Sapan Patel

Background/Objectives: Poor bone quality compromises pedicle screw fixation, and cement augmentation of fenestrated screws improves fixation at the screw–bone interface. Whether low interface-failure rates translate into low all-cause reoperation rates in routine practice is not established. We characterized the institutional use of cement-augmented fenestrated pedicle screws, the retrospectively measured vertebral computed tomography (CT) attenuation of selected patients, and subsequent interface failure and reoperation. Methods: We reviewed all patients undergoing thoracolumbar pedicle screw fixation between January 2016 and June 2022 at one tertiary referral center. Vertebral attenuation was measured retrospectively in Hounsfield units (HU) at L1 through L4. Outcome proportions are reported with Wilson 95% confidence intervals. Comparisons across surgical indications used exact tests with Holm correction and were treated as exploratory. Cement leakage and other cement-specific safety events could not be ascertained and were not study outcomes. Results: Cement augmentation was used in 101 of 2285 screened patients (4.4%), and 68 met the criteria for the outcome cohort (median follow-up, 44.9 weeks). Median attenuation was 94 HU, and 35 of 53 measurable patients (66.0%) fell below 110 HU, whereas formal densitometry was documented in 3. Screw loosening and pullout each occurred in three patients (4.4%), and reoperation for any cause occurred in nine (13.2%). Reoperation was more frequent among deformity constructs (30.4%) than for trauma (6.1%) or oncologic disease (0%); omnibus exact p = 0.016, although this result did not remain significant after Holm correction (adjusted p = 0.10). Conclusions: Cement augmentation was applied selectively, and retrospective CT measurements identified low vertebral attenuation in most measurable patients, despite infrequent formal densitometry. Failure at the screw–bone interface was infrequent, whereas all-cause reoperation remained clinically relevant and varied by surgical context. This study describes the selection and outcomes after augmentation but cannot establish comparative effectiveness or the safety of the augmentation technique.

Study Design: Retrospective cohort study.Purpose: To compare three cervical sarcopenia metrics and frailty as preoperative predictors of unfavorable postoperative outcomes following surgical fixation of odontoid fractures.Overview of Literature: Sarcopenia is increasingly recognized as an indicator of physiologic vulnerability in spine surgery and thoracolumbar trauma. However, its prognostic significance in odontoid fractures remains unclear, and no previous study has directly compared cervical sarcopenia measurement sites in this population.Methods: Adult patients who underwent surgical fixation of traumatic odontoid fractures at a single level I trauma center were retrospectively reviewed. Sarcopenia was quantified on perioperative computed tomography using sternocleidomastoid, prevertebral, and paraspinal cross-sectional area normalized to the C3 vertebral body area. Frailty was assessed using the 5-factor modified frailty index (mFI-5), with hypertension status confirmed through a review of prescribed medications. Associations with postoperative outcomes were evaluated using threshold-based analyses, intercorrelation testing, subgroup analysis of combined low-sarcopenia/high-frailty patients, and an exploratory Combined Sarcopenia-Frailty Score.Results: This study included 61 patients (mean age, 61.7 years; 50.8% female). The three sarcopenia metrics were only modestly intercorrelated (Spearman rho, 0.34–0.47), with 46.7%–53.3% overlap among patients in the most sarcopenic quartiles. No individual sarcopenia or mFI-5 threshold independently predicted postoperative outcomes. However, patients in the most sarcopenic quartile on any cervical metric with an mFI-5 ≥2 (n=11) experienced higher rates of mortality, urinary tract infection, pneumonia, and nonunion. In exploratory receiver operating characteristic analysis, the Combined Sarcopenia-Frailty Score exhibited moderate discrimination for significant adverse events, with an area under the curve of 0.73 and an optimal threshold of ≥9.Conclusions: Cervical sarcopenia and frailty were not independently associated with adverse outcomes following odontoid fracture fixation. However, their combination identified patients at substantially higher risk for mortality, complications, and nonunion, supporting a potential role for combined preoperative risk stratification (Level of Evidence: level III).

Background/Objectives: Lumbar fusion for degenerative pathology is increasingly common, yet revision surgery, often due to adjacent segment disease, remains a major concern. While sagittal alignment has been widely studied, the role of preoperative lumbar retrolisthesis is less clear. This study evaluated the prevalence, distribution, and clinical significance of preoperative retrolisthesis in patients undergoing single-level L4–L5 fusion, with a focus on its association with revision surgery. Materials and Methods: A retrospective cohort study of 116 adult patients undergoing single-level L4–L5 posterior fusion with multilevel decompression from 2018 to 2022 was performed. Retrolisthesis was defined as posterior translation ≥ 2 mm and assessed across lumbar levels. Patients were stratified by revision status. Statistical comparisons and Cox proportional hazards models were used to evaluate associations between retrolisthesis burden, radiographic parameters, and revision risk. Results: Preoperative retrolisthesis was present in 78.4% of patients, most commonly at L3–L4 and L2–L3, and frequently involved multiple levels. Presence of retrolisthesis alone was not associated with revision (85.7% vs. 77.5%, p = 0.73). However, patients with ≥3 retrolisthesis levels demonstrated reduced revision-free survival, with a higher hazard of revision on univariate analysis (HR 3.65, p = 0.055). In multivariate analysis, ≥3 levels (HR 5.50, p = 0.018) and greater absolute L4–S1 lordosis change (HR 1.09 per degree, p = 0.031) were independent predictors of revision. Conclusions: Retrolisthesis is highly prevalent in patients undergoing L4–L5 fusion but is not predictive of revision when considered alone. A greater multilevel retrolisthesis burden, particularly when combined with larger segmental lordosis change, may represent a mechanically vulnerable spine phenotype associated with increased revision risk. These findings should be interpreted as exploratory and require validation in larger cohorts.

Background/Objectives: Postoperative cervical spine radiographs are routinely obtained during in-hospital and follow-up period. We aim to evaluate the utility of postoperative radiographs for identifying instrumentation failure and the subsequent need for revision surgery in patients with traumatic cervical spine injuries. Materials and Methods: A retrospective chart review of patients who had surgical treatment for traumatic cervical spine injury was conducted. Clinical notes and radiographic reports were evaluated. Postoperative radiographs were obtained prior to discharge from the hospital, and subsequently at 2, 6, 12, 24 weeks, and 1 year. Patients who underwent revision surgery, described as any reoperation, were identified. The patients’ indications for surgery were evaluated. The results of postoperative radiographs that prompted a change in management and reoperation were analyzed. Sensitivity and specificity for postoperative radiographs were calculated. Results: A total of 295 patients were reviewed. The rate of revision surgery was 3.7% (n = 11). All 11 patients presented changes in clinical findings and physical exam, but only 3 patients (1%) were identified to have undergone revision surgery due to instrumentation failure seen on radiographs at 13, 89, and 112 days postoperatively, and none within the inpatient period. Two patients underwent revision surgery due to epidural hematoma, and six patients due to wound infection. The overall sensitivity and specificity of routine postoperative radiographs were 27% and 100%, respectively. Conclusions: Postoperative radiographs after cervical spine trauma have low clinical utility for predicting instrumentation failure in the absence of clinical findings, particularly in the inpatient period.

Study Design: Randomized controlled survey study. Purpose: Evaluate the level of similarity between AI-generated and fellowship-trained spine surgeon-written operative reports. Overview of Literature: Large language models (LLMs) are a subset of generative artificial intelligence (AI) designed to produce human-like text. LLMs have demonstrated an ability to generate contextually accurate, detailed, and coherent writing across various domains. Their potential to enhance healthcare efficiency, particularly in streamlining medical documentation such as operative notes, is of growing interest. Methods: Operative reports for two common spine surgeries—anterior cervical discectomy and fusion (ACDF) and lumbar microdiscectomy were generated using ChatGPT-3 (OpenAI). A fellowship-trained spine surgeon wrote corresponding operative reports. These reports were randomized and presented to attending surgeons, fellows, and residents in orthopedic or neurosurgery, who were asked to identify whether each report was written by AI. Results: Fifty-two respondents completed the survey. For ACDF, 69.2% correctly identified AI-generated reports ( P =0.050); for lumbar microdiscectomy, 61.5% were correct ( P =0.239). In side-by-side comparisons, correct identification improved to 79.2% for ACDF ( P =0.004) and 60% for microdiscectomy ( P =0.317). Accuracy increased with training level, from 55.6% among residents to 100% among attending spine surgeons. Most participants reported that AI-generated reports had human-like language (86.3%), adequate detail (68.6%), essential procedural steps (78.4%), and accurate descriptions (68.6%). Notably, 87.5% expressed interest in incorporating AI into future operative documentation. Conclusions: Differentiation of AI-generated operative reports improves with training level. These reports share many characteristics with surgeon-written notes and are viewed favorably, suggesting a future role for AI in surgical documentation. Level of Evidence: II