Artificial intelligence (AI) is rapidly reshaping healthcare and the competencies expected of graduating medical students, yet AI curricula and competency recommendations for undergraduate medical education (UME) remain fragmented. We conducted a PRISMA-ScR scoping review to map and synthesize proposed AI competencies for UME by performing a global search of PubMed, Embase, Web of Science, and ERIC without language restrictions and from database inception through July 28, 2025. Verbatim competency-relevant text was extracted and decomposed into discrete statements and classified using domains, competencies, or learning objectives. Statement frequencies were summarized to characterize recurring areas of emphasis, underrepresented topics, and cross-domain relationships. Of 4071 records identified, 54 studies from 22 countries met inclusion criteria. From 564 eligible statements, we synthesized a taxonomy comprising seven domains (AI ethics; AI law and regulation; AI professionalism in healthcare; clinical applications of AI; critical appraisal of AI output; research and innovation in AI; theory and foundations of AI) spanning 37 competencies and 170 learning objectives. Sources were predominantly editorial/opinion, with recurring emphasis on ethicolegal oversight, critical appraisal of AI outputs, and foundational understanding of AI methods and data. This synthesis provides a structured inventory to inform curriculum planning and future stakeholder-based refinement, prioritization, and evaluation.

This study investigated the tolerability and preliminary efficacy of duloxetine as an alternative nonopioid therapeutic option for the prevention of persistent musculoskeletal pain (MSP) among adults presenting to the emergency department with acute MSP after trauma or injury. In this randomized, double-blind, placebo-controlled study, eligible participants (n = 78) were randomized to 2 weeks of a daily dose of one of the following: placebo (n = 27), 30 mg duloxetine (n = 24), or 60 mg duloxetine (n = 27). Tolerability, the primary outcome, was measured by dropout rate and adverse effects. Secondary outcomes assessed drug efficacy as measured by (1) the proportion of participants with moderate to severe pain (numerical rating scale ≥ 4) at 6 weeks (pain persistence); and (2) average pain by group over the six-week study period. We also explored treatment effects by type of trauma (motor vehicle collision [MVC] vs non-MVC). In both intervention groups, duloxetine was well tolerated and there were no serious adverse events. There was a statistically significant difference in pain over time for the 60 mg vs placebo group (P = 0.03) but not for the 30 mg vs placebo group (P = 0.51). In both types of analyses, the size of the effect of duloxetine was larger in MVC vs non-MVC injury. Consistent with the role of stress systems in the development of chronic pain after traumatic stress, our data indicate duloxetine may be a treatment option for reducing the transition from acute to persistent MSP. Larger randomized controlled trials are needed to confirm these promising results.

The role of prophylactic musculocutaneous flap closure following posterior spine surgery remains under-characterized. This study presents a single-institution experience with paraspinous-only musculocutaneous flap reconstruction among high-risk patients following spine surgery. Associations between risk factors, surgical indication, intraoperative characteristics, and postoperative wound complications are explored. A retrospective chart review identified all cases of prophylactic paraspinous flap reconstruction following posterior spine over an 11-year period. Patients who had uncomplicated postoperative courses were compared to those who developed wound complications. Multivariate logistic regression characterized associations among risk factors, surgical indication, and wound complications. Two hundred fifty-seven patients underwent primary prophylactic closure using paraspinous musculocutaneous flaps only. 49.4% female, with a mean age of 60.7±13.9 years. Surgical indications included degenerative disease (n=124, 48.2%), tumor (n=78, 30.4%), deformity (n=22, 8.6%), congenital anomaly (n=18, 7.0%), and trauma (n=15, 5.8%). This population exhibited high-risk features, including diabetes (19.5%), history of smoking (53.3%), prior spine surgery (58.8%); mean body mass index was 30.1±6.9. Wound complications occurred in 37 patients (14.4%). Postoperative complications coincided with greater number of incised levels, higher degree of instrumentation, and longer closure length. Prophylactic flap closure was associated with wound complication rates consistent with the literature in cohorts with substantial comorbidity burden. Outcomes were predominantly influenced by procedural factors rather than baseline patient characteristics. The findings support the feasibility of prophylactic flap closure in high-risk patients across the spectrum of spinal indications. Controlled studies are necessary to evaluate effectiveness.

Chordomas are rare, highly morbid tumors arising from notochordal progenitor cells along the spinal axis, associated with severe neurological complications and high recurrence rates. Their resistance to conventional therapies and limited options beyond surgical resection and high-dose radiation underscore the urgent need for novel therapeutic targets. Publicly available preliminary RNA sequencing data from the Chordoma Foundation identified chitinase-3-like 1 (CHI3L1), a secreted glycoprotein implicated in immune checkpoint regulation and epithelial–mesenchymal transition (EMT), as a promising candidate for chordoma immunotherapy. Yet, the comprehensive function of CHI3L1 in chordoma immune response remains unclear. To evaluate its presence in chordoma, we employed RNA-based analyses alongside enzyme-linked immunosorbent assays (ELISA) on commercially available chordoma cell lines (JHC7, U-CH12, U-CH1, U-CH1-N) and human chordoma tumor specimens. Our results demonstrate elevated CHI3L1 expression in chordoma cells relative to notochordal precursors, with comparative analyses revealing higher CHI3L1 expression in the primary tumor relative to recurrent samples. These findings suggest the potential role of CHI3L1 in chordoma tumorigenesis, emphasizing its relevance as a biomarker and therapeutic target for primary tumors. Future studies are necessary to elucidate the mechanistic role of CHI3L1 in chordoma immune evasion and to explore targeted interventions that may improve patient outcomes in this aggressive cancer.

BACKGROUND: Ambiguous destructive lumbosacral tumors with intractable pain and neurological compromise present a dilemma between timely decompression and oncological adequacy. The authors present a rare case of primary unclassified sarcoma of the sacrum to illustrate the implications of diagnostic uncertainty in surgical decision-making. OBSERVATIONS: A 59-year-old woman presented with excruciating low back pain and bilateral sciatica from a destructive lumbosacral mass spanning L5–S4 with circumferential cauda equina compression. CT-guided biopsy demonstrated an atypical epithelioid and spindle cell neoplasm, not otherwise classified. Given rapid neurological decline and refractory pain, she underwent preoperative embolization and urgent posterior decompression with multilevel laminectomies (L4–S4), transpedicular corpectomies (S1–3), and lumbopelvic fixation, followed by paraspinous flap closure. Frozen-section analysis favored a tenosynovial giant cell tumor (TGCT) to support a nerve root–sparing resection. Postoperative MRI showed small residual enhancement at S1–2. Final pathological analysis revealed an intermediate-grade unclassified sarcoma, and she subsequently underwent adjuvant radiation therapy. Systemic staging is ongoing. At the 6-month follow-up, she reported durable analgesia and function. LESSONS: Destructive lumbosacral tumors should be approached with an oncological mindset even when histology is uncertain. In urgent cases, timely decompression and functional preservation may outweigh radical resection, underscoring the value of adaptable, multidisciplinary management. https://thejns.org/doi/10.3171/CASE2646

Background Posterior decompression for degenerative lumbar spinal stenosis (DLSS) carries approach-related morbidity. In this study, we hypothesized that multilevel lateral lumbar interbody fusion (LLIF) achieves effective indirect decompression with acceptable safety and patient-reported improvement among DLSS patients without scoliosis. Methods This was a single-institution retrospective case series (2016–2022) of adults with symptomatic spondylotic stenosis and severe disc degeneration without scoliosis (Cobb angle <10°) undergoing multilevel (≥2) LLIF. Patients with concurrent posterior decompression or deformity correction were excluded. Primary outcomes were radiographic decompression (central canal diameter and bilateral foraminal height), patient-reported pain and disability (visual analog scale and Oswestry Disability Index), and complications. Secondary measures included spinopelvic parameters and fusion by the Brantigan-Steffee-Fraser scale. Imaging was assessed on pre- and postoperative magnetic resonance imaging. Tests of significance included 1-sided paired t tests for parametric variables and Wilcoxon signed-rank tests otherwise. Results Twenty-five patients (mean age 65.8 years; 56% men; mean body mass index 31.2 ± 5.4) underwent 57 LLIF levels with a mean follow-up of 41.3 ± 31.6 months. Central canal diameter increased by 31% (2.2 mm absolute), and foraminal height increased 17% to 39% (2.5–13.1 mm). Lumbar lordosis improved from 39.6° to 44.8°, with PI–LL mismatch improving by 5.4°. Early fusion status (BSF-3) at the last radiological assessment (mean 7.2 months) was 91.3% (21/23 evaluated). Visual analog scale score improved from 7.1 ± 2.0 to 3.0 ± 2.4 (Δ−4.1; n = 20), and Oswestry Disability Index score improved from 65.9 ± 12.9 to 47.5 ± 19.8 (Δ−18.4; n = 17). Overall complication rate was 40% with no major events; postoperative neurological complications included transient proximal lower-extremity weakness in 4% and persistent sensory symptoms in 12%. Conclusions In carefully selected DLSS patients without scoliosis, multilevel LLIF achieved meaningful indirect decompression, substantial pain and disability improvement, and high early fusion rates with no major complications. The findings support LLIF as a viable alternative to posterior approaches. Clinical Relevance Multilevel LLIF can facilitate multilevel indirect decompression with favorable radiographic and clinical outcomes while avoiding posterior soft-tissue disruption. Routine posterior instrumentation at the index surgery may support fusion and reduce returns to the OR. Level of Evidence 4.