Current Trends in Artificial Intelligence-Assisted Spine Surgery: A Systematic Review

This systematic review summarizes existing evidence and outlines the benefits of artificial intelligence-assisted spine surgery. The popularity of artificial intelligence has grown significantly, demonstrating its benefits in computer-assisted surgery and advancements in spinal treatment. This study adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a set of reporting guidelines specifically designed for systematic reviews and meta-analyses. The search strategy used Medical Subject Headings (MeSH) terms, including “MeSH (Artificial intelligence),” “Spine” AND “Spinal” filters, in the last 10 years, and English— from January 1, 2013, to October 31, 2023. In total, 442 articles fulfilled the first screening criteria. A detailed analysis of those articles identified 220 that matched the criteria, of which 11 were considered appropriate for this analysis after applying the complete inclusion and exclusion criteria. In total, 11 studies met the eligibility criteria. Analysis of these studies revealed the types of artificial intelligence-assisted spine surgery. No evidence suggests the superiority of assisted spine surgery with or without artificial intelligence in terms of outcomes. In terms of feasibility, accuracy, safety, and facilitating lower patient radiation exposure compared with standard fluoroscopic guidance, artificial intelligence-assisted spine surgery produced satisfactory and superior outcomes. The incorporation of artificial intelligence with augmented and virtual reality appears promising, with the potential to enhance surgeon proficiency and overall surgical safety.

Artificial neural networks for the detection of odontoid fractures using the Konstanz Information Miner Analytics Platform

Methods@#This study analyzed 432 open-mouth (odontoid) radiographic views of cervical spine X-ray images obtained from dataset repositories, which were used in developing ANN models based on the convolutional neural network theory. All the images contained diagnostic information, including 216 radiographic images of individuals with normal odontoid processes and 216 images of patients with acute odontoid fractures. The model classified each image as either showing an odontoid fracture or not. Specifically, 70% of the images were training datasets used for model training, and 30% were used for testing. KNIME’s graphic user interface-based programming enabled class label annotation, data preprocessing, model training, and performance evaluation. @*Results@#The graphic user interface program by KNIME was used to report all radiographic X-ray imaging features. The ANN model performed 50 epochs of training. The performance indices in detecting odontoid fractures included sensitivity, specificity, F-measure, and prediction error of 100%, 95.4%, 97.77%, and 2.3%, respectively. The model’s accuracy accounted for 97% of the area under the receiver operating characteristic curve for the diagnosis of odontoid fractures. @*Conclusions@#The ANN models with the KNIME Analytics Platform were successfully used in the computer-assisted diagnosis of odontoid fractures using radiographic X-ray images. This approach can help radiologists in the screening, detection, and diagnosis of acute odontoid fractures.

Radiological Characteristics of Low-Grade Lytic Spondylolisthesis: Similarity to Dysplastic Spondylolisthesis

Methods@#Patients admitted and treated for one-level (L4/5 or L5/S1) low-grade spondylolisthesis were included in the study. A total of 135 patients were divided into the degenerative or lytic spondylolisthesis groups according to their condition (81 patients [degenerative group] vs. 54 patients [lytic group]). To assess the level of similarity in the radiological findings between low-grade lytic spondylolisthesis and dysplastic spondylolisthesis, the pedicle diameters and vertebral heights of the L4 and L5 vertebrae were measured on computed tomography images. Measurements were then converted to each vertebra’s ratio to reduce confounding factors among individuals. @*Results@#The affected vertebra had a smaller sagittal pedicle diameter/transverse pedicle diameter ratio in the low-grade lytic spondylolisthesis group compared to the degenerative group, and the posterior vertebral height/anterior vertebral height ratio of L5 was smaller in the L5/S1 lytic spondylolisthesis group compared to the degenerative spondylolisthesis group. @*Conclusions@#Low-grade lytic spondylolisthesis and dysplastic spondylolisthesis demonstrated similar radiological findings. Hence, surgeons should be attentive to the morphology of the vertebral body and posterior column during preoperative planning for the treatment of low-grade lytic spondylolisthesis.

Surgical Treatment of AO/OTA 33-C Intra-Articular Distal Femoral Fractures through Parapatellar Approach

Purpose@#To report the surgical results of the parapatellar approach for AO/OTA 33-C distal femoral intra-articular fractures. @*Materials and Methods@#Twenty-one patients with AO/OTA 33-C distal femoral intra-articular fracture were included. There were 11 cases of C2 and 10 cases of C3 fractures. The time of union and the coronal alignment were radiographically investigated. The complications related to surgery were clinically investigated, and a functional evaluation using the range of motion and Oxford knee score was performed to compare the surgical results according to fracture classification. @*Results@#In all cases, sufficient articular exposure and anatomical reduction were achieved with the parapatellar approach. No cases of coronal malalignment, loss of reduction, and plate failure were noted. On the other hand, in four cases (19.0%), an autogenous bone graft was performed due to delayed union on the meta-diaphyseal fracture site. There were no differences in the radiological and clinical outcomes of the C2 and C3 fractures. The knee joint pain and Oxford knee score were poorer in the delayed union group than the normal union group. @*Conclusion@#The parapatellar approach is useful for achieving an anatomical reduction of the articular surface of the distal femur and minimally invasive plating technique. Although satisfactory surgical results could be obtained regardless of the degree of articular comminution, a study of the risk factors of delayed metaphyseal fusion may be necessary.

Absolute Bed Rest Duration of 3 Days for Osteoporotic Vertebral Fractures: A Retrospective Study

Methods@#This study was conducted in 134 patients with OVFs initially treated conservatively. The patients were split into two groups: 3-day and 7-day ABR. From the time of injury to 1, 4, and 12 weeks after injury, compression rate (CR) and local kyphotic angle (LKA) were assessed and compared between the two groups. Any complications such as pneumonia, deep vein thrombosis, delirium, and urinary tract infection known to be related to ABR were examined based on the electronic medical record. @*Results@#Forty-four patients underwent ABR for 3 days and 90 underwent ABR for 7 days. There was no significant difference in CR and LKA between the two groups at the time of injury versus 1, 4, and 12 weeks after injury. The patients were divided into two groups: those who received a 3-day ABR and those who received a 7-day ABR. CR and LKA were measured and compared between the two groups from the time of damage to 1, 4, and 12 weeks after injury. The ABR-related complication rate was 43.4% in the 7-day ABR group and 22.7% in 3-day ABR group (p=0.02). The duration of hospital stay was significantly shorter in the 3-day ABR group (12.8 days) than in the 7-day group (16 days) (p=0.01). @*Conclusions@#Considering radiological outcomes, prognosis, complications, patient convenience, and economic impact, a 3-day ABR period is appropriate for the conservative treatment of OVFs.

Minimally Invasive Surgery for Hallux Valgus Deformity Using Intramedullary Low Profile Plate Fixation: A Case Report / 대한족부족관절학회지

According to a recent systemic review, hallux valgus deformity has a prevalence rate of about 23% among adults aged 18 to 65 years. To date, more than 100 operative methods have been reported for the correction of hallux valgus deformity. For young female with mild to moderate hallux valgus deformity, minimally invasive surgery can be considered for aesthetic demands. Here, we report a case of a young female patient with mild hallux valgus deformity treated by minimally invasive surgery using intramedullary low profile plate fixation. This can be the favorable method for secure fixation of the osteotomy site and prevention of medial skin irritation symptoms derived from a sharp osteotomy margin.

Arginine metabolism in Trichomonas vaginalis infected with Mycoplasma hominis.

Both Mycoplasma hominis and Trichomonas vaginalis utilize arginine as an energy source via the arginine dihydrolase (ADH) pathway. It has been previously demonstrated that M. hominis forms a stable intracellular relationship with T. vaginalis; hence, in this study we examined the interaction of two localized ADH pathways by comparing T. vaginalis strain SS22 with the laboratory-generated T. vaginalis strain SS22-MOZ2 infected with M. hominis MOZ2. The presence of M. hominis resulted in an approximately 16-fold increase in intracellular ornithine and a threefold increase in putrescine, compared with control T. vaginalis cultures. No change in the activity of enzymes of the ADH pathway could be demonstrated in SS22-MOZ2 compared with the parent SS22, and the increased production of ornithine could be attributed to the presence of M. hominis. Using metabolic flow analysis it was determined that the elasticity of enzymes of the ADH pathway in SS22-MOZ2 was unchanged compared with the parent SS22; however, the elasticity of ornithine decarboxylase (ODC) in SS22 was small, and it was doubled in SS22-MOZ2 cells. The potential benefit of this relationship to both T. vaginalis and M. hominis is discussed.

Yeast cell adhesion molecules have functional amyloid-forming sequences.

The occurrence of highly conserved amyloid-forming sequences in Candida albicans Als proteins (H. N. Otoo et al., Eukaryot. Cell 7:776-782, 2008) led us to search for similar sequences in other adhesins from C. albicans and Saccharomyces cerevisiae. The beta-aggregation predictor TANGO found highly beta-aggregation-prone sequences in almost all yeast adhesins. These sequences had an unusual amino acid composition: 77% of their residues were beta-branched aliphatic amino acids Ile, Thr, and Val, which is more than 4-fold greater than their prevalence in the S. cerevisiae proteome. High beta-aggregation potential peptides from S. cerevisiae Flo1p and C. albicans Eap1p rapidly formed insoluble amyloids, as determined by Congo red absorbance, thioflavin T fluorescence, and fiber morphology. As examples of the amyloid-forming ability of the native proteins, soluble glycosylphosphatidylinositol (GPI)-less fragments of C. albicans Als5p and S. cerevisiae Muc1p also formed amyloids within a few days under native conditions at nM concentrations. There was also evidence of amyloid formation in vivo: the surfaces of cells expressing wall-bound Als1p, Als5p, Muc1p, or Flo1p were birefringent and bound the fluorescent amyloid-reporting dye thioflavin T. Both of these properties increased upon aggregation of the cells. In addition, amyloid binding dyes strongly inhibited aggregation and flocculation. The results imply that amyloid formation is an intrinsic property of yeast cell adhesion proteins from many gene families and that amyloid formation is an important component of cellular aggregation mediated by these proteins.

Structure and function of glycosylated tandem repeats from Candida albicans Als adhesins.

Tandem repeat (TR) regions are common in yeast adhesins, but their structures are unknown, and their activities are poorly understood. TR regions in Candida albicans Als proteins are conserved glycosylated 36-residue sequences with cell-cell aggregation activity (J. M. Rauceo, R. De Armond, H. Otoo, P. C. Kahn, S. A. Klotz, N. K. Gaur, and P. N. Lipke, Eukaryot. Cell 5:1664-1673, 2006). Ab initio modeling with either Rosetta or LINUS generated consistent structures of three-stranded antiparallel beta-sheet domains, whereas randomly shuffled sequences with the same composition generated various structures with consistently higher energies. O- and N-glycosylation patterns showed that each TR domain had exposed hydrophobic surfaces surrounded by glycosylation sites. These structures are consistent with domain dimensions and stability measurements by atomic force microscopy (D. Alsteen, V. Dupres, S. A. Klotz, N. K. Gaur, P. N. Lipke, and Y. F. Dufrene, ACS Nano 3:1677-1682, 2009) and with circular dichroism determination of secondary structure and thermal stability. Functional assays showed that the hydrophobic surfaces of TR domains supported binding to polystyrene surfaces and other TR domains, leading to nonsaturable homophilic binding. The domain structures are like "classic" subunit interaction surfaces and can explain previously observed patterns of promiscuous interactions between TR domains in any Als proteins or between TR domains and surfaces of other proteins. Together, the modeling techniques and the supporting data lead to an approach that relates structure and function in many kinds of repeat domains in fungal adhesins.