Ethical Application of Generative Artificial Intelligence in Medicine.

Generative artificial intelligence(AI) may revolutionize healthcare, providing solutions that range from enhancing diagnostic accuracy to personalizing treatment plans. However, its rapid and largely unregulated integration into medicine raises ethical concerns related to data integrity, patient safety, and appropriate oversight. One of the primary ethical challenges lies in generative AI's potential to produce misleading or fabricated information, posing risks of misdiagnosis or inappropriate treatment recommendations, which underscore the necessity for robust physician oversight.

Custom Large Language Models Improve Accuracy: Comparing Retrieval Augmented Generation and Artificial Intelligence Agents to Noncustom Models for Evidence-Based Medicine.

Purpose: The purpose of the study is to demonstrate the value of custom methods, namely Retrieval Augmented Generation (RAG)-based Large Language Models (LLMs) and Agentic Augmentation, over standard LLMs in delivering accurate information using an anterior cruciate ligament (ACL) injury case.

Methods: A set of 100 questions and answers based on the 2022 AAOS ACL guidelines were curated. Closed-source (open AI GPT4/GPT 3.

The Fundamentals and Applications of Wearable Sensor Devices in Sports Medicine: A Scoping Review.

Purpose: To (1) characterize the various forms of wearable sensor devices (WSDs) and (2) review the peer-reviewed literature of applied wearable technology within sports medicine.

Methods: A systematic search of PubMed and EMBASE databases, from inception through 2023, was conducted to identify eligible studies using WSDs within sports medicine. Data extraction was performed of study demographics and sensor specifications.

The Risk of Lymphedema After Breast Cancer Surgery Should Not Restrict Necessary Hand Surgery Interventions.

Background: The purpose of this study was to evaluate the incidence of lymphedema onset or exacerbation in patients undergoing upper extremity interventions, both nonoperative and operative, after breast cancer surgery.

Methods: The study inclusion criteria were the following: (1) prior history of breast cancer surgery or lymphedema from the cancer; (2) upper extremity intervention, ipsilateral to the breast cancer side; and (3) follow-up of at least 1 month. Patients were evaluated for demographic information, type of breast cancer procedure and hand intervention, number of lymph nodes dissected, preexisting lymphedema, exacerbation of lymphedema, and new-onset lymphedema.

Does a dedicated "Scoliosis Team" and surgical standardization improve outcomes in adolescent idiopathic scoliosis surgery and is it reproducible?

Purpose: The objective of this study was to determine if standardization improves adolescent idiopathic scoliosis (AIS) surgery outcomes and whether it is transferrable between institutions.

Methods: A retrospective review was conducted of AIS patients operated between 2009 and 2021 at two institutions (IA and IB). Each institution consisted of a non-standardized (NST) and standardized group (ST).

Single Long-Incision Minimally Invasive Surgery.

Study Design: Retrospective cohort study.

Objective: The objective of this study is to determine differences in outcomes in patients with adolescent idiopathic scoliosis undergoing spinal deformity correction surgery using a posterior spinal fusion (PSF) approach versus single and triple-incision minimally invasive surgery (MIS).

Summary Of Background Data: MIS increased in popularity as surgeons' focus moved towards soft tissue preservation, but it carries technical demands and increased surgical time compared with PSF.

Exposure to Extended Reality and Artificial Intelligence-Based Manifestations: A Primer on the Future of Hip and Knee Arthroplasty.

Background: Software-infused services, from robot-assisted and wearable technologies to artificial intelligence (AI)-laden analytics, continue to augment clinical orthopaedics - namely hip and knee arthroplasty. Extended reality (XR) tools, which encompass augmented reality, virtual reality, and mixed reality technology, represent a new frontier for expanding surgical horizons to maximize technical education, expertise, and execution. The purpose of this review is to critically detail and evaluate the recent developments surrounding XR in the field of hip and knee arthroplasty and to address potential future applications as they relate to AI.

Effect of Pedicle Screw Size on Surgical Outcomes Following Surgery for 412 Adolescent Idiopathic Scoliosis Patients.

Study Design: Retrospective Review.

Objective: The objective of this study was to determine differences in surgical and post-operative outcomes in AIS patients undergoing spinal deformity correction surgery using standard or large pedicle screw size.

Summary Of Background: Use of pedicle screw fixation in spinal deformity correction surgery is considered safe and effective.

Paraspinal muscle approach for neuromuscular scoliosis: A comparative study evaluating deformity correction and perioperative morbidity in 91 patients with minimum 2-year follow-up.

Purpose: We present the paraspinal approach use for neuromuscular scoliosis with focus on deformity correction, perioperative (≤30 days) morbidity and outcome at a minimal follow-up length of 2 years.

Methods: We prospectively collected data of 61 neuromuscular scoliosis patients operated using a paraspinal (Wiltse) approach between 2013 and 2019. We additionally collected data of 104 control cases, operated using a midline approach between 2005 and 2016.

What is a better value for your time? Anterior cervical discectomy and fusion versus cervical disc arthroplasty.

Introduction: Compared to anterior cervical discectomy and fusion (ACDF), the motion preservation of cervical disc arthroplasty (CDA) provides an attractive alternative with similar short-term results. However, there is a paucity of the economics of performing CDA over ACDF.

Study Design: This was retrospective study.

A Newer Way of Determining LIV in AIS Patients: Rotation of the Touched Vertebrae.

Study Design: A retrospective review.

Objective: The objective of this study was to determine whether fusing to touched vertebra (TV) on prone x-rays (XRs) with minimal rotation (Gd 0/1) allow for shorter fusion with optimal correction.

Summary Of Background: Previous studies have shown risk of "adding on" when TV is not selected as lowest instrumented vertebra (LIV).

The Volume-Cost Relationship: How Does Surgical Volume Affect Cost and Value in AIS Surgery.

Study Design: Retrospective review.

Objective: The objective of this study was to evaluate and compare distribution of hospital and operating room charges and outcomes during posterior spinal fusion for adolescent idiopathic scoliosis (AIS) patients by high-volume (HV) and standard-volume (SV) surgeons at one institution and examine potential cost savings.

Summary Of Background Data: Increased surgical volume has been associated with improved perioperative outcomes after spinal deformity correction.

In Scheuermann's kyphosis, a proximal UIV and postop kyphosis value close to patients' PI decreases the risk of PJK.

Purpose: Prevalence of proximal junctional kyphosis (PJK) in Scheuermann's kyphosis (SK) varies between 24 and 40%. Multiple factors have been implicated, including kyphosis overcorrection, failure to include proximal end vertebra, and implant choice. This study aimed to determine the goal correction parameters based upon patients' pelvic incidence, and UIV to decrease PJK in Scheuermann's kyphosis.

Scoliosis Surgery Normalizes Cardiac Function in Adolescent Idiopathic Scoliosis Patients.

Study Design: Single-center retrospective chart review with minimum 2-year follow up.

Objective: To determine incidence of pulmonary hypertension in adolescent idiopathic scoliosis patients and to determine the effect of scoliosis surgery on pulmonary hypertension.

Summary Of Background Data: Spinal deformity in adolescent idiopathic scoliosis can increase right atrial and ventricular pressures secondary to restrictive lung disease.

Zero Patient-controlled Analgesia is an Achievable Target for Postoperative Rapid Recovery Management of Adolescent Idiopathic Scoliosis Patients.

Study Design: Retrospective review.

Objective: The objective of this study was to report on one institution's use of single bolus micro-dose intrathecal morphine as part of a rapid recovery pathway during posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and its comparison to patients whose pain was controlled with patient-controlled analgesia (PCA).

Summary Of Background Data: Narcotic substance addiction has risen across all patient populations, including pediatrics.

Scheuermann Kyphosis Patients Have a Similar Revision and Infection Rate to Adolescent Idiopathic Scoliosis Patients.

Study Design: Multicenter retrospective review.

Objective: This study aims to address major postoperative complications associated with Scheuermann kyphosis (SK) when compared with adolescent idiopathic scoliosis (AIS) in a large population matched by demographic characteristics, levels fused and operative technique.

Summary Of Background Data: Prior studies have found that SK patients are 3.

Effects of Fellowship Training on Pediatric Anterior Cruciate Ligament Reconstruction Techniques and Outcomes.

The purpose of this study is to examine differences in pediatric anterior cruciate ligament reconstruction (ACLR) between surgeons with either pediatric or sports medicine fellowship training. Patients were divided into two groups, those performed by either a pediatric or sports medicine fellowship-trained surgeon. One hundred and forty-one patients were identified: 91 (64.

Impact of Navigation on 30-Day Outcomes for Adult Spinal Deformity Surgery.

Study Design: Retrospective database study.

Objective: Navigation has been increasingly used to treat degenerative disease, with positive radiographic and clinical outcomes and fewer adverse events and reoperations, despite increased operative time. However, short-term analysis on treating adult spinal deformity (ASD) surgery with navigation is limited, particularly using large nationally represented cohorts.

Minimally Invasive Versus Standard Surgery in Idiopathic Scoliosis Patients: A Comparative Study.

Study Design: Retrospective review of prospective case-control study.

Objective: To compare minimally invasive scoliosis surgery (MIS) and posterior spinal fusion (PSF) in a large group of patients.

Summary Of Background Data: MIS, has been shown to have benefits over standard PSF in adolescent idiopathic scoliosis (AIS).

Ambulatory Neuromuscular Scoliosis Patients Have Superior Perioperative Results Than Nonambulatory Neuromuscular Scoliosis Patients and Can Approach Adolescent Idiopathic Scoliosis Outcomes After Posterior Spinal Fusion.

Study Design: Retrospective cohort study.

Objective: This study aims to identify differences in perioperative outcomes between ambulatory patients with neuromuscular scoliosis (ANMS) and adolescent idiopathic scoliosis (AIS) following spinal fusion.

Summary Of Background Data: NMS patients have severe curves with more comorbidities and procedural complexity.

Screw Malposition: Are There Long-term Repercussions to Malposition of Pedicle Screws?

Background/introduction: Pedicle screws have long been part of the continued advancements in spine surgery. Despite the many techniques that have been devised for their safe placement, malposition of screws continues to occur. Studies have evaluated the possible safe limits of screw malposition, and have given some insight on anatomic variation in spinal deformity.