Faculty Bibliography

PURPOSE/OBJECTIVE:Lumbar spinal stenosis (LSS) is a common degenerative spinal condition and a leading cause of pain and disability in adults. With increasing use of artificial intelligence (AI) for medical information, this study evaluated and compared the accuracy and completeness of responses generated by large language models (LLMs) and Google Search to standardized patient-oriented questions about LSS, aiming to characterize AI performance in patient education. METHODS:Eight frequently asked questions regarding LSS were identified using NHS hospital websites, NASS clinical guidelines, Google "People Also Ask," Reddit discussions, and common ChatGPT prompts. Each question was submitted to Google Search, ChatGPT, Gemini, and Perplexity under standardized conditions. Orthopedic spine surgeons independently rated responses for accuracy and completeness using 5-point Likert scales. Parametric (one-way ANOVA) and non-parametric (Kruskal-Wallis) tests evaluated overall differences. A minimal clinically important difference (MCID) was established as a ≥ 1.0-point delta, with post-hoc pairwise comparisons evaluated using Tukey's Honestly Significant Difference. RESULTS:Gemini achieved the highest completeness (4.47 ± 0.67) and accuracy (4.34 ± 0.65), followed by Perplexity (completeness 4.03 ± 0.82; accuracy 4.00 ± 0.95). Google and ChatGPT demonstrated similar completeness (3.75 ± 1.04 vs. 3.78 ± 0.71), though Google showed slightly higher accuracy than ChatGPT (3.78 ± 0.91 vs. 3.63 ± 0.75). Global performance variations were highly significant across both omnibus parametric testing (completeness: p = 0.002; accuracy: p = 0.004) and non-parametric Kruskal-Wallis testing (completeness: p = 0.003; accuracy: p = 0.004). Post-hoc pairwise testing via Tukey's HSD confirmed that this statistical significance was driven solely by Gemini, which outperformed both ChatGPT (completeness p = 0.006; accuracy p = 0.004) and Google Search (completeness p = 0.004; accuracy p = 0.036). No other isolated pairwise combinations achieved statistical significance (p > 0.05). Despite these isolated statistical boundaries, no platform pairing cleared the predefined ≥ 1.0-point threshold for clinical significance, with maximum mean score deltas reaching only 0.72 for completeness and 0.71 for accuracy. CONCLUSIONS:Although newer-generation and search-augmented LLMs demonstrate clear statistical superiority over traditional web results in synthesizing structured spine information, these differences do not yet translate into clinically meaningful quality shifts under concise prompt constraints. Substantial inter-rater variability and the lack of threshold-clearing clinical significance reinforce that these emerging AI platforms should serve as supplements to, rather than substitutes for, physician-guided counseling in degenerative spine care.

BACKGROUND/UNASSIGNED:Cervical spine pathologies causing nerve-root compression are treated with use of decompression through a variety of techniques. Although several operative management options exist, cervical foraminotomy may be indicated in patients with isolated, unilateral cervical radiculopathy. Biportal endoscopic cervical foraminotomy allows decompression with minimal soft-tissue disturbance and excellent visualization. DESCRIPTION/UNASSIGNED:The procedure is performed with the patient in a prone position with routine neuromonitoring. Intraoperative fluoroscopy is utilized to identify the operative level, and 2 paramedian incisions are made for the portal sites at a 20° to 30° angle to the desired disc space. The working portal is utilized for surgical instruments, and the second portal serves as a viewing portal for the endoscope. Sequential dilators are utilized to establish the working portal, and a semi-tubular sheath of the desired length is placed. For the viewing portal, an endoscopic trocar is advanced through the fascia, and the camera is introduced. After endoscope insertion, surgical landmarks are identified, beginning with the interlaminar V point that marks the junction of adjacent laminae at the medial border of the facet joint. Once identified, overlying soft tissue is removed using radiofrequency ablation, and decompression of the nerve root can begin. We alternate between utilizing a high-speed diamond burr and a Kerrison rongeur to perform a laminoforaminotomy. Care is taken to minimize the facetectomy extent to <50% in order to reduce the risk of iatrogenic instability. The ligamentum flavum is preserved until the end in order to protect the dura from fluid pressure and surgical instruments. In the presence of disc herniation, disc fragments are removed through the working portal after gentle nerve root retraction. Once decompression of the neural foramen is completed to the lateral border of the pedicle, meticulous hemostasis is achieved using radiofrequency ablation, bone wax, and flowable thrombin-based hemostatic agents. Patients are typically discharged home on the same day. ALTERNATIVES/UNASSIGNED:Patients can undergo cervical foraminotomy utilizing traditional open, microscopic tubular, or uniportal endoscopic techniques. Alternatively, patients may undergo anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty (CDA), according to surgeon preference and individual patient pathology. RATIONALE/UNASSIGNED:. However, minimally invasive approaches are associated with earlier discharge, and reduced muscle damage and operative blood loss. Although tubular foraminotomy is a traditional minimally invasive option, endoscopic approaches offer distinct benefits. First, biportal endoscopy allows for greater maneuverability and visualization of the neural foramen. Second, compared with ACDF and CDA, foraminotomy obviates the need for instrumentation, preserves segmental motion, and avoids the anterior approach, which is associated with dysphagia, dysphonia, and potential for vascular injury. EXPECTED OUTCOMES/UNASSIGNED:. IMPORTANT TIPS/UNASSIGNED:Achieve adequate endoscopic visualization before starting osseous resection.Avoid inserting instruments blindly into the interlaminar space.Complete removal of the medial superior articular process up to the lateral border of the pedicle.Ensure palpation of the lateral aspect of the cranial and caudal pedicles.Inspect for extruded disc material.Maintain the ligamentum flavum until the end of the decompression.Achieve hemostasis to prevent postoperative epidural hematoma. ACRONYMS AND ABBREVIATIONS/UNASSIGNED:NSAID = nonsteroidal anti-inflammatory drugACDF = anterior cervical discectomy and fusionCDA = cervical disc arthroplastyESI = epidural steroid injectionRFA = radiofrequency ablation.

BACKGROUND/UNASSIGNED:Although vertebral hemangiomas (VH) are relatively common, aggressive symptomatic VH are rarely reported (i.e. in up to 11% of cases). Multiple other benign and malignant primary bone tumors must be considered in the differential diagnosis. Here, we review the clinical diagnosis and surgical management for aggressive hemangiomas, while also presenting 2 patients with thoracic lesions requiring posterior surgical decompression/fusion, with/without vertebroplasty, embolization, and/or CyberKnife radiosurgery. METHODS/UNASSIGNED:The classification system for these tumors ranges from Types I-IV; I Occupy < 50% of a vertebral body (VB), II-Occupy > 50% VB (IIb Thoracolumbar - Symptomatic), III-Occupy 100% VB, and IV-Occupy 100% VB involved plus extension into the pedicles, laminae, spinous process, and epidural space. RESULTS/UNASSIGNED:Radiographically (i.e. X-rays, MR, CT) these lesions originate in the vertebral bodies, but aggressive VH extend into the pedicles, laminae, spinous processes, and epidural space causing both spinal cord/root (i.e., myelopathy/radiculopathy)) compression. Surgical options include anterior, posterior, or circumferential decompressions with/without fusions, percutaneous vertebroplasty, embolization, radiation, and/or chemotherapy. Early treatment maximizes neurological recovery and limits/avoids permanent injury. CONCLUSION/UNASSIGNED:Aggressive VH are rare lesions that most frequently occur in the thoracic spine. Notably, the subset of Type IV lesions that extend into the pedicles, laminae, spinous processes, and epidural space may cause symptomatic myelopathy/radiculopathy warranting early surgical intervention to optimize neurological outcomes.

BACKGROUND:Bispecific T-cell-engaging antibodies against BCMA and GPRC5D demonstrate high efficacy in relapsed/refractory multiple myeloma (RRMM) but are associated with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), traditionally prompting inpatient monitoring when commencing therapy. Contemporary step-up dosing and prophylactic strategies may enable safe outpatient administration. PATIENTS AND METHODS/METHODS:We conducted a single-center retrospective study evaluating outpatient step-up dosing (SUD) of teclistamab or talquetamab in adults with RRMM. Patients met institutional outpatient eligibility criteria and received standard pre-medications; prophylactic tocilizumab was administered at physician discretion. The primary endpoint was incidence and severity of CRS/ICANS. Secondary endpoints included SUD completion, healthcare utilization, and need for hospitalization. RESULTS:Thirty-eight patients underwent 43 outpatient SUD initiations (teclistamab n = 30; talquetamab n = 13). Median age was 72 years, and disease burden was high. SUD completion occurred in 93%. CRS occurred in 26% of initiations and was exclusively grade 1-2; no grade ≥ 3 CRS occurred. One possible grade III ICANS event (2%) occurred after completion of SUD. CRS incidence was similar with and without prophylactic tocilizumab (29% vs 32%). Most events occurred during the first two step-up doses. Hospitalization occurred in 5 (12%) SUD initiations for CRS/ICANS events and overall healthcare utilization was modest. CONCLUSION/CONCLUSIONS:Outpatient administration of teclistamab and talquetamab SUD in RRMM is feasible and safe with low rates of low-grade CRS. Toxicities occur early and are manageable with structured monitoring, supporting outpatient delivery in appropriately selected patients.

Contact dermatitis (CD) is the 5th most common skin disease1 and affects 15-20% of the general population over their lifetimes.2 Currently, the T.R.U.E. TEST® is the only FDA-approved diagnostic product to aid in the diagnosis of Allergic Contact Dermatitis. To address that diagnostic gap, the US Food and Drug Administration held a public workshop in October 2025. These proceedings summarize the workshop presentations and discussions.

Background Stroke remains a leading cause of death and long-term disability. Although stem cell-based approaches are being investigated as possible regenerative strategies for stroke, public perceptions of their potential benefits, risks, mechanisms, and clinical use are not well-characterized. This exploratory survey described responses to an investigator-developed questionnaire about stem cell therapy for stroke. Methods A 10-item cross-sectional questionnaire was distributed electronically through Google Forms (Google, Inc., Mountain View, CA) to 36 individuals in a convenience sample; 26 completed questionnaires were received (response rate: 72.2%). The questionnaire was investigator-developed and was not validated as a measure of factual knowledge, clinical efficacy, or safety. Responses were categorized as "yes," "no," or "maybe"; one item used time-based response categories. Counts and percentages were calculated using the total number of completed questionnaires as the denominator. The survey was independently conducted as a student-led summer academic project and did not undergo review by an institutional review board, school ethics committee, or independent ethics authority. Results Twenty-six responses were analyzed. For the item asking whether embryonic stem cells are effective in stroke treatment, eight respondents (30.77%) selected "yes," 16 (61.54%) selected "maybe," and two (7.69%) selected "no." For the item asking whether stem cell treatment has advantages for stroke, 21 respondents (80.77%) selected "yes," four (15.38%) selected "maybe," and one (3.85%) selected "no." "Maybe" was the majority or joint-most-frequent response for six of 10 items, including items about animal testing, adverse effects, alternative regenerative treatments, and use during pregnancy. Conclusions In this small convenience sample, responses to an investigator-developed questionnaire suggested favorable perceptions of possible benefits of stem cell therapy for stroke, alongside frequent uncertainty about safety, mechanisms, the timing of improvement, and use in special populations. Because the questionnaire was not validated as a factual-knowledge instrument, findings should be interpreted strictly as descriptive perceptions rather than as evidence of respondents' medical knowledge, treatment confidence, or the clinical efficacy or safety of stem cell therapy. Larger studies using validated instruments and representative sampling are needed.

Percutaneous transhepatic biliary drainage (PTBD) is a common interventional radiology (IR) procedure typically used in the treatment of biliary obstruction when an endoscopic approach has failed or is not technically feasible. PTBD has a low overall complication rate with the Society of Interventional Radiology suggesting adverse event thresholds of 10% for major complications, 5.7% for hemorrhage, 2% for hemobilia, and 3.3% for death, with the average reported rates of each of these being significantly lower. However, in rare instances serious complications such as vascular injury occur. The present report describes a case of a 62-year-old woman with Non-Alcoholic Steatohepatitis (NASH) cirrhosis and remote Whipple procedure who developed symptomatic choledocholithiasis with failed Endoscopic Retrograde Cholangiopancreatography (ERCP). Interventional radiology was consulted for PTBD, which was complicated by an iatrogenic portobiliary fistula (PBF). Diagnosis required sequential imaging and procedural evaluation, as initial non-invasive computed tomography (CT) and initial portal venography failed to clearly demonstrate the connection due to catheter occlusion of the fistula. This case report focuses on the management of this complication, which was successfully treated with balloon-expandable covered stent placement in the biliary system and dual-tract coil embolization.

OBJECTIVES/OBJECTIVE:To compare growth z-scores and prematurity-related comorbidities for preterm infants receiving Soybean Oil-Intravenous Lipid Emulsion (SO-ILE) versus Soybean + Medium-chain triglycerides + Olive + Fish oil ILE (SMOF-ILE). STUDY DESIGN/METHODS:A multicenter, retrospective cohort study of 347 preterm infants <32 weeks' gestational age with birth weight ≤1500 grams who received SO-ILE or SMOF-ILE for at least seven consecutive days. RESULTS:SO-ILE group (n = 179) demonstrated significantly improved growth for length (p ≤ 0.001) and head circumference z-scores (p = 0.015) at 36 weeks' postmenstrual age and significantly worse growth for weight z-scores at 1 month (p = 0.017) compared to the SMOF-ILE group (n = 168). SO-ILE group had significantly lower rates of bronchopulmonary dysplasia (BPD) (p < 0.001) and urinary tract infections (UTI) (p = 0.045). CONCLUSION/CONCLUSIONS:In this population, SO-ILE had better outcomes for growth, BPD, and UTI compared to SMOF-ILE. Therefore, SO-ILE remains a reasonable lipid emulsion for preterm infants until more evidence is available.