Natural language processing (NLP) is a discipline of machine learning concerned with the analysis of language and text. Although NLP has been applied to various forms of clinical text, the ...applications and utility of NLP in spine surgery remain poorly characterized. Here, we systematically reviewed studies that use NLP for spine surgery applications, and analyzed applications, bias, and reporting transparency of the studies.
We performed a literature search using the PubMed, Scopus, and Embase databases. Data extraction was performed after appropriate screening. The risk of bias and reporting quality were assessed using the PROBAST and TRIPOD tools.
A total of 12 full-text articles were included. The most common diseases represented include spondylolisthesis (25%), scoliosis (17%), and lumbar disk herniation (17%). The most common procedures included spinal fusion (42%), imaging (e.g. magnetic resonance, X-ray) (25%), and scoliosis correction (17%). Reported outcomes were diverse and included incidental durotomy, venous thromboembolism, and the tone of social media posts regarding scoliosis surgery. Common sources of bias identified included the use of older methods that do not capture the nuance of a text, and not using a prespecified or standard outcome measure when evaluating NLP methods.
Although the application of NLP to spine surgery is expanding, current studies face limitations and none are indicated as ready for clinical use. Thus, for future studies we recommend an emphasis on transparent reporting and collaboration with NLP experts to incorporate the latest developments to improve models and contribute to further innovation.
Introduction/Aims
There is a dearth of knowledge regarding the status of infralesional lower motor neurons (LMNs) in individuals with traumatic cervical spinal cord injury (SCI), yet there is a ...growing need to understand how the spinal lesion impacts LMNs caudal to the lesion epicenter, especially in the context of nerve transfer surgery to restore several key upper limb functions. Our objective was to determine the frequency of pathological spontaneous activity (PSA) at, and below, the level of spinal injury, to gain an understanding of LMN health below the spinal lesion.
Methods
Ninety‐one limbs in 57 individuals (53 males, mean age = 44.4 ± 16.9 years, mean duration from injury = 3.4 ± 1.4 months, 32 with motor complete injuries), were analyzed. Analysis was stratified by injury level as (1) C4 and above, (2) C5, and (3) C6‐7. Needle electromyography was performed on representative muscles innervated by the C5‐6, C6‐7, C7‐8, and C8‐T1 nerve roots. PSA was dichotomized as present or absent. Data were pooled for the most caudal infralesional segment (C8‐T1).
Results
A high frequency of PSA was seen in all infralesional segments. The pooled frequency of PSA for all injury levels at C8‐T1 was 68.7% of the limbs tested. There was also evidence of PSA at the rostral border of the neurological level of injury, with 58.3% of C5‐6 muscles in those with C5‐level injuries.
Discussion
These data support a high prevalence of infralesional LMN abnormalities following SCI, which has implications to nerve transfer candidacy, timing of the intervention, and donor nerve options.
We diagnosed 66 peripheral nerve injuries in 34 patients who survived severe coronavirus disease 2019 (COVID-19). We combine this new data with published case series re-analyzed here (117 nerve ...injuries; 58 patients) to provide a comprehensive accounting of lesion sites. The most common are ulnar (25.1%), common fibular (15.8%), sciatic (13.1%), median (9.8%), brachial plexus (8.7%) and radial (8.2%) nerves at sites known to be vulnerable to mechanical loading. Protection of peripheral nerves should be prioritized in the care of COVID-19 patients. To this end, we report proof of concept data of the feasibility for a wearable, wireless pressure sensor to provide real time monitoring in the intensive care unit setting.
Osteoporosis is a well-known risk factor for instrumentation failure and subsequent pseudoarthrosis after spinal fusion. In the present systematic review, we analyzed the biomechanical properties, ...clinical efficacy, and complications of cement augmentation via fenestrated pedicle screws in spinal fusion.
We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Reports appearing in the PubMed database up to March 31, 2020 were queried using the key words “cement,” “pedicle screw,” and “osteoporosis.” We excluded non-English language studies, studies reported before 2000, studies that had involved use of cement without fenestrated pedicle screws, nonhuman studies, technical reports, and individual case reports.
Twenty-five studies met the inclusion criteria. Eleven studies had tested the biomechanics of cement-augmented fenestrated pedicle screws. The magnitude of improvement achieved by cement augmentation of pedicle screws increased with the degree of osteoporosis. The cement-augmented fenestrated pedicle screw was superior biomechanically to the alternative “solid-fill” technique. Fourteen studies had evaluated complications. Cement extravasation with fenestrated screw usage was highly variable, ranging from 0% to 79.7%. However, cement extravasation was largely asymptomatic. Thirteen studies had assessed the outcomes. The use of cement-augmented fenestrated pedicles decreased screw pull out and improved fusion rates; however, the clinical outcomes were similar to those with traditional pedicle screw placement.
The use of cement-augmented fenestrated pedicle screws can be an effective strategy for achieving improved pedicle screw fixation in patients with osteoporosis. A potential risk is cement extravasation; however, this complication will typically be asymptomatic. Larger comparative studies are needed to better delineate the clinical efficacy.
•Endoscopic endonasal skull base surgery (EESBS) provides minimally invasive corridors to intracranial lesions.•The use of antibiotic prophylaxis for patients undergoing EESBS is quite variable.•Our ...antibiotic prophylaxis protocol led to low rates of postoperative meningitis.•Dural reconstruction has added to low rates of CSF leaks and infection.•Possible changes to our protocol would be to decrease the duration of prophylaxis.
Endoscopic endonasal approaches to the skull base provide minimally invasive corridors to intracranial lesions; however, enthusiasm for this new approach is always tempered by the recognition that this route requires passage through a nonsterile sinonasal corridor. Despite an increasing number of patients undergoing these surgeries, there remains no consensus on the use of perioperative antibiotics. A retrospective review of consecutive patients undergoing endoscopic endonasal skull base surgery (EESBS) at Loyola University Medical Center by the same neurosurgeon and otolaryngologist team between February 2015 and October 2016 was performed. Antibiotic regimens, presence of an intraoperative or postoperative cerebrospinal fluid (CSF) leak, dural reconstruction method, and rates of sinusitis, meningitis, and/or intracranial abscess were analyzed. 39 patients who underwent a total of 41 EESBSs with a mean age of 46 years were identified. A vascularized nasoseptal flap was used for dural reconstruction when high flow CSF leaks were encountered intraoperatively (n = 17); otherwise, reconstruction mostly consisted of allografts and/or free mucosal grafts. There were zero postoperative cases of CSF leaks, meningitis, or intracranial infection. Our current antibiotic prophylaxis protocol coupled with the use of variable dural reconstruction techniques dictated by intraoperative findings has led to low rates of postoperative CSF leaks, intracranial infections, and meningitis. A survey was also distributed to Neurological Surgery Residency Programs to gain a better understanding of the EESBS protocols that are being used nationally. The practice of antibiotic prophylaxis for patients undergoing EESBS is quite variable and this study should provide the impetus for multi-institutional comparison studies.
Entrapment neuropathies, typically carpal tunnel syndrome and ulnar neuropathy, frequently occur in patients with spinal cord injury (SCI). Upper limb impairments due to entrapment neuropathy can be ...particularly debilitating in this population. Anterior interosseous nerve (AIN) neuropathy has not been previously described in the SCI population.
A 27-year-old left-handed man with a history of C7 ASIA Impairment Scale B spinal cord injury five years prior presented to clinic with decreased left thumb function as well as thumb flexion. Workup including nerve conduction studies, electromyogram, ultrasonographic assessment, and magnetic resonance neurography was consistent with compressive AIN neuropathy. Surgical exploration and neurolysis was performed, with improvement of symptoms.
Entrapment neuropathies should be carefully considered in the evaluation of patients with SCI with new motor deficits. We report a case of AIN neuropathy in a patient with SCI successfully treated with surgical decompression, and review the literature describing upper extremity entrapment neuropathies in this population. Surgical decompression is an effective option for treatment of AIN neuropathy in the setting of SCI, though further characterization of the optimal management strategy is needed.
•Prone transpsoas is a novel approach to perform lateral lumbar interbody fusion.•Prone transpsoas simultaneously uses a posterior and a lateral transpsoas approach.•The prone transpsoas (PTP) ...position may facilitate lateral corpectomy.•Initial reports do not suggest inferiority of PTP compared to other approaches.•We performed a prone lateral corpectomy and simultaneous posterior osteotomies.
Prone transpsoas (PTP) is a novel approach for performing lateral lumbar interbody fusion in a single position. This approach may be beneficial for difficult clinical scenarios. In particular, the PTP position may facilitate lateral corpectomy for certain lumbar pathologies where a circumferential approach is necessary.
A 23-year-old woman presented to the ED with wound breakdown four months after a T10-L2 posterior spinal fusion (PSF) was performed following a motor vehicle accident. Imaging studies revealed distal hardware failure and compromise of her distal vertebral body. A lateral corpectomy and interbody fusion was performed.
We report a case of lateral lumbar corpectomy via a novel PTP approach for a patient with a significant amount of kyphosis, wound breakdown, and hardware failure. We include a review of the current literature on prone transpsoas lateral lumbar interbody fusion. Initial reports do not suggest inferiority compared to other approaches. However, given its novelty, further investigation is needed.
Dystonia is a movement disorder characterized by involuntary muscle contractions, which cause twisting movements or abnormal postures. Deep brain stimulation has been used to improve the quality of ...life for secondary dystonia caused by cerebral palsy. Despite being a viable treatment option for childhood dystonic cerebral palsy, deep brain stimulation is associated with a high rate of infection in children. The authors present a small series of patients with dystonic cerebral palsy who underwent a stepwise approach for bilateral globus pallidus interna deep brain stimulation placement in order to decrease the rate of infection. Four children with dystonic cerebral palsy who underwent a total of 13 surgical procedures (electrode and battery placement) were identified via a retrospective review. There were zero postoperative infections. Using a multistaged surgical plan for pediatric patients with dystonic cerebral palsy undergoing deep brain stimulation may help to reduce the risk of infection.
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