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Introduction This study investigates the changes in bicycle-related injury rates between 2017 and 2021. We focus specifically on changes in age demographics, and the most common diagnoses and body parts injured. Methods We queried the National Electronic Injury Surveillance System (NEISS) for injuries associated with bicycles from 2017 to 2021. Chi-square analysis was used to evaluate trends in injuries vs. time for the entire sample, age groups in five-year increments, and the proportion of injury types by diagnosis and body part. Results The highest annual injury rate (12,800 counts) occurred in 2020, coinciding with the COVID-19 safer-at-home order. Pediatric patients continue to make up the majority of injured cyclists (48% of patients are younger than 19 years), but their percentage is decreasing (zero to four years (-13%, p < 0.005), five to nine years (-17%, p < 0.005), 10-14 years (-5%, p < 0.005), 20-24 years (-16%, p < 0.005), 25-29 years (-2%, p < 0.005), and 50-54 years (-14%, p < 0.005)) and mirrored by an increase in the proportion of older injured cyclists (40-44 years (+26%, p < 0.005), 60-64 years (+44%, p < 0.005), 65-69 years (+69%, p < 0.005), and 70+ years (+57%, p < 0.005)). The past five years saw an increase in injuries associated with higher impact forces and the potential for more severe morbidity and mortality, such as internal organ injuries (+13%, p < 0.01). The incidence of concussions, however, has not changed significantly. The extremities are the most commonly injured body parts (upper and lower arm, elbow, wrist, hand, fingers, upper and lower leg, knee, ankle, foot, and toe = 47% total) and continue to increase in frequency (lower arm (+2%, p < 0.005), lower leg (+3%, p < 0.01), upper arm (+18%, p < 0.005), and hand (+11%, p < 0.05)), while facial injuries are becoming less common (-3%, p < 0.05), and head injuries have not experienced a significant change of incidence. Conclusion Although there was an increase in bicycle-related injuries during the COVID-19 safer-at-home order, numbers have since returned to pre-COVID-19 levels. Other changes in bicycle injury demographics and mechanisms, such as a rise in older adult cyclists and high-force mechanism injuries, however, call for a re-evaluation of preventive and treatment priorities.
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BACKGROUND: Awake surgery is performed in multiple surgical specialties, but historically, awake surgery in the field of neurosurgery was limited to craniotomies. Over the past two decades, spinal surgeons have pushed for techniques that only require regional anesthesia as they may provide reduced financial burdens on patients, faster recovery times, and better outcomes. The list of awake spine surgeries that have been found in the literature include: laminectomies/discectomies, anterior cervical discectomy and fusions (ACDFs), lumbar fusions, and dorsal column (DC) stimulator placement. METHODS: An extensive review of the published literature was conducted through PubMed database with articles containing the search term "awake spine surgery." No date restrictions were used. RESULTS: The search yielded 293 related articles. Cross-checking of articles was conducted to exclude of duplicate articles. The articles were screened for their full text and English language availability. We finalized those articles pertaining to the topic. Findings have shown that lumbar laminectomies performed with local anesthesia have shown shorter operating time, less postoperative nausea, lower incidence of urinary retention and spinal headache, and shorter hospital stays when compared to those performed under general anesthesia. Lumbar fusions with local anesthesia showed similar outcomes as patients reported better postoperative function and fewer side effects of general anesthesia. DC stimulator placement performed with local anesthesia is advantageous as it allows real time patient feedback for surgeons as they directly test affected nerves. However, spontaneous movement during the placement of DC stimulators is associated with higher failure rates when compared to general anesthesia (29.7% vs. 14.9%). Studies have shown that the use of local anesthesia during ACDFs has no significant differences when compared to general anesthesia, and patient's report better tolerated pain with general anesthesia. CONCLUSION: The use of awake spine surgery is beneficial for those who cannot undergo general anesthesia. However, it is limited to patients who can tolerate prone positioning with no central airway (i.e., normal BMI with a healthy airway), have no pre-existing mental health conditions (e.g., anxiety), and require a minimally invasive procedure with a short operating time. Future studies should focus on long-term efficacies of these procedures that provide further insight on the indications and limitations of awake spine surgery.