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  • Variation in Patient Spine Education By Search Engine

    Final Number:

    George M. Ghobrial MD; Angud Mehdi; Mitchell Gil Maltenfort PhD; Ashwini Dayal Sharan MD; James S. Harrop MD, FACS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Patients are obtaining a significant amount of their medical education prior to being evaluated by medical personnel. This has particularly accelerated over the last decade due to the information age, facilitated by the world wide web. Variations in how spine information is presented for patients by different web browsers has not been well studied.

    Methods: An online internet search was conducted from September 1st, 2012 until September 30th, 2012 using the internet search engines Google™ (, Yahoo™ (, and Bing™ ( The following key terms were individually searched: cauda equina, epidural abscess, low back pain, spondylolisthesis, scoliosis, fusion, spinal surgery, sciatica, herniated disk, minimally invasive, laser spine surgery, and spinal cord injury. The top one hundred search results for each individual term were categorized as follows: educational site without advertisements, educational site with advertisements, medicolegal, hospital advertisement, industry, consumer, news, government, and surgical group.

    Results: Distribution for the top fifty results of each search parameter are displayed according to search engine. Controlling for Bing and Yahoo search engines, Google was more likely to return hospital ads (P=0.002) and more likely to return scholarly sites of peer-reviewed literature (P=0.003) than Bing or Yahoo search engines. When controlling for type of search engine, educational web sites, surgical group sites, and online web communities had a significantly higher likelihood of returning on any search, regardless of search engine, or search string (P=0.007). Likewise, professional websites, including hospital run, industry sponsored, legal, and peer-reviewed web pages were less likely to be found on a search overall, regardless of engine and search string (P=0.078).

    Conclusions: The internet is a rapidly growing body of medical information which can serve as a useful tool for patient education, provided that the patient understands the prevalence of bias in search engines.

    Patient Care: Highlight how patient expectations and education are shaped by web browsers and the internet. Patient care can be improved by physicians who recognize the impact of the internet on patient expectation.

    Learning Objectives: At the conclusion of this session, participants should be able to: 1. Understand the importance of the web and specific web browser on patient education. 2. Understand how this information dictates biases that are not evaluated by an unbiased scientific community.

    References: Li L, Irvin E, Guzman J, Bombardier C: Surfing for back pain patients: the nature and quality of back pain information on the Internet. Spine (Phila Pa 1976) 26:545-557, 2001 2. LLC A: Alexa Web Information Company, in, 2012 3. Mathur S, Shanti N, Brkaric M, Sood V, Kubeck J, Paulino C, et al: Surfing for scoliosis: the quality of information available on the Internet. Spine (Phila Pa 1976) 30:2695-2700, 2005 4. Orabi AA, D'Souza AR, Walsh RR, Irving RM: The influence of the Internet on decision making in acoustic neuroma. J Laryngol Otol 119:806-809, 2005

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