Assessment of Impact of Long-Cassette Standing X-rays on Surgical Planning for Lumbar Pathology: An International Survey of Spine Surgeons
Bibliographic record
Abstract
Introduction Surgical planning to address significant lumbar spine pathology, performed without appreciation of global spinal alignment, may have negative consequences. Our objective was to assess whether the extent of recommended surgery for lumbar pathology would significantly change with the addition of long-cassette standing X-rays. Materials and Methods This was an international online survey of spine surgeons. A series of 15 cases of lumbar spine pathology was presented with a brief clinical vignette and lumbar imaging (X-rays and MRI/CT). Surgeons were asked to select the most appropriate surgical plan, with five choices, ranging from least aggressive (decompression alone; 1 point) to the most aggressive (upper thoracic to sacrum/ilium fusion ± osteotomies/decompression/interbodies; 5 points). Cases were then reordered and presented with long-cassette standing X-rays and the same surgical planning question. Results were compared based on lumbar imaging only versus addition of long-cassette X-rays. Five cases (control group) had normal global alignment and 10 cases (study group) had global malalignment. Results A total of 316 surgeons completed the survey, predominantly (63%) from North America and Europe. Specialties included orthopedic surgery (65%) and neurosurgery (34%), 68% completed spine fellowship, and responders had a mean 13.4 years in practice that was a mean of 76% spine and included a mean of 123 fusions per year. For study cases, extent of recommended surgery increased significantly with the addition of long-cassette X-rays versus lumbar imaging only ( p = 0.002). For control cases with normal global alignment, no significant changes in surgery plans were identified with the addition of long-cassette X-rays ( p = 0.280). Conclusion Long-cassette standing X-rays can have a significant impact on surgical planning for lumbar pathology. Surgeons should maintain a relatively low threshold for obtaining long-cassette standing X-rays when contemplating surgical treatment for significant lumbar spine pathology.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".