Analysis of ChatGPT in the Triage of Common Spinal Complaints.

Background: ChatGPT is a natural language processing chatbot with a significant prevalence in modern media with a clear application in the medical triage workflow. ChatGPT has shown significant capacity for understanding clinical vignettes, radiology reports, and even passing the American Board of Neurological Surgery board examination. There has never been an evaluation of the chatbot in triage and diagnosing spinal vignettes common to primary and urgent care practice.

ChatGPT as a Decision Support Tool in the Management of Chiari I Malformation: A Comparison to 2023 CNS Guidelines.

Objective: ChatGPT has been increasingly investigated for its ability to provide clinical decision support in the management of neurosurgical pathologies. However, concerns exist regarding the validity of its responses. To assess the reliability of ChatGPT, we compared its responses against the 2023 Congress of Neurological Surgeons (CNS) guidelines for patients with Chiari I Malformation (CIM).

Organizing a Regional In-Person Medical Student Symposium in Neuroscience and Neurosurgery Research: A How-To Guide.

Background: Medical students are increasingly seeking out research opportunities to build their skills and network with future colleagues. Medical student-led conferences are an excellent endeavor to achieve this goal.

Methods: The American Association of Neurological Surgeons student chapter at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell designed an in-person medical student research symposium alongside the Northwell Health Department of Neurosurgery.

A Quantitative Assessment of ChatGPT as a Neurosurgical Triaging Tool.

Background And Objectives: ChatGPT is a natural language processing chatbot with increasing applicability to the medical workflow. Although ChatGPT has been shown to be capable of passing the American Board of Neurological Surgery board examination, there has never been an evaluation of the chatbot in triaging and diagnosing novel neurosurgical scenarios without defined answer choices. In this study, we assess ChatGPT's capability to determine the emergent nature of neurosurgical scenarios and make diagnoses based on information one would find in a neurosurgical consult.

Web-Based Education and Social Media Increase Access to Careers in Neurosurgery: The Lenox Hill Hospital BRAINterns Experience.

Objective: To replace educational opportunities lost during the coronavirus disease 2019 (COVID-19) pandemic, the Department of Neurosurgery at Lenox Hill Hospital produced an open-access webinar series ("BRAINterns") that covered a broad range of health care topics with a focus on neurosurgery.

Methods: This 8-week webinar series ran from July 1 to August 28, 2020. An optional exit survey was distributed to participants.

Current Procedural Terminology-based Procedure Categorization Enhances Cost Prediction of Medicare Severity Diagnosis Related Group in Spine Surgery.

Study Design: Retrospective cohort study.

Objective: The aim of this study was to analyze how a Current Procedural Terminology (CPT)-based categorization method can predict cost variation in surgical spine procedures.

Summary Of Background Data: Neck and back disorders affect a majority of the adult population and account for tens of billions of dollars in health care spending each year.

Surgeons lack of agreement on determining preoperative radiographic and clinical shoulder balance in adolescent and adult idiopathic scoliosis patients.

Purpose: Preoperative shoulder balance is an important factor in determining the upper instrumented vertebrae (UIV). In adolescent and adult idiopathic scoliosis (AIS/AdIS) patients, we studied the intraobserver and interobserver reliability of spinal surgeons' assessment of preoperative shoulder balance using X-rays (XR) and anterior/posterior photographs.

Methods: An observational review of a prospective multicenter database (AIS Lenke Type 1/5/6) and prospective single-institution database (AdIS) was conducted.

Does the Global Alignment and Proportion score overestimate mechanical complications after adult spinal deformity correction?

Objective: The goal of this study was to validate the Global Alignment and Proportion (GAP) score in a cohort of patients undergoing adult spinal deformity (ASD) surgery. The GAP score is a novel measure that uses sagittal parameters relative to each patient's lumbosacral anatomy to predict mechanical complications after ASD surgery. External validation is required.

A new modular radiographic classification of adult idiopathic scoliosis as an extension of the Lenke classification of adolescent idiopathic scoliosis.

Purpose: To propose and test the reliability of a radiographic classification system for adult idiopathic scoliosis.

Methods: A three-component radiographic classification for adult idiopathic scoliosis consisting of curve type, a lumbosacral modifier, and a global alignment modifier is presented. Twelve spine surgeons graded 30 pre-marked cases twice, approximately 1 week apart.

Coronavirus Neurosurgical/Head and Neck Drape to Prevent Aerosolization of Coronavirus Disease 2019 (COVID-19): The Lenox Hill Hospital/Northwell Health Solution.

Background: The coronavirus disease 2019 (COVID-19) pandemic has infected more than 13 million people on a global scale and claimed more than half million deaths across 213 countries and territories. While the focus is currently on recovery from the pandemic, the disease has significantly changed the way we practice medicine and neurosurgery in New York City and the United States. Apart from the emergency cases, several health systems across the country have similarly started to perform elective surgeries.

Partial Intraoperative Global Alignment and Proportion Scores Do Not Reliably Predict Postoperative Mechanical Failure in Adult Spinal Deformity Surgery.

Study Design: Retrospective radiographic review.

Objectives: The Global Alignment and Proportion (GAP) score allows sagittal plane analysis for deformity patients and may be predictive of mechanical complications. This study aims to assess the effectiveness of predicting mechanical failure based on partial intraoperative GAP (iGAP) scores.

Virtual Spine: A Novel, International Teleconferencing Program Developed to Increase the Accessibility of Spine Education During the COVID-19 Pandemic.

Background: The coronavirus identified in 2019 (COVID-19) pandemic effectively ended all major spine educational conferences in the first half of 2020. In response, the authors formed a "virtual" case-based conference series directed at delivering spine education to health care providers around the world. We herein share the technical logistics, early participant feedback, and future direction of this initiative.

A novel MRI-based classification of spinal cord shape and CSF presence at the curve apex to assess risk of intraoperative neuromonitoring data loss with thoracic spinal deformity correction.

Study Design: Retrospective cohort. We present a simple classification system that is able to identify patients with increased odds of losing intraoperative neuromonitoring data during thoracic deformity correction. Type 3 spinal cords, with the cord deformed against the concave pedicle in the axial plane, have ×28 greater odds of losing monitoring data during surgery.

C1 Stenosis - An Easily Missed Cause for Cervical Myelopathy.

C1 stenosis is often an easily missed cause for cervical myelopathy. The vast majority of cervical myelopathy occurs in the subaxial cervical spine. The cervical canal is generally largest at C1/2, explaining the relatively rare incidence of neurological deficits in patients with odontoid fractures.

Dynamic Cord Compression Causing Cervical Myelopathy.

Due to the highly mobile nature of the cervical spine, and the fact that most magnetic resonance imagings (MRIs) and computed tomography scans are obtained only in one single position, dynamic cord compression can be an elusive diagnosis that is often missed and not well-understood. In this context, dynamic MRI (dMRI) has been utilized to improve the diagnostic accuracy of cervical stenosis. We performed a literature review on dynamic cord compression in the context of cervical spondylotic myelopathy (CSM), with particular emphasis on the role of dMRI.

Minimally invasive approach to the lumbosacral junction with a single position, 360° fusion.

Degenerative lumbar pathologies are commonly encountered at the lumbosacral junction. The transition from the mobile lumbar spine to the stiff sacroiliac segment results in high biomechanical stresses and can lead to disc degeneration, ligamentum flavum hypertrophy, neural foraminal stenosis, and other causes of pain or neurologic deficit. Surgical intervention at the lumbosacral junction must be tailored to maximize pain relief and relieve neural compression and reverse neurologic deficit while preserving the spine's natural biomechanical strength and flexibility and preventing the slow march of adjacent segment degeneration cranially into the thoracolumbar spine.

Dynamic Cord Compression Causing Cervical Myelopathy.

The diagnosis of cervical spondylotic myelopathy (CSM) is made based on clinical signs and symptoms, and then confirmed with magnetic resonance imaging (MRI) or CT myelogram. Due to the highly mobile nature of the cervical spine, and the fact that most MRIs and CTs are obtained only in one single position, dynamic cord compression can be an elusive diagnosis that is often missed and not well-understood. In this context, dynamic MRI (dMRI) has been utilized to improve the diagnostic accuracy of cervical stenosis in cases where static MRI does not provide enough information to establish a diagnosis or to provide additional information.

Motion-preserving, 2-stage transoral and posterior treatment of an unstable Jefferson fracture in a professional football player.

The authors report the case of a patient who suffered a Jefferson fracture during a professional football game. The C-1 (atlas) fracture was widely displaced anteriorly, but the transverse ligament was intact. In an effort to enable a return to play and avoid intersegmental (C1-2) fusion, the patient underwent a transoral approach for open reduction and internal fixation of the fracture.

The role of diffusion tensor imaging in spinal pathology: A review.

Diffusion tensor imaging (DTI) allows for noninvasive, in vivo visualization of white matter fiber tracts in the central nervous system by measuring the diffusion of water molecules. It provides both quantitative and qualitative (i.e.

Anterior Cervical Discectomy and Fusion: Comparison of Fusion, Dysphagia, and Complication Rates Between Recombinant Human Bone Morphogenetic Protein-2 and Beta-Tricalcium Phosphate.

Introduction: Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures performed. A direct comparison of the fusion and complication rates between recombinant human bone morphogenetic protein-2 (rhBMP2) and beta-tricalcium phosphate (bTCP) has not been reported.

Methods: A retrospective study of 191 consecutive patients who underwent ACDF with polyetheretherketone plastic fusion spacers during a 2-year period with either rhBMP2 (n = 84, 46%) or bTCP (n = 107, 56%) was performed.

Neurological outcomes following iatrogenic vascular injury during posterior atlanto-axial instrumentation.

Background: Iatrogenic vascular injury is a feared complication of posterior atlanto-axial instrumentation. A better understanding of clinical outcome and management options following this injury will allow surgeons to better care for these patients. The object of the study was to systematically review the neurologic outcomes after iatrogenic vascular injury during atlanto-axial posterior instrumentation.

Implications of Isolated Transverse Process Fractures: Is Spine Service Consultation Necessary?

Background: Acute traumatic isolated transverse process fractures (ITPFs) are increasingly identified in trauma patients owing to the increased use of routine computed tomography imaging. Despite repeated demonstrations that these fractures are treated only symptomatically, patterns of consultation with a spine service have not changed. We aim to provide information on long-term outcomes following conservative treatment to help clarify the role of the spine service in the treatment of ITPFs.

Focal Correction of Severe Fixed Kyphosis with Single Level Posterior Ponte Osteotomy and Interbody Fusion.

Objective: To report the successful correction of a severe, fixed kyphotic deformity utilizing a combination posterior lumbar interbody fusion (PLIF) and Ponte osteotomy at the site of acute kyphosis.

Summary Of Background Data: There have been no reports on the experience and surgical strategy of combined one-level focal PLIF and Ponte osteotomy for fixed severe kyphotic deformity. Typically, these corrections would need a pedicle subtraction osteotomy or a vertebrectomy.