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This chapter discusses the evaluation of the upper cervical spine with the use of plain radiographs. It starts by presenting a broad overview of the pertinent anatomy of the upper cervical spine and the utility of the radiographic evaluation of this anatomy. Next, important pathological findings and their evaluation are presented. These include, but are not limited to, occipital condyle fractures, craniocervical dissociation, and injuries involving the atlas and axis. Throughout this chapter, various radiographic parameters are discussed and shown using diagrams and actual patient cervical spine radiographs. These parameters are further discussed to delve into their applications and limitations. This chapter will aid the reader in evaluating the upper cervical spine using radiographs; however, other imaging modalities and treatments are beyond the scope of this chapter.

In 2014, Maryland implemented an experimental reimbursement model, Global Budget Revenue (GBR). This model provided hospitals with a capitated annual budget each fiscal year to use toward all services, regardless of payer. Goals of GBR include reductions in cost, improvements in care quality, and increased access for patients to high-volume procedures, such as total knee arthroplasty (TKA). We assessed demographics and outcomes among patients with low incomes and patients of racial minority groups in Maryland who underwent TKA before and after GBR implementation. Patients undergoing TKAs from 2011 to 2016 were queried from the Maryland State Inpatient Database, resulting in 71,066 patients. There were 13,722 patients with low incomes and 19,846 patients of racial minority groups. The chi-square test was used for sex, income, insurance, Charlson Comorbidity Index, and morbid obesity, with the Student's t test being reserved for age before and after GBR. The proportion of patients with low incomes decreased the year before GBR but increased with GBR and maintained ( P P P P P Orthopedics . 2022;45(1):e11–e16.]

Same-day bilateral total knee arthroplasties (BTKAs) are associated with increased complications compared with staged procedures; however, as complication rates and lengths of stay (LOS) for same-day procedures decrease, they may become attractive alternatives to staged procedures. The void of recent nationwide studies comparing the 30-day total cost and risks of these procedures inspired this propensity matched review. Therefore, we compared 30-day outcomes in staged and same-day BTKAs occurring in 2016 and 2017 using the National Readmission Database (NRD), a nationwide database. The NRD was queried for all same-day and staged BTKA patients from January 1 to November 30 for both 2016 and 2017. Since the NRD links readmissions within one calendar year, TKAs occurring in this month were excluded to allow 30-day follow-up. Propensity matching was performed based on demographics, producing 19,334 patients in both cohorts. Thirty-day readmission, revision, and mortality rates, hospital costs, LOS, discharge dispositions, and complications were analyzed. Chi-square and Student's t-tests assessed categorical and continuous variables, respectively. A p-value of 0.050) were associated staged compared with same-day BTKAs. The results suggest inpatient cost savings associated with same-day surgeries should be weighed against the slight increase in LOS and PEs. Ultimately, as LOS and PE rates continue to decrease from innovations and quality improvements, same-day BTKA may become an attractive alternative to staged BTKAs, especially if payer's incentive surgeons by increasing physician reimbursements.

BACKGROUND CONTEXT In the next decade, health care reimbursement will be more aligned to patient clinical outcomes. A factor impacting these outcomes is the patient's perceived opinion of his or her care, and specifically the surgical provider. An evaluation into the role of surgeon demographics, social media accessibility, and office wait times was conducted to identify correlations with these among three online review platforms. PURPOSE To evaluate patient satisfaction scores for spine surgeons practicing in New York State using leading physician ratings websites. STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE Spine surgeons with a review on Healthgrades.com (HG), Vitals.com (V), or Google.com (G) online rating websites as of 11/1/2019. OUTCOME MEASURES Number of ratings, number of comments, overall rating, patient reported wait times, physician website presence and physician social media presence (SM). METHODS A total of 206 (148 orthopedic, 58 neurosurgery-trained) spine surgeons were included after excluding those that no longer practiced, were still in training, or actually practiced outside of the selected geographic area. Spine surgeon ratings and demographics data from three physician rating websites (HG, V, G) were collected in November 2019. Using only the first 10 search results from Google.com we then identified if the surgeon had publicly accessible Facebook (FB), Twitter (TW) or Instagram (IG) accounts. RESULTS The mean age of the cohort was 54.3 years (± 9.40 years) and 28.2% had one form of publicly accessible SM. Having any SM was significantly correlated with higher scores on HG and G. An IG account was associated with significantly higher scores on all three platforms and having a FB account correlated with significantly higher scores on HG in multivariate analysis. An office wait time between 16-30 minutes and greater than 30 minutes was associated with worse scores on all three platforms in multivariate analysis (all CONCLUSIONS A shorter office wait time and an academic setting practice are associated with higher patient satisfaction scores on all three physician review websites. Accessible social media accounts are also associated with higher ratings on physician review websites, particularly IG. While surgical outcomes are likely the most important influence of perceived patient satisfaction, additional factors should continue to be considered. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.