Study Design: Comparative study. Objectives: This study aims to compare Google and GPT-4 in terms of (1) question types, (2) response readability, (3) source quality, and (4) numerical response accuracy for the top 10 most frequently asked questions (FAQs) about anterior cervical discectomy and fusion (ACDF). Methods: “Anterior cervical discectomy and fusion” was searched on Google and GPT-4 on December 18, 2023. Top 10 FAQs were classified according to the Rothwell system. Source quality was evaluated using JAMA benchmark criteria and readability was assessed using Flesch Reading Ease and Flesch-Kincaid grade level. Differences in JAMA scores, Flesch-Kincaid grade level, Flesch Reading Ease, and word count between platforms were analyzed using Student’s t-tests. Statistical significance was set at the .05 level. Results: Frequently asked questions from Google were varied, while GPT-4 focused on technical details and indications/management. GPT-4 showed a higher Flesch-Kincaid grade level (12.96 vs 9.28, P = .003), lower Flesch Reading Ease score (37.07 vs 54.85, P = .005), and higher JAMA scores for source quality (3.333 vs 1.800, P = .016). Numerically, 6 out of 10 responses varied between platforms, with GPT-4 providing broader recovery timelines for ACDF. Conclusions: This study demonstrates GPT-4’s ability to elevate patient education by providing high-quality, diverse information tailored to those with advanced literacy levels. As AI technology evolves, refining these tools for accuracy and user-friendliness remains crucial, catering to patients’ varying literacy levels and information needs in spine surgery.

Study Design: Cross-sectional ecological analysis. Objectives: This study aims to assess the availability of robotic spine surgery across the United States and identify disparities in access. Methods: We utilized provider-finding functions from major medical equipment manufacturers to identify robotic spine surgeons and categorized affiliated hospitals. Geospatial analyses combined with socioeconomic indicators, Rural-Urban Continuum Codes, and the Area Deprivation Index (ADI) provided insights into access disparities. Multivariate logistic regression and Student’s t-tests were used to identify county-level variables associated with hotspots and coldspots. Statistical significance was set at the P < .05 level. Results: Ninety-one robotic spine surgeons were identified. Robotic spine surgeons were predominantly affiliated with nonteaching hospitals (50.55%), followed by minor teaching (38.46%) and major teaching (10.99%) hospitals. Access hotspots are in the Northeast and Southeast, with rural areas showing 22% lower odds of being hotspots (OR = 0.78, P < .001). Factors increasing the odds of being a hotspot include higher disability prevalence (OR = 1.19, P < .001), lack of insurance (OR = 1.18, P < .001), and older median age (OR = 1.17, P < .001). Educational attainment and ADI, despite being significant, had lower predictive values for access. Conclusions: Disparities in access to robotic spine surgery are associated with socioeconomic, demographic, and geographic factors. The concentration of surgeons in nonteaching hospitals and higher-income areas may reflect market dynamics. Efforts to improve access should consider regional resources, hospital type, and community disadvantage.

Study Design: Narrative review. Objectives: The objectives of this study were to answer the following questions: (1) What is the quality of informed consent in spine surgery, including both neurosurgery and orthopaedic spine surgery? (2) What limitations impede the ability of surgeons to engage in effective shared decision-making (SDM) and obtain adequate informed consent? (3) What strategies and solutions may improve the quality of informed consent and SDM? (4) What factors decrease the incidence of litigation in spine surgery? Methods: N/A. Results: SDM is a collaborative process where patients are involved in their treatment choices through open communication about risks, alternatives, and postoperative expectations. Informed consent is a vital component of this process, ensuring that patients are fully informed and empowered to make decisions based on their values and preferences. This review highlights the current state of informed consent within the context of SDM in spine surgery and explores how enhancing this process can improve patient outcomes, reduce dissatisfaction, and decrease litigation. By emphasizing patient autonomy and improving the quality of risk communication, SDM fosters better physician-patient relationships and more positive clinical outcomes. Conclusions: Orthopaedic surgery and neurosurgery are highly litigated specialties, with failure to obtain informed consent frequently cited in lawsuits. These legal challenges are costly and time-consuming for both physicians and patients. Integrating SDM into the informed consent process can help mitigate these issues, leading to improved patient satisfaction and fewer legal disputes.

Study design: Retrospective cohort study. Objectives: To examine differences in postoperative complications, recovery course, and costs between patients with and without obstructive sleep apnea (OSA) undergoing single-level anterior cervical discectomy and fusion (ACDF). Methods: The National Inpatient Sample (NIS) database was queried to identify patients undergoing single-level ACDF between 2016 and 2022. After exclusions, patients were divided into OSA and control groups. Propensity score matching (1:2) controlled for age, sex, obesity, and year of surgery to balance characteristics. Postoperative outcomes, including complications, length of stay (LOS), hospital costs, and discharge disposition, were compared using chi-square tests for categorical variables and t-tests for continuous variables. A Bonferroni correction was applied, with significance set at P < 0.002. Results: A total of 36,000 matched cases were analyzed (12,000 OSA and 24,000 controls). OSA patients had significantly higher rates of acute respiratory failure (4.7% vs 1.9%; P < 0.001) and mechanical ventilation (1.5% vs 0.6%; P < 0.001). The OSA cohort also had a longer LOS (2.3 vs 1.9 days; P < 0.001), higher hospital costs ($23,300 vs $21,100; P < 0.001), and greater non-routine discharge rates (20.4% vs 16.8%; P < 0.001). Conclusions: OSA is associated with increased respiratory complications, prolonged LOS, and higher costs in single-level ACDF. These findings underscore the importance of preoperative screening and tailored perioperative management to improve outcomes in this high-risk population.

Study Design: Retrospective analysis using national Medicare data. Objectives: To evaluate historical trends in single and multi-level ACDF utilization and project future procedure volumes among Medicare beneficiaries through 2060. Methods: Publicly available data from the Centers for Medicare and Medicaid Services (CMS) Medicare Part-B National Summary were analyzed for single-level and multi-level ACDF from 2011 through 2022. Analyses were limited to Part-B claims and therefore excluded inpatient-only procedure codes that are not reported in Part-B. Volumes were adjusted for Medicare Advantage enrollment. Four forecasting models were applied, with Poisson regression selected based on model performance. Point forecasts and 95% confidence intervals were generated through 2060. Results: Single-level ACDF volumes decreased by 0.32% from 2011 to 2022, with the largest annual increase from 2011 to 2012 (11.3%) and 5-year growth from 2011 to 2016 (25.7%). In contrast, multi-level ACDF volumes increased by 86.9%, with a 19.5% increase between 2011 and 2012 and 69.8% growth from 2011 to 2016. The Poisson model projected stable annual growth for single-level ACDF at 0.04%, reaching 8,789 procedures (95% CI: 8,606-8,973) by 2060. Multi-level ACDF is projected to grow by approximately 4.9% annually, reaching 377,826 procedures (95% CI: 376,622-379,031) by 2060. Conclusions: Single-level ACDF utilization is projected to remain stable, while multi-level ACDF is expected to increase substantially through 2060. These trends highlight the growing reliance on ACDF for complex cervical pathology and carry implications for surgical workforce planning, hospital resource allocation, and policy in an aging population.