PURPOSE:Routine augmentation of pedicle screws in standard clinical practice is performed using polymethylmethacrylate (PMMA) cement. However, owing to its high compressive strength and high Young's modulus, this material acts more as a stiffener in the spine than as a suitable replacement for compressed cancellous bone. Adjacent fractures caused by this represent a common clinical problem. A new experimental magnesium phosphate cement seems more suitable for this purpose, as it shows promising biomechanical properties and has been proven to be injectable via long cannulated systems. However, the application of this material has not yet been explored or quantified. METHODS:Fenestrated pedicle screws were inserted into polyurethane bone blocks of different densities and augmented with experimental magnesium phosphate cement. This was followed by biomechanical testing in a realistic loading scenario. In addition, the injection force required for augmentation was quantified depending on the syringe type. RESULTS:Cement augmentation was possible in all bone blocks used and consistently had a positive effect on the biomechanical stability of fenestrated pedicle screws. The size of this effect varied depending on the density of the bone blocks used. No cutoff value could be identified at which augmentation should be performed. CONCLUSION:The novel experimental ready-to-use formulation of magnesium phosphate cement reliably enabled cement augmentation of fenestrated pedicle screws and consistently resulted in improved biomechanical stability. These findings suggest that a biocompatible and degradable bone cement with suitable biomechanical properties may represent a future alternative for spinal augmentation.
Abstract Background Patients increasingly use large language models (LLMs) to obtain medical information, but the quality of LLM-generated information on complex spinal infections such as spondylodiscitis remains uncertain. Existing evaluations in spine surgery have mainly addressed degenerative conditions or surgical procedures, and disease-specific data for spondylodiscitis are limited. Objective This preliminary study evaluated spine surgeons’ ratings of single-turn LLM responses to 10 author-curated frequently asked questions (FAQs) about spondylodiscitis and compared answer sets generated from GPT-4, GPT-4o, and Google Gemini web interfaces under the authors’ implemented prompting conditions. Methods A pool of patient-oriented questions was generated through a chronological workflow including publicly available FAQ sources, PubMed-informed terminology review, Google Trends topic checking, and LLM-generated candidate questions. Duplicate and semantically overlapping questions were removed, the remaining questions were grouped into thematic categories, and 10 final FAQ-style prompts were synthesized. Each prompt was submitted once to the publicly accessible web interfaces of GPT-4, GPT-4o, and Google Gemini. The study was interpreted as an expert evaluation of the resulting answer sets. Seven blinded board-certified spine surgeons rated the responses using a 4-level rating system ranging from excellent to unsatisfactory and additionally assessed comprehensiveness, clarity, empathy, and appropriateness of length. Descriptive statistics and nonparametric comparisons were performed. Interrater reliability was assessed using the intraclass correlation coefficient. Results Across all responses, 38.6% (81/210) were rated as excellent, 39% (82/210) as satisfactory with minimal clarification needed, 16.7% (35/210) as satisfactory with moderate clarification needed, and 5.7% (12/210) as unsatisfactory. The most common reason for necessary clarification was insufficient information (58/141, 41.1%), followed by language-related issues (21/141, 14.9%) and overly detailed responses (18/141, 12.8%). The complication-related question received the highest mean rating (3.4/5), whereas treatment- and prognosis-related questions received lower ratings (2.7/5 and 2.9/5). Median overall ratings did not differ significantly among the 3 evaluated LLMs. Spine surgeons reported a generally positive attitude toward artificial intelligence–supported patient information but expressed remaining uncertainty regarding reliability and direct patient-physician communication. Conclusions In this preliminary expert evaluation, selected publicly accessible LLM web interfaces generated mostly satisfactory responses to author-curated spondylodiscitis FAQs. The findings reflect outputs produced at the time of access under the authors’ implemented prompting conditions. LLMs may support patient education only with clinician oversight. Future research should explore advanced, domain-specific models to further improve the quality of communication between clinicians and patients.
Introduction:The number of arthroplasty procedures on hip and knee joints is expected to continue to rise in the coming years. At the same time, postgraduate training in arthroplasty faces significant structural challenges in German-speaking countries. This study aimed to assess the current state of postgraduate clinical training, the role of external education offered by the German Society of Arthroplasty (AE), and the ways in which young physicians can access AE-YOUTH (the AE's youth organisation). Methodology:An online survey was distributed to members of AE-YOUTH. The structured questionnaire included 20 items covering demographic information, clinical training experiences, and participation in AE-provided educational activities. Data analysis was performed, using descriptive and exploratory methods in Excel and SPSS. Results:A total of 92 AE-YOUTH members responded to the survey (response rate: 21.4%). While 75.3% reported that they had had the opportunity to perform arthroplastic procedures as primary surgeon, only about 22 % met the procedural volume required by official training regulations. Gender (p = 0.021) and stage of training (p = 0.001) were significantly associated with the number of procedures performed. In response to structural deficits, participants expressed a desire for stepwise surgical training concepts and structured mentoring programmes. Satisfaction with clinical training in arthroplasty averaged 2.9 out of 5, while AE-provided continuing education was rated higher, at 4.0 out of 5. More than half of respondents used online formats, and one-third participated in hands-on training courses. Most became aware of AE-YOUTH through colleagues or the AE website, with social media playing only a minor role. Discussion:The results reveal a clear discrepancy between expectations and reality in clinical arthroplasty training. In contrast, educational programmes provided by the professional society were perceived as more structured and accessible. These offerings may effectively complement clinical training, which is often constrained by time pressure and administrative workload. Digital content, simulation-based training, and practical courses are especially valuable in this context. As a low-barrier and needs-driven platform, AE-YOUTH has the potential to foster early-career engagement in arthroplasty and to support postgraduate education in a more structured and sustainable manner.
Purpose To evaluate whether patients aged > 75 years with spinal cord injury (SCI) benefit from specialized inpatient rehabilitation, focusing on functional outcomes and discharge destination. Methods This retrospective single-center cohort study was conducted at a specialized SCI unit at the BG Trauma Center Frankfurt, Germany. A total of 160 patients aged ≥ 60 years who completed inpatient SCI rehabilitation between 2010 and 2025 were analyzed. Patients were stratified into two groups: 60–75 years (n = 96) and > 75 years (n = 64). Functional status was assessed using the Spinal Cord Independence Measure (SCIM) at admission and discharge. Outcomes included discharge destination (home vs. institutional care), functional gain (ΔSCIM), in-hospital complications, and medication at discharge. Groups were compared using standard statistical methods. Results At discharge, 68.8% of patients aged > 75 years returned home compared with 81.3% of those aged 60–75 years. Only 7.8% of the older group were discharged home without nursing support. SCIM scores were lower in the > 75 group (27 ± 18 vs. 40 ± 24; p = 0.003), as were functional gains (ΔSCIM: 12 ± 13 vs. 20 ± 19; p = 0.004). Baseline neurological status and in-hospital mortality (6.3% vs. 4.2%; p = 0.554) did not differ significantly between groups. Conclusions Despite reduced functional gains, most very old patients with SCI can be discharged home after rehabilitation. Advanced age alone should not be considered a barrier to treatment. Early, structured discharge planning and adequate post-acute support are essential to reduce institutionalization and support community reintegration.
