Nancy Shrestha

Systematic review and meta-analysis. To perform a comprehensive meta-analysis comparing clinical outcomes of uniportal versus biportal endoscopic spine surgery across decompression procedures in patients with lumbar degenerative disease (LDD). Uniportal endoscopic spine surgery has been a widely adopted minimally invasive technique, whereas biportal endoscopy has recently emerged as a promising alternative with potential advantages in surgical outcomes. A systematic review and meta-analysis of comparative studies was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, Embase, and Scopus databases were searched to identify relevant studies. Eleven studies encompassing 374 uniportal and 368 biportal patients were included. Outcomes analyzed were Oswestry Disability Index (ODI), Visual Analog Scale (VAS) scores for back and leg pain, complication rates, operative time, and length of hospital stay. Biportal endoscopic surgery was associated with a significantly lower ODI at 1-3 months and at final follow-up compared with uniportal surgery. However, uniportal discectomy demonstrated significantly shorter operative time and length of hospital stay than biportal discectomy. No significant differences were observed between approaches in terms of VAS scores, complication rates, or ODI at other time points. Both uniportal and biportal endoscopic spine surgeries yield comparable postoperative outcomes in LDD. Although biportal surgery showed a modest advantage in ODI improvement, it did not reach the minimal clinically important difference. Uniportal surgery demonstrated greater efficiency in terms of operative time and recovery, particularly for discectomy procedures.

Study Design: Narrative Review. Objectives: Endoscopic spine surgery is becoming an increasingly popular approach to treat spinal disease due to its minimally invasive nature. Although certain adverse events are well-reported within the literature, there is a scarcity of information for complications that are rare but still potentially serious. The purpose of this study is to describe these rare complications of endoscopic spine surgery and discuss management and prevention strategies. Methods: A search was conducted in PubMed and Embase to review the literature for all adverse events following endoscopic spine surgery, with no restrictions on publication year. Cohort and case report studies describing infrequently reported complications were collected for analysis. Results: A total of 38 studies were included which described rare complications in 93 patients following endoscopic spine surgery. These included neurological events (seizure, pseudomeningocele, pneumocephalus, upper limb palsy), vascular events (hemorrhage, hematoma, arteriovenous fistula), mechanical events (cage migration, guidewire breakage), and additional events (discal pseudocyst, pulmonary edema, arrhythmia, total spinal anesthesia). Conclusions: Endoscopic spine surgery is rapidly evolving and emerging as a popular alternative to conventional approaches. Though regarded as a generally safe form of surgery, it is imperative that surgeons are aware of all complications which may occur, even those that may be infrequently reported in the literature.

Objective: Large language models, such as chat generative pre-trained transformer (ChatGPT), have great potential for streamlining medical processes and assisting physicians in clinical decision-making. This study aimed to assess the potential of ChatGPT’s 2 models (GPT-3.5 and GPT-4.0) to support clinical decision-making by comparing its responses for antibiotic prophylaxis in spine surgery to accepted clinical guidelines.Methods: ChatGPT models were prompted with questions from the North American Spine Society (NASS) Evidence-based Clinical Guidelines for Multidisciplinary Spine Care for Antibiotic Prophylaxis in Spine Surgery (2013). Its responses were then compared and assessed for accuracy.Results: Of the 16 NASS guideline questions concerning antibiotic prophylaxis, 10 responses (62.5%) were accurate in ChatGPT’s GPT-3.5 model and 13 (81%) were accurate in GPT-4.0. Twenty-five percent of GPT-3.5 answers were deemed as overly confident while 62.5% of GPT-4.0 answers directly used the NASS guideline as evidence for its response.Conclusion: ChatGPT demonstrated an impressive ability to accurately answer clinical questions. GPT-3.5 model’s performance was limited by its tendency to give overly confident responses and its inability to identify the most significant elements in its responses. GPT-4.0 model’s responses had higher accuracy and cited the NASS guideline as direct evidence many times. While GPT-4.0 is still far from perfect, it has shown an exceptional ability to extract the most relevant research available compared to GPT-3.5. Thus, while ChatGPT has shown far-reaching potential, scrutiny should still be exercised regarding its clinical use at this time.