Background Lumbar fusion has long been the gold standard operation for degenerative disc disease; however, lumbar disc replacement has recently gained popularity due to its motion-sparing benefits and increasing patient demand influenced by social media. The social media platform X (formerly Twitter) is widely used in healthcare for sharing patient experiences, and sentiment analysis can assess the emotional tone of these tweets to gauge public perception of medical procedures. The aim of this study was to analyze tweets referencing lumbar fusion and lumbar disc replacement to evaluate the tone of the content and to assess the trend of patient preference for disc replacement over fusion.

Methods All tweets containing keywords most frequently adopted in discussions related to lumbar fusion and disc replacement were collected from January 2013 through August 2023. These phrases included: lumbar fusion, lumbar arthrodesis, lumbar interbody fusion, lumbar disc replacement, lumbar disk replacement, total disc replacement, total disk replacement, lumbar disc arthroplasty, lumbar disk arthroplasty, total disc arthroplasty, and total disc arthroplasty. Sentiment analysis was then performed using TweetNLP, a cutting-edge natural language processing library, and sentiment analysis time series plots were created. ANOVA was used for combined sentiment analysis, and the Wilcoxon Rank-Sum test for time series plots.

Results There were 7377 and 1572 tweets mentioning lumbar fusion and lumbar disc replacement, respectively. Sentiment analysis demonstrated 1254 positive, 1389 negative, and 4734 neutral lumbar fusion related tweets (p < 0.001). For lumbar disc replacement, there were 248 positive, 113 negative, and 1211 neutral tweets (p < 0.001). The percentage of positive tweets each month was slightly higher for lumbar fusion (16.16% ± 7.28%) compared to disc replacement (15.20% ± 14.41%), while negative sentiment was 2.6 times higher for lumbar fusion (17.79% ± 8.42%) than disc replacement (6.77% ± 7.89%) (p < 0.001), with a continued rise over the past 5 years.

Conclusion Over the past decade, patients have increasingly used X to share opinions on lumbar fusion vs. disc replacement. Though the number of tweets discussing lumbar fusion outnumber those of disc replacement, there has been considerably more negative sentiment across tweets discussing lumbar fusion. This trend may reflect the growing preference for disc replacement among patients, and spine surgeons should recognize the influence of social media on patient perceptions and its potential impact on their practice.