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.

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.

Sacral insufficiency fracture after lumbosacral decompression and fusion.

Sacral insufficiency fracture is becoming increasingly recognized as a complication of lumbosacral fusion, due to alteration of spinal biomechanics. Recognition of patient presentation is important because plain films may initially be negative with this complication. This case series of seven sacral insufficiency fractures following lumbosacral fusion characterizes key characteristics of presentation and management for sacral insufficiency fracture following lumbosacral fusion, which does not have a clearly defined algorithm for treatment. These seven fractures presented with initial complaints of back pain, lower extremity radicular symptoms, or a combination of the two. All identified fractures in this series were located below the inferior-most level of the fusion construct. Cross-sectional imaging such as computed tomography or magnetic resonance imaging was utilized in each case to make the diagnosis of sacral insufficiency fracture. Management depends on the patient's presentation, symptoms, and fracture pattern, but treatment options include operative revision surgery and nonoperative modalities such as a standard rehabilitation protocol, lumbar bracing, and bone stimulators with close follow-up.

Instagram and Anterior Cervical Discectomy and Fusion Surgery: An Analysis of Social Media and Its Relationship to Patient Perception of Surgery.

BACKGROUND: Multiple studies have utilized social media to evaluate patient-perceived outcomes after surgery. To the authors knowledge, no published studies have evaluated patient-perceived outcomes after ACDF surgery through social media analysis. OBJECTIVE: To analyze posts shared on Instagram referencing anterior cervical discectomy and fusion (ACDF) for tone, gender, activities of daily living (ADLs), rehabilitation, incision, pain, neurological injury, complications, and content of post. STUDY DESIGN: Cross-sectional study. METHODS: Public instragram posts were isolated and evaluated using the hashtag "#ACDF." Each individual post was analyzed by the authors for the variables previously listed. In total, 529 posts were included for investigation and analysis of patient perception of ACDF through social media. RESULTS: Of all included posts, approximately 95% of posts had a positive tone. There was statistical significance between positive tone and ADLs (P = 0.0379) and rehabilitation (P = 0.0118), as well as negative tone with persistent pain (P ≤ 0.001), incision/scar (P = .0143), and surgical complications (need for reoperation/nonunion/infection) (P = 0.0259). CONCLUSIONS: Reported outcomes after ACDF have not been evaluated through social media avenues. This analysis of patients sharing their experiences on social media after ACDF demonstrates that returning to ADL, rehabilitation, pain, and incisions are of the utmost importance to patients.

Design and Retrospective Application of a Spine Trauma DVT Prophylaxis Protocol on Level 1 Trauma Center Patient Database.

STUDY DESIGN: Systematic literature review. OBJECTIVES: The impact of thromboembolic disease on the morbidity and mortality of patients with acute spinal cord injury is well documented, with rates as high as 67%-100% among untreated patients. The efficacy of mechanical prophylaxis as a stand-alone measure has been questioned, so we sought to determine a safe perioperative window for chemical anticoagulation use after spine surgery. Many surgeons have concerns anticoagulants may cause post-operative hematoma. METHODS: A systematic literature review was performed, ultimately yielding 13 articles. Based on the existing literature and input from our multidisciplinary institutional trauma committee, a Spine Trauma DVT Prophylaxis Protocol was developed. RESULTS: Effort was placed to identify cases within our institution in which patients suffered vertebral column fractures and/or spinal cord injuries. Of these 466 vertebral column fractures and/or spinal cord injuries, 4 patients were identified and diagnosed with DVTs while admitted. CONCLUSIONS: Of these patients, there is a clear dilemma with regard to safety of chemoprophylaxis use versus risk of developing a DVT. Though none of the patients developed a PE, utilizing the protocol would have led to earlier IVC filter placement or initiation of a VTE surveillance protocol in 2 of the patients. Initiation of enoxaparin before surgery in one patient (despite delay of surgical timing) may have avoided his subsequent LUE DVT. Though not appropriate for all clinical scenarios, we are confident that our treatment algorithm will prove beneficial for patient care in avoiding DVTs and helping trauma surgeons with evidence-based clinical decision making.

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.

The erector spinae plane block for analgesia after lumbar spine surgery: A systematic review.

OBJECTIVE: To evaluate the available evidence for the utility of Erector Spinae Plane blocks (ESPB) after Lumbar surgery. METHODS: Databases were searched until December 20, 2020. ESPB was utilized as a MesH term and terms such as: lumbar spinal stenosis, spondylolisthesis, decompression and lumbar spine surgery. RESULTS: Studies demonstrate that ESPB are consistently found to be a safe and effective method of analgesia after lumbar surgery, with limited adverse effects. CONCLUSION: ESPB appear to be an effective method to relieve pain after lumbar surgery. More RCTs will be needed to further investigate the clinical effectiveness of this intervention.

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.

Giant cell tumor of the sacrum.

Giant cell tumor of the sacrum is a rare primary tumor in a challenging anatomical location without clear consensus on treatment. We present a case of giant cell tumor of the sacrum and subsequent treatment with preoperative embolization, L5 to S4 laminectomy, partial sacrectomy, intraoperative thermal ablation, and L4 to pelvis stabilization and fusion.

Superior sulcus tumor disguised as cervical radiculopathy with metastasis to brachial plexus.

A 74-year-old man presented to an orthopedic spine surgeon with signs and symptoms consistent with cervical radiculopathy. Investigation revealed metastasis of a Pancoast tumor to the patient's brachial plexus. A year after initial diagnosis, the patient achieved full neurological function of his left arm. Pancoast tumors are rare in the orthopedic population. Thorough physical examination, imaging, and nerve conduction studies ultimately led to the patient's diagnosis.

The regenerative effects of electromagnetic field on spinal cord injury.

Traumatic spinal cord injury (SCI) is typically the result of direct mechanical impact to the spine, leading to fracture and/or dislocation of the vertebrae along with damage to the surrounding soft tissues. Injury to the spinal cord results in disruption of axonal transmission of signals. This primary trauma causes secondary injuries that produce immunological responses such as neuroinflammation, which perpetuates neurodegeneration and cytotoxicity within the injured spinal cord. To date there is no FDA-approved pharmacological agent to prevent the development of secondary SCI and induce regenerative processes aimed at healing the spinal cord and restoring neurological function. An alternative method to electrically activate spinal circuits is the application of a noninvasive electromagnetic field (EMF) over intact vertebrae. The EMF method of modulating molecular signaling of inflammatory cells emitted in the extra-low frequency range of <100 Hz, and field strengths of <5 mT, has been reported to decrease inflammatory markers in macrophages, and increase endogenous mesenchymal stem cell (MSC) proliferation and differentiation rates. EMF has been reported to promote osteogenesis by improving the effects of osteogenic media, and increasing the proliferation of osteoblasts, while inhibiting osteoclast formation and increasing bone matrix in vitro. EMF has also been shown to increase chondrogenic markers and collagen and induce neural differentiation, while increasing cell viability by over 50%. As advances are made in stem cell technologies, stabilizing the cell line after differentiation is crucial to SCI repair. Once cell-seeded scaffolds are implanted, EMF may be applied outside the wound for potential continued adjunct treatment during recovery.

Fascicular anatomy of human femoral nerve: implications for neural prostheses using nerve cuff electrodes.

Clinical interventions to restore standing or stepping by using nerve cuff stimulation require a detailed knowledge of femoral nerve neuroanatomy. We harvested eight femoral nerves with all distal branches and characterized the branching patterns and diameters. The fascicular representation of each distal nerve was identified and traced proximally to create fascicle maps of the compound femoral nerve in four cadaver specimens. Distal nerves were consistently represented as individual fascicles or distinct groups of fascicles in the compound femoral nerve. Branch-free length of the compound femoral nerve was 1.50 +/- 0.47 cm (mean +/- standard deviation). Compound femoral nerve cross sections were noncircular with major and minor diameters of 10.50 +/- 1.52 mm and 2.30 +/- 0.63 mm, respectively. In vivo intraoperative measurements in six subjects were consistent with cadaver results. Selective stimulation of individual muscles innervated by the femoral nerve may therefore be possible with a single neural prosthesis able to selectively stimulate individual groups of fascicles.