Retrospective cohort study. To compare thrombotic complication rates in thoracolumbar spine surgery patients before and after the coronavirus disease 2019 (COVID-19) pandemic. Thrombotic complications are a major cause of postoperative morbidity and mortality in spine surgery. Both COVID-19 infection and vaccination have been linked to hypercoagulability. However, data on pre- versus post-pandemic thrombotic risk in spine surgery are limited, and the influence of infection severity or vaccination status has not been examined. Adult patients (≥18 years) undergoing primary thoracolumbar decompression with or without fusion were identified, excluding trauma and neoplastic cases. Patients were divided into "pre-COVID" and "post-COVID" cohorts. Outcomes included 90-day rates of postoperative deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), and cerebrovascular accident (CVA). Cohorts were compared using Pearson's chi-square tests, and multivariable regression adjusted for demographics and comorbidities. A total of 784,498 patients were included. Post-COVID, rates of DVT (1.4% vs. 1.3%; risk ratio [RR], 1.11; p <0.001), PE (0.9% vs. 0.8%; RR, 1.14; p <0.001, and CVA (0.8% vs. 0.7%; RR, 1.17; p <0.001) were higher. Multivariable analysis demonstrated a 7% increase in odds of VTE post-COVID (odds ratios [OR], 1.07; p =0.002). Unvaccinated patients had a 6% higher odds of VTE (OR, 1.06; p =0.006), whereas vaccinated patients showed a nonsignificant increase (OR, 1.16; p =0.109). Patients with prior COVID-19 hospitalization had approximately double the odds of VTE (OR, 2.03; p =0.011). Thrombotic complications modestly increased after the COVID-19 pandemic. Vaccination status showed no clear association, while prior hospitalization for COVID-19 was the strongest predictor of postoperative thrombotic risk.

Study Design: Randomized controlled survey study. Purpose: Evaluate the level of similarity between AI-generated and fellowship-trained spine surgeon-written operative reports. Overview of Literature: Large language models (LLMs) are a subset of generative artificial intelligence (AI) designed to produce human-like text. LLMs have demonstrated an ability to generate contextually accurate, detailed, and coherent writing across various domains. Their potential to enhance healthcare efficiency, particularly in streamlining medical documentation such as operative notes, is of growing interest. Methods: Operative reports for two common spine surgeries—anterior cervical discectomy and fusion (ACDF) and lumbar microdiscectomy were generated using ChatGPT-3 (OpenAI). A fellowship-trained spine surgeon wrote corresponding operative reports. These reports were randomized and presented to attending surgeons, fellows, and residents in orthopedic or neurosurgery, who were asked to identify whether each report was written by AI. Results: Fifty-two respondents completed the survey. For ACDF, 69.2% correctly identified AI-generated reports ( P =0.050); for lumbar microdiscectomy, 61.5% were correct ( P =0.239). In side-by-side comparisons, correct identification improved to 79.2% for ACDF ( P =0.004) and 60% for microdiscectomy ( P =0.317). Accuracy increased with training level, from 55.6% among residents to 100% among attending spine surgeons. Most participants reported that AI-generated reports had human-like language (86.3%), adequate detail (68.6%), essential procedural steps (78.4%), and accurate descriptions (68.6%). Notably, 87.5% expressed interest in incorporating AI into future operative documentation. Conclusions: Differentiation of AI-generated operative reports improves with training level. These reports share many characteristics with surgeon-written notes and are viewed favorably, suggesting a future role for AI in surgical documentation. Level of Evidence: II

Background: Tendinopathy, a pathology of tendons characterized by inflammation and or degeneration, is a prevalent cause of disease and disability in active and working patients. Within the past decade, orthobiologic injections such as Platelet Rich Plasma (PRP) have become increasingly popular within the musculoskeletal physician’s practice for treatment of chronic tendinopathies. However, there is a lack of standardization of PRP preparation and injection protocols, leading to gaps in our knowledge regarding the optimal administration dosages to maximize treatment efficacy. Purpose: This review aims to compile and evaluate the existing data for PRP injection volumes for various tendinopathies in hopes of contributing to standardization of PRP protocols, with a further goal of minimiz-ing waste of a costly therapeutic. Study Design: Systematic Review Methods: In June 2020, comprehensive electronic database searches were conducted by a medical librarian in Medline via PubMed, EMBASE (embase.com), CINAHL (EbscoHost), CENTRAL and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data was extracted from studies meeting inclusion criteria on injection volumes and outcomes and grouped based on anatomic injection location. Results: Twenty-eight studies were identified for inclusion in which ultrasound-guided intra-tendinous PRP injections were administered to patients to treat various tendinopathies. For all tendon locations, the mini-mum volume of injectate reported achieved positive clinical outcomes in patients compared to baseline. Conclusions: Despite its many benefits—tendon healing, pain relief, increased function—PRP can pose a significant financial burden to patients, with patients often having to pay for the full cost out-of-pocket due to lack of insurance coverage. This study provides evidence that PRP can be effective at smaller volumes, minimizing waste and the out-of-pocket cost to the patient. In addition, this study further stresses the impor-tance of protocol standardization. Clinical Relevance: Though more data is needed, it is apparent that the minimum amount of injectate used clinically for various anatomic locations is enough for overall positive outcomes, and therefore can be the recommended dose given. As such, the authors have incorporated the minimum injection volume into their practice using the following volumes: Rotator Cuff-1 mL, Lateral or Medial Epicondyle-1.5 mL, Gluteal or Hamstring-3 mL, Patella-2 mL, Achilles-3 mL. Unfortunately, without more data available in the literature, the authors cannot make stronger recommendations at this time. What is known about the subject: Among intralesional injections for the treatment of tendinopathy, PRP has shown positive results in multiple trials and has made its way into many musculoskeletal physicians’ practice. However, there is a significant lack of standardization in PRP protocols. What this study adds to existing knowledge: While other reviews have highlighted the discrepancies amongst PRP protocols, our review is the first to examine injection volume and its effect on outcomes. We were able to suggest a minimum injectate amount for positive outcomes, either pain relief or improvement in the tendon appearance on imaging.

Background/Objectives: A superinfection occurs when a new, secondary organism colonizes an existing infection. Spine infections are associated with high patient morbidity and sometimes require multiple irrigations and debridements (I&Ds). When multiple I&Ds are required, the risk of complications increases. The purpose of this study was to report our experience with spine superinfections and determine which patients are typically affected. Methods: A retrospective case series of spine superinfections and a retrospective case–control analysis were conducted. Data were collected manually from electronic medical records. Spine I&Ds were identified. Groups were created for patients who had multiple I&Ds for (1) a recurrence of the same causative organism or (2) a superinfection with a novel organism. Preoperative demographic, clinical, and microbiologic data were compared between these two outcomes. A case series of superinfections with descriptive data was constructed. Lastly, two illustrative cases were provided in a narrative format. Results: A total of 92 patients were included in this analysis. Superinfections occurred after 6 out of the 92 (7%) initial I&Ds and were responsible for 6 out of the 24 (25%) repeat I&Ds. The preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of the patients with a superinfection were significantly lower than those in the control group (p = 0.022 and p = 0.032). Otherwise, the observed differences in the preoperative variables were not statistically different. In the six cases of superinfection, the presence of high-risk comorbidities, a history of substance abuse, or a lack of social support were commonly observed. The superinfecting organisms included Candida, Pseudomonas, Serratia, Klebsiella, Enterobacter, and Staphylococcus species. Conclusions: Superinfections are a devastating complication requiring reoperation after initial spine I&D. Awareness of the possibility of superinfection and common patient archetypes can be helpful for clinicians and care teams. Future work is needed to examine how to identify, help predict, and prevent spine superinfections.