title: Analysis of Internet information on the controversial X-Stop device.
abstract: BACKGROUND
  The Internet is frequently used by patients to aid in medical decision making. Multiple studies display the Internet's ineffectiveness in presenting high-quality information regarding surgical procedures and devices. With recent reports of unacceptably high complication rates and poor outcomes with the X-Stop device, it is important that online information is comprehensive and accurate. This study is the first to examine Internet information on the controversial X-Stop.
  
  
  OBJECTIVE
  To determine how accurately public information over the Internet portrays the existing primary literature on the X-Stop, how extensively the X-Stop is characterized online, and how patient decision making could foreseeably be affected.
  
  
  METHODS
  This cross-sectional study analyzed publicly available Internet information, including videos on the web site YouTube regarding the X-Stop device.
  
  
  METHODS
  No patients were involved in this study.
  
  
  METHODS
  No specific outcome measures were used.
  
  
  METHODS
  Search engines Google, Yahoo, and Bing were used to identify 105 web sites providing information on the X-Stop. Videos on the web site YouTube were included. Web sites were categorized based on the authorship. Each site was analyzed for the provision of appropriate patient inclusion and exclusion criteria, surgical and nonsurgical treatment alternatives, purported benefits, common complications, peer-reviewed literature citations, and descriptions/diagrams of the procedure. Data were evaluated for each authorship subgroup and the entire group of sites.
  
  
  RESULTS
  Forty-three percent of sites were authored by a private medical group, 4% by an academic medical group, 16% by an insurance company, 9% by a biomedical industry, 10% by news sources, and 19% by other. Thirty-one percent of web sites and 11% of sites authored by private medical groups contained references to peer-reviewed literature. Fifty-six percent of web sites reported patient inclusion criteria, whereas 33% reported exclusion criteria. Benefits and complications were reported within 91% and 23% of sites, respectively. Surgical and nonsurgical treatment options were mentioned within 59% and 61% of web sites, respectively.
  
  
  CONCLUSIONS
  Our study demonstrates the Internet's ineffectiveness in reporting quality information on the X-Stop. Information was often incomplete and potentially misleading. Significant controversy exists within primary literature regarding the safety and efficacy of the X-Stop. Yet, publicly available Internet information largely provided misinformation and did not reflect any such controversy. This raises the concern that such information lends itself more toward patient recruitment than patient education. Medical professionals need to know how this may affect their patients' decision making.
authors: Department of Orthopaedic Surgery, University Hospitals Case Medical Center, 10900 Euclid Ave, Cleveland, Ohio 44106, USA; Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, Ohio 44106, USA. Electronic address: JoshTAnderson36@gmail.com.
authors: Joshua T
authors: JT
authors: Anderson
authors: Department of Orthopaedic Surgery, University Hospitals Case Medical Center, 10900 Euclid Ave, Cleveland, Ohio 44106, USA; Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, Ohio 44106, USA.
authors: T Barrett
authors: TB
authors: Sullivan
authors: New Hampshire Neuro Spine Institute, 4 Hawthorne Drive Bedford, NH 03110, USA.
authors: Uri M
authors: UM
authors: Ahn
authors: Department of Orthopaedic Surgery, University Hospitals Case Medical Center, 10900 Euclid Ave, Cleveland, Ohio 44106, USA.
authors: Nicholas U
authors: NU
authors: Ahn
mesh_terms: D020811:Biomedical Technology; D003430:Cross-Sectional Studies; D003657:Decision Making; D004864:Equipment and Supplies / Q000009:adverse effects*; D006801:Humans; D033181:Information Dissemination; D007348:Insurance, Health; D007383:Intermittent Claudication / Q000601:surgery*; D020407:Internet / Q000592:standards*; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D010353:Patient Education as Topic / Q000592:standards*; D011331:Private Practice; D012577:Schools, Medical; D057386:Search Engine / Q000592:standards*; D013130:Spinal Stenosis / Q000150:complications*
keywords: Internet; Interspinous distraction device; Lumbar spinal stenosis; Neurogenic intermittent claudication; Patient education; X-Stop