Rodrigo Muscogliati

Study Design: Retrospective concordance analysis. Objective: To evaluate the concordance between ChatGPT-4 and a spinal multidisciplinary team (MDT) in management decisions for metastatic spinal disease and to explore the potential role of large language models (LLMs) as decision-support tools in oncologic spine care. Summary of Background Data: Management of metastatic spinal disease requires multidisciplinary input balancing neurological preservation, mechanical stability, and systemic prognosis. Frameworks such as the Spine Instability Neoplastic Score (SINS) and the NOMS model guide decisions, but variability persists. Artificial intelligence tools like ChatGPT may standardize reasoning, yet their concordance with expert MDTs remains unexplored in this context. Methods: A retrospective analysis was performed on 100 anonymized adult cases referred to a spinal MDT for spinal metastases with suspected instability or metastatic spinal cord compression (MSCC). Ten additional cases were used to calibrate the model input. Each case summary, including demographics, tumor histology, SINS, Karnofsky Performance Scale, and Tokuhashi estimates, was presented identically to ChatGPT-4 (OpenAI, March 2025 snapshot) and the MDT. Management recommendations: surgical versus palliative (noncurative therapy including radiotherapy, systemic treatment, or best supportive care) were compared using Cohen κ, and discordant cases underwent qualitative analysis. Results: ChatGPT and the MDT were concordant in 86% of cases (κ=0.66, P <0.001), indicating substantial agreement. Concordant recommendations included surgery in 26% and palliative care in 60%. Discordance occurred in 14% of cases, typically involving younger patients or rare tumor histologies. ChatGPT emphasized mechanical instability and high SINS scores, whereas the MDT weighted systemic prognosis more heavily. Conclusions: ChatGPT-4 achieved substantial concordance with expert MDT decision-making in metastatic spinal disease. While it aligned well in structurally clear-cut cases, discordance in prognostically complex scenarios underscores the need for prognosis-aware, dynamically validated AI models. These findings support AI as an adjunct—not a replacement—for multidisciplinary clinical workflows.

Objectives To compare clinical outcomes after unipolar versus bipolar sternocleidomastoid (SCM) release for congenital muscular torticollis (CMT), and to describe how patient age, chronicity, and postoperative rehabilitation varied across studies and may have contributed to between study differences. Methods Following PRISMA guidelines, 17 observational studies were included, comprising 382 surgical procedures (unipolar 228; bipolar 154). The primary outcome was achievement of a global good–excellent clinical result using validated composite scoring systems (Lee, Cheng–Tang, Tanabe, or Lee–Kang). Secondary outcomes were recurrence and complications. Comparative quantitative synthesis was restricted to studies reporting both techniques within the same cohort and extractable technique-specific data. For recurrence, comparative quantitative synthesis was feasible in two cohorts. For global good–excellent outcome, head-to-head data were too sparse and confounded for a robust pooled comparison, and evidence remained descriptive. Heterogeneity was assessed using I². Results Only a small number of studies provided extractable head-to-head comparisons. In these cohorts, no statistically significant difference was observed between unipolar and bipolar release in achieving a good–excellent global clinical outcome, and recurrence rates did not differ significantly between techniques, although confidence intervals were wide and events were sparse. Across single-arm cohorts, both techniques were associated with high rates of good–excellent outcomes and low recurrence, with greater variability observed in bipolar cohorts that more frequently included older or neglected cases. Complications were uncommon overall and were predominantly minor; technique-stratified reporting suggested a higher frequency of minor complications following bipolar release. Where reported, cervical alignment and range of motion improved substantially after both procedures, with no consistent radiographic advantage of one technique over the other. Across studies, postoperative rehabilitation intensity and patient chronicity appeared to influence durability of correction at least as much as release extent. Conclusion Within the limits of available observational evidence, unipolar and bipolar SCM release yield comparable global clinical outcomes with low recurrence and complication rates. No consistent comparative advantage of greater release extent was demonstrated. Between-study differences may also reflect variation in patient age, deformity chronicity, and postoperative rehabilitation. Comparative certainty remains limited by small head-to-head cohorts, heterogeneous outcome definitions, and incomplete arm-level reporting.

Purpose: Sexual dysfunction is a recognised but underreported outcome following cauda equina syndrome (CES), with existing evidence fragmented and methodologically heterogeneous. Its true prevalence and clinical significance remain unclear. To systematically evaluate the prevalence, characteristics, and predictors of long-term sexual dysfunction following CES. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Studies reporting sexual function outcomes following CES were identified from database inception to 16 December 2025. Eligible studies included adult patients undergoing surgical decompression for CES with extractable long-term sexual function data. Data were synthesised narratively with exploratory quantitative pooling where appropriate. Results: Five studies were included. Sexual dysfunction was common, with reported prevalence ranging from 48% to 67% and a pooled estimate of 58.4% at long-term follow-up. Dysfunction affected both men and women and extended beyond erectile dysfunction to include impairments in arousal, orgasm, and satisfaction. Studies using validated patient-reported outcome measures generally reported broader and higher burdens of dysfunction than studies relying on descriptive or neurological assessment alone. Limited evidence suggested associations with increasing age, longer duration of pre-operative bladder dysfunction, and markers of sacral nerve root involvement, including bowel dysfunction and perianal sensory loss. Timing of surgery was not consistently associated with long-term sexual outcomes. Baseline sexual function was rarely reported. Conclusions: Sexual dysfunction affects more than half of patients following CES and represents a persistent and under-recognised component of long-term morbidity. Current evidence is limited by heterogeneity and lack of baseline assessment, but suggests that outcomes are driven more by severity of neural compromise than timing alone. Routine assessment using validated patient-reported measures should be incorporated into CES follow-up to better define recovery and guide patient counselling.

Study Design: Systematic Review. Objective: To evaluate neurological outcomes, complication rates, and operative characteristics of the posterior transdural approach for thoracic disc herniation causing myelopathy. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. MEDLINE, Embase, and PubMed were searched from inception to January 2026. Studies including adult patients undergoing posterior transdural decompression for thoracic disc herniation were eligible. Two reviewers independently performed study selection, data extraction, and methodological quality assessment using the Joanna Briggs Institute checklist for case series. Extracted variables included patient demographics, disc characteristics, operative details, neurological outcomes, follow-up duration, and complications. Results: Seven Level IV studies comprising 74 patients were included. The weighted mean age was 52.8 years, and 70.3% of discs were calcified. The posterior transdural corridor was utilized in all cases; however, ventral durotomy was performed in 72 of 74 patients (97.3%), with preservation of the ventral dura reported in selected cases. Across studies reporting extractable outcome data, 76% of patients demonstrated neurological improvement, 21% remained stable, and 1.4% experienced persistent neurological deterioration. Transient postoperative neurological worsening occurred in 9.5% of patients and resolved in nearly all cases. Cerebrospinal fluid leakage occurred in 4.1%, with reoperation required in 2.7%. No mortality was reported. Reported operative time varied across studies, ranging from a mean of 124 min in the prospective cohort to a mean of 241 min in the transpedicular–transdural series, with other studies reporting median values between 152 and 210 min. Conclusion: Posterior transdural decompression for thoracic disc herniation causing myelopathy is associated with favorable neurological outcomes and a low rate of permanent morbidity, even in predominantly calcified or giant disc pathology. In appropriately selected patients, this technique appears to provide effective ventral decompression with an acceptable safety profile.

A recent trend in healthcare education has been the increasing emphasis on the development of humanism and empathy in students. Within anatomy education, some institutions have implemented curricular innovations such as donor non‐anonymization to facilitate this development. This systematic review aims to evaluate the existing literature on donor non‐anonymization, with a particular focus on its potential humanistic and educational impacts on students. A comprehensive search was conducted across eight databases on the 27th of June 2024, yielding 3516 studies after duplicate removal. Following a two‐stage screening process and independent review, 11 studies met inclusion criteria. These were assessed for quality using the Medical Education Research Study Quality Instrument and the Critical Appraisal Skills Programme Qualitative Checklist. Given the qualitative nature of the data, a thematic analysis was conducted, identifying three overarching themes: students' emotional responses, reciprocity to the community and empathy, and the impact of non‐anonymization on learning. Of the included studies, nine were deemed high quality, one medium, and one low quality and were weighed accordingly during analysis. Overall, non‐anonymization was associated with positive outcomes, including greater emotional engagement, enhanced empathy, and deeper motivation to learn. Optional participation in non‐anonymization anatomy programs appeared beneficial for accommodating varied emotional responses among students. However, due to limitations of included studies and potential cultural variability, findings should be interpreted with caution. Further longitudinal research is needed to better understand the long‐term educational and professional impacts of donor non‐anonymization in anatomy education.

Study Design: Case series. Objective: This study aims to analyze the characteristics of spinal and other injuries in survivors of suicide attempts who jump from heights. Summary of Background Data: Suicide attempts by jumping often result in severe injuries, particularly affecting the spine. The severity and pattern of these injuries are strongly influenced by the height of the fall. However, there is a lack of comprehensive studies directly correlating jump height with injury outcomes. Methods: Patient data from 100 survivors of suicide attempts were retrospectively analyzed and categorized into 3 groups based on jump height: Group 1: 3 m or less (n=26). Group 2: 3–6 m (n=36). Group 3: >6 m (n=38). Results: The average number of spinal fractures increased significantly with jump height ( P 6 m). ASIA scores showed a significant association with jump height ( P =0.036). Notably, 0% of group 1 and 14% of group 3 had an ASIA A score. The need for additional surgeries was significantly higher in group 3 ( P =0.018), with 39% of patients undergoing multiple operations, compared with 30% in group 1 and 35% in group 2. TLICS correlated more closely with actual surgical intervention than TL AOSIS, which consistently underestimated operative need. Abdominal injuries were identified only in falls >3 m, highlighting an additional height-dependent risk. Conclusions: Jump height is a key determinant of injury severity, neurological outcomes, and the complexity of medical management in survivors of suicide attempts. Falls from greater heights (>6 m) result in more severe spinal fractures and higher rates of neurological impairment.

Objectives To determine how often adult spinal deformity (ASD) surgery meets preoperative sagittal alignment goals and whether these corrections are durable over time, including the impact of planning frameworks and enabling technologies. Methods We performed a PRISMA-guided search of MEDLINE, EMBASE, Web of Science, Cochrane Library, and Scopus through June 2025. Eligible studies enrolled adults undergoing ASD surgery where preoperative alignment targets were defined by numeric thresholds (e.g., SVA, PI–LL, PT), algorithmic frameworks (e.g., Roussouly, GAP), or technology-assisted modalities (e.g., virtual surgical planning/patient-specific rods/robotics/custom implants). Outcomes included plan-to-achieved alignment fidelity, longitudinal maintenance of targets, mechanical complications, and PROMs. Risk of bias was assessed with ROBINS-I. When data were sufficiently homogeneous, random-effects meta-analyses were performed for commonly reported targets (SVA < 5 cm, PI–LL ≤ 10°, PT ≤ 20°). Results Fifteen unique studies (Fig. 1) from 2006–2025 encompassing ~ 1,980 patients reported outcomes for achieving preoperative alignment goals in ASD. Cohort sizes ranged from 15 to 608; among cohorts reporting demographics, mean age was 65 years (range means 58–72) with 68% female (57–80%). Mean follow-up was 20 months (immediate postoperative to 5 years). Across studies, most patients achieved early postoperative targets for SVA, PI–LL and/or PT, though durability attenuated on longer follow-up in several cohorts. Algorithm-driven planning—particularly restoration to a Roussouly-consistent profile—was associated with lower mechanical complication rates, while technology-assisted approaches (virtual planning/patient-specific rods/custom implants/robotics) generally improved plan-to-achieved fidelity; translation to superior PROMs was inconsistent. Overall study quality varied: several small, single-center series were at higher risk of bias, whereas multicenter prospective cohorts showed lower risk but remained heterogeneous in definitions, targets, and follow-up windows. Prisma chart [17] Conclusions Adult spinal deformity surgery reliably achieves planned sagittal alignment early postoperatively, but long-term durability is variable. Pelvic tilt is the most difficult parameter to correct and maintain, with loss of correction by one to two years. Alignment strategies emphasizing restoration of physiologic sagittal profile, particularly Roussouly-based frameworks, show superior long-term maintenance and fewer mechanical failures than isolated numeric targets. Although patient-reported outcomes improve consistently, enabling technologies enhance alignment fidelity without consistent incremental PROM benefit. Future studies should prioritize profile-driven, patient-specific planning and assess durability and patient-centered outcomes beyond two years in prospective multicenter cohorts.

Background While the primary goal of treating Adolescent Idiopathic Scoliosis (AIS) is curve correction, long-term psychological and sexual outcomes are rarely examined. This systematic review evaluates whether bracing or surgical treatment affects sexual health, body image, and psychological well-being compared to healthy controls. Methods A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and CENTRAL were searched up to November 2024 for studies assessing sexual and psychological outcomes in AIS patients treated with bracing or surgery. Inclusion criteria encompassed observational and interventional studies with validated outcome tools. Risk of bias was assessed using the ROBINS-I tool. Results Nine studies involving 3231 participants were included. Among 1085 AIS patients (average age at treatment 15.6 years; female-to-male ratio 18:1), 498 underwent bracing and 587 underwent surgery. Meta-analyses demonstrated that AIS patients had significantly lower sexual function (FSFI: SMD = 0.54, 95% CI: 0.29–0.80), higher sexual distress (FSDS: SMD = 0.76, 95% CI: 0.21–1.32), and reduced sexual satisfaction (GSSI: SMD = 0.39, 95% CI: 0.10–0.74) compared to controls, with low heterogeneity across outcomes (I² = 0%). Narrative synthesis further revealed higher rates of body image dissatisfaction and reduced self-esteem among AIS patients. Surgically treated individuals showed marginally better sexual satisfaction than braced patients, though differences in psychological and intimacy outcomes were inconsistent. Physical limitations and pain-related sexual dysfunction were noted across both treatment groups. Conclusion AIS treatment may influence long-term sexual and psychological health, particularly among brace-treated patients. While surgical intervention may offer modest benefits, evidence remains limited. These outcomes should be incorporated into AIS follow-up and future research, emphasizing patient-centred care.