Advancements in spine surgery have dramatically enhanced minimally invasive techniques, prominently through integrating robotic systems. Although pedicle screw placement remains the most widespread application of this technology, new developments are emerging to create innovative future avenues for these tools. This review explores the promising applications of robotic technology in minimally invasive spinal procedures, ranging from assistance with laminectomies and vertebroplasty to pain management and treatment of spinal tumors. We also discuss the potential for integrating artificial intelligence and augmented reality with robotic systems. If the current trajectory of research and innovation continues, there is promise in creating fully autonomous robotic systems that can revolutionize spine surgery by processing, planning, and performing procedures without heavy reliance on the surgeon.

Background/Objectives: Spinal metastases are a common and severe complication of lung cancer, particularly in small cell lung cancer (SCLC), and are associated with poor survival. Despite advancements in treatment, optimal management strategies remain unclear, with significant differences between non-small cell lung cancer (NSCLC) and SCLC. This study evaluates treatment patterns, survival outcomes, and prognostic factors in lung cancer patients with spinal metastases, integrating deep learning survival prediction models. Methods: This retrospective cohort study analyzed the National Cancer Database (NCDB) to identify NSCLC and SCLC patients diagnosed with spinal metastases. Demographics and treatment modalities were analyzed and adjusted for age, sex, and comorbidities. Kaplan–Meier analysis and Cox proportional hazards models assessed overall survival (OS). Five advanced survival prediction models estimated 1-year and 10-year mortality, with feature importance determined via permutation analysis. Results: Among 428,919 lung cancer patients, 5.1% developed spinal metastases, with a significantly higher incidence in SCLC (13.6%) than in NSCLC (5.1%). SCLC patients had poorer OS. Radiation therapy alone was the predominant treatment, and stereotactic body radiation therapy (SBRT) predicted better short- and long-term survival compared to other radiation techniques. High-dose radiation (71–150 Gy BED) improved OS in NSCLC, while reirradiation benefited NSCLC but had a limited impact in SCLC. SurvTrace demonstrated the highest predictive accuracy for 1-year and 10-year mortality, identifying age, radiation dose, reirradiation, and race as key prognostic factors. Conclusions: The management of spinal metastases requires a histology-specific approach. Radiation remains the primary treatment, with SBRT predicting better short- and long-term survival. High-dose radiation and reirradiation should be considered for NSCLC, while the benefits are limited in SCLC. These findings support histology-specific treatment strategies to improve survival of patients with metastatic lung cancer to the spine.

Study Design: Retrospective. Objective: To identify factors correlated with surgical duration, LOS, and COA for 3-level ACDF. Background: Three-level ACDF can treat multilevel spine pathologies, but is associated with higher complexity and increased risk profiles compared with single- and 2-level ACDF. This study examined factors affecting surgical duration, length of stay (LOS), and costs of admission (COA) specifically for patients undergoing 3-level ACDF to identify patients at higher risk of these adverse outcomes. Methods: Patient demographics, baseline health factors, and perioperative outcomes were retrospectively collected for patients undergoing 3-level ACDF. Univariable analysis correlated each variable with increased surgical duration, LOS, and COA as outcomes. Patient comorbidities and functional status were incorporated into conceptual multivariable regression models for each outcome variable. Results: The cohort included 137 patients with a mean age of 59.1±11.3 years. Seventy-one (51.8%) patients were male, with a median (IQR) surgical duration of 211.5 (70) minutes, LOS of 2 (2) days, and COA of $39,998 ($12,329). On multivariable analysis, hypertension was associated with extended surgical duration (OR=3.00, 95% CI: 1.16–8.44, P =0.028); total functional dependence (OR=7.70, 95% CI: 1.26–59.57, P =0.033), cerebrovascular disease (OR=6.51, 95% CI: 1.05–37.43, P =0.034), and diabetes (OR=10.33, 95% CI: 3.09–37.95, P <0.001) were associated with extended LOS; COPD (OR=8.32, 95% CI: 1.60–50.36, P =0.014) and diabetes (OR=8.00, 95% CI: 1.96–37.05, P =0.005) were associated with increased COA. In addition, patients who are Black experienced higher risks of extended surgical duration (OR=5.84, 95% CI: 1.85–20.25, P =0.003) and LOS (OR=6.01, 95% CI: 1.47–27.12, P =0.014). Conclusion: Surgical duration, hospital LOS, and total COA for 3-level ACDF operations are correlated with multiple baseline health factors that can be identified perioperatively. Awareness of modifiable factors can help guide added interventions to improve patient outcomes and increase the cost-value of the operation. Level of Evidence: Level III.

BACKGROUND AND OBJECTIVES: Chemotherapeutic drug delivery to intramedullary spinal cord tumors (IMSCTs) is restricted by the blood–spinal cord barrier. Focused ultrasound (FUS), however, can transiently disrupt the blood–spinal cord barrier. Therefore, this study investigates the feasibility of using FUS-enhanced Abraxane (albumin-bound paclitaxel) delivery to improve the treatment of IMSCTs using a rodent model. METHODS: Twenty-eight F344 rats received an intramedullary injection of 100 000 luciferase-tagged 9L gliosarcoma cells. Rats were classified into 4 cohorts: no-treatment, FUS, Abraxane, and FUS-enhanced Abraxane delivery. Treatments were administered on days 7, 14, and 21. Tumor burden was assessed weekly using bioluminescence-based imaging. Twice a week, nociceptive thresholds were assessed using the Von Frey Filament test, and motor function was assessed using the Basso-Beattie-Bresnahan locomotor scale. RESULTS: The FUS-enhanced Abraxane delivery cohort had significantly decreased tumor burden ([1.52 ± 0.69] × 10 ⁶ photons/s) compared with the no-treatment ([9.03 ± 5.13] × 10 ⁶ photons/s), FUS-only ([8.25 ± 1.58] × 10 ⁶ photons/s) and Abraxane-only ([4.19 ± 1.91] × 10 ⁶ photons/s) groups (day 18, P < .0001). Although all rodents initially demonstrated motor decline, the FUS-enhanced Abraxane group had complete return-to-baseline motor scores (21.0) by day 27, whereas the no-treatment (8.3 ± 1.5), FUS-only (6.0 ± 1.4), and Abraxane-only (16.3 ± 1.3) cohorts maintained decreased Basso, Beattie, and Bresnahan scale scores to day 48. Similarly, while all animals demonstrated initial hypersensitivity to pain, only the FUS-enhanced Abraxane group returned to baseline pain response by day 48 (17.4 ± 6.1 g) when compared with the no-treatment (7.0 ± 6.2 g), FUS-only (5.0 ± 1.4 g), and Abraxane-only (11.2 ± 7.5 g) cohorts. CONCLUSION: FUS-enhanced Abraxane delivery significantly reduced IMSCT tumor burden and improved neurological recovery over intravenous administration alone. Therefore, FUS-mediated chemotherapeutic drug delivery may represent a noninvasive, clinically relevant, and effective treatment paradigm for intramedullary pathologies.

Arabidopsis leaf epidermal cells have a wide range of sizes and ploidies, but how large cells are spatially patterned alongside smaller cells remains unclear. Here, we demonstrate that the same genetic pathway that creates giant cells in sepals is also responsible for their formation in the leaf epidermis. In both sepals and leaves, giant cells are scattered among smaller cells; therefore, we asked whether the spatial arrangement of giant cells is random. By comparing sepal and leaf epidermises with computationally generated randomized tissues we show that giant cells are clustered more than is expected by chance. Our cell-autonomous and stochastic computational model recapitulates the observed giant cell clustering, indicating that clustering emerges as a result of the cell division pattern. Overall, cell size patterning is developmentally regulated by common mechanisms in leaves and sepals rather than a simple byproduct of cell growth. Teaser The spatial pattern of giant cells becomes non-random as the surrounding cells divide.