TLIF Online Videos for Patient Education-Evaluation of Comprehensiveness, Quality, and Reliability.

Over the last few decades, the number of lumbar interbody fusion surgeries performed has been constantly increasing, with transforaminal lumbar interbody fusion (TLIF) being one of the most common surgical techniques. Due to easy accessibility, patients frequently use YouTube to obtain information on health-related issues. Consequently, online video platforms may be a valuable tool for patient education. The aim of this study was to assess the quality, reliability, and comprehensiveness of online videos on TLIF. We screened 180 videos on YouTube, yielding a total of 30 videos that met the inclusion criteria. These videos were evaluated using Global Quality Scale, DISCERN reliability tool, and JAMA Benchmark Score, and assessed in regard to their comprehensiveness and coverage of relevant aspects. At the time of rating, the videos had between 9188 and 1,530,408 views and between 0 and 3344 likes. The median rater assessment for all videos was "moderate quality". GQS and subjective grades showed a moderate to strong statistically significant association with views and likes. Considering this association of GQS and subjective grade with views and likes, these criteria could be used by laypersons to identify good-quality content. Nevertheless, there is an urgent need for peer-reviewed content that covers all of the relevant aspects.

Risk Factors of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis-The Spinous Processes and Proximal Rod Contouring.

Proximal junctional kyphosis (PJK), as one of the most discussed problems after corrective surgery in adolescent idiopathic scoliosis (AIS), is still not fully clarified and seems to be multifactorial. Biomechanical and a few clinical studies have shown the influence of destruction of posterior ligaments by resection of spinous processes and some parameters concerning rod contouring as risk factors for PJK. To verify these results, 192 patients with AIS and corrective surgery via a posterior approach between 2009 and 2017 were included. Radiographic parameters were analyzed preoperatively (preOP), postoperatively (postOP), and with a mean follow up (FU) of 27 months. The participants were divided into two groups (PJK group and non-PJK group). The incidence of PJK was 15.6%. Contrary to the results of biomechanical studies, we could not find any significant influence of the spinous process resection. However, the PJK group had significantly larger preOP T4-T12 kyphosis (31.1° ± 13.93° vs. 23.3° ± 14.93°, p = 0.016). Furthermore, the PJK group showed a significantly larger rod contour angle (RCA) (8.0° ± 4.44° vs. 5.9° ± 3.28°, p = 0.003) and mismatch of postOP proximal junctional angle (PJA) and RCA (3.5° ± 5.72° vs. 0.9° ± 4.86°, p = 0.010) compared to the non-PJK group. An increase in the mismatch of postOP PJA and RCA (OR = 1.14, p = 0.008) and a high RCA are risk factors for PJK and need to be focused on by surgeons.

Surgeons' non-transparent facemasks challenge the physician-patient relationship in the orthopedic outpatient clinic of a tertiary university hospital during the COVID-19 pandemic: a prospective cohort study of 285 patients.

Background and purpose - Facemasks play a role in preventing the respiratory spread of SARS-CoV-2, but their impact on the physician-patient relationship in the orthopedic outpatient clinic is unclear. We investigated whether the type of surgeons' facemask impacts patients' perception of the physician-patient relationship, influences their understanding of what the surgeon said, or affects their perceived empathy. Patients and methods - All patients with an appointment in the orthopedic outpatient clinic of a tertiary university hospital during the 2-week study period were included. During consultations, all surgeons wore a non-transparent (first study week) or transparent facemask (second study week). Results of 285 of 407 eligible patients were available for analysis. The doctor-patient relationship was evaluated using the standardized Patient Reactions Assessment (PRA) and a 10-point Likert-scale questionnaire ranging from 0 (strongly disagree) to 10 (strongly agree). Results - A non-transparent facemask led to more restrictions in the physician-patient communication and a worse understanding of what the surgeon said. Patients' understanding improved with a transparent facemask with greatest improvements reported by patients aged 65 years and older (non-transparent: 6 [IQR 5-10] vs. transparent: 10 [IQR 9-10], p < 0.001) and by patients with a self-reported hearing impairment (non-transparent: 7 [IQR 3-7] vs. transparent: 9 [IQR 9-10], p < 0.001). The median PRA score was higher when surgeons wore a transparent facemask (p= 0.003). Interpretation - Surgeons' non-transparent facemasks pose a new communication barrier that can negatively affect the physician-patient relationship. While emotional factors like affectivity and empathy seem to be less affected overall, the physician-patient communication and patients' understanding of what the surgeon said seem to be negatively affected.

Invasive diagnostic and therapeutic measures are unnecessary in patients with symptomatic van Neck-Odelberg disease (ischiopubic synchondrosis): a retrospective single-center study of 21 patients with median follow-up of 5 years.

Background and purpose - Van Neck-Odelberg disease (VND) is a self-limiting skeletal phenomenon characterized by a symptomatic or asymptomatic uni- or bilateral overgrowth of the pre-pubescent ischiopubic synchondrosis. It is frequently misinterpreted as a neoplastic, traumatic, or infectious process, often resulting in excessive diagnostic and therapeutic measures. This study assessed the demographic, clinical, and radiographic features of the condition and analyzed diagnostic and therapeutic pathways in a large single-center cohort.Patients and methods - We retrospectively analyzed 21 consecutive patients (13 male) with a median age of 10 years (IQR 8-13) and a median follow-up of 5 years (IQR 42-94 months), who were diagnosed at our department between 1995 and 2019.Results - VND was unilateral in 17 cases and bilateral in 4 cases. Initial referral diagnoses included suspected primary bone tumor (n = 9), fracture (n = 3), osteomyelitis (n = 2), and metastasis (n = 1). The referral diagnosis was more likely to be VND in asymptomatic than symptomatic patients (4/6 vs. 2/15). More MRI scans were performed in unilateral than bilateral VND (median 2 vs. 0). All 15 symptomatic patients underwent nonoperative treatment and reported a resolution of symptoms and return to physical activity after a median time of 5 months (IQR 0-6).Interpretation - By understanding the physiological course of VND during skeletal maturation, unnecessary diagnostic and therapeutic measures can be avoided and uncertainty and anxiety amongst affected patients, their families, and treating physicians can be minimized.

Magnetically Controlled Growing Rods in Treatment of Early-Onset Scoliosis: A Single Center Study With a Minimum of 2-Year-Follow up and Preliminary Results After Converting Surgery.

STUDY DESIGN: Case series. OBJECTIVE: To evaluate complications and radiographic parameters after magnetically controlled growing rod (MCGR) index surgery (IS), during lengthening and following converting surgery (CS) with a minimum of 2-year follow up (FU). SUMMARY OF BACKGROUND DATA: MCGR are maintaining skeletal growth in treatment of early onset scoliosis (EOS). There is no data regarding correction potential after CS available. METHODS: Twenty-four cases were included. Two patients with rib and pelvic hook fixation instead of pedicle screws and three patients with previous spinal surgery were excluded from radiographic analysis. RESULTS: Twenty-one patients received grade 3 or 4 in Classification of Early-Onset-Scoliosis (C-EOS) for main curve severity. The kyphotic modifiers (-) were given to seven and (+) to seven patients. Mean age at IS was 10.5 ±â€Š2.4 years with a mean FU time of 42.3 ±â€Š11.3 months. Deformity correction was only achieved during IS (46%) and CS (36%). During MCGR treatment a 5° loss of correction seen, while 25 mm of T1-S1 length was gained during the lengthening period. An overall average lengthening of 1.6 mm per lengthening procedure was achieved. Possibility to gain length during distractions decreases over time. No major failure of the distraction mechanism was observed, only 16 lengthening procedures failed within a total of 264 lengthening procedures. A total of 19 revision surgeries in 10 patients were observed. Four patients received more than one revision surgery. CONCLUSION: Applying MCGR results in a revision rate of 0.23 per patient and per one FU year, while making further lengthening procedures obsolete compared with conventional growing rod techniques. Correction of major curve is possible during IS und CS. The law of diminishing returns applies during the period of lengthening. LEVEL OF EVIDENCE: 4.