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.

The rapid growth of computed tomography (CT) has resulted in increased concerns of ionizing radiation exposure and its subsequent risk of cancer development. We evaluated the impact of a new protocol using rapid sequence magnetic resonance imaging (rsMRI) instead of CT in children presenting with possible ventriculoperitoneal shunt (VPS) malfunction to promote patient safety. This is a retrospective case series of pediatric patients who received a neuroimaging study for emergency evaluation of possible VPS malfunction at New York University's Tisch Hospital Emergency Department between January 2010 and July 2011. Radiology Charge Master was queried to identify the patient database. The trend in the use of rsMRI and CT was calculated for 3 patient age groups and compared across 3 chronological intervals. The effective dose of ionizing radiation per CT scan was calculated using the CT dose index and dose-length product for each patient. Total of 365 patients with the mean age of 8.87 years received either rsMRI or CT study during the study period. One hundred forty-four of these patients required the imaging studies because of VPS malfunction. Overall, 62% of all VPS malfunction cases used rsMRI instead of CT. The ratio of the number of patients receiving rsMRI divided by CT studies has progressively increased from 1.4:1 to 2.1:1 over 3 chronologic periods. Children with VPS are subject to multiple neuroimaging studies throughout their lifetime. Rapid sequence MRI is an effective alternative to CT while providing no ionizing radiation exposure or risk of developing radiation-induced cancer.

Background/Objectives: This study compares clinical and radiological outcomes of open microscopic posterior cervical foraminotomy (PCF) and biportal endoscopic spine surgery (BESS) PCF in multi-level cases. While BESS PCF is effective in single-level surgeries, its role in multi-level procedures remains unclear. Methods: This retrospective cohort study included 60 patients treated for cervical radiculopathy from 2016 to 2023, divided into two groups, open microscopic PCF (Group M, n = 30) and BESS PCF (Group B, n = 30). Clinical outcomes were assessed using visual analogue scale (VAS) scores for neck and arm pain and the neck disability index (NDI). Radiological parameters included cervical angle, segmental angle, range of motion (ROM), and the extent of facetectomy. Results: Both groups showed improvement in the arm pain VAS and the NDI. However, Group B exhibited significantly better neck pain on the VAS at the final follow-up (p = 0.03). Radiologically, Group B maintained lordotic cervical and segmental angles postoperatively, while Group M showed kyphotic changes (p < 0.01). Segmental ROM was larger in Group M, indicating greater instability (p < 0.01). Group B had less extensive facetectomy while achieving comparable foraminal enlargement. Operative time was longer for Group B (p < 0.001). Conclusions: BESS PCF preserves cervical stability and reduces postoperative neck pain compared to open microscopic PCF in multi-level procedures. Despite longer operative times, its benefits in minimizing instability make it a promising option for treating multi-level cervical radiculopathy. Further research with long-term follow-up is recommended.

Background: Brachymetatarsia is usually treated by lengthening the metatarsals, but excessive lengthening can be associated with complications. Our technique combines 1-stage step-cut lengthening of the first metatarsal with shortening and/or lengthening of the neighboring metatarsals and/or phalanges. Methods: Twenty-four feet (15 patients) were treated for first-ray brachymetatarsia. Widely available commercial image-editing software was used to make a preoperative plan for each patient, with emphasis on the creation of a cosmetically satisfying toe-length arc with minimum shortening and lengthening of the affected metatarsals and proximal phalanges. Length gain and percentage increase were also recorded postoperatively. The American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scoring system was used for clinical evaluation. Results: In all 24 feet, smooth parabolas were created at the level of the metatarsal heads and at the toe tips. All patients showed osseous union, and no complications were noted. However, most patients showed mildly restricted range of motion of the first metatarsophalangeal joint. The mean AOFAS score of the hallux significantly improved from 88.3 preoperatively to 98.1 at the latest follow-up (p < 0.001). Conclusions: One-stage step-cut lengthening of the first metatarsal combined with shortening and/or lengthening of the adjacent metatarsal and phalangeal bones provides excellent cosmetic and functional results. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background: Oblique lumbar interbody fusion (OLIF) is a minimally invasive technique used to manage degenerative lumbar conditions. The presence of vacuum phenomenon (VP) and associated endplate sclerosis may increase the risk of cage subsidence. This study evaluated the relationship between VP grade, endplate sclerosis, and subsidence in OLIF. Methods: This retrospective cohort study included 165 patients who underwent a single-level OLIF for lumbar stenosis. Patients were stratified into VP grades (0–3) based on preoperative computed tomography scans. Disc height, endplate sclerosis, and cage subsidence were radiologically assessed. Clinical outcomes, including back and leg pain visual analog scale, Oswestry Disability Index, and EuroQol-5 Dimension, were measured preoperatively and at follow-up. Results: High VP grades were associated with low preoperative disc height and increased endplate sclerosis. Although no significant differences in clinical outcomes or final fusion rates across VP grades were observed, the subsidence rate increased with VP grade, with a significant difference between VP grades 1 and 2 (p = 0.045) and between VP grades 2 and 3 (p = 0.032), indicating that subsidence rates increased as the VP grade advanced. Conclusions: High VP grades, particularly grades 2 and 3, may increase the risk of cage subsidence following OLIF. Therefore, VP grading may be worth considering during surgical planning to reduce the subsidence risk and improve outcomes.

김건중, et al. J Korean Soc Spine Surg. 2023 Sep;30(3):91-97. https://doi.org/10.4184/jkss.2023.30.3.91