Instagram and Spine Fusion: An Analysis of Social Media and Its Relationship to Patient Perception of Surgery

STUDY DESIGN

Cross sectional study.

OBJECTIVES

To analyze posts shared on Instagram referencing spinal fusion for tone, gender, activities of daily living (ADLs), rehabilitation, incision, pain, neurological injury, and content of post.

METHODS

Public instragram posts, which were isolated and evaluated using the hashtags "#spinefusion" and "#spinalfusion." All posts were analyzed by the authors for the variables previously listed. In total, 264 posts were included for investigation and analysis of patient perception of spine fusion through social media.

RESULTS

Of all included posts, approximately 86% of posts had a positive tone. There was statistical significance between positive tone and activities of daily living (ADLs) (P = 0.047), as well as negative tone and persistent pain (P = 0.008). Adequate return to activities of daily living is perceived by patients as a positive outcome after surgery: odds ratio (OR) (95% CI) of 2.11 (1.01-4.39). Persistent post operative pain results negatively on perceived outcomes after surgery OR = 0.38 (0.18-0.78).

CONCLUSIONS

Reported outcomes after spine fusion has not been evaluated through social media avenues. This analysis of patients sharing their experience on social media after spinal fusion demonstrates that returning to activities of daily living is of the utmost importance to patients. Additionally, post-operative pain is a strong metric utilized by patients with their satisfaction after surgery.

Posterior Capsule Reconstruction with Polypropylene Mesh After Total Hip Arthroplasty

Instability remains a challenge after total hip arthroplasty (THA). We have previously utilized a monofilament polypropylene mesh to reconstruct the posterior capsule for unstable THA. This study identified 24 hips that underwent mesh reconstruction of the posterior capsule for instability. Survivorship was 70.8% at mean 6.5 years (range 6 weeks-20.1 years). Six patients underwent re-operation, and one patient had the mesh removed. Of eight hips, five (62.5%) with a history of prior revision re-dislocated, while only 2/16 hips (12.5%) with no previous revision history re-dislocated (p = 0.02). Posterior capsule reconstruction with polypropylene mesh has reasonable mid-term survivorship in this challenging population. (Journal of Surgical Orthopaedic Advances 32(2):092-096, 2023).

Treatment for sacral insufficiency fractures: A systematic review

Intro

Sacral insufficiency fractures after lumbosacral fusion continue to establish themselves as a rare complication after surgery. The diagnosis can often be missed due to inconclusive imaging and non-specific symptoms. In the literature, the treatment of sacral insufficiency fractures varies from non-operative and conservative management to surgical intervention with lumbopelvic fixation.

Methods

We performed a systematic review searching the PubMed database using sacral insufficiency fracture treatment after lumbosacral fusion and sacral insufficiency fracture after posterior spinal instrumentation as keywords.

Results

This search strategy identified 32 publications from the PubMed database for literature review. After evaluating the inclusion and exclusion criteria, a total of 17 articles were included in the review. 65% of sacral insufficiency fractures were managed surgically with 35% of patients proceeding with non-operative, conservative management only. Revision surgery always involved sacropelvic fixation which typically led to immediate resolution or reduction of symptoms, with the exception of 2 cases that did not receive adequate reduction of symptoms. Five cases reported failed non-operative management that subsequently responded to revision surgery.

Conclusion

Outcomes after non-operative management usually leads to symptom resolution; however has a slower symptom relief time as well as a higher chance of failed treatment. Operative outcomes, generally with a variation of sacropelvic fixation lead to immediate symptom resolution and very rarely failed treatment. Clinicians must always maintain a high index of suspicion of new onset lower back or sacral pain after lumbosacral surgery and order a CT scan to rule out a potential insufficiency fracture.

Objectives

The objective of this study was to review the literature to examine treatment options for sacral insufficiency fractures after lumbosacral fusion in order to improve clinical practice and management. This systematic review of the literature regarding treatment of sacral insufficiency fractures will assist clinicians in making the accurate diagnosis and devise a strategic treatment plan for patients with sacral insufficiency fractures after spinal instrumentation.

William Beall Carrell, MD (1883-1944)

This article commemorates Dr. William Beall Carrell, who made many contributions to the field of orthopedic surgery. His legacy continues through the Carrell Clinic and Scottish Rite for Children in Dallas.

Brandon Carrell, MD (1911-1981)

This biographical sketch on Dr. Brandon Carrell commemorates the life of an influential surgeon in the Dallas community. His contributions to pediatric orthopedic surgery helped form the field it is today.

Spinal Brucellosis: A Case Report and Review of the Literature

Introduction:

The most common location of infection of brucellosis is the musculoskeletal system. It is estimated that the spine is involved in 2–54% of brucellosis infections, with the lumbar spine most commonly affected. We report an uncommon case of brucellar spondylodiscitis, in addition to the pathology, common presentation, and management of spinal brucellosis through additional literature review.

Case Report:

A 65-year-old Hispanic male presented to an orthopedic spine surgeon with signs and symptoms concerning for metastatic disease to the spine. Investigation revealed that the patient had the rare diagnosis of brucellar spondylodiscitis. This only became apparent after detailed questioning of the patient’s history revealed his employment within a Mexican meat slaughterhouse and a regular consumer of unpasteurized Mexican cheeses.

Conclusion:

Although uncommon, brucellosis spondylodiscitis should remain as a differential diagnosis in any patient who presents with back pain and fever. Detailed history taking and thorough physical examination remain vital in the work-up of brucellar spondylodiscitis. Understanding the pathology, radiographic findings, and necessary work-up are essential to properly treat this infection.

Leon L. Wiltse, MD (1913-2005)

This biographical sketch draws on articles written by and about one of the most influential orthopedic spine surgeons of our time, Dr. Leon L. Wiltse. Our aim is to commemorate his life and contributions to the fields of orthopedic and spine surgery, while also highlighting his early connections to the Dallas area.

Triaging Spine Surgery and Treatment during the COVID-19 Pandemic

OBJECTIVE

To utilize evidence-based medicine to help determine guidelines for spinal surgery during the Covid-19 era.

METHODS

A literature review was performed of peer-reviewed articles focused on indications for common procedures in spine surgery. Based on these indications, we sub-categorized these procedures into elective, urgent and emergent categories. Case examples provided.

RESULTS

Indications for spinal surgery were reviewed based on current literature and categorized. This manuscript presents a decision-making algorithm to help provide a guideline for determining the appropriateness of proceeding with spinal surgery during this COVID-19 time period.

CONCLUSIONS

Spinal surgery during the COVID-19 pandemic is an intricate challenging decision-making process, involving clinical, sociologic and economic factors.

James Pat Evans, MD, 1930-2019

This biographical sketch of Dr. J. Pat Evans commemorates the life and contributions of one of the most influential sports surgeons in the history of orthopedic surgery, drawing on articles written in remembrance of him and his contributions to orthopedic surgery and sports medicine.

Surgical automation reduces operating time while maintaining accuracy for direct anterior total hip arthroplasty

Objective

Investigate the efficiency/accuracy of surgical automation versus manual component implantation in DA THA.

Methods

Retrospective review of 111 hips: 51 hips via automation and 60 hips via manual technique for DA THA.

Results

OR time averaged 8 min faster in the Automated group, compared to Manual group (p = 0.0009). Average femoral size was one size larger in the Automated group compared to Manual group (p = 0.007). No clinically significant differences were found between Manual and Automated groups for cup position or limb-length discrepancy. One calcar fracture occurred in the Automated group.

Conclusion

Surgical automation is efficient and accurate for DA THA.

Robert Wilson Jackson, MD (1932-2010)

This article commemorates the life and contributions of one of the most influential sports surgeons in the history of orthopedic surgery, Dr. Robert Jackson.

Financial impact of removal of total knee arthroplasty from the inpatient-only list for a physician-owned BPCI program

Objective

Assessing financial effects of removal of TKA from CMS inpatient-only list on physician-owned bundles.

Methods

We determined whether Medicare TKAs remained inpatient, versus changed to observational. We used CMS data to determine savings. Direct costs associated with BPCI were calculated.

Results

7/28 TKAs (25.0%) had inpatient status changed to observational, excluding them from BPCI. Estimated savings losses were $24,332. Direct costs for administrating BPCI were $51,250. Had the rate of patients changed to observational been 50%, bundle savings from remaining patients would be less than direct costs.

Conclusion

Removing TKA from CMS inpatient-only list may have negative financial implications.

The Interaction of Caseload and Usage in Determining Outcomes of Unicompartmental Knee Arthroplasty: A Meta-Analysis

BACKGROUND

Outcomes after unicompartmental knee arthroplasty (UKA) are variable and influenced by caseload (UKA/y) and usage (percentage of knee arthroplasty that are UKA), which relates to indications. This meta-analysis assesses the relative importance of these factors.

METHODS

MEDLINE (Ovid), Embase (Ovid), and Web of Science (ISI) were searched for consecutive series of cemented Phase 3 Oxford medial UKA. The primary outcome was revision rate/100 observed component years (% pa) with subgroup analysis based on caseload and usage.

RESULTS

Forty-six studies (12,520 knees) with an annual revision-rate ranging from 0% to 4.35% pa, mean 1.21% pa (95% confidence interval [CI], 0.97-1.47), were identified. In series with mean follow-up of 10-years, the revision-rate was 0.63% pa (95% CI, 0.46-0.83), equating to a 94% (95% CI, 92%-95%) 10-year survival. Aseptic loosening, lateral arthritis, bearing dislocation, and unexplained pain were the predominant failure mechanisms with revision for patellofemoral problems and polyethylene wear exceedingly rare. The lowest revision-rates were achieved with caseload >24 UKA/y (0.88% pa; 95% CI, 0.63-1.61) and usage >30% (0.69% pa; 95% CI, 0.50-0.90). Usage was more important than caseload; with high usage (≥20%), the revision-rate was low, whether the caseload was high (>12 UKA/y) or low (≤12 UKA/y; (0.94% pa; 95% CI, 0.69-1.23 and 0.85% pa; 95% CI, 0.65-1.08), respectively); with low usage (<20%), the revision-rate was high, whether the caseload was high or low (1.58% pa; 95% CI, 0.57-3.05 and 1.76% pa; 95% CI, 1.21-2.41, respectively).

CONCLUSION

To achieve optimum results, surgeons, whether high or low caseload, should adhere to the recommended indications such that ≥20%, or ideally >30% of their knee arthroplasties are UKA. If they do this, then they can expect to achieve results similar to those of the long-term series, which all had high usage (>20%) and an average 10-year survival of 94%.