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Yahanda AT, Joseph K, Bui T, Greenberg JK, Ray WZ, Ogunlade JI, Hafez D, Pallotta NA, Neuman BJ, Molina CA. Current Applications and Future Implications of Artificial Intelligence in Spine Surgery and Research: A Narrative Review and Commentary. Global Spine J 2024:21925682241290752. [PMID: 39359113 PMCID: PMC11559723 DOI: 10.1177/21925682241290752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES Artificial intelligence (AI) is being increasingly applied to the domain of spine surgery. We present a review of AI in spine surgery, including its use across all stages of the perioperative process and applications for research. We also provide commentary regarding future ethical considerations of AI use and how it may affect surgeon-industry relations. METHODS We conducted a comprehensive literature review of peer-reviewed articles that examined applications of AI during the pre-, intra-, or postoperative spine surgery process. We also discussed the relationship among AI, spine industry partners, and surgeons. RESULTS Preoperatively, AI has been mainly applied to image analysis, patient diagnosis and stratification, decision-making. Intraoperatively, AI has been used to aid image guidance and navigation. Postoperatively, AI has been used for outcomes prediction and analysis. AI can enable curation and analysis of huge datasets that can enhance research efforts. Large amounts of data are being accrued by industry sources for use by their AI platforms, though the inner workings of these datasets or algorithms are not well known. CONCLUSIONS AI has found numerous uses in the pre-, intra-, or postoperative spine surgery process, and the applications of AI continue to grow. The clinical applications and benefits of AI will continue to be more fully realized, but so will certain ethical considerations. Making industry-sponsored databases open source, or at least somehow available to the public, will help alleviate potential biases and obscurities between surgeons and industry and will benefit patient care.
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Affiliation(s)
- Alexander T. Yahanda
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Karan Joseph
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Tim Bui
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jacob K. Greenberg
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - John I. Ogunlade
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Daniel Hafez
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Nicholas A. Pallotta
- Department of Orthopedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Brian J. Neuman
- Department of Orthopedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Camilo A. Molina
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Lafage R, Sheehan C, Smith JS, Daniels A, Diebo B, Ames C, Bess S, Eastlack R, Gupta M, Hostin R, Kim HJ, Klineberg E, Mundis G, Hamilton K, Shaffrey C, Schwab F, Lafage V, Burton D. Incremental Increase in Hospital Length of Stay Due to Complications of Surgery for Adult Spinal Deformity. Global Spine J 2024:21925682241283724. [PMID: 39235925 PMCID: PMC11571788 DOI: 10.1177/21925682241283724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES Length of Stay (LOS) and resource utilization are of primary importance for hospital administration. This study aimed to understand the incremental effect of having a specific complication on LOS among ASD patients. METHODS A retrospective examination of prospective multicenter data utilized patients without a complication prior to discharge to develop a patient-adjusted and surgery-adjusted predictive model of LOS among ASD patients. The model was later applied to patients with at least 1 complication prior to discharge to investigate incremental effect of each identified complication on LOS vs the expected LOS. RESULTS 571/1494 (38.2%) patients experienced at least 1 complication before discharge with a median LOS of 7 [IQR 5 to 9]. Univariate analysis demonstrated that LOS was significantly affected by patients' demographics (age, CCI, sex, disability, deformity) and surgical strategy (invasiveness, fusion length, posterior MIS fusion, direct decompression, osteotomy severity, IBF use, EBL, ASA, ICU stay, day between stages, Date of Sx). Using patients with at least 1 complication prior discharge and compared to the patient-and-surgery adjusted prediction, having a minor complication increased the expected LOS by 0.9 day(s), a major complication by 3.9 days, and a major complication with reoperation by 6.3 days. CONCLUSION Complications following surgery for ASD correction have different, but predictable impact on LOS. Some complications requiring minimal intervention are associated with significant and substantial increases in LOS, while complications with significant impact on patient quality of life may have no influence on LOS.
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Affiliation(s)
- Renaud Lafage
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Connor Sheehan
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Justin S. Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Alan Daniels
- Department of Orthopedic Surgery, Brown University, Providence, RI, USA
| | - Bassel Diebo
- Department of Orthopedic Surgery, Brown University, Providence, RI, USA
| | - Christopher Ames
- Department of Neurosurgery, University of California School of Medicine, San Francisco, CA, USA
| | - Shay Bess
- Denver International Spine Center, Presbyterian St. Luke’s/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Robert Eastlack
- Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA, USA
| | - Munish Gupta
- Department of Orthopedic Surgery, Washington University, St Louis, MO, USA
| | - Richard Hostin
- Southwest Scoliosis and Spine Institute, Dallas, TX, USA
| | - Han Jo Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Eric Klineberg
- Department of Orthopedic Surgery, UTHealth, Hoston, TX, USA
| | - Gregory Mundis
- Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA, USA
| | - Kojo Hamilton
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Frank Schwab
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Douglas Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - On behalf of the International Spine Study Group (ISSG)
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
- Department of Orthopedic Surgery, Brown University, Providence, RI, USA
- Department of Neurosurgery, University of California School of Medicine, San Francisco, CA, USA
- Denver International Spine Center, Presbyterian St. Luke’s/Rocky Mountain Hospital for Children, Denver, CO, USA
- Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA, USA
- Department of Orthopedic Surgery, Washington University, St Louis, MO, USA
- Southwest Scoliosis and Spine Institute, Dallas, TX, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, UTHealth, Hoston, TX, USA
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
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Ton A, Wishart D, Ball JR, Shah I, Murakami K, Ordon MP, Alluri RK, Hah R, Safaee MM. The Evolution of Risk Assessment in Spine Surgery: A Narrative Review. World Neurosurg 2024; 188:1-14. [PMID: 38677646 DOI: 10.1016/j.wneu.2024.04.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Risk assessment is critically important in elective and high-risk interventions, particularly spine surgery. This narrative review describes the evolution of risk assessment from the earliest instruments focused on general surgical risk stratification, to more accurate and spine-specific risk calculators that quantified risk, to the current era of big data. METHODS The PubMed and SCOPUS databases were queried on October 11, 2023 using search terms to identify risk assessment tools (RATs) in spine surgery. A total of 108 manuscripts were included after screening with full-text review using the following inclusion criteria: 1) study population of adult spine surgical patients, 2) studies describing validation and subsequent performance of preoperative RATs, and 3) studies published in English. RESULTS Early RATs provided stratified patients into broad categories and allowed for improved communication between physicians. Subsequent risk calculators attempted to quantify risk by estimating general outcomes such as mortality, but then evolved to estimate spine-specific surgical complications. The integration of novel concepts such as invasiveness, frailty, genetic biomarkers, and sarcopenia led to the development of more sophisticated predictive models that estimate the risk of spine-specific complications and long-term outcomes. CONCLUSIONS RATs have undergone a transformative shift from generalized risk stratification to quantitative predictive models. The next generation of tools will likely involve integration of radiographic and genetic biomarkers, machine learning, and artificial intelligence to improve the accuracy of these models and better inform patients, surgeons, and payers.
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Affiliation(s)
- Andy Ton
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Danielle Wishart
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jacob R Ball
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ishan Shah
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kiley Murakami
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Matthew P Ordon
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - R Kiran Alluri
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Raymond Hah
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael M Safaee
- Department of Neurological Surgery, Keck School of MedicineUniversity of Southern California, Los Angeles, California, USA.
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Han IH. Commentary on "Development and Validation of an Online Calculator to Predict Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery Using Machine Learning". Neurospine 2023; 20:1281-1283. [PMID: 38171295 PMCID: PMC10762415 DOI: 10.14245/ns.2347302.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- In Ho Han
- Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Snowdon E, Biswas S, Almansoor ZR, Aizan LNB, Chai XT, Reghunathan SM, MacArthur J, Tetlow CJ, Sarkar V, George KJ. Temporal trends in neurosurgical volume and length of stay in a public healthcare system: A decade in review with a focus on the COVID-19 pandemic. Surg Neurol Int 2023; 14:407. [PMID: 38053709 PMCID: PMC10695347 DOI: 10.25259/sni_787_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023] Open
Abstract
Background Over the past decade, neurosurgical interventions have experienced changes in operative frequency and postoperative length of stay (LOS), with the recent COVID-19 pandemic significantly impacting these metrics. Evaluating these trends in a tertiary National Health Service center provides insights into the impact of surgical practices and health policy on LOS and is essential for optimizing healthcare management decisions. Methods This was a single tertiary center retrospective case series analysis of neurosurgical procedures from 2012 to 2022. Factors including procedure type, admission urgency, and LOS were extracted from a prospectively maintained database. Six subspecialties were analyzed: Spine, Neuro-oncology, Skull base (SB), Functional, Cerebrospinal fluid (CSF), and Peripheral nerve (PN). Mann-Kendall temporal trend test and exploratory data analysis were performed. Results 19,237 elective and day case operations were analyzed. Of the 6 sub-specialties, spine, neuro-oncology, SB, and CSF procedures all showed a significant trend toward decreasing frequency. A shift toward day case over elective procedures was evident, especially in spine (P < 0.001), SB (tau = 0.733, P = 0.0042), functional (tau = 0.156, P = 0.0016), and PN surgeries (P < 0.005). Over the last decade, decreasing LOS was observed for neuro-oncology (tau = -0.648, P = 0.0077), SB (tau = -0.382, P = 0.012), and functional operations, a trend which remained consistent during the COVID-19 pandemic (P = 0.01). Spine remained constant across the decade while PN demonstrated a trend toward increasing LOS. Conclusion Most subspecialties demonstrate a decreasing LOS coupled with a shift toward day case procedures, potentially attributable to improvements in surgical techniques, less invasive approaches, and increased pressure on beds. Setting up extra dedicated day case theaters could help deal with the backlog of procedures, particularly with regard to the impact of COVID-19.
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Affiliation(s)
- Ella Snowdon
- Department of Neurosurgery, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sayan Biswas
- Department of Neurosurgery, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Zahra R. Almansoor
- Department of Neurosurgery, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Luqman Naim Bin Aizan
- Department of Colorectal Surgery, Warrington and Halton Foundation Trust, Warrington, United Kingdom
| | - Xin Tian Chai
- Department of Neurosurgery, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sharan Manikanda Reghunathan
- Department of Neurosurgery, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Joshua MacArthur
- Department of Neurosurgery, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Callum James Tetlow
- Department of Data Science, National Health Service (NHS) Northern Care Alliance, Manchester, United Kingdom
| | - Ved Sarkar
- Department of Data Science, College of Letters and Sciences, University of California, Berkeley, United Kingdom
| | - K. Joshi George
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Salford, United Kingdom
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