Current Trends in Artificial Intelligence-Assisted Spine Surgery: A Systematic Review.

This systematic review summarizes existing evidence and outlines the benefits of artificial intelligence-assisted spine surgery. The popularity of artificial intelligence has grown significantly, demonstrating its benefits in computer-assisted surgery and advancements in spinal treatment. This study adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a set of reporting guidelines specifically designed for systematic reviews and meta-analyses. The search strategy used Medical Subject Headings (MeSH) terms, including "MeSH (Artificial intelligence)," "Spine" AND "Spinal" filters, in the last 10 years, and English- from January 1, 2013, to October 31, 2023. In total, 442 articles fulfilled the first screening criteria. A detailed analysis of those articles identified 220 that matched the criteria, of which 11 were considered appropriate for this analysis after applying the complete inclusion and exclusion criteria. In total, 11 studies met the eligibility criteria. Analysis of these studies revealed the types of artificial intelligence-assisted spine surgery. No evidence suggests the superiority of assisted spine surgery with or without artificial intelligence in terms of outcomes. In terms of feasibility, accuracy, safety, and facilitating lower patient radiation exposure compared with standard fluoroscopic guidance, artificial intelligence-assisted spine surgery produced satisfactory and superior outcomes. The incorporation of artificial intelligence with augmented and virtual reality appears promising, with the potential to enhance surgeon proficiency and overall surgical safety.

Does Posterior Cord Compression From the Ligamentum Flavum Influence Clinical Outcomes After Anterior Cervical Discectomy and Fusion?

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To clarify whether outcomes of anterior cervical discectomy and fusion (ACDF) differ according to the presence of posterior cord compression from the ligamentum flavum (CCLF). SUMMARY OF BACKGROUND DATA: Although ACDF effectively addresses anterior cord compression from disc material and bone spurs, it cannot address posterior compression. Whether ACDF could result in favorable outcomes when CCLF is present remains unclear. PATIENTS AND METHODS: A total of 195 consecutive patients who underwent ACDF and were followed up for >2 years were included. CCLF was graded based on magnetic resonance imaging findings. Patients with CCLF grade 2 were classified as such, whereas patients with CCLF grades 0 to 1 were classified as the no-CCLF group. Patient characteristics, cervical sagittal parameters, neck pain visual analog scale, arm pain visual analog scale, and Japanese Orthopedic Association (JOA) score were assessed. Categorical variables were analyzed using a χ 2 test, whereas continuous variables were analyzed using the Student t test. Multivariable logistic regression analysis was performed to elucidate factors associated with JOA recovery rates of >50%. RESULTS: One hundred sixty-seven patients (85.6%) were included in the no-CCLF group, whereas the remaining 28 patients (14.4%) were included in the CCLF group. Among patients in the CCLF group, 14 patients (50.0%) achieved clinical improvement. JOA score significantly improved in the no-CCLF group after the operation ( P < 0.001), whereas improvement was not appreciated in the CCLF group ( P = 0.642). JOA scores at 3 months ( P = 0.037) and 2 years ( P = 0.001) postoperatively were significantly higher in the no-CCLF group. Furthermore, the JOA recovery rate at 2 years after surgery was significantly higher in the no-CCLF group ( P = 0.042). Logistic regression demonstrated that CCLF was significantly associated with a JOA recovery rate of >50% at 2 years after surgery (odds ratio: 2.719; 95% CI: 1.12, 6.60). CONCLUSION: ACDF performed for patients with CCLF grade 2 showed inferior JOA score improvement compared with those with CCLF grade 0 or 1. ACDF cannot remove posterior compressive structures, which limits its utility when ligamentum flavum significantly contributes to cord compression.

Radiological Characteristics of Low-Grade Lytic Spondylolisthesis: Similarity to Dysplastic Spondylolisthesis.

STUDY DESIGN: Retrospective case-control study. PURPOSE: This study aimed to analyze the etiology of low-grade lytic spondylolisthesis based on the radiologic features of the vertebra. OVERVIEW OF LITERATURE: According to the Marchetti-Bartolozzi classification scheme, high-grade lytic spondylolisthesis (Meyerding grade 3-5) is classified as dysplastic. However, determination of the etiology for low-grade lytic spondylolisthesis as developmental or traumatic remains controversial. METHODS: Patients admitted and treated for one-level (L4/5 or L5/S1) low-grade spondylolisthesis were included in the study. A total of 135 patients were divided into the degenerative or lytic spondylolisthesis groups according to their condition (81 patients [degenerative group] vs. 54 patients [lytic group]). To assess the level of similarity in the radiological findings between low-grade lytic spondylolisthesis and dysplastic spondylolisthesis, the pedicle diameters and vertebral heights of the L4 and L5 vertebrae were measured on computed tomography images. Measurements were then converted to each vertebra's ratio to reduce confounding factors among individuals. RESULTS: The affected vertebra had a smaller sagittal pedicle diameter/transverse pedicle diameter ratio in the low-grade lytic spondylolisthesis group compared to the degenerative group, and the posterior vertebral height/anterior vertebral height ratio of L5 was smaller in the L5/S1 lytic spondylolisthesis group compared to the degenerative spondylolisthesis group. CONCLUSIONS: Low-grade lytic spondylolisthesis and dysplastic spondylolisthesis demonstrated similar radiological findings. Hence, surgeons should be attentive to the morphology of the vertebral body and posterior column during preoperative planning for the treatment of low-grade lytic spondylolisthesis.

Forearm bone mineral density as a predictor of reduction loss in distal radius fractures treated with cast immobilization.

Objective: Many potential predictors have been identified and proposed for predicting late reduction loss in distal radius fractures. However, no report exists on whether the bone mineral density (BMD) of the forearm correlates with the loss of reduction in distal radius fractures. This study aimed to investigate whether forearm BMD can be used as a predictor of reduction loss in distal radius fractures treated with cast immobilization. Methods: Ninety patients with distal radius fractures were divided into two groups according to the maintenance or loss of reduction evaluated from radiographs taken at least 6 weeks after their injury. Lumbar and forearm BMD (total and metaphysis) T-scores were measured and compared between the maintenance of reduction (MOR) group and the loss of reduction (LOR) group. Additionally, serologic markers (C-terminal telopeptide, osteocalcin, vitamin D) and radiologic risk factors (intra-articular fracture, ulnar fracture, dorsal comminuted fracture, volar hook) were evaluated and a logistic multiple regression analysis was performed to know the main risk factors of reduction loss. Results: Reduction loss was observed in 38 patients (42.2%). The total and metaphyseal BMD of the forearm was less in the LOR group than in the MOR group. However, the difference was not statistically significant [-2.9 vs. -2.5 for total (p = 0.18), -2.3 vs. -2.0 for metaphysis (p = 0.17)]. Multiple logistic regression analysis showed initial dorsal comminution (p = 0.008) and ulnar variance (p = 0.01) were the main risk factors for reduction loss. Conclusions: Forearm BMD was not a valuable prognostic factor for reduction loss in distal radius fractures. Initial dorsal comminution and ulnar variance rather than forearm BMD should be considered preferentially when predicting which patients are at high risk of reduction loss in distal radius fractures.

Fixation of Transverse Olecranon Fractures by Suture Bridge Method Using Suture Anchor: Biomechanical Comparison with Tension Band Wiring Technique.

Background: Olecranon fractures are common in motorcycle accidents, falls, or in direct elbow injury. In cases of transverse olecranon fracture, surgery is frequently required in adults. The aim of this study is to compare the biomechanical durability of suture anchor fixation in olecranon fractures to conventional tension band wiring technique in saw bones. Methods: 12 plastic saw bones were divided into 3 groups: tension band wiring fixation, modified Cha-Batman method, and a modified simple suture method using a suture anchor. After fixation, cyclic load tests were conducted for 1,000 cycles, at 5 Hz with a force of 10 N to 250 N. After cycling loading, the extent of displacement was measured using a non-contact coordinate measuring instrument, and statistical analysis performed. Results: The average displacement was significantly smaller in the modified Cha-Bateman method (1.4 mm) than in the tension band wiring method (3.8 mm, p = 0.007) and the modified simple suture method using suture anchor (3.3 mm, p = 0.012). There was no significant difference in displacement between tension band wiring fixation and the modified simple suture method (p = 0.564). Conclusions: This study provides a biomechanical basis for the hypothesis that the suture anchor technique in weak bone model could obtain results comparable to those of conventional tension band wiring. In particular, the modified Cha-Bateman method, showed stronger biomechanical properties than the tension band wiring method and modified simple suture method using a suture anchor. The current study could also provide pilot data that can be used in future experiments.

Arthroscopy-controlled medial reefing and lateral release for recurrent patellar dislocation: clinical, radiologic outcomes and complications.

BACKGROUND: Few studies have reported the clinical outcomes of the medial reefing procedure and lateral release with arthroscopic control of medial retinacular tension in patients with recurrent patellar dislocation. The purpose of this study was to investigate the clinical, radiologic outcomes and complications of arthroscopy-controlled medial reefing and lateral release. METHODS: Patients who underwent arthroscopy-controlled medial reefing and lateral release for recurrent patellar dislocation between November 2007 and June 2017 were retrospectively evaluated. The clinical outcome (Kujala score), radiologic outcome (congruence and patellar tilt angles), and complications were evaluated at final follow-up. The results were also compared with literature-reported outcomes of other surgical procedures for patellar dislocation. RESULTS: Twenty-five patients (mean age, 18.3 ± 4.8 years) were included in the study. The mean clinical follow-up period was 7.0 ± 2.5 (range, 3.8-12.2) years. The mean Kujala score was significantly improved from 54.7 ± 14.0 (range, 37-86) preoperatively to 91.0 ± 7.6 (range, 63-99) at a mean follow-up period of 7 years (P < 0.001). The radiologic results also significantly improved from 17.8° ± 5.9° to 6.8° ± 2.4° (P < 0.001) in the congruence angle and from 17.5° ± 8.2° to 5.6° ± 3.1° (P < 0.001) in the patella tilt angle at a mean follow-up period of 3.6 years. One patient developed a redislocation after a traumatic event, and two patients showed patellofemoral osteoarthritis progression. CONCLUSIONS: Arthroscopy-controlled medial reefing and lateral release significantly improved the clinical and radiologic outcomes of the patients with recurrent patellar dislocation at a mean follow-up period of 7 years. The results of this study are comparable with the literature-reported outcomes of other surgical procedures for patellar dislocation. LEVEL OF EVIDENCE: Level IV, retrospective therapeutic case series.

Comparison of the outcomes between two different target points after open wedge high tibial osteotomy: The Fujisawa point versus the lateral tibial spine.

BACKGROUND: The purpose of this study was to compare the clinical, radiographic and arthroscopic outcomes after open wedge high tibial osteotomy (OWHTO) aiming either at the Fujisawa point (group F) or the lateral tibial spine (LTS, group L). METHODS: Between January 2011 and May 2017, 89 cases underwent implant removal procedures with second-look arthroscopy at 19.8 months after OWHTO with first-look arthroscopy. Among them, 24 and 65 cases were enrolled in groups F and L, respectively. Outcomes included clinical (evaluated using the Western Ontario and McMaster Universities Osteoarthritis index and the International Knee Documentation Committee subjective score), radiographic (observation of the mechanical axis (MA) and tibial slope), and arthroscopic (including chondral lesions of the medial femoral condyle (MFC), trochlea, and patella scored according to the International Cartilage Repair Society grading) measures, investigated at index surgery and implant removal surgery. Outcomes were compared between two groups. RESULTS: Preoperative clinical characteristics and postoperative outcomes were similar between both groups. The mean postoperative MA was significantly lower in group F compared with group L (-3.9° vs. -1.6°, respectively; P < 0.001). Similar MFC cartilage grading changes from index surgery to second look surgery were shown; however, further progression of patellofemoral grading was shown in group F. CONCLUSIONS: OWHTO aimed at the LTS has similar clinical outcomes to Fujisawa point. Surgery aimed at the LTS was slightly less corrected. Targeting the LTS could be an option after consideration of joint geometry and patellofemoral joint problems.

Determining the factors influencing the symptoms related to naviculo-medial cuneiform coalition.

PURPOSE: We aimed to determine the factors that influence the symptoms of naviculo-cuneiform (NC) coalition using radiography and computed tomography (CT). METHODS: We retrospectively reviewed the radiographic and CT findings of 37 NC coalition cases. The existence of a large pit (depth >3 mm), irregular articular surface, joint space narrowing, dorsal bony spur, subchondral sclerosis, multiple subchondral bony cysts, and intra-articular loose body were evaluated on radiographs or CT. The size of the largest subchondral bony cyst was also measured using CT. All cases were divided into two subgroups according to the symptoms. Fisher's exact test was used to distinguish the factors influencing the symptoms. RESULTS: Twenty-three and fourteen feet were enrolled into the symptomatic and asymptomatic groups, respectively. The rates of the large pit on either radiograph (47.83 vs. 21.43%) or CT (65.22 vs. 28.57%) were significantly different between both groups ( p = 0.001). The mean size of the largest subchondral bony cyst on CT was also significantly greater in the symptomatic group (4.25 vs. 1.53 mm, p = 0.005). CONCLUSION: A large deep pit and huge subchondral bony cyst on the radiograph or CT can be related to symptoms for the patient with NC coalition. A CT is highly recommended for a more accurate evaluation in patients with NC coalition.