bims-rebome 2025-08-24 papers

Neurosurgery. 2025 Aug 15.

Automating the Referral of Bone Metastases Patients With and Without the Use of Large Language Models.

Karl L Sangwon, Xu Han, Anton Becker, Yuchong Zhang, Richard Ni, Jeff Zhang, Daniel Alexander Alber, Anton Alyakin, Michelle Nakatsuka, Nicola Fabbri, Yindalon Aphinyanaphongs, Jonathan T Yang, Abraham Chachoua, Douglas Kondziolka, Ilya Laufer, Eric Karl Oermann.

BACKGROUND AND OBJECTIVES: Bone metastases, affecting more than 4.8% of patients with cancer annually, and particularly spinal metastases require urgent intervention to prevent neurological complications. However, the current process of manually reviewing radiological reports leads to potential delays in specialist referrals. We hypothesized that natural language processing (NLP) review of routine radiology reports could automate the referral process for timely multidisciplinary care of spinal metastases.
METHODS: We assessed 3 NLP models-a rule-based regular expression (RegEx) model, GPT-4, and a specialized Bidirectional Encoder Representations from Transformers (BERT) model (NYUTron)-for automated detection and referral of bone metastases. Study inclusion criteria targeted patients with active cancer diagnoses who underwent advanced imaging (computed tomography, MRI, or positron emission tomography) without previous specialist referral. We defined 2 separate tasks: task of identifying clinically significant bone metastatic terms (lexical detection), and identifying cases needing a specialist follow-up (clinical referral). Models were developed using 3754 hand-labeled advanced imaging studies in 2 phases: phase 1 focused on spine metastases, and phase 2 generalized to bone metastases. Standard McRae's line performance metrics were evaluated and compared across all stages and tasks.
RESULTS: In the lexical detection, a simple RegEx achieved the highest performance (sensitivity 98.4%, specificity 97.6%, F1 = 0.965), followed by NYUTron (sensitivity 96.8%, specificity 89.9%, and F1 = 0.787). For the clinical referral task, RegEx also demonstrated superior performance (sensitivity 92.3%, specificity 87.5%, and F1 = 0.936), followed by a fine-tuned NYUTron model (sensitivity 90.0%, specificity 66.7%, and F1 = 0.750).
CONCLUSION: An NLP-based automated referral system can accurately identify patients with bone metastases requiring specialist evaluation. A simple RegEx model excels in syntax-based identification and expert-informed rule generation for efficient referral patient recommendation in comparison with advanced NLP models. This system could significantly reduce missed follow-ups and enhance timely intervention for patients with bone metastases.

Keywords: Bone metastases; Large language models; Metastatic cancer; Natural language processing; Spinal metastases

DOI: https://doi.org/10.1227/neu.0000000000003683

Eur J Orthop Surg Traumatol. 2025 Aug 18. 35(1): 353

Timing and neurological recovery in metastatic spinal cord compression: short and long-term outcomes of the internal bracing technique.

Paolo Brigato, Giuseppe Francesco Papalia, Gianluca Vadalà, Luisana Sisca, Girolamo Maltese, Fabrizio Russo, Rocco Papalia, Vincenzo Denaro.

PURPOSE: Spinal metastases, affecting up to 40% of cancer patients, often arise from lung, prostate, and breast cancers. Metastatic spinal cord compression (MSCC) causes pain and neurological deficits, requiring timely surgical or radiotherapy interventions. This study evaluates neurological recovery after decompressive surgery and fixation using the "internal bracing" technique in patients with acute MSCC-related deficits, examining overall survival (OS) and its correlation with neurological outcomes.
METHODS: This retrospective, single-center study included adult MSCC patients who underwent posterior spinal decompression and instrumentation from 2009 to 2022. Exclusion criteria were age < 21 years, hematologic metastases, cervical spine involvement, anterior surgery, and incomplete data. The primary outcome was postoperative neurological recovery, while secondary outcomes were major complications according to Clavien-Dindo classification, Health-Related Quality of Life (HRQoL) measures and OS. Statistical analysis employed Wilcoxon and ANOVA tests, Kaplan-Meier survival analysis and multivariate analysis (p < 0.05).
RESULTS: The study involved 34 patients (mean age 58.8 ± 12.6 years), with lung cancer as the most common primary tumor (44.2%). The mean time from symptom onset to surgery was 47 ± 40.2 h. Surgery included decompression and instrumentation with sublaminar hooks and rods, averaging 123 ± 36 min operative time and 260 ± 140 mL blood loss. Postoperative neurological improvement was significant (Frankel score, p = 0.002). No surgical site complications occurred, while systemic complications were noted in 16 patients, all minor (< IIIB). The mean European Quality of Life-5 Dimensions (EQ-5D) score significantly improved from 0.52 ± 0.20 preoperatively to 0.68 ± 0.17 postoperatively (p = 0.035). The mean OS was 14.1 months, significantly correlated with postoperative Frankel grades (p = 0.049). Kaplan-Meier survival curves further confirmed that earlier surgical intervention was associated with improved OS.
CONCLUSION: Posterior decompression with the "internal bracing" technique showed satisfactory outcomes in neurological recovery and pain management. Early intervention improved outcomes, with neurological function influencing long-term survival.

Keywords: Decompressive surgery; Frankel grade; Metastatic spinal cord compression; Neurological status; Quality of life; Spinal metastases

DOI: https://doi.org/10.1007/s00590-025-04481-4

Brain Spine. 2025 ;5 104387

Treatment approaches for multiple Myeloma vertebral column lesions - Results from an international survey distributed to the AO spine knowledge forum tumor.

Vanessa Hubertus, Emily J von Bronewski, Lucius S Fekonja, Anton M Früh, Christian J Entenmann, Hannah Miller, Charlotte Buhre, Michael G Fehlings, Ilya Laufer, Peter Vajkoczy, Julia S Onken.

Introduction: Vertebral fractures and epidural compression are common complications in Multiple Myeloma (MM). Although non-surgical management is generally preferred, internationally accepted management guidelines are lacking. This study aimed to assess current international treatment approaches and clinical conditions guiding decision-making in MM vertebral lesions.
Research question: Assessing international treatment standards for MM vertebral column lesions.
Material and methods: A survey was distributed to members of the AO Spine Knowledge Forum Tumor, an expert forum specialized on the treatment of oncologic spine disease. The survey consisted of 25 questions, of which 15 assessed the participant's background, clinical expertise, and experienced treatment standards regarding MM vertebral lesions, followed by ten fictional case examples with seven possible treatment scenarios each.
Results: 51 international experts completed the survey, 51 % being of orthopedic, and 44 % of neurosurgical background, while 5 % were radio-oncologists. 84 % of the participants stated they "see vertebral lesions in MM in general as a non-surgical disease". As strongest indicators to perform surgery, neurological deficits (74 %), and potentially unstable lesions (20 %) were chosen. Clinical and radiological follow-up is performed by 83 %, however only in 46 % at defined intervals. 89 % would choose "less invasive" surgical strategies in MM than in similar lesions related to metastatic spine disease.
Discussion and conclusion: The participating experts agreed towards a more restrained and less invasive management of MM patients, however the applicability of surgical scores, standards for follow-up, and indications as well as surgical strategies for MM vertebral lesions varied widely, illustrating the need for international guidelines standardizing treatment.

Keywords: Chronic vertebral pain; International treatment standards; Multiple Myeloma; Surgical decision-making; Vertebral column lesions

DOI: https://doi.org/10.1016/j.bas.2025.104387

Rev Bras Ortop (Sao Paulo). 2025 Jun;60(3): 1-7

[Advances in Radiotherapy in the Treatment of Metastatic Spinal Lesions].

Brian Guilherme Monteiro Marta Coimbra, Alice Roxo Nobre de Souza E Silva, Cauã Bhering Soares, Caio César Nogueira de Figueiredo, Manuel Salvado Macamo, Alexandre Fogaça Cristante.

Metastatic spinal disease has become increasingly common due to advances in systemic oncological therapies and the increase in the overall survival of cancer patients. Its treatment is palliative, but the meaning of this term has evolved and, today, consists of better and more effective condition control over longer periods. In the past, surgical and radiotherapy techniques, especially conventional external beam radiation therapy (cEBRT), were ineffective or morbid for controlling many types of tumors. Now, the emergence and advancement of stereotactic body radiation therapy (SBRT) drastically changed this scenario. Surgery for managing metastatic disease remains significant in radiotherapy-associated strategies, but its purpose and technique have undergone major updates. However, despite all technical advances, radiotherapy has toxicity and side effects that warrant consideration. In this article, we provide an updated review covering everything from history to innovations in treating spinal metastases, focusing on their benefits, indications, and clinical impact.

Keywords: neoplasm metastasis; radiotherapy; spine/surgery

DOI: https://doi.org/10.1055/s-0045-1810031

Rev Bras Ortop (Sao Paulo). 2025 Jun;60(3): 1-7

Advances in Radiotherapy in the Treatment of Metastatic Spinal Lesions.

Brian Guilherme Monteiro Marta Coimbra, Alice Roxo Nobre de Souza E Silva, Cauã Bhering Soares, Caio César Nogueira de Figueiredo, Manuel Salvado Macamo, Alexandre Fogaça Cristante.

Metastatic spinal disease has become increasingly common due to advances in systemic oncological therapies and the increase in the overall survival of cancer patients. Its treatment is palliative, but the meaning of this term has evolved and, today, consists of better and more effective condition control over longer periods. In the past, surgical and radiotherapy techniques, especially conventional external beam radiation therapy (cEBRT), were ineffective or morbid for controlling many types of tumors. Now, the emergence and advancement of stereotactic body radiation therapy (SBRT) drastically changed this scenario. Surgery for managing metastatic disease remains significant in radiotherapy-associated strategies, but its purpose and technique have undergone major updates. However, despite all technical advances, radiotherapy has toxicity and side effects that warrant consideration. In this article, we provide an updated review covering everything from history to innovations in treating spinal metastases, focusing on their benefits, indications, and clinical impact.

Keywords: neoplasm metastasis; radiotherapy; spine/surgery

DOI: https://doi.org/10.1055/s-0045-1810030