• Joshua T Anderson, T Barrett Sullivan, Uri M Ahn, and Nicholas U Ahn.
• 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.
• Spine J. 2014 Oct 1;14(10):2412-9.

Background ContextThe 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.PurposeTo 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.Study DesignThis cross-sectional study analyzed publicly available Internet information, including videos on the web site YouTube regarding the X-Stop device.Patient SampleNo patients were involved in this study.Outcome MeasuresNo specific outcome measures were used.MethodsSearch 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.ResultsForty-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.ConclusionsOur 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.Copyright © 2014 Elsevier Inc. All rights reserved.

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