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Abstract Artificial intelligence (AI)-facilitated clinical automation is expected to become increasingly prevalent in the near future. AI techniques may permit rapid and detailed analysis of the large quantities of clinical data generated in modern healthcare settings, at a level that is otherwise impossible by humans. Subsequently, AI may enhance clinical practice by pushing the limits of diagnostics, clinical decision making, and prognostication. Moreover, if combined with surgical robotics and other surgical adjuncts such as image guidance, AI may find its way into the operating room and permit more accurate interventions, with fewer errors. Despite the considerable hype surrounding the impending medical AI revolution, little has been written about potential downsides to increasing clinical automation. These may include both direct and indirect consequences. Directly, faulty, inadequately trained, or poorly understood algorithms may produce erroneous results, which may have wide-scale impact. Indirectly, increasing use of automation may exacerbate de-skilling of human physicians due to over-reliance, poor understanding, overconfidence, and lack of necessary vigilance of an automated clinical workflow. Many of these negative phenomena have already been witnessed in other industries that have already undergone, or are undergoing “automation revolutions,” namely commercial aviation and the automotive industry. This narrative review explores the potential benefits and consequences of the anticipated medical AI revolution from a neurosurgical perspective.

Background Autogenous iliac crest bone marrow aspirate (BMA) has been shown to be a safe osteobiological adjunct to anterior cervical discectomy and fusion (ACDF), but little evidence exists to support its superiority to traditional methods. The object of this study was to retrospectively evaluate two cohorts of patients undergoing ACDF - with or without the use of BMA - in an effort to better characterize the clinical and radiographic outcomes associated with the use of BMA in ACDF. Methods The charts of all patients undergoing ACDF with a collagen-hydroxyapatite (CHA) sponge, local vertebral autograft and a polyetheretherketone (PEEK) interbody graft with or without BMA by a single staff neurosurgeon between 2011 and 2016 were retrospectively reviewed. Post-operative dynamic plain films and CT scans for each patient were reviewed and each instrumented level was independently evaluated for fusion over time. Results A total of 203 cervical levels were instrumented in 92 patients (with BMA, 52 patients, 122 levels; without BMA, 40 patients, 81 levels). The mean radiographic follow-up period was 21.4 ± 18.4 months, over which time 154 of 203 (75.6%) instrumented cervical levels were found to have fused (BMA group, 93/122 segments fused [76.2%]; non-BMA group, 61/81 segments fused [75.3%], p = 1). Kaplan-Meier survival analysis demonstrated a higher probability of fusion at any given time point for the BMA group when compared with the non-BMA group (p < 0.001, log-rank test). Conclusions BMA is a readily accessible, low-cost adjunct to ACDF that enhances the fusion rates seen with a CHA/PEEK allograft combination.

The distribution of relaxation rates of water in \"normal\" (autopsy) samples of canine and human brain shows considerable overlap with that for brain tumor samples. The following ranges of values for the spin-spin relaxation rates were observed: for normal brain gray matter, 8.6 to 11.3 sec$^{-1}$ (mean, 9.5 sec$^{-1}$); for normal brain white matter, 13.3 to 15.7 sec$^{-1}$ (mean, 15.5 sec$^{-1}$); for six types of malignant tumor, 4.8 to 13.4 sec$^{-1}$ (mean, 9.3 sec$^{-1}$); for five types of benign tumor, 7.1 to 16.4 dsec$^{-1}$ (mean, 11.5 sec$^{-1}$). Spin-lattice relaxation rates showed a similar pattern. At least two nonexchanging water components with different relaxation rates were indicated by the analysis of the spin-spin relaxation measurements for the white matter samples.

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Just about everybody who has been conned into contributing to a pension scam will never receive back anything like the amount they invested or the predicted annuity they were \"promised\" (Teachers lose pounds 8,000 from switch to CPI, 8 October). The only exceptions are the MPs who get the very best gold-plated, inflation-linked, final-salary, taxpayer-funded pensions, and the \"fat cat\" bankers who selfishly take all the profits and pass the losses back to the investor. * Those who complain about and criticise teachers because they have \"gold-plated\" pensions of, on average, pounds 10,000 a year, should try teaching in a school for a week to see what it's like.