Study Design. Retrospective, observational study of clinical outcomes at a single institution. Objective. To compare postoperative complication and readmission rates of payer groups in a cohort of patients undergoing anterior cervical discectomy and fusion (ACDF). Summary of Background Data. Studies examining associations between primary payer and outcomes in spine surgery have been equivocal. Methods. Patients at Mount Sinai having undergone ACDF from 2008 to 2016 were queried and assigned to one of five insurance categories: uninsured, managed care, commercial indemnity insurance, Medicare, and Medicaid, with patients in the commercial indemnity group serving as the reference cohort. Multivariable logistic regression equations for various outcomes with the exposure of payer were created, controlling for age, sex, American Society of Anesthesiology Physical Status Classification (ASA Class), the Elixhauser Comorbidity Index, and number of segments fused. A Bonferroni correction was utilized, such that alpha = 0.0125. Results. Two thousand three hundred eighty seven patients underwent ACDF during the time period. Both Medicare (P < 0.0001) and Medicaid (P < 0.0001) patients had higher comorbidity burdens than commercial patients when examining ASA Class. Managed care (2.86 vs. 2.72, P = 0.0009) and Medicare patients (2.99 vs. 2.72, P < 0.0001) had more segments fused on average than commercial patients. Medicaid patients had higher rates of prolonged extubation (odds ratio [OR]: 4.99; 95% confidence interval [CI]: 1.13–22.0; P = 0.007), and Medicare patients had higher rates of prolonged length of stay (LOS) (OR: 2.44, 95% CI: 1.13–5.27%, P = 0.004) than the commercial patients. Medicaid patients had higher rates of 30- (OR: 4.12; 95% CI: 1.43–11.93; P = 0.0009) and 90-day (OR: 3.28; 95% CI: 1.34–8.03; P = 0.0009) Emergency Department (ED) visits than the commercial patients, and managed care patients had higher rates of 30-day readmission (OR: 3.41; 95% CI: 1.00–11.57; P = 0.0123). Conclusion. Medicare and Medicaid patients had higher rates of prolonged LOS and postoperative ED visits, respectively, compared with commercial patients. Level of Evidence: 3

Study Design: Narrative review. Objectives: Artificial intelligence (AI) and machine learning (ML) have emerged as disruptive technologies with the potential to drastically affect clinical decision making in spine surgery. AI can enhance the delivery of spine care in several arenas: (1) preoperative patient workup, patient selection, and outcome prediction; (2) quality and reproducibility of spine research; (3) perioperative surgical assistance and data tracking optimization; and (4) intraoperative surgical performance. The purpose of this narrative review is to concisely assemble, analyze, and discuss current trends and applications of AI and ML in conventional and robotic-assisted spine surgery. Methods: We conducted a comprehensive PubMed search of peer-reviewed articles that were published between 2006 and 2019 examining AI, ML, and robotics in spine surgery. Key findings were then compiled and summarized in this review. Results: The majority of the published AI literature in spine surgery has focused on predictive analytics and supervised image recognition for radiographic diagnosis. Several investigators have studied the use of AI/ML in the perioperative setting in small patient cohorts; pivotal trials are still pending. Conclusions: Artificial intelligence has tremendous potential in revolutionizing comprehensive spine care. Evidence-based, predictive analytics can help surgeons improve preoperative patient selection, surgical indications, and individualized postoperative care. Robotic-assisted surgery, while still in early stages of development, has the potential to reduce surgeon fatigue and improve technical precision.

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With a growing trend in medicine towards individualized, patient-centric care, traditional health information technology limits progress. With high administrative costs and the lack of universal data access, contemporary electronic medical records serve more the institution rather than the patient. Blockchain technology, as presently described, was initially developed for use in financial markets, serving as a decentralized, distributed ledger of transactions. However, certain inherent characteristics of this technology suit it for use in the healthcare sector. Potential applications of the blockchain in medicine include interoperable health data access, data storage and security, value-based payment mechanisms, medical supply chain efficiency, amongst others. While the technology remains in nascent stages, it is essential that members of the healthcare community understand the fundamental concepts behind blockchain, and recognize its potential impact on the future of medical care.

Sports-related concussion has emerged as a public health crisis due to increased diagnosis of the condition and increased participation in organized and recreational athletics worldwide. Under-recognition of concussions can lead to premature clearance for athletic participation, leaving athletes vulnerable to repeat injury and subsequent short- and long-term complications. There is overwhelming evidence that assessment and management of sports-related concussions should involve a multifaceted approach. A number of assessment criteria have been developed for this purpose. It is important to understand the available and emerging diagnostic testing modalities for sports-related concussions. The most commonly used tools for evaluating individuals with concussion are the Post-Concussion Symptom Scale (PCSS), Standard Assessment of Concussion (SAC), Standard Concussion Assessment Tool (SCAT3), and the most recognized computerized neurocognitive test, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The strengths and limitations of each of these tools, and the Concussion Resolution Index (CRI), CogSport, and King-Devick tests were evaluated. Based on the data, it appears that the most sensitive and specific of these is the ImPACT test. Additionally, the King-Devick test is an effective adjunct due to its ability to test eye movements and brainstem function.

Direct targeting of the sensorimotor STN using QSM demonstrates MER correlation and can be safely used for deep brain stimulation lead placement with satisfactory clinical response. These results imply that targeting based on QSM signaling alone is sufficient to obtain reliable and reproducible outcomes in the absence of physiological recordings.

Recent evidence suggests a link between brain injury and the autonomic release of proinflammatory cytokines by resident macrophages in the spleen. This phenomenon, termed "brainspleen inflammatory coupling," has garnered attention from scientific and medical communities interested in developing novel treatments for traumatic brain injury (TBI). Cholinergic stimulation of the α7-subunit nicotinic acetylcholine receptor (α7NAchR) on splenic macrophages has been shown to inhibit their release of pro-inflammatory cytokines. This inhibition, mediated by the parasympathetic nervous system, has been shown to improve outcomes in animal models of sepsis, stroke, and TBI. As evidence of a beneficial role of splenic inhibition grows, new treatment strategies might be applied to many medical conditions involving neuroinflammation, a process that contributes to further neurological deterioration.Located within the peritoneal cavity, the spleen monitors the circulation and removes foreign material in the blood that potentially threatens homeostasis. As the primary mediator of the mononuclear phagocyte system, splenic leukocytes in the red and white pulp prevent devastating infections by encapsulated bacteria and intracellular pathogens. It comes as a surprise, then, that the same organ that plays such a crucial role in preventing infection may simultaneously exacerbate the inflammatory response after brain injury. With this in mind, a fresh body of evidence has suggested a link between brain injury and the autonomic release of inflammatory cytokines by macrophages in the spleen (Figure 1). This phenomenon, termed "brain-spleen inflammatory coupling," has garnered attention from scientific and medical communities seeking new treatments for ischemic and traumatic brain injuries.Physicians and scientists readily acknowledge that the intricate mechanisms driving acute inflammation remain a mystery. Dr. Niels Jerne, a Nobel Prize-winning immunologist, once described the immune system as a network of interacting cells and antibodies, analogous to the communication among neurons, glia, and their neurotransmitters in the central nervous system (CNS) (Jerne, 1985). For decades, these systems were thought to function independently; however, scientists have discovered several physiologic processes linking them. In the 1980s, Damjanovich and colleagues discovered that lymphocytes possess excitable membranes that behave similarly to those of neurons (Damjanovich et al., 1989). Leukocytes have also been shown to express β2-adrenergic receptors, indicating they are sensitive to changes in autonomic output (Bruynzeel, 1984). These findings provided the framework for the development of theories describing neurotransmitter control of inflammation and the link between emotional states and immune status.

BACKGROUND: The coronavirus identified in 2019 (COVID-19) pandemic effectively ended all major spine educational conferences in the first half of 2020. In response, the authors formed a "virtual" case-based conference series directed at delivering spine education to health care providers around the world. We herein share the technical logistics, early participant feedback, and future direction of this initiative.-METHODS: The Virtual Global Spine Conference (VGSC) was created in April 2020 by a multiinstitutional team of spinal neurosurgeons and a neuroradiologist. Biweekly virtual meetings were established wherein invited national and international spine care providers would deliver casebased presentations on spine and spine surgeryLrelated conditions via teleconferencing. Promotion was coordinated through social media platforms such as Twitter.-RESULTS: VGSC recruited more than 1000 surgeons, trainees, and other specialists, with 50e100 new registrants per week thereafter. An early survey to the participants, with 168 responders, indicated that 92% viewed the content as highly valuable to their practice and 94% would continue participating post COVID-19. Participants from the United States (29%), Middle East (16%), and Europe (12%) comprised the majority of the audience. Approximately 52% were neurosurgeons, 18% orthopedic surgeons, and 6% neuroradiologists. A majority of participants were physicians (55%) and residents/fellows (21%).-CONCLUSIONS: The early success of the VGSC reflects a strong interest in spine education despite the COVID-19 pandemic and social distancing guidelines. There is widespread opinion, backed by our own survey results, that many clinicians and trainees want to see "virtual" education continue post COVID-19.