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Validity of Scoliosis Information Available on the Internet
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Proceedings of the NASS 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S
three-fourth of these will involve the axial skeleton, thus increasing the risk of bone pain, pathologic vertebral fractures, and compression of neural elements. Increased morbidity and mortality have been associated with patients who are bed-ridden due to pain or neurologic deficit. Therapeutic goals are pain control, spinal stabilization, reducing risk of spinal cord compression, and tumor control. Targeted radiofrequency ablation (t-RFA) of malignant spinal lesions represents a novel minimally invasive approach to achieving these goals in the oncology population. PURPOSE: Report initial clinical experience and determine the efficacy and safety of targeted radiofrequency ablation (t-RFA) of malignant spinal lesions using a novel bipolar RF ablation system designed for use in the spine. Demonstrate the use of real time temperature monitoring of thermocouples (TC) on an articulating electrode to determine ablation size and morphology with use of post-ablation magnetic resonance imaging (MRI) and comparison with pre-clinical thermal distribution curves. STUDY DESIGN/SETTING: Retrospective chart review was performed on patients treated at the H. Lee Moffitt Cancer Center, University of California-San Diego, and Washington University School of medicine, between 2011 and 2013. PATIENT SAMPLE: Oncology patients (n587). OUTCOME MEASURES: Demographic data, type of tumor, tumor location, number of levels treated, surgical approach, history of previous or concurrent therapy, pain score (VAS), functional score (ODI), opioid requirement, total ablation time, use of cement augmentation, complications, and tumor progression at treated level were collected. METHODS: A novel spine tumor ablation system (STAR, DFINE Inc), which includes an articulating, navigational bipolar electrode/osteotome containing two thermocouples along its shaft to permit real time monitoring of ablation zone was used to treat 118 vertebral metastatic lesions. Cement augmentation was performed through the same coaxial system when required. RESULTS: Tumor etiology involved a wide variety of metastatic lesions from T2 to S2 and ilium. Unipedicular approach was used in over 95% of cases. No complications or thermal injury occurred. Cement augmentation following t-RFA was efficient and resulted in predictable cement filling. Post-ablation MRI confirmed ablated lesions were within discrete ablation zones consistent in size with intra-op thermal monitoring by TCs. Post contrast MRI and histopathology confirmed tumor necrosis. Tumor control was observed by histopathology and PET imaging 10 months post ablation. Patients evaluated by VAS and ODI reported clinically significant improvement (O30%, p!0.05) in pain and functional score, respectively. Functional performance increase was demonstrated in all participants. CONCLUSIONS: The STAR tumor ablation system was safely and effectively used in the navigation and targeted RF ablation of spinal malignant lesions. The devices navigational ability allowed for improved access to previously difficult posterior vertebral body lesions. This technique allowed for treatment of individual lesions in close proximity to neural elements without risk of thermal injury. t-RFA can reduce pain, improve function, and serve as a critical adjunct to chemoradiation in patients with spinal metastatic disease. FDA DEVICE/DRUG STATUS: DFINE STAR targeted radiofrequency ablation system (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2013.07.416
P143. Validity of Scoliosis Information Available on the Internet J. Matthew Cage, DO1, Joseph Orchowski, MD2, Jeffrey B. Knox, MD3; 1 Orthopedic Surgery, Tripler Army Medical Center, Honolulu, HI, US; 2 Tripler Army Medical Center, Honolulu, HI, US; 3New York, NY, US BACKGROUND CONTEXT: According to recent data, 173 million Americans search the Internet for health information. This represents an increase of 48 percent since 2005. The immense amount of health information available on the World Wide Web is largely unregulated with little guidance to help patients locate quality resources. Subsequently, patients
often are exposed to misleading and potentially harmful information. Scoliosis is one of the most common conditions searched on the Internet by patients and family members. There are literally millions of websites providing information on scoliosis. PURPOSE: The purpose of this study is to evaluate the current information about scoliosis on the Internet and determine the best websites for patient information based on accuracy and readability. METHODS: An Internet search of the term ‘‘scoliosis’’ was conducted using the five most common internet search engines in 2010 (Google, Yahoo, Bing, Ask, AOL Search). The top twenty websites from each search engine were selected for analysis. Each website was analyzed by fellowship-trained orthopedic spine surgeon and a fellowship-trained pediatric orthopedic surgeon. The analysis was performed using the DISCERN Instrument, a validated tool that quantifies the completeness and quality of information written about medical treatment choices, and the Flesch Reading Ease and Flesch-Kincaid Grade level. RESULTS: After duplicate search results were eliminated a total of 31 unique websites were identified. Of these websites, 52% were commercial, 29% were academic, 10% were physician-based, 3% were non-physician provider based and 6% were categorized as ‘‘other.’’ The websites demonstrated a wide range of quality and reading level. Scores ranged from 1 to 5 (scale 1-5) with a mean rating of 3. SRS.org and Emedicine.com were the only two websites to attain a rating of 5 using the DISCERN instrument, indicating ‘‘minimal shortcomings.’’ The mean Flesch Reading Ease score for all websites was 47.8 and the mean Flesch-Kincaid Grade Level was 10.5, indicating an overall moderate level of reading difficulty. Six websites required a reading ability above 12th grade, while 16 required a 9th-12th grade reading ability and 9 required less than a 9th grade reading ability. Two of the top six rated sites required a reading ability of 6th-8th grade, while three of the six lowest rated sites required a reading ability above 12th grade. CONCLUSIONS: In our review of current websites providing information on scoliosis we identified a broad range of overall quality, accuracy, and reading difficulty. Of the 31 websites evaluated using the DISCERN instrument, 16 (51%) had ‘‘serious or important shortcomings.’’ In general no specific category of website consistently provided high or low quality information. This highlights the varied quality of medical information available on the Internet. SRS.org and emedicine.com provided the highest quality information, but the SRS website provided the information at lower reading level. Overall our findings highlight three important points. First, both high and low quality information can be found in all categories of websites. Secondly, quality information can be found on the Internet at a reasonable reading level for the vast majority of patients and their family members. Lastly, because of the overwhelming body of medical information on the Internet, surgeons should take an active role in directing their patients to websites providing quality information. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.417
P144. Do Residents Know Evidence-Based Guidelines for Cervical Spine Clearance in Blunt Trauma Patients? Elizabeth R. Inkellis, MD1, Alexander A. Theologis, MD1, Murat Pekmezci, MD2; 1University of California San Francisco/San Francisco General Hospital Orthopaedic Trauma Institute, San Francisco, CA, US; 2 Orthopedic Trauma Institute, San Francisco, CA, US BACKGROUND CONTEXT: Cervical spine clearance protocols have been developed to prevent neurological deficits secondary to missed unstable spine injuries. As new imaging techniques become available, the guidelines on cervical spine clearance are evolving. PURPOSE: This study was designed to investigate resident knowledge of cervical spine clearance in adult blunt trauma patients at an academic Level 1 trauma center. The hypothesis was that most residents would be able to apply an evidence based algorithm to clear the cervical spine
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
Proceedings of the NASS 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S
three-fourth of these will involve the axial skeleton, thus increasing the risk of bone pain, pathologic vertebral fractures, and compression of neural elements. Increased morbidity and mortality have been associated with patients who are bed-ridden due to pain or neurologic deficit. Therapeutic goals are pain control, spinal stabilization, reducing risk of spinal cord compression, and tumor control. Targeted radiofrequency ablation (t-RFA) of malignant spinal lesions represents a novel minimally invasive approach to achieving these goals in the oncology population. PURPOSE: Report initial clinical experience and determine the efficacy and safety of targeted radiofrequency ablation (t-RFA) of malignant spinal lesions using a novel bipolar RF ablation system designed for use in the spine. Demonstrate the use of real time temperature monitoring of thermocouples (TC) on an articulating electrode to determine ablation size and morphology with use of post-ablation magnetic resonance imaging (MRI) and comparison with pre-clinical thermal distribution curves. STUDY DESIGN/SETTING: Retrospective chart review was performed on patients treated at the H. Lee Moffitt Cancer Center, University of California-San Diego, and Washington University School of medicine, between 2011 and 2013. PATIENT SAMPLE: Oncology patients (n587). OUTCOME MEASURES: Demographic data, type of tumor, tumor location, number of levels treated, surgical approach, history of previous or concurrent therapy, pain score (VAS), functional score (ODI), opioid requirement, total ablation time, use of cement augmentation, complications, and tumor progression at treated level were collected. METHODS: A novel spine tumor ablation system (STAR, DFINE Inc), which includes an articulating, navigational bipolar electrode/osteotome containing two thermocouples along its shaft to permit real time monitoring of ablation zone was used to treat 118 vertebral metastatic lesions. Cement augmentation was performed through the same coaxial system when required. RESULTS: Tumor etiology involved a wide variety of metastatic lesions from T2 to S2 and ilium. Unipedicular approach was used in over 95% of cases. No complications or thermal injury occurred. Cement augmentation following t-RFA was efficient and resulted in predictable cement filling. Post-ablation MRI confirmed ablated lesions were within discrete ablation zones consistent in size with intra-op thermal monitoring by TCs. Post contrast MRI and histopathology confirmed tumor necrosis. Tumor control was observed by histopathology and PET imaging 10 months post ablation. Patients evaluated by VAS and ODI reported clinically significant improvement (O30%, p!0.05) in pain and functional score, respectively. Functional performance increase was demonstrated in all participants. CONCLUSIONS: The STAR tumor ablation system was safely and effectively used in the navigation and targeted RF ablation of spinal malignant lesions. The devices navigational ability allowed for improved access to previously difficult posterior vertebral body lesions. This technique allowed for treatment of individual lesions in close proximity to neural elements without risk of thermal injury. t-RFA can reduce pain, improve function, and serve as a critical adjunct to chemoradiation in patients with spinal metastatic disease. FDA DEVICE/DRUG STATUS: DFINE STAR targeted radiofrequency ablation system (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2013.07.416
P143. Validity of Scoliosis Information Available on the Internet J. Matthew Cage, DO1, Joseph Orchowski, MD2, Jeffrey B. Knox, MD3; 1 Orthopedic Surgery, Tripler Army Medical Center, Honolulu, HI, US; 2 Tripler Army Medical Center, Honolulu, HI, US; 3New York, NY, US BACKGROUND CONTEXT: According to recent data, 173 million Americans search the Internet for health information. This represents an increase of 48 percent since 2005. The immense amount of health information available on the World Wide Web is largely unregulated with little guidance to help patients locate quality resources. Subsequently, patients
often are exposed to misleading and potentially harmful information. Scoliosis is one of the most common conditions searched on the Internet by patients and family members. There are literally millions of websites providing information on scoliosis. PURPOSE: The purpose of this study is to evaluate the current information about scoliosis on the Internet and determine the best websites for patient information based on accuracy and readability. METHODS: An Internet search of the term ‘‘scoliosis’’ was conducted using the five most common internet search engines in 2010 (Google, Yahoo, Bing, Ask, AOL Search). The top twenty websites from each search engine were selected for analysis. Each website was analyzed by fellowship-trained orthopedic spine surgeon and a fellowship-trained pediatric orthopedic surgeon. The analysis was performed using the DISCERN Instrument, a validated tool that quantifies the completeness and quality of information written about medical treatment choices, and the Flesch Reading Ease and Flesch-Kincaid Grade level. RESULTS: After duplicate search results were eliminated a total of 31 unique websites were identified. Of these websites, 52% were commercial, 29% were academic, 10% were physician-based, 3% were non-physician provider based and 6% were categorized as ‘‘other.’’ The websites demonstrated a wide range of quality and reading level. Scores ranged from 1 to 5 (scale 1-5) with a mean rating of 3. SRS.org and Emedicine.com were the only two websites to attain a rating of 5 using the DISCERN instrument, indicating ‘‘minimal shortcomings.’’ The mean Flesch Reading Ease score for all websites was 47.8 and the mean Flesch-Kincaid Grade Level was 10.5, indicating an overall moderate level of reading difficulty. Six websites required a reading ability above 12th grade, while 16 required a 9th-12th grade reading ability and 9 required less than a 9th grade reading ability. Two of the top six rated sites required a reading ability of 6th-8th grade, while three of the six lowest rated sites required a reading ability above 12th grade. CONCLUSIONS: In our review of current websites providing information on scoliosis we identified a broad range of overall quality, accuracy, and reading difficulty. Of the 31 websites evaluated using the DISCERN instrument, 16 (51%) had ‘‘serious or important shortcomings.’’ In general no specific category of website consistently provided high or low quality information. This highlights the varied quality of medical information available on the Internet. SRS.org and emedicine.com provided the highest quality information, but the SRS website provided the information at lower reading level. Overall our findings highlight three important points. First, both high and low quality information can be found in all categories of websites. Secondly, quality information can be found on the Internet at a reasonable reading level for the vast majority of patients and their family members. Lastly, because of the overwhelming body of medical information on the Internet, surgeons should take an active role in directing their patients to websites providing quality information. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.417
P144. Do Residents Know Evidence-Based Guidelines for Cervical Spine Clearance in Blunt Trauma Patients? Elizabeth R. Inkellis, MD1, Alexander A. Theologis, MD1, Murat Pekmezci, MD2; 1University of California San Francisco/San Francisco General Hospital Orthopaedic Trauma Institute, San Francisco, CA, US; 2 Orthopedic Trauma Institute, San Francisco, CA, US BACKGROUND CONTEXT: Cervical spine clearance protocols have been developed to prevent neurological deficits secondary to missed unstable spine injuries. As new imaging techniques become available, the guidelines on cervical spine clearance are evolving. PURPOSE: This study was designed to investigate resident knowledge of cervical spine clearance in adult blunt trauma patients at an academic Level 1 trauma center. The hypothesis was that most residents would be able to apply an evidence based algorithm to clear the cervical spine
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.