Pain management in spine surgery can be challenging. Cannabis might be an interesting choice for analgesia while avoiding some side effects of opioids. Recent work has reported on the potential benefits of cannabinoids for multimodal pain control, but very few studies focus on spinal surgery patients. This study aims to examine demographic and health status differences between patients who report the use of (1) cannabis, (2) narcotics, (3) cannabis and narcotics or (4) no cannabis/narcotic use. Retrospective cohort study of thoracolumbar patients enrolled in the CSORN registry after legalization of cannabis in Canada. Variables included: age, sex, modified Oswestry Disability Index (mODI), Numerical Rating Scales (NRS) for leg and back pain, tingling/numbness leg sensation, SF-12 Quality of Life- Mental Health Component (MCS), Patient Health Questionnaire (PHQ-9), and general health state. An ANCOVA with pathology as the covariate and post-hoc analysis was run. The majority of the 704 patients enrolled (mean age: 59; female: 46.9%) were non-users (41.8%). More patients reported narcotic-use than cannabis-use (29.7% vs 12.9%) with 13.4% stating concurrent-use. MCS scores were significantly lower for patients with concurrent-use compared to no-use (mean of 39.95 vs 47.98, p=0.001) or cannabis-use (mean=45.66, p=0.043). The narcotic-use cohort had significantly worse MCS scores (mean=41.37, p=0.001) than no-use. Patients reporting no-use and cannabis-use (mean 41.39 vs 42.94) had significantly lower ODI scores than narcotic-use (mean=54.91, p=0.001) and concurrent-use (mean=50.80, p=0.001). Lower NRS-Leg pain was reported in cannabis-use (mean=5.72) compared to narcotic-use (mean=7.19) and concurrent-use (mean=7.03, p=0.001). No-use (mean=6.31) had significantly lower NRS-Leg pain than narcotic-use (p=0.011), and significantly lower NRS-back pain (mean=6.17) than narcotic-use (mean=7.16, p=0.001) and concurrent-use (mean=7.15, p=0.012). Cannabis-use reported significantly lower tingling/numbness leg scores (mean=4.85) than no-use (mean=6.14, p=0.022), narcotic-use (mean=6.67, p=0.001) and concurrent-use (mean=6.50, p=0.01). PHQ-9 scores were significantly lower for the no-use (mean=6.99) and cannabis-use (mean=8.10) than narcotic-use (mean=10.65) and concurrent-use (mean=11.93) cohorts. Narcotic-use reported a significantly lower rating of their overall health state (mean=50.03) than cannabis-use (mean=60.50, p=0.011) and no-use (mean=61.89, p=0.001). Patients with pre-operative narcotic-use or concurrent use of narcotics and cannabis experienced higher levels of disability, pain and depressive symptoms and worse mental health functioning compared to patients with no cannabis/narcotic use and cannabis only use. To the best of our knowledge, this is the first and largest study to examine the use of cannabis amongst Canadian patients with spinal pathology. This observational study lays the groundwork to better understand the potential benefits of adding cannabinoids to control pain in patients waiting for spine surgery. This will allow to refine recommendations about cannabis use for these patients

Aims. Healthcare systems have been rapidly restructured to meet COVID-19 demand. Clinicians are working to novel clinical guidelines, treating new patient cohorts and working in unfamiliar environments. Trauma and orthopaedics (T&O) has experienced cancellation of routine clinics and operating, with redistribution of the workload and human resources. To date, no studies have evaluated the mental health impact of these changes on the T&O workforce. We report the results of a novel survey on the impact of the pandemic on the mental health of our orthopaedic workforce and the contributory factors. Methods. A 20-question survey-based cross-sectional study of orthopaedic team members was conducted during the COVID-19 pandemic. The primary objective was to identify the impact of the pandemic on mental health in the form of major depressive disorder (MDD) and general anxiety disorder (GAD). The survey incorporated the patient health questionnaire (PHQ-2), which is validated for screening of MDD, and the generalized anxiety disorder questionnaire (GAD-2), which is validated for screening of GAD. Results. There were 62 respondents (18 females and 44 males). As compared to the general population, we noted a greater estimated prevalence of GAD (17.7% vs 5.9%, p = 0.0009297) and MDD (19.4% vs 3.3%, p = 0.0000007731). The prevalence of MDD symptoms was greatest among senior house officers (SHOs) (p = 0.02216). Female respondents scored higher for symptoms of MDD (p = 0.03583) and GAD (p = 0.0001086). Those identifying as ‘Black, African, Caribbean or Black British’ displayed a higher prevalence of GAD symptoms (p = 0.001575) and felt least supported at work (p = 0.001341). Conclusion. Our study, in the first of its kind, shows a significant prevalence of GAD and MDD in the workforce. We found that SHOs, females and those of Black, African, Caribbean, or Black British origin were disproportionately affected. Action should be taken to help prevent adverse mental health outcomes for our colleagues during the pandemic. Cite this article: Bone Joint Open 2020;1-6:316–325