Summer Shabana

Objective: This scoping review evaluated the impact of social determinants of health (SDOH) on health care delivery and access for US children with cerebral palsy (CP). Method: A comprehensive literature search was conducted using Medline, Embase, CINAHL Complete, and Scopus. Studies lacking extractable data or published before 2010 or outside the United States were excluded. Two independent investigators screened abstracts and a third resolved disagreements. Selected manuscripts underwent full-text review and data extraction for thematic and comparative analysis. Descriptive statistics were calculated in Excel. Results: In total, 6482 articles were identified and 146 underwent full-text review. Ultimately, 9 studies were included. The 3 main themes discussed were race (n = 6), economic standing (n = 5), and insurance status (n = 3). Three articles examined multiple themes. Black and multiracial individuals had significantly higher postoperative complication rates and unmet care coordination needs, and lower rates of receiving special services (e.g., physical therapy). Higher economic status was associated with greater health care expenses and service access. Public insurance was associated with insufficient care coordination, decreased special service utilization, and increased rates of readmission and inpatient complications. Conclusion: Included articles demonstrate that race, insurance status, and economic standing are significantly associated with unequal health care access and outcomes for US children with CP. Future efforts should prioritize standardization of reported metrics for SDOH and investigation into systemic inequalities in health care access.

Transforaminal lumbar interbody fusion (TLIF) is a commonly employed surgical technique for managing lumbar degenerative disease and spinal instability. While it offers advantages over posterior lumbar interbody fusion (PLIF), traditional TLIF often involves prolonged recovery and morbidity due to muscle retraction. To improve outcomes, several alternative techniques have emerged, including minimally invasive TLIF (MIS-TLIF), trans-Kambin percutaneous TLIF (PE-TLIF), and transfacet TLIF (TF-TLIF). Each approach presents distinct anatomical and technical advantages, yet no standardized framework exists to guide their selection based on individual patient anatomy. In this study, we review the evolution of TLIF techniques and propose a novel algorithm that integrates patient-specific imaging, anatomical variability, and segmentation data to guide surgical decision-making. By analyzing the surgical corridors, indications, and limitations of each approach, and presenting representative clinical cases, we demonstrate how this algorithm can be applied in practice. For instance, TF-TLIF may be optimal in patients requiring direct decompression without major deformity, while PE-TLIF may be appropriate for those with Kambin’s triangles measuring ≥ 9 mm, allowing for indirect decompression. This tailored framework aims to optimize outcomes and reduce complications. Further prospective validation and incorporation of AI-driven segmentation tools are needed to support broader clinical implementation.