Post-operative quadriparesis following posterior cervical laminectomy and fusion: A case-series of incidence, risk factors, and management.

OBJECTIVE: Post-operative quadriparesis following posterior cervical decompression and fusion is a rare but devastating complication. Unless rapidly identified and treated, it can cause permanent injury and disability. Given the sparse literature on this topic we intend to report on its incidence, to identify potential predisposing risk factors, and to discuss management considerations. METHODS: We retrospectively reviewed a series of 301 patients who underwent posterior cervical decompressive laminectomies and instrumented fusion performed by the senior author between 2006 and 2020. We describe the clinical courses and interventions for the seven of these 301 patients who developed post-operative quadriparesis. RESULTS: The incidence of post-operative quadriparesis following cervical spine decompressive laminectomies and instrumented fusion was 2.3% (7/301) in our study. The mean time-to-onset was 2 days, and the most common pathology was post-operative hematoma. We did not identify any statistically significant risk factors that predispose patients to post-operative quadriparesis. In our series, the patients with post-operative quadriparesis without profound hypotension who underwent emergent surgical decompression demonstrated improved neurologic outcomes compared to those who underwent interval imaging prior to decompression. CONCLUSION: Post-operative quadriparesis following cervical spine surgery is a catastrophic complication that is poorly reported and under-studied in current literature. In this study, we found a 2.3% incidence of post-operative quadriparesis with no obvious risk factors predisposing patients to this adverse outcome. We advocate that post-operative quadriparesis following cervical spine surgery, in the absence of profound hypotension, warrants emergent surgical site exploration without delay for interval imaging.

General Surgery Going Viral: Current Trends in Social Media Utilization by General Surgery Residency Programs.

OBJECTIVE: This study examined the current and changing trends in utilization of social media platforms by general surgery residency programs. DESIGN: US general surgery residency programs were identified. Facebook, Instagram, and Twitter were surveyed for active accounts specific to an institution's general surgery residency program. Metrics for these accounts included: Date of first post/date of account creation, total number of posts, number of followers, number of posts categorized per year for 2017, 2018, 2019, 2020, and 2021. Active accounts were categorized into university based, university affiliated, or independent programs. Number of followers and the number of posts were compared among those categories. Data collection took place from 7/21/2021 - 8/2/2021. RESULTS: 295 social media accounts were identified. 55% of all programs have at least one social media account. Instagram (47.8%) and Twitter (36.3%) make up the majority of the social media accounts. The majority of all social media accounts (51.2%) were created in 2020. Instagram saw the largest increase in activity in 2020 with posting increasing by 403.7% compared to 2019. Twitter accounts had the highest amount of posts in 2020 (9940). Instagram accounts have the highest follower base (113,499). Facebook also saw increased posting in 2020 but its overall account creation has remained stagnant. University based program accounts have higher on average followers and posts when compared to independent program accounts. CONCLUSION: Social media accounts specific to general surgery residency programs have grown steadily in the past few years, with a dramatic rise of account creation and activity in 2020. Instagram and Twitter serve as the dominant platforms for new account creation and activity. University based programs attract more followers than independent programs on Instagram and Twitter.