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PurposeFull-endoscopic techniques are minimally invasive surgery alternatives to traditional spinal surgery. We performed a systematic review of the literature to assess the costs of these techniques compared to traditional approaches.MethodsA systematic review of the literature was performed for economic evaluations that compare endoscopic decompressions of the lumbar spine for stenosis or disc herniation to open or microsurgical decompressions. The search was performed in the following databases: Medline, Embase Classic, Embase, and Central Cochrane library, from January 1, 2005, to October 22, 2022. The included studies were each evaluated according to a formal assessment checklist to evaluate the quality of economic evaluations based on 35 criteria.ResultA total of 1153 studies were identified, with 9 articles included in the final analysis. In evaluating the quality of economic evaluations, the study with the fewest met criteria scored 9/35 and the study with the most met criteria scored 28/35. Only 3 studies completed cost-effectiveness analyses. Surgical procedure duration varied between studies, but hospital length of stays were consistently shorter with endoscopy. While endoscopy was more frequently associated with higher operating costs, studies that measured healthcare and societal costs found endoscopy to be advantageous.ConclusionEndoscopic spine surgery was found to be cost-effective in treating patients with lumbar stenosis and disc herniation when compared to standard microscopic approaches from a societal perspective. More well-designed economic evaluations investigating the cost-effectiveness of endoscopic spine procedures are needed to further support these findings.

Many Royal College of Physicians and Surgeons of Canada (RCPSC) graduates in neurosurgery face significant challenges in finding full-time employment. The current study describes the career outcomes of neurosurgery residents from Canadian programs. All RCPSC neurosurgery graduates ( = 106) who completed their residency between 2015 and 2020 were included in this study. Baseline characteristics were determined for the entire cohort and then stratified by employment status. Several logistic regression models were used to identify predictors of full-time employment after residency. Overall, 26.4% of neurosurgery graduates from 2015 to 2020 have been underemployed, defined as locum and clinical associate positions (6.6%), the pursuit of multiple fellowships (16%) and career change/nonsurgical career (3.8%). Only 52.0% of graduates were fully employed in Canada, with 30.2% appointed at academic institutions. Skull-base/open vascular (OR: 0.055, 95%CI [<0.01, 0.74]) and general neurosurgery (OR: 0.027, 95% CI [<0.01, 0.61]) fellowships were associated with underemployment. Advanced research degrees (master's or Ph.D.) and sex were not associated with full-time employment. Over one-quarter of recent Canadian neurosurgery graduates were underemployed, and nearly half do not find employment in Canada. These results reflect a concerning reality for current and prospective neurosurgery graduates in Canada and will hopefully serve as a call to action for the Canadian neurosurgery community.

The advent of robotic total knee arthroplasty (TKA) in the field of orthopedics has caused much discussion on social media. As social media grows, its platforms are becoming an increasingly popular medium for health care-related discussions. This study aimed to better understand the current public discussion about robotic TKA on social media. We aimed to characterize these discussions by analyzing their contributors, the general sentiment, the temporal trends, and the content. A comprehensive search of the Twitter database for academic research was performed from inception (March 2006) to April 1, 2023, to identify all tweets related to robotic TKA. General data regarding the tweets and the accounts were retrieved. ChatGPT-4o (OpenAI) was used to categorize the post's content and the accounts into different categories developed via iterative testing. The content was categorized using a rule-based classification algorithm developed using Python to assign categories based on keyword presence, phrase matching, and syntactic patterns. Regarding the accounts, an automated keyword-based rule engine was implemented in Python to classify accounts based on the account's name and description. We used a lexicon-based natural language processing Python library, via ChatGPT-4o, to assign a sentiment to the tweets and conducted subgroup sentiment analysis. A total of 2000 tweets were retrieved for analysis. Account analysis revealed that the most prevalent account categories were \"medical professionals\" (619/2000, 31.0%), \"patients and community\" (274/2000, 13.7%), and \"media and publications\" (268/2000, 13.4%). Content analysis revealed that the most prevalent tweet themes were \"technology and innovation\" (550/2000, 27.5%), \"advertising and promotion\" (176/2000, 8.8%), and \"research and data\" (172/2000, 8.6%). Sentiment analysis showed that 61.6% (1231/2000) of the tweets had a positive sentiment, while 9.2% (183/2000) were neutral, and 29.3% (586/2000) had a negative sentiment. Accounts categorized as \"institutions\" had the highest prevalence of positive sentiment (165/229, 72.1%), while accounts categorized as \"media and publications\" had the highest prevalence of negative sentiment (88/268, 32.8%). The number of tweets relating to robotic TKA has been steadily rising since 2016, with a peak incidence of 402 (20.1%) tweets published in 2022. The increased number of tweets with a positive sentiment suggests a positive outlook toward robotic TKA. Institutions had the highest prevalence of positive sentiment, suggesting a possible bias toward positive reporting of robotic TKA, likely for commercial reasons. Media and publications had the highest prevalence of negative sentiment, which may represent skepticism and bias toward negative reporting on robotic technologies in health care. Medical professionals contributed significantly to the discussion about robotic TKA, while patient involvement was relatively small. The number of tweets relating to robotic TKA has been steadily growing since 2016, which indicates that robotic TKA has been gaining in popularity over recent years.

PurposeThe number of articles retracted by peer-reviewed journals has increased in recent years. This study systematically reviews retracted publications in the spine surgery literature.MethodsA search of PubMed MEDLINE, Ovid EMBASE, Retraction Watch, and the independent websites of 15 spine surgery-related journals from inception to September of 2022 was performed without language restrictions. PRISMA guidelines were followed with title/abstract screening, and full-text screening was conducted independently and in duplicate by two reviewers. Study characteristics and bibliometric information for each publication was extracted.ResultsOf 250 studies collected from the search, 65 met the inclusion criteria. The most common reason for retraction was data error (n = 15, 21.13%), followed by plagiarism (n = 14, 19.72%) and submission to another journal (n = 14, 19.72%). Most studies pertained to degenerative pathologies of the spine (n = 32, 80.00%). Most articles had no indication of retraction in their manuscript (n = 24, 36.92%), while others had a watermark or notice at the beginning of the article. The median number of citations per retracted publication was 10.0 (IQR 3–29), and the median 4-year impact factor of the journals was 5.05 (IQR 3.20–6.50). On multivariable linear regression, the difference in years from publication to retraction (p = 0.0343, β = 6.56, 95% CI 0.50–12.62) and the journal 4-year impact factor (p = 0.0029, β = 7.47, 95% CI 2.66–12.28) were positively associated with the total number of citations per retracted publication. Most articles originated from China (n = 30, 46.15%) followed by the United States (n = 12, 18.46%) and Germany (n = 3, 4.62%). The most common study design was retrospective cohort studies (n = 14, 21.54%).ConclusionsThe retraction of publications has increased in recent years in spine surgery. Researchers consulting this body of literature should remain vigilant. Institutions and journals should collaborate to increase publication transparency and scientific integrity.

Robotic technology has been used in total hip arthroplasty (THA) for several years. Despite the advances in this field, perspectives surrounding robotic THA are not fully understood. This study aimed to characterize the landscape of robotic THA on social media. The Twitter application programming interface was queried from inception to October 2022 for keywords related to THA and robotics. Posts and accounts were extracted and classified using thematic labels. Sentiment analysis was performed on the extracted tweets. After removal of duplicate posts and illegitimate accounts, a total of 742 tweets from 741 accounts were retrieved. Most posts pertained to raising awareness about robotic THA ( = 340, 45.8%), advertisements for THA robots ( = 204, 27.5%), and personal experiences ( = 138, 18.6%). Research was discussed in 7.0% ( = 52) of posts. Most accounts belonged to patients or caregivers ( = 177, 23.9%), followed by medical centres ( = 175, 23.6%), news outlets ( = 158, 21.3%), and physicians or researchers ( = 101, 13.6%). Most posts discussing personal experience were positive ( = 70, 50.7%) or neutral ( = 39, 28.2%). Presence of media (β = 3.3, 95% confidence interval [CI] 1.5 to 5.1) and tagging (β = 2.1, 95% CI 0.3 to 2.8) positively affected user engagement, whereas the presence of a link decreased tweet engagement count by 2.8 (95% CI -5.4 to -0.2). Topics about robotic THA were discussed in a positive tone on Twitter (rebranded to X in 2023). Posts about raising awareness and advertisements for robotic THA were most prevalent, while research-related posts were limited. Orthopedic surgeons can leverage social media to better understand patient perspectives and glean insight from the robotic surgery industry. La robotique est utilisée depuis plusieurs années pour l'arthroplastie totale de la hanche (ATH). Malgré les progrès réalisés dans ce domaine, on connaît encore mal l'opinion qu'elle suscite. La présente étude visait à dresser un tableau de l'ATH robotisée telle qu'on l'aborde sur les réseaux sociaux. MÉTHODES: L'interface de programmation d'application de Twitter a été analysée depuis sa création et jusqu'à octobre 2022 à partir de mots clés reliés à l'ATH et à la robotique. Les messages et les comptes ont été extraits et classés par thèmes et une analyse des sentiments a été effectuée à partir de ces messages. RÉSULTATS: Après élimination des doublons et des faux comptes, nous avons retenu en tout 742 messages provenant de 741 comptes. La plupart visaient à faire connaître l'ATH assistée par robot ( = 340, 45,8 %), faisaient la publicité pour des robots d'ATH ( = 204, 27,5 %) et relataient des expériences personnelles ( = 138, 18,6 %). La recherche était abordée dans 7,0 % ( = 52) des messages. Les comptes étaient principalement ceux de patientes ou patients ou de membres du personnel soignant ( = 177, 23,9 %), suivis des centres médicaux ( = 175, 23,6 %), des médias d'information ( = 158, 21,3 %) et du milieu médical ou scientifique ( = 101, 13,6 %). La majorité des messages concernant une expérience personnelle étaient positifs ( = 70, 50,7 %) ou neutres ( = 39, 28,2 %). La présence de médias d'information (β = 3,3, intervalle de confiance [IC] de 95 % 1,5 à 5,1) et le marquage (β = 2,1, IC de 95 % 0,3 à 2,8) ont exercé une influence positive sur l'engagement des utilisateurs, tandis que la présence d'un lien a eu l'effet contraire en réduisant l'engagement de 2,8 (95 % CI -5,4 à -0,2). Les thèmes entourant l'ATH assistée par robot ont fait l'objet de discussions favorables sur Twitter (devenu X en 2023). Les messages visant à en faire connaître l'existence ou à en faire la publicité étaient les plus nombreux, tandis que les messages portant sur la recherche étaient limités. Les orthopédistes peuvent mettre les médias sociaux à profit pour mieux comprendre le point de vue des malades et prendre le pouls de l'industrie.

Degenerative cervical myelopathy (DCM) is a progressive neurologic condition caused by age-related degeneration of the cervical spine. Social media has become a crucial part of many patients' lives; however, little is known about social media use pertaining to DCM. This manuscript describes the landscape of social media use and DCM in patients, caretakers, clinicians, and researchers. A comprehensive search of the entire Twitter application programing interface database from inception to March 2022 was performed to identify all tweets about cervical myelopathy. Data on Twitter users included geographic location, number of followers, and number of tweets. The number of tweet likes, retweets, quotes, and total engagement were collected. Tweets were also categorized based on their underlying themes. Mentions pertaining to past or upcoming surgical procedures were recorded. A natural language processing algorithm was used to assign a polarity score, subjectivity score, and analysis label to each tweet for sentiment analysis. Overall, 1859 unique tweets from 1769 accounts met the inclusion criteria. The highest frequency of tweets was seen in 2018 and 2019, and tweets decreased significantly in 2020 and 2021. Most (888/1769, 50.2%) of the tweets' authors were from the United States, United Kingdom, or Canada. Account categorization showed that 668 of 1769 (37.8%) users discussing DCM on Twitter were medical doctors or researchers, 415 of 1769 (23.5%) were patients or caregivers, and 201 of 1769 (11.4%) were news media outlets. The 1859 tweets most often discussed research (n=761, 40.9%), followed by spreading awareness or informing the public on DCM (n=559, 30.1%). Tweets describing personal patient perspectives on living with DCM were seen in 296 (15.9%) posts, with 65 (24%) of these discussing upcoming or past surgical experiences. Few tweets were related to advertising (n=31, 1.7%) or fundraising (n=7, 0.4%). A total of 930 (50%) tweets included a link, 260 (14%) included media (ie, photos or videos), and 595 (32%) included a hashtag. Overall, 847 of the 1859 tweets (45.6%) were classified as neutral, 717 (38.6%) as positive, and 295 (15.9%) as negative. When categorized thematically, most tweets were related to research, followed by spreading awareness or informing the public on DCM. Almost 25% (65/296) of tweets describing patients' personal experiences with DCM discussed past or upcoming surgical interventions. Few posts pertained to advertising or fundraising. These data can help identify areas for improvement of public awareness online, particularly regarding education, support, and fundraising.

Given the recent evolution and achievements in brain-computer interface (BCI) technologies, understanding public perception and sentiments toward such novel technologies is important for guiding their communication strategies in marketing and education. This study aims to explore the public perception of BCI technology by examining posts on X (formerly known as Twitter) using natural language processing (NLP) methods. A mixed methods study was conducted on BCI-related posts from January 2010 to December 2021. The dataset included 65,340 posts from 38,962 unique users. This dataset was subject to a detailed NLP analysis including VADER, TextBlob, and NRCLex libraries, focusing on quantifying the sentiment (positive, neutral, and negative), the degree of subjectivity, and the range of emotions expressed in the posts. The temporal dynamics of sentiments were examined using the Mann-Kendall trend test to identify significant trends or shifts in public interest over time, based on monthly incidence. We used the Sentiment.ai tool to infer users' demographics by matching predefined attributes in users' profile biographies to certain demographic groups. We used the BERTopic tool for semantic understanding of discussions related to BCI. The analysis showed a significant rise in BCI discussions in 2017, coinciding with Elon Musk's announcement of Neuralink. Sentiment analysis revealed that 59.38% (38,804/65,340) of posts were neutral, 32.75% (21,404/65,340) were positive, and 7.85% (5132/65,340) were negative. The average polarity score demonstrated a generally positive trend over the course of the study (Mann-Kendall Statistic=0.266; τ=0.266; P<.001). Most posts were objective (50,847/65,340, 77.81%), with a smaller proportion being subjective (14,393/65,340, 22.02%). Biographic analysis showed that the \"broadcasting\" group contributed the most to BCI discussions (17,803/58,030, 30.67%), while the \"scientific\" group, contributing 27.58% (n=16,005), had the highest overall engagement metrics. The emotional analysis identified anticipation (score = 10,802/52,618, 20.52%), trust (score=9244/52,618, 17.56%), and fear (score=7344/52,618, 13.95%) as the most prominent emotions in BCI discussions. Key topics included Neuralink and Elon Musk, practical applications of BCIs, and the potential for gamification. This NLP-assisted study provides a decade-long analysis of public perception of BCI technology based on data from X. Overall, sentiments were neutral yet cautiously apprehensive, with anticipation, trust, and fear as the dominant emotions. The presence of fear underscores the need to address ethical concerns, particularly around data privacy, safety, and transparency. Transparent communication and ethical considerations are essential for building public trust and reducing apprehension. Influential figures and positive clinical outcomes, such as advancements in neuroprosthetics, could enhance favorable perceptions. The gamification of BCI, particularly in gaming and entertainment, also offers potential for wider public engagement and adoption. However, public perceptions on X may differ from other platforms, affecting the broader interpretation of results. Despite these limitations, the findings provide valuable insights for guiding future BCI developments, policy making, and communication strategies.

Background There is little data on patient and caregiver perceptions of spine surgery in children and youth. This study aims to characterize the personal experiences of patients, caregivers, and family members surrounding pediatric spine surgery through a qualitative and quantitative social media analysis. Methods The Twitter application programming interface was searched for keywords related to pediatric spine surgery from inception to March 2022. Relevant tweets and accounts were extracted and subsequently classified using thematic labels. Tweet metadata was collected to measure user engagement via multivariable regression. Sentiment analysis using Natural Language Processing was performed on all tweets with a focus on tweets discussing the personal experiences of patients and caregivers. Results 2424 tweets from 1847 individual accounts were retrieved for analysis. Patients and caregivers represented 1459 (79.0%) of all accounts. Posts discussed the personal experiences of patients and caregivers in 83.5% of tweets. Pediatric spine surgery research was discussed in few posts (n=90, 3.7%). Within the personal experience category, 975 (48.17%) tweets were positive, 516 (25.49%) were negative, and 533 (26.34%) were neutral. Presence of a tag (beta: -6.1, 95% CI -9.7 to -2.5) and baseline follower count (beta<0.001, 95% CI <0.001 to <0.001) significantly affected tweet engagement negatively and positively, respectively. Conclusions Patients and caregivers actively discuss topics related to pediatric spine surgery on Twitter. Posts discussing personal experience are most prevalent, while posts on research are scarce, unlike previous social media studies. Pediatric spine surgeons can leverage this dialogue to better understand the worries and needs of patients and their families.

Despite decades of research, the rate of cerebral spinal fluid (CSF) shunt failure for pediatric hydrocephalus remains high.1 The most common cause of CSF shunt failure is proximal shunt obstruction, often due to underlying brain tissues, cells, or inflammatory debris.2 Choroid plexus (CP) is recognized as a major cause of proximal CSF shunt obstruction.2 When replacing a CSF catheter, the neurosurgeon must consider the possibility of CP as the cause of obstruction; removal of hardware without proper preparation and cauterization may result in avulsion of the underlying, well-vascularized CP, thus causing intraventricular hemorrhage.3 Despite its clinical relevance, radiological imaging revealing overt CP obstructing the proximal catheter tip has, to our knowledge, not been well highlighted in the literature. A cerebral MRI was performed and compared with previous imaging and showed an increase in ventricular dilation caused by hypo-intense CP on T2-weighted MRI obstructing an otherwise clear proximal catheter tip in the occipital horn of the left lateral ventricle (Figure 1.) Post-operative non-contrast axial CT showing intraventricular hemorrhage surrounding the newly placed catheter located in the left lateral ventricle.

Brain tumors are the most common solid malignancy and leading cause of cancer-related deaths in infants. Current epidemiological data is limited by low numbers of reported cases. This study used a population-based approach with analysis of contemporary and historical survival curves to provide up-to-date prognostication. Observational cohort analysis was performed using the Surveillance, Epidemiology and End Results (SEER) database. Infants with brain tumors diagnosed from 1973 to 2013 were categorized by the most common tumor types (diffuse astrocytic and oligodendroglioma, choroid plexus, embryonal, ependymal, medulloblastoma and pilocytic astrocytoma). The 1, 5 and 10 year survival was stratified by decade, with trends in management and outcomes analyzed. We identified 2996 affected infants satisfying inclusion criteria. All tumor types, except embryonal and choroid plexus, demonstrated improving survival with time. Infants with embryonal tumors showed a decline in survival from the 1970s to 1990s (p = 0.009), whereas infants with choroid plexus tumors had no change in survival. Infants with ependymal tumors experienced the greatest improvement in survival from 1980s to 1990s and 1990s to 2000s (p = 0.0001, p = 0.01), with 5-year survival probability improving from 28% (95% CI 15-42%) in the 1980s to 77% (95% CI 69-83%) the 2000s. The use of radiation declined from 1970 to 2000 for all tumors; however, radiation treatment for embryonal and ependymal subtypes increased after 2000. While overall survival for infants with brain tumors has improved from the 1970s onwards, not every tumor type has seen a statistically significant change. Given changes in management and survival, prognostication of infants with brain tumor should be updated.