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Background: 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., Objective: This manuscript describes the landscape of social media use and DCM in patients, caretakers, clinicians, and researchers., Methods: 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., Results: 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., Conclusions: 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., (©Lior M Elkaim, Jordan J Levett, Farbod Niazi, Mohammed A Alvi, Nathan A Shlobin, Joseph R Linzey, Faith Robertson, Rakan Bokhari, Naif M Alotaibi, Oliver Lasry. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 22.05.2023.)

Background: Computer-assisted navigation (CAN) improves the accuracy of spinal instrumentation in vertebral fractures and degenerative spine disease; however, it is not widely adopted because of lack of training, high capital costs, workflow hindrances, and accuracy concerns. We characterize shifts in the use of spinal CAN over time and across disciplines in a single-payer health system, and assess the impact of intra-operative CAN on trainee proficiency across Canada., Methods: A prospectively maintained Ontario database of patients undergoing spinal instrumentation from 2005 to 2014 was reviewed retrospectively. Data were collected on treated pathology, spine region, surgical approach, institution type, and surgeon specialty. Trainee proficiency with CAN was assessed using an electronic questionnaire distributed across 15 Canadian orthopedic surgical and neurosurgical programs., Results: In our provincial cohort, 16.8% of instrumented fusions were CAN-guided. Navigation was used more frequently in academic institutions (15.9% vs. 12.3%, p<0.001) and by neurosurgeons than orthopedic surgeons (21.0% vs. 12.4%, p<0.001). Of residents and fellows 34.1% were fully comfortable using spinal CAN, greater for neurosurgical than orthopedic surgical trainees (48.1% vs. 11.8%, p=0.008). The use of CAN increased self-reported proficiency in thoracic instrumentation for all trainees by 11.0% (p=0.036), and in atlantoaxial instrumentation for orthopedic trainees by 18.0% (p=0.014)., Conclusions: Spinal CAN is used most frequently by neurosurgeons and in academic centers. Most spine surgical trainees are not fully comfortable with the use of CAN, but report an increase in technical comfort with CAN guidance particularly for thoracic instrumentation. Increased education in spinal CAN for trainees, particularly at the fellowship stage and, specifically, for orthopedic surgery, may improve adoption.