Objective: The use of social media applications to disseminate information has substantially risen in recent decades. Spine and back pain-related hashtags have garnered several billion views on TikTok. As such, these videos, which share experiences, offer entertainment, and educate users about spinal surgery, have become increasingly influential. Herein, we assess the quality of spine surgery content TikTok from providers and patients.Methods: Fifty hashtags encompassing spine surgery (“#spinalfusion,” “#scoliosissurgery,” and “#spinaldecompression”) were searched using TikTok’s algorithm and included. Two independent reviewers rated the quality of each video via the DISCERN questionnaire. Video metadata (likes, shares, comments, views, length) were all collected; type of content creator (musculoskeletal, layperson) and content category (educational, patient experience, entertainment) were determined.Results: The overall DISCERN score was, on average, 24.4. #Spinalfusion videos demonstrated greater engagement, higher average likes (p = 0.02), and more comments (p < 0.001) compared to #spinaldecompression and #scoliosissurgery. #Spinaldecompression had the highest DISCERN score (p < 0.001), likely explained by the higher percentage of videos that were educational (p < 0.001) and created by musculoskeletal (MSK) professionals (p < 0.001). Compared to laypersons, MSK professionals had significantly higher quality videos (p < 0.001). Similarly, the educational category demonstrated higher quality videos (p < 0.001). Video interaction trended lower with MSK videos and educational videos had the lowest interaction of the content categories (likes: p = 0.023, comments: p = 0.005).Conclusion: The quality of spine surgery videos on TikTok is low. As the influence of the new social media landscape governs how the average person consumes information, MSK providers should participate in disseminating high-quality content.

Study Design.: Retrospective cohort. Objective.: To compare navigation and robotics in terms of clinical outcomes after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Summary of Background Data.: Although robotics has been shown to have advantages like reduced radiation exposure, greater screw size, and slightly better accuracy over navigation, none of the studies has compared these two modalities in terms of clinical outcomes. Methods.: Patients who underwent single-level MI-TLIF using robotics or navigation and had a minimum of 1-year follow-up were included. The robotics and navigation groups were compared for improvement in patient-reported outcome measures (PROMs), minimal clinically important difference, patient-acceptable symptom state, response on the global rating change scale, and screw-related complication and reoperation rates. Results.: A total of 278 patients (143 robotics, 135 navigation) were included. There was no significant difference between the robotics and navigation groups in the baseline demographics, operative variables, and preoperative PROMs. Both groups showed significant improvement in PROMs at below six and six months or above, with no significant difference in the magnitude of improvement between the two groups. Most patients achieved minimal clinically important difference and patient-acceptable symptom state and reported feeling better on the global rating change scale, with no significant difference in the proportions between the robotics and navigation groups. The screw-related complication and reoperation rates also showed no significant difference between the two groups. Conclusions.: Robotics did not seem to lead to significantly better clinical outcomes compared with navigation following MI-TLIF. Although the clinical outcomes may be similar, robotics offers the advantages of reduced radiation exposure, greater screw size, and slightly better accuracy over navigation. These advantages should be considered when determining the utility and cost-effectiveness of robotics in spine surgery. Larger multicenter prospective studies are required in the future to further investigate this subject.

Objective: While minimally invasive-transforaminal lumbar interbody fusion (MIS-TLIF) has shown superiority in key clinical metrics over the open approach, evidence regarding patient-reported outcomes remains limited. This study compared postoperative recovery trajectories and symptomatic improvement phases between MIS and open TLIF.Methods: This retrospective review included patients who underwent single-level MIS or open TLIF. Oswestry Disability Index (ODI) and Numerical Rating Scale (NRS) for back and leg pain were collected preoperatively and postoperatively. Segmented regression analysis with mixed-effects modeling, allowing for identification of distinct recovery phases, compared symptomatic trends between approaches.Results: Of 324 patients (268 MIS, 56 open), baseline demographics were similar except for greater preoperative leg pain in the MIS group (NRS: 6.0 vs. 5.0, p = 0.027). A segmented regression model identified 4 ODI recovery phases: postoperative disability phase (PDP, day 0 to 13), early improvement phase (day 13 to 28), late improvement phase (day 28 to 110), and plateau phase (later than day 110). The MIS group exhibited significantly lower disability exacerbation during PDP (β = 0.93 vs. 1.42 points per day, p = 0.008). Additionally, the plateau of NRS back occurred significantly earlier in the MIS group than in the open group (MIS, 26.7 ± 2.6 days vs. open, 51.7 ± 6.6 days, p < 0.001).Conclusion: MIS-TLIF resulted in lower postoperative disability during the first 2 weeks compared to the open approach. Furthermore, low back pain achieved an earlier plateau in back pain by about 4 weeks in the MIS approach.

Background: Postoperative urinary retention (POUR), a common complication after spine surgery, can contribute to longer hospital stays, urinary tract infection, pain, and morbidity. This study aimed to determine the incidence of POUR in patients who underwent lumbar decompression and to construct a predictive model for preoperatively identifying high-risk patients. Methods: This was a retrospective review of patients undergoing primary lumbar decompression from 2017 to 2023. Demographic characteristics, comorbidities, and perioperative data were collected. Factors associated with POUR were assessed, and multivariable logistic regressions were performed to identify independent predictors of the development of POUR. A nomogram to predict the development of POUR was developed within a training subset, based on a multivariable logistic regression model of preoperative variables, followed by the internal validation of the model in a validation subset and assessment of its performance. Results: Of the 1,938 patients included in this study, 133 (6.9%) developed POUR. Following multivariable analysis, the following risk factors for POUR were identified: a history of urinary retention (odds ratio [OR], 4.956 [95% confidence interval (CI), 2.157 to 11.383]; p < 0.001), insurance that was not commercial (private) (OR, 2.256 [95% CI, 1.298 to 3.922]; p = 0.004), intraoperative Foley catheter use (OR, 5.967 [95% CI, 3.506 to 10.156]; p < 0.001), inpatient opioid consumption of >93 morphine milligram equivalents (OR, 1.898 [95% CI, 1.220 to 2.952]; p = 0.004), and anticholinergic medication use during hospitalization (OR, 3.450 [95% CI, 2.313 to 5.148]; p < 0.001). The nomogram, which included the preoperative variables of male sex, age of >65 years, history of urinary retention, history of benign prostatic hyperplasia, not having commercial insurance, and American Society of Anesthesiologists (ASA) classification of >2, demonstrated good discrimination in the training subset (area under the curve [AUC], 0.725 [95% CI, 0.673 to 0.776]) and the validation subset (AUC, 0.709 [95% CI, 0.599 to 0.819]). The Hosmer-Lemeshow goodness-of-fit test demonstrated that the model fit the data well (chi-square test = 9.063; p = 0.170). Conclusions: The incidence of POUR after lumbar decompression surgery was found to be 6.9%. A history of urinary retention, not having commercial (private) insurance, intraoperative Foley catheter usage, inpatient opioid consumption of >93 morphine milligram equivalents, and the administration of anticholinergic medication during hospitalization increased the risk of developing POUR. Furthermore, we constructed a preoperative predictive model with good performance metrics to help clinicians to identify patients at elevated risk for developing POUR. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Study Design: Propensity-matched retrospective cohort. Objective: The objective of this study was to determine whether lumbar disc replacement (LDR) can provide radiographic indirect decompression as effectively as anterior lumbar interbody fusion (ALIF). Summary of Background Data: Isolated lumbar foraminal stenosis can often be treated with indirect decompression via ALIF. More recently, LDR has emerged as a motion-preserving treatment option for lumbar disease; however, its ability to provide indirect decompression has not been studied. Methods: All patients undergoing 1-level ALIF and LDR over a 7-year period were queried. A propensity-matched cohort was then identified utilizing patient-specific factors. This yielded 23 patients undergoing LDR and 44 undergoing ALIF. The primary outcome of this study was the change in radiographic foraminal height (FH) and segmental lordosis (SL) from pre- to postoperatively. All measurements were performed by 2 independent reviewers, and intraclass correlation coefficients (ICC) were calculated. Patient-reported outcome measures, including visual analog scale (VAS) back and leg scores, were collected for comparison at early and late postoperative timepoints. Intercohort comparisons were performed via Mann-Whitney U tests. P -values <0.05 were deemed significant. Results: Patients undergoing LDR had shorter operative time (98.9 vs. 136.7 min, P 0.75) across both reviewers. Preoperatively, ALIF patients had smaller radiographic FH (13.8 vs. 15.6 mm, P =0.01), but no other differences were seen. Both ALIF and LDR provided significant increases in FH (ALIF: 3.5 mm and LDR: 3.7 mm) and SL (ALIF: 8.0 degrees and LDR: 8.0 degrees). There were no differences in the mean ΔFH ( P =0.56) or ΔSL ( P =0.85) between cohorts. Both groups showed significant improvement in postoperative VAS leg scores at early and late time points. Conclusions: LDR can provide indirect decompression and segmental lordosis restoration as effectively as ALIF.