Faculty Bibliography

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.

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.

MOTIVATION/UNASSIGNED:Ferroptosis is an iron-dependent regulated cell death process involving lipid peroxidation, redox imbalance, and impaired antioxidant defense. It is increasingly relevant to metabolic liver disease and non-alcoholic steatohepatitis. Existing ferroptosis resources mainly provide gene annotations and disease associations, but they do not offer an integrated workflow for user-uploaded transcriptome data, liver-focused enrichment, dataset-level scoring, and ferroptosis-senescence cross-talk analysis. RESULTS/UNASSIGNED:We developed FerroEnrich, an open-source web platform for analyzing ferroptosis and senescence programs in human and mouse liver transcriptome datasets. FerroEnrich supports count matrix upload, metadata-guided differential expression analysis, identification of ferroptosis-prone and ferroptosis-resistant genes, dataset-level ferroptosis index scoring, sample-level susceptibility estimation, curated liver module enrichment, interaction network visualization, and ferroptosis-senescence cross-talk analysis. Application to human advanced non-alcoholic steatohepatitis and mouse diet-induced liver disease datasets demonstrated cross-species utility and identified conserved remodeling, including reduced ferroptosis-protective signatures and increased senescence- and fibrosis-associated modules. AVAILABILITY AND IMPLEMENTATION/UNASSIGNED:FerroEnrich is freely available at https://ferroenrich.shinyapps.io/ferroenrich/. Source code, documentation, and demo datasets are available at the FerroEnrich GitHub repository.

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.

BACKGROUND:Mild autonomous cortisol secretion causes substantial cardiometabolic morbidity, yet evidence for benefits following adrenalectomy remains mixed. Prior studies are limited by small sample sizes and heterogeneous definitions. This study evaluates the metabolic impact of adrenalectomy compared with nonoperative management in mild autonomous cortisol secretion using standardized biochemical criteria from the Epic Cosmos database. METHODS:Mild autonomous cortisol secretion was defined biochemically using dexamethasone suppression test cortisol 1.8-10 μg/dL, dexamethasone, and adrenocorticotropic hormone levels. Surgical patients underwent unilateral adrenalectomy with biochemical resolution of hypercortisolism. Inverse probability of treatment weighting was performed, adjusting for demographics, baseline cardiometabolic parameters, dexamethasone suppression test cortisol level, and glucagon-like peptide-1 receptor agonist use. The starting time point was the adrenalectomy date or, for nonoperative patients, the dexamethasone suppression test date plus the median time to surgery. Follow-up outcomes (A1C, lipid profile, body mass index, and blood pressure) were assessed for categorical improvement at last follow-up within 3 years using a weighted logistic regression model. RESULTS:From 2018 to 2025, 395 patients met inclusion criteria (54 surgical, 341 nonoperative). Surgical patients had a higher adjusted likelihood of categorical improvements in A1C (25.6% vs 9.5%, odds ratio, 3.30; P = .002), total cholesterol (14.6% vs 3.9%, odds ratio, 4.25; P = .004), and body mass index (24.9% vs 12.1%, odds ratio, 2.42; P = .018). There were no differences in blood pressure between groups (28.4% vs 26.7%, odds ratio, 1.09; P = .803). CONCLUSION/CONCLUSIONS:This is the largest cohort study to date evaluating metabolic outcomes after surgery for mild autonomous cortisol secretion. Adrenalectomy was associated with categorical improvement in A1C, body mass index, and total cholesterol, supporting more widespread consideration for selective operative management.

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.