incidence, lumbar index, and disc angles, were assessed. MAIN OUTCOME MEASURES: The proportional ratio of ULL and LLL to TLL (ULL/TLL and LLL/TLL) was measured to describe the proportion effect. These values were compared with those of the control group. Weight lifters with and those without anatomical changes were subdivided into a deformed and nondeformed group, respectively, and further analyzed for differences. The correlation between these spinal parameters and the amount and duration of weight lifting training was also analyzed. RESULTS: Anatomical changes in the lumbar spine were seen in 6 weight lifters (28.6%, P = 0.01). The mean TLL, ULL, and LLL values (59.8, 22.6, and 37.2 degrees, respectively) were increased, whereas PT (10.3 degrees) was decreased in the athletes compared with the volunteers (P = 0.001, 0.005, 0.07, and 0.018, respectively). The ULL/TLL was higher in the deformed group than in the nondeformed group (P = 0.036). The duration and amount of weight lifting training were not correlated with the spinopelvic parameters measured in this study. CONCLUSIONS: The elite weight lifters had increased lumbar lordosis and decreased PT compared with the healthy volunteers. The ULL/TLL ratio may be used as a predictive marker for lumbar deformation.

Hidden Blood Loss and Its Risk Factors for Oblique Lumbar Interbody Fusion.

(1) Background: The amount of blood loss during oblique lumber interbody fusion (OLIF) surgery is often underestimated and may contribute to adverse postoperative outcomes. This study aims to evaluate hidden blood loss (HBL) in patients who underwent OLIF for degenerative lumbar spine disease and to analyze its risk factors. (2) Methods: The medical records of 179 patients who underwent OLIF surgery from 2015 to 2022 were reviewed. The HBL and total blood loss (TBL) were estimated using the Gross formula. Pearson correlation, Spearman correlation, and multivariate linear regression analyses were used to investigate risk factors for HBL. (3) Results: The mean HBL was 675.2 mL, and the mean hemoglobin loss was 1.7 g/dL during OLIF surgery. In the multivariate linear regression analysis, TBL (p < 0.001), estimated blood loss (p < 0.001), and pedicle screw fixation type (p = 0.039) were identified as independent risk factors of HBL. (4) Conclusions: The OLIF is associated with substantial perioperative HBL, for which we identified risk factors of TBL, EBL, and pedicle screw fixation type. Notably, OLIF with percutaneous pedicle screw fixation resulted in greater HBL than stand-alone OLIF or OLIF with open pedicle screw fixation.

Comparative Analysis of Monoaxial and Polyaxial Pedicle Screws in the Surgical Correction of Adolescent Idiopathic Scoliosis.

Background: Although several biomechanical studies have been reported, few clinical studies have compared the efficacy of monoaxial and polyaxial pedicle screws in the surgical treatment of adolescent idiopathic scoliosis (AIS). This study aims to compare the radiological and clinical outcomes of mono- and polyaxial pedicle screws in the surgical treatment of AIS. Methods: A total of 46 AIS patients who underwent surgery to treat scoliosis using pedicle screw instrumentation (PSI) and rod derotation (RD) were divided into two groups according to the use of pedicle screws: the monoaxial group (n = 23) and polyaxial group (n = 23). Results: The correction rate of the main Cobb's angle was higher in the monoaxial group (70.2%) than in the polyaxial group (65.3%) (p = 0.040). No differences in the rotational correction of the apical vertebra were evident between the two groups. SRS-22 scores showed no significant differences according to the type of pedicle screws used. Conclusions: The use of polyaxial pedicle screws resulted in coronal, sagittal, and rotational correction outcomes comparable to those associated with the use of monoaxial pedicle screws for surgical treatment using PSI and RD to treat moderate cases of AIS.