Faculty Bibliography

PURPOSE OF REVIEW/UNASSIGNED:Alzheimer disease (AD) and epilepsy are major causes of neurologic disability and are reciprocally related: epileptiform discharges, subclinical seizures, and epilepsy are more prevalent in patients with AD compared with controls; progressive cognitive impairment commonly afflicts epilepsy patients; and late-onset epilepsy patients have higher rates of new-onset dementia. RECENT FINDINGS/UNASSIGNED:Epidemiologic studies support shared risk factors (e.g., genetic variants, vascular disease, sleep disorders, microbiome) with notable divergences. AD and epilepsy have some overlapping anatomic (e.g., hippocampus, entorhinal, and association cortex), clinical (e.g., memory, attentional, and executive) impairments, and neuropathologic (e.g., amyloid, tau, neurofibrillary tangles) features. Shared clinical and translational challenges include underlying mechanisms (e.g., genetic variants, neuroinflammation, metabolic and mitochondrial dysfunction, excitatory/inhibitory imbalance, microbiome, and sociodemographic factors) and identifying valid and reliable biomarkers (e.g., total tau and phosphorylated tau (p-tau), amyloid deposition, Aβ42/Aβ40 ratio) to assess disease progression, predict outcomes, and assess potentially disease-modifying interventions. SUMMARY/UNASSIGNED:Identifying convergences and divergences between epilepsy and AD may inform our understanding. The clinical, neurophysiologic, neuropathologic, and molecular pathologic changes in AD and epilepsy may reveal pathophysiologic insights and therapeutic opportunities.

Clinical evaluations of large language models (LLMs) have rapidly expanded since 2022, yet their evidence base remains opaque. The overwhelming volume of studies creates challenges for manual curation and review. However, LLMs themselves offer the scalability and capability to evaluate the ever-growing evidence base. This LLM-assisted review identified 4,609 peer-reviewed studies in clinical medicine between January 2022 and September 2025, equating to roughly 3.2 papers per day. Only 1,048 studies used real-world patient data and of these only 19 were prospective randomized trials; most addressed simulated scenarios (n = 1,857) or exam-style tasks (n = 1,704). ChatGPT and related OpenAI models constitute 65.7% of evaluated models, with Gemini/Bard a distant second constituting 13.1% of evaluated models. Patient-facing communication and education comprised 17% of tasks, followed by knowledge retrieval, and education and assessment simulation. Across 1,046 head-to-head comparisons, LLMs outperformed humans in 33% of comparisons, with a strong dependency on task realism and level of training. At least 25% of studies had sample sizes less than 30. Despite the growth of LLMs in medicine, rigorous, patient-centered evidence remains scarce, underscoring the need for larger prospective trials before clinical adoption.

Clinical evaluations of large language models (LLMs) have rapidly expanded since 2022, yet their evidence base remains opaque. The overwhelming volume of studies creates challenges for manual curation and review. However, LLMs themselves offer the scalability and capability to evaluate the ever-growing evidence base. This LLM-assisted review identified 4,609 peer-reviewed studies in clinical medicine between January 2022 and September 2025, equating to roughly 3.2 papers per day. Only 1,048 studies used real-world patient data and of these only 19 were prospective randomized trials; most addressed simulated scenarios (n = 1,857) or exam-style tasks (n = 1,704). ChatGPT and related OpenAI models constitute 65.7% of evaluated models, with Gemini/Bard a distant second constituting 13.1% of evaluated models. Patient-facing communication and education comprised 17% of tasks, followed by knowledge retrieval, and education and assessment simulation. Across 1,046 head-to-head comparisons, LLMs outperformed humans in 33% of comparisons, with a strong dependency on task realism and level of training. At least 25% of studies had sample sizes less than 30. Despite the growth of LLMs in medicine, rigorous, patient-centered evidence remains scarce, underscoring the need for larger prospective trials before clinical adoption.

STUDY DESIGN/METHODS:Retrospective review of a prospective, multicenter adult cervical deformity (CD) database. OBJECTIVE:Investigate the prevalence and clinical significance of combined cervical scoliosis (CS) and cervical kyphosis (CK) among patients undergoing surgical management of CD. SUMMARY OF BACKGROUND DATA/BACKGROUND:Although adult CD patients may have both CS and CK, few studies have confirmed prevalence of CK and CS and associated radiographic and clinical findings. MATERIALS AND METHODS/METHODS:Patients undergoing surgery for CD [defined as C2-C7 ≥10° kyphosis, cervical sagittal vertical axis (SVA) >4 cm, or C2-C7 coronal Cobb angle ≥10°] were included. CS was defined as C2-C7 coronal Cobb angle ≥10°. RESULTS:Totally, 114 patients were included (mean age 62.5 yr, 51.8% female). Fourteen patients (12.3%) had combined CS and CK, and 100 patients (87.7%) had CK alone. Preoperative maximum cervical coronal Cobb angle was 3.9° in the CK alone group and 14.6° in the combined CS and CK group. In the combined CS and CK group, this value improved to 8.1° postoperatively ( P =0.0007 vs. preoperative), but CS ≥10° was still present in three patients, with a mean correction percentage of only 48.0% of initial CS.No significant differences were observed between the CK only and combined CS and CK groups with regard to baseline sagittal parameters, change between immediate postoperative and baseline sagittal parameters, surgical approach, age, or baseline HRQOL. Patients with combined CS and CK were more frequently female than patients with CK alone (85.7% vs. 41.2%, P =0.0066). CONCLUSIONS:The vast majority of patients presented with CK alone (88%), and only 12% of adult CD patients had combined CS and CK. Because of the significant residual coronal plane deformity-∼50%-surgical correction should be focused on both coronal and sagittal plane deformity in the combined CS and CK group.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Since the introduction of the Leksell Gamma Knife to North America in 1987, stereotactic radiosurgery (SRS) has increasingly been used for patients with intracranial meningiomas. We evaluated the evolving application and outcomes of meningioma patients managed with both primary and adjuvant SRS during a 35-year interval. METHODS:The authors reviewed the outcomes of meningioma patients (1229 female, 69.8%; 2220 tumors) who underwent single-fraction SRS from August 1987 to March 2022 and who had a minimum of 6-month follow-up. The rates of treated tumor control and overall survival up to 20 years after SRS were measured. Risk factors analyzed included age, sex, tumor volume, margin dose, Ki-67, anatomical location, and pre-SRS surgical resection. RESULTS:Primary SRS showed superior tumor control compared with adjuvant SRS after previous resection. Overall, 191 of 2220 patients (8.6%) had local progression at last follow-up with the 5-year, 10-year, 15-year, and 20-year tumor control rates were 92.1%, 88.3%, 84.1%, and 81.1%, respectively. The median overall survival after SRS was 17.4 years, and 2.6% of patients died related to meningioma progression. Patients treated so that ≥60% of the tumor received at least 16 Gy demonstrated significantly superior tumor control. Fifty-eight patients (3.3%) experienced symptomatic adverse radiation effects after SRS. CONCLUSION/CONCLUSIONS:SRS provided excellent local tumor control rates that extended beyond 20 years. Primary SRS was an effective strategy for patients with unresected or known WHO grade I meningiomas. Adjuvant SRS was an important option to enhance tumor control and survival in patients with residual or progressive tumors after resection.

STUDY DESIGN/METHODS:Prospective, multi-center analysis. OBJECTIVE:Evaluate the impact that self-image has upon operative vs. nonoperative treatment choice for adult spine deformity (ASD) patients, and evaluate the association of post-treatment self-image with treatment satisfaction. SUMMARY OF BACKGROUND DATA/BACKGROUND:ASD outcomes traditionally focus upon pain and physical function. Self-image is an important outcome measure for pediatric spine deformity. Little data exists regarding the impact self-image has upon ASD treatment choice and outcomes. METHODS:Factor analysis and decision tree modeling was performed upon ASD patients prospectively enrolled into a multi-center study from 2009-2020. Data elements from physical examination, demographics, spinal alignment, and individual questions from administered PROMs including SRS-22r, ODI, SF-36, and NRS back and leg pain were evaluated for variables that correlated most with (1) patients electing for operative vs. nonoperative treatment and (2) treatment satisfaction at minimum 2-year follow-up. RESULTS:Evaluation of 735 ASD patients demonstrated operatively treated patients (OP; n=548) were older (58.0±15.3 vs. 52.4±16.0 years; P<0.0001), had similar scoliosis (44.9±20.1° vs. 45.5±16.1°; P=0.5555) but worse sagittal malalignment than nonoperatively treated patients (NON; n=187; P<0.0001, respectively). Baseline PROMs were worse for OP vs. NON (P<0.0001). Gradient-boosted decision trees, factor analysis, and logistic regression of demographic, physical examination, radiographic, and PROM variables associated with treatment choice demonstrated self-image (odds ratio=4.5; 95% CI=3.4-6.0; P<0.0001) had the greatest correlation for patients choosing operative treatment. At minimum 2-year follow-up self-image demonstrated the greatest health domain improvement for OP and self-image improvement correlated most with post-treatment satisfaction, while NON demonstrated deterioration of self-image and reported poor treatment satisfaction. CONCLUSION/CONCLUSIONS:Multi-variable evaluation of 735 operative and nonoperative treated ASD patients demonstrated baseline self-image strongly correlated with ASD patients pursuing surgical treatment and postoperative treatment satisfaction. Patient self-image is a critical measure that must be assessed in ASD.

STUDY DESIGN/METHODS:Retrospective cohort study. OBJECTIVE:To examine the degree of overlap between disability, multimorbidity, and frailty in a cohort of ASD patients. SUMMARY OF BACKGROUND DATA/BACKGROUND:Frailty is a popular topic in spine research, as it is a reported risk factor for poor outcomes. Disability, multimorbidity, and frailty can coexist, sometimes causing or exacerbating one another. It is important to distinguish these conditions for perioperative optimization and to guide research initiatives. METHODS:A multicenter registry of ASD patients was queried for baseline data regarding frailty, as measured by the Edmonton Frail Scale, disability, as measured by the Oswestry Disability Index, and multimorbidity, as measured by the Charlson Comorbidity Index. The relationships between these measures and both chronological and biological age (PhenoAge) were explored. Exploratory factor analysis (EFA) examined areas of overlap between these diagnoses. RESULTS:There were 861 patients contributing data, mostly female (68%), most undergoing primary surgery at a median age of 66 years (Interquartile Range (55.1-71.6), with 6% classified as "Frail." Chronological and PhenoAge showed weak to moderate associations with disability and frailty, though PhenoAge was stronger. There was no evidence of distinct clusters, rather a continuity of condition severity. EFA found overlap between subjective and objective measures of disability, function, and frailty. CONCLUSIONS:Frailty was rare (6%) in this multicenter cohort of patients. Conflation of disability and frailty is a real risk due to overlap in measures of both conditions. Disability and frailty do not form discrete categories but rather exist along a continuum, underscoring the need to abandon categorical labels in favor of continuous measures for both clinical assessment and research settings.

STUDY DESIGN/METHODS:Retrospective Multi-Center Study. OBJECTIVE:To investigate how advances in spine realignment have impacted lumbar segmental alignment. SUMMARY OF BACKGROUND DATA/BACKGROUND:The understanding of spine alignment and Adult Spinal Deformity (ASD) management continues to advance. It remains unknown how these advances have influenced lumbar segmental alignment changes in the setting of surgical correction. METHODS:Patients undergoing primary thoracolumbar fusion for ASD were stratified based on enrolment in two distinct multicenter registries; forming an 'Early' (2008-2017) and a 'Late cohort' (2018-present). Patients were further stratified based on pelvic incidence (PI) and Roussouly type. Segmental alignment was determined based on published values of asymptomatic individuals. Pelvic incidence-based alignment and Roussouly-based alignment were determined in alignment with previously published normative values. Means comparisons tests and multivariate analyses compared segmental & regional parameters between groups. RESULTS:1240 patients included (622 EARLY, 618 LATE). The mean age was 61.4±14.5 years, body mass index (BMI) was 28.0±5.8 kg/m2, and Charlson comorbidity index (CCI) was 1.55±1.70. 70.2% of patients were female gender. LATE consistently displayed better L5-S1 alignment across all PI and Roussouly types (P=0.001) However, EARLY demonstrated better L4-5 alignment (P=0.001). Improved alignment in L5-S1, L4-5 and L3-4 was associated with achieving minimum clinically important difference in ODI scores and decreased risk of mechanical complications. Both cohorts demonstrated low rates of matching L4-S1 regional and overall lumbar lordosis L1-S1 alignment, with no differences between both groups. By lordosis distribution index, both groups had predominantly hyperlordotic maldistribution postop, but LATE had more 'Aligned' patients (15.9 vs. 11%, P<0.001). CONCLUSIONS:Over the past 15 years, surgeons appear to be better at restoring ideal lumbar segmental sagittal alignment in ASD patients. However, idealized correction does not appear to be uniform across all lumbar segments, representing an opportunity for further improvement. LEVEL OF EVIDENCE/METHODS:III.