Spine pathology afflicts people across the globe and is responsible for a large portion of physician visits and healthcare costs. Imaging such as plain radiographs, CT, MRI, and ultrasound is vital to assess structure, function, and stability of the spine and also provide guidance in therapeutic interventions. Ultrasound utilization in spine conditions is less ubiquitous, but provides benefits in low costs, portability, and dynamic imaging. This study assesses ultrasound efficacy in diagnosis and therapeutic interventions for spine pathology. A systematic review conducted via PubMed, MEDLINE, and Google Scholar identified 3,630 papers with eventual inclusion of 73 papers with an additional 21 papers supplemental papers subsequently added. Findings highlighted ultrasound utilization for different structural elements of the spine such as muscle, bone, disc, ligament, canal, and joints are presented and compared with radiographs, CT, and MRI imaging where relevant. Spinal curvature and mobility are similarly presented. Ultrasound efficacy for guided therapeutics about the spine is presented and assessed against other modalities. Ultrasound is a widely used and efficacious modality to guide injections about the spine. Diagnostic utility is less well studied, but shows promise in assessing fractures, posterior ligamentous stability, and intra-operative hardware placement. The low cost, portability, and dynamic imaging ability make it an attractive modality particularly for developing health systems and resource limited environments such as combat settings and the International Space Station. Further study is recommended before broad adoption in diagnostics.

The global rise in orthopaedic care coupled with increasing costs necessitates surgical auditing. Orthopaedic registries in the United States (US) and Norway survey data to discern practice differences and improve clinical decisions, but they have key distinctions. In this study, we elucidate the creation, growth, and clinical relevance of registries in the US and Norway, emphasizing distinguishing features and effects on orthopaedic practice. Registries were selected based on geographic representation, enrollment, and scholarly relevance. The databases surveyed were PubMed, MEDLINE, The Texas Medical Center Library, The University of Texas System Library, and Google Scholar. Registry reports, websites, and direct conversations with staff were also utilized. Twelve US and five Norwegian registries were studied. Norwegian registries began in 1987, publish more clinical practice changes than US registries, are federally mandated, and operate on the national level. US registries began in 1969, are fragmented, and not mandated. The majority of US and Norwegian registries gather level II and III data, while some report Level IV data. Delayed US registry adoption is due to scale, patient identification, and a multi-payer system, impediments absent in Norway. Norwegian registries produce annual reports and publish clinical improvements in open journals. We recommend similar US registry accessibility to advance patient care. Additionally, we convey that the American Joint Replacement Registry is poised to become a prodigious national registry due to high demographic diversity, data volume, and potential to collect level IV elements. Overall, US orthopaedic practice may benefit by incorporating aspects of the Norwegian registry system.

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