The dissemination of information is only as effective as the accuracy of the content. As a popular, often anecdotal source of knowledge, the scientific validity of social media may be poor. In fact, a recent study compared the 100 most posted social media articles about spine surgery to the 100 most cited peer reviewed articles about spine surgery.5 The two lists showed minimal overlap, indicating a substantial divergence between the sources easily accessible on social media and sources with a scientific backing. So, while the theoretical benefits of disseminating novel research and reliable patient information appear promising, in reality there is serious concern about accuracy. Several factors may be contributing to this phenomenon including: a lack of understanding by those access the scientific research, cherry-picking of information from specific articles to fit a narrative, or simply a small presence of spine surgeons participating in the dissemination of information.6

Spine surgeons have a limited presence on social media. One study concerning social media use by members of the Cervical Spine Research Society (CSRS) indicated less than one-third used popular platforms such as Facebook, X, Instagram, or YouTube. This is despite the fact that 98% had a provider page or website.6 A cross-sectional observational study addressing the frequency of social media use by spine surgeons reported that 64% of the surgeons had not engaged in social media during the past 90 days.7 There is a scarcity of content provided by the surgeons, which may contribute to a lack of reliable information. This deficit then allows space for misinformation to dominate the narrative that patients absorb on social media.

The solution to this predicament seems simple: increase surgeon engagement on social media discussions related to spine surgery. However, with busy clinical schedules and administrative burdens, spine surgeons lack the time required to provide accurate and meaningful educational content on social media. As many companies across various sectors employ entire departments to manage social media content, it seems unlikely that any one surgeon would undertake such a task on their own. Additionally, a more significant social media presence means more exposure to the public that some may prefer to avoid. Some surgeons also have concerns about the ethics of interacting with the general population online. In fact, after surveying a group of almost 500 practitioners, 68% expressed ethical concerns related to the violation of HIPAA compliance that could occur from interacting with patients over social media.8 So, while the layperson would benefit from an increased spine surgeon presence in the social media space, it is essential to consider the additional demands and ethical quandaries placed on the physicians.

A potential remedy to these burdens has been explored by a group called Neurosurgery Cocktail (NC). NC is a platform that aims to disseminate reliable neurosurgical information primarily to other physicians, and secondarily, to the public.9 It was originally created by a group of young neurosurgeons to connect with colleagues via X and Facebook. It now serves as a platform for 35,000 neurosurgeons spanning over 100 countries.9 There is an element of self-policing that occurs to prevent the dissemination of misinformation because of the sheer number of experts contributing to the same platform. Having demonstrated great success, NC serves as a social media model that could be emulated to provide patient education on spine health, spine injury, and spine surgery in a way that is both easily accessible to the public through these platforms and is accurate. By “crowdsourcing” content production to many neurosurgeons rather than one, the time burden required to maintain a strong social media presence is mitigated as each contributor only needs to create one or two posts per month. This model may prove to be a solution to combat misinformation that is currently found on social media.

The lack of credible information has always been a concern across social media platforms which, in the field of spine surgery, can have drastic consequences. The “wrong” information obtained by patients on social media who use the platforms to share their experiences, questions, and concerns can be detrimental to long-term outcomes and drive health care costs up for the patient and society. A recent study examined the educational value of spine-related content on TikTok, a topic that has amassed billions of views.10 The study used the DISCERN scale to gauge the quality of the content of the post and then cross-referenced the scores to how frequently each post was accessed.10 Unfortunately, educational videos and videos created by musculoskeletal professionals had the lowest interaction compared to videos created by laypersons, casting doubt on the accuracy of spine-related information.10 This may be detrimental, due predominantly to accurate preconceived notions fostered by poor information quality. Intervention with dissemination of accurate information by spine professionals within the social media space could help to improve patient education and remedy anxiety and bias that patients may experience. It is important to note that spine surgeons are also capable of providing misinformation. However, the risk is arguably lower compared to the layperson-created educational content.

The literature on frequency of patient social media use also suggests that patients are primarily turning to online platforms both to seek support and to share perspectives about their own experiences.11 One study analyzed the tone of Instagram, X, and Reddit posts that included the phrase “scoliosis surgery.” In one year, there were 100 Reddit posts, 5,022 Instagram posts, and 1,414 tweets with the phrase.11 The investigators found that patients shared anecdotes ranging from postoperative progress to struggles with long-term back pain to questions about risks of spine procedures.11 Another similar study assessing tone of posts found that Instagram posts about spinal cord injury focused on spreading positivity and awareness.12 These findings demonstrate how online platforms can serve as a valuable support system and resource for patients going through difficult injuries and illnesses. As a provider, understanding this specific utilization of social media is invaluable because it is a free and accessible platform that could be recommended by providers to help patients find support during challenging times. Taking advantage of this opportunity could help improve the holistic care of the spine patient because social media can act as a supplementary support tool for patients that extends beyond the office. This also further highlights the importance of engaging with social media as a surgeon to self-police the quality and type of information being conveyed. Surgeons engaging this way can help ensure that factual, reliable information is being presented on social media platforms so that those who turn to it for emotional support during unsettling times are not left misinformed and scared.

When considering what patients share on social media about spine surgery, it is also important to ask whether their posts have the potential to help or harm the reputation of spine surgeons. A study conducted in 2019 looked at how the social media presence of 206 spine surgeons correlated to their online review scores on three physician rating websites.13 While shorter office wait-times and a practice based in an academic setting were both correlated with higher patient satisfaction ratings, accessible social media accounts, specifically Instagram accounts, also correlated to a higher patient ranking of physician services.13 Even though the lack of a social media presence does not directly guarantee a lower grade on health care provider ranking websites, it does highlight the phenomenon that patients’ opinions of surgeons have the ability to significantly impact, either positively or negatively, the perception of a surgeon’s practice. In an age of consumer-focused medicine, patients’ perceptions, especially when publicly shared online, can impact a surgeon’s broader reputation. This, in turn, may affect the success of a practice. Given the growing traffic towards online reputations in the form of ratings and patient comments, the consumerization of health care, especially in the world of spine surgery, is now a reality.

Although social media can impact a surgeon’s reputation, it also serves as a platform to boost their exposure and showcase research and clinical accomplishments. A recent study examined the influence of online presence on the number of citations of lead authors.14 Although no correlation between social media presence and article citations was observed, the study found that utilization of certain social media platforms did correlate with higher Mendeley readership.14 This finding may be impactful on several fronts. With the growing paperless shift, peer-reviewed manuscripts/journals are now being accessed at far greater rates than printed journals. Receiving notifications about publications through social media, instead of sorting through a crowded email inbox, would grant physicians immediate and more direct access to the latest advancements. Additionally, this study demonstrates that social media can be effectively employed for both individual and organizational promotion of research and academic endeavors. This could enhance information dissemination by facilitating broader and easier access to peer-reviewed publications, thereby improving overall visibility. There will continue to be debates regarding the benefits and risks associated with social media use. However, the safety and efficacy of these platforms will likely improve with additional time and users.