Spine Surgeons Social Dilemma: Benefits and Risks of Social Media for Spine Surgery Practice in the 21st Century.

STUDY DESIGN: Cross-sectional observational. BACKGROUND: The use of social media by providers can enhance patient education, complement offline information, facilitate patient support, stimulate brand building, and strengthen the organization's market position. Risks of social media include, but are not limited to, a lack of quality, reliability, misrepresentation of credentials, influence of hidden and overt conflicts of interest, content that may jeopardize patient privacy, HIPAA regulations, and physicians' credentials and licensure. Physicians' use of social media may also expose him/her to lawsuits if providing specific medical advice on media platforms. OBJECTIVE: To document the social media presence of a broad cohort of spine surgeons, and to discuss the benefits and risks of a social media presence. METHODS: Cross-sectional observational of 325 Spine Surgeons from 76 institutions across the US. Description statistic and Pearson's correlation were used to investigate the relationships between the variables. RESULTS: Out of the 325 surgeons, 96% were male with an average age of 51.5 ± 10.7 years and 14.1 ± 9.6 years of experience. The frequency of social media use included 57.2% of surgeons had professional LinkedIn, 17.8% had professional Facebook, and less than 16% had other social media platforms. When combining all platforms together, 64.6% of all surgeons had at least one professional social media platform. 64.0% of these surgeons had no social media activity in the past 90 days, while 19.4% and 10.9% were active once and twice a month, respectively. Surgeon age (P = 0.004), years in practice (P < 0.001), and practice type (P < 0.001) were strongly correlated with social media activity. CONCLUSIONS: Given the scarcity of research on this topic and the novelty of the platforms, social media and online services continue to be utilized at a low level by spine surgeons. Issues regarding the risks of privacy issues with social media users continue to be a concern among medical professionals adopting this technology. This can largely be mitigated with the combination of physician education and informed consent from patients. The ability to connect with patients directly, and provide access to high-quality education and information will be of considerable benefit to our field well into the future.

The Effect of Esophageal Temperature Probes on Postoperative Dysphagia Following Primary Anterior Cervical Discectomy and Fusion: A Randomized Prospective Study.

BACKGROUND: The anterior approach to the cervical spine is associated with postoperative dysphagia. It is difficult to predict which patients are most at risk for dysphagia. The objective of this study was to determine if placing an esophageal temperature probe preoperatively would affect the severity and length of postoperative dysphagia. We hypothesize that use of an esophageal temperature probe would result in worse postoperative dysphagia at all measured time points as measured by the Swallowing-Quality of Life (SQAL-QOL) survey after anterior cervical discectomy and fusion (ACDF). METHODS: A total of 44 patients were enrolled in a prospective, randomized controlled trial and randomized into groups: 1 with an esophageal temperature probe placed at the time of surgery and 2 without. A total of 39 patients filled out postoperative SWAL-QOL questionnaires at their preoperatives. Using the survey results, the data were analyzed between groups and subanalyzed based on number of operative levels and sex. RESULTS: SWAL-QOL scores for patients undergoing 2-level ACDF with an esophageal temperature probe were significantly better compared with those without a probe at 2 weeks and 6 months postoperatively. These results were not significant at other time points in in the overall analysis, but a trend toward improved dysphagia scores at each time point postoperatively was seen with the probe group. No differences were found between the 2 groups with respect to age at the time of surgery, sex, and preoperative SWAL-QOL score. CONCLUSIONS: Placement of an esophageal temperature probe at the time of surgery significantly improved postoperative dysphagia scores in patients undergoing 2-level ACDF at 2 weeks and 6 months postoperatively. LEVEL OF EVIDENCE: 2 CLINICAL RELEVANCE: Placement of a temperature probe is a safe and effective technique that is readily available and easily applicable to the practice of spine surgery and may improve postoperative dysphagia after ACDF.

Analysis of the OITE Oncology Section: An Updated Review of Years 2013 to 2019.

OBJECTIVES: The importance of the Orthopaedic In-Training Examination (OITE) is well documented. The purpose of this study is to provide an updated analysis of the oncology section compared to the review by Frassica et al. from 2002 to 2006, as a means to provide insight into more focused resident study. DESIGN: This study is a retrospective database review using published OITE exams from years 2013 to 2019. Methods were based off a previous review by Frassica et al. where oncology-related questions were analyzed for underlying diagnosis, benign versus malignant condition, imaging and histology provided, and genes/translocations tested. Questions were classified by category and taxonomy. RESULTS: Oncology-related questions per exam ranged from 19 (7%) to 23 (8.4%) of total questions, which is fewer than years 2002 to 2006. Twenty malignant and 27 benign entities were tested with malignant conditions tested at a higher rate of 1.3:1 versus benign. Eighteen combinations of imaging modalities were provided for analysis versus 11 from 2002 to 2006. With regard to taxonomy, the average number of questions per classification ranged from 2.4 to 5.4. The least common classification tested was treatment modality and the most commonly tested classification was treatment from diagnosis (taxonomy 3). Previously, tumor knowledge (taxonomy 1) was most tested with an average of 8.8 questions per exam. 12 questions were directly related to genes and translocations across all years. CONCLUSIONS: Oncology questions made up a smaller percentage of the OITE exam than previous years, although more conditions were tested using more imaging combinations, necessitating a wider range of knowledge. However, malignant conditions continue to be tested more commonly. There has been a shift toward Taxonomy 3 level questions, indicating a higher level of thought processing required from residents as opposed to recall. Additionally, genes and translocations became more commonly tested throughout the most recent analysis, indicating a focus for future years of study.

Cervical Spine Injury Following Thoracic Spinal Fusion for Adolescent Idiopathic Scoliosis.

Spinal fusion for adolescent idiopathic scoliosis (AIS) can have many potential complications, including spinal cord injury. Most often, spinal cord injury occurs in the region of surgery due to direct mechanical trauma. Vascular compromise in this area may also occur due to a high degree of correction or excessive distraction of the spine. In these cases, the impairment of spinal cord function is often detected intraoperatively with spinal cord monitoring and confirmed in the immediate postoperative period. Injury to the spinal cord above the level of instrumentation is rare. We review the clinical history and outcome of a female adolescent who underwent posterior spinal fusion (PSF) for AIS and developed a cervical spine injury 12 hours postoperatively. The patient is a 13-year old female who underwent PSF for AIS from T1 to L1 for progressive scoliosis measuring over 53 degrees in her right thoracic curve. During surgery, she had modest correction with minimal blood loss and with normal intraoperative motor evoked and somatosensory evoked potentials. The immediate postoperative examination was neurologically intact. Twelve hours later, she developed weakness and tingling in her right upper extremity. Magnetic resonance imaging (MRI) of the cervical spine demonstrated myelomalacia on the right side of the spinal cord at the C5-7 levels. Cervical spine injuries are rare following lower-level fusions, however, these injuries can occur and it is important to be vigilant in monitoring patients for these symptoms. The exact mechanism is unknown and may include a combination of postoperative hypotension with altered vascular anatomy from cord stretch and abnormal cervical positioning.

The Effect of Alendronate on Subsidence After Lateral Transpsoas Interbody Fusion: A Preliminary Report.

BACKGROUND: Success after lateral transpsoas interbody fusion (LLIF) partially depends on avoidance of subsidence to maintain spinal alignment, disc space height, and indirect neural decompression. Techniques for preventing subsidence have focused largely on surgical and biomechanical properties of spinal reconstruction; however, medical management may also affect subsidence rates as well. The purpose of this study is to examine the effect of alendronate on minimally invasive LLIF patients with regard to radiographic and catastrophic subsidence. METHODS: We followed 26 patients who had LLIF at the L4-5 level (13 on alendronate, 13 control) and 22 patients at the L3-4 level (10 on alendronate, 12 control). Radiographs were reviewed to obtain measurements of subsidence at the 4 corners of the cage at 3 follow-up time points (2-3, 5-8, and 10-12 months). A Tobit mixed model was used to confirm the results. RESULTS: We found no relationship between alendronate and subsidence for L3-4 fusion. At L4-5 we observed increased subsidence in the control group compared to the alendronate group (difference = 0.07 cm, 95% confidence interval [CI]: -0.01, 0.16, P = .08). There was a decrease in subsidence noted for the alendronate group for each time period (differences: 2-3: -0.06 cm, 95% CI: -0.28, 0.15], P = .27; 5-8: -0.14 cm, 95% CI: -0.36, .08, P = .10; 10-12: -0.21 cm, 95% CI: -0.48, .04, P = .05). CONCLUSIONS: A clear reduction in subsidence was found with the use of postoperative alendronate in patients undergoing L4-5 LLIF. Alendronate had a significant decrease in subsidence at L4-5 after 10-12 months as compared to the control group. Additionally, no patients treated with alendronate had catastrophic subsidence. These data suggest the need for further study of alendronate in the prevention of subsidence after LLIF. LEVEL OF EVIDENCE: 3.