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281. C5 palsy and neurological complications after cervical spine surgery
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S101−S140 improved patient outcomes. This matched cohort study sought to analyze the effect of using two attending surgeons in single level ACDF procedures. PURPOSE: To analyze the effect of a 2-attending surgeon team on the outcomes of patients undergoing single-level ACDF procedures. STUDY DESIGN/SETTING: Retrospective matched cohort study PATIENT SAMPLE: A total of 42 matched patients who underwent single level ACDF with a minimum of 2-year follow-up. OUTCOME MEASURES: (1) Anesthesia time, (2) surgical time, (3) blood loss, (4) postoperative complication rate, (5) fusion rate METHODS: A retrospective matched cohort study of patients undergoing 1-level ACDF for degenerative cervical spondylosis, with minimum 2-year follow-up. Patients were subdivided into 2 cohorts: (A) cases performed by one attending surgeon assisted by resident, fellow, physician assistant or other medical staff, and (B) cases performed by an attending surgeon with another attending surgeon as first-assist. Patients were matched by age, sex, BMI, ASA and CCI. Perioperative data including anesthesia, surgical time, blood loss, postoperative complications and rate of fusion were compared. Standard binomial and categorical comparative analysis were performed. A p-value <0.05 was deemed significant. RESULTS: A total of 42 patients were included (21 in each group). There were 22 males and 20 females, with a mean age of 47.7 years and mean follow-up of 43.4 months. There were no differences in any demographic variable between the two groups, indicating successful matching. Cohort B had decreased anesthesia time (114.9 vs 157.1 minutes, p<0.001), operative time (58.1 vs 98.9 minutes, p<0.001) and blood loss (14.8 vs 24.3 mL, p=0.012). There were no significant differences in terms of postoperative complications including dysphagia, wound infection, neurologic or cardiovascular related complications. All patients achieved successful fusion at final follow-up. CONCLUSIONS: A 2-attending surgeon team significantly reduces anesthesia time, surgical time and blood loss, in 1-level ACDF procedures, without an increase in complications, or decrease in fusion rates. This further highlights the importance and benefits of having a second experienced attending surgeon present in these cases. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.296
281. C5 palsy and neurological complications after cervical spine surgery Dominic J. Carusillo1, Ali Siddiqui2, Blake G. Formanek, BA2, Raymond J. Hah, MD1, Zorica Buser, PhD1, Jeffrey C. Wang, MD3; 1 Keck School of Medicine of USC, Los Angeles, CA, US; 2 Los Angeles, CA, US; 3 USC Spine Center, Los Angeles, CA, US BACKGROUND CONTEXT: Neurologic complications of cervical spine surgery include C5 palsy, monoplegia, paraplegia and quadriplegia and can have significant impact on quality of life. C5 palsy has a reported incidence of 0-30% with few well-established risk factors. Postoperative cervical spine iatrogenic monoplegia, paraplegia and quadriplegia have little literature supporting their incidence. The Charlson Comorbidity Index is a measure of comorbidity in patients that is associated with surgical outcomes. PURPOSE: The objective of this study was to identify the incidence and risk factors for severe neurological complications including C5 palsy after cervical spine surgery using a nationwide patient database. STUDY DESIGN/SETTING: Retrospective database study. PATIENT SAMPLE: Patients from the Humana national database who underwent cervical spine surgery between 2007 and 2016. OUTCOME MEASURES: Neurological complications, CCI, patient demographics. METHODS: The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9), The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10), and Current
S137
Procedural Terminology (CPT) codes were used to identify and evaluate patients from the Humana national database for neurological complications following posterior fusion cervical spine surgery, anterior fusion cervical spine surgery, laminectomy/laminotomy of the cervical spine, and artificial disc replacement of the cervical spine. Neurological complications were evaluated over a 14-day postoperative period. Using Chi-squared testing, complication incidences and relative risk ratios were calculated with respect to type of cervical spine surgery, CCI, patient age, and patient sex. RESULTS: A total of 45,373 patients from the Humana database fit the inclusion criteria for cervical spine surgery. Of these, 732 (1.61%) patients experienced a neurological complication within 14 days after cervical spine surgery. C5 palsy had an incidence of 0.06% across all cervical spine surgeries (29 of 45,373 patients). A CCI >3 had a 5.44 times relative risk for any neurological complication (RR: 5.44; 95% CI: 4.70 - 6.30; p<<0.001) and a 2.85 times relative risk of C5 palsy complications (RR: 2.85; 95% CI: 1.37 - 5.92; p <0.05). The incidence of neurological complications varied by surgery: posterior fusion (4.56%), anterior fusion (1.10%), laminotomy (1.84%) and artificial disc replacement (1.08%). Compared to female patients, male patients had a 1.43x increased risk of neurological complications (RR: 1.43; 95% CI: 1.23-1.65; p<<0.001), but not C5 palsy (RR: 1.23, 95% CI: 0.592.56, p=0.57314). Patients 90 years of age and over had the highest incidence of neurological complications (10.26%). Incidence of neurological complications followed a linear increase as age increased. CONCLUSIONS: Patients who underwent cervical spine surgery and had a CCI > 3 were at a significantly increased relative risk for neurological complications including C5 palsy within 14 days after surgery. Compared to female patients, male patients had a statistically significant increased incidence in neurological complications, but no significant increase in incidence for C5 palsy. Posterior fusion cervical spine surgery had the highest incidence of neurological complications. Age was correlated with greater incidence of neurological complications. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.297
Friday, September 27, 2019 4:05 − 5:05 PM Complication Avoidance 282. Vertebral Hounsfield unit is a better predictor of pedicle screw loosening than the t-score of DXA in patients with lumbar degenerative diseases Da Zou, MD, Weishi Li, MD; Peking University Third Hospital, Beijing, China BACKGROUND CONTEXT: Pedicle screw loosening is a common complication after pedicle screw fixation in osteoporotic patients. The Tscore of DXA is widely used to identify osteoporosis preoperatively, but it can be falsely overestimated because of lumbar degenerative changes. Vertebral Hounsfield unit (HU) has proven to be a better tool for evaluating bone mineral density (BMD) in patients with lumbar degenerative diseases (LDD). PURPOSE: To compare the performance of using HU and T-score of DXA to evaluate the risk of pedicle screw loosening. STUDY DESIGN/SETTING: This is a retrospective study PATIENT SAMPLE: We reviewed 252 patients ≥ 50 years old who underwent posterior lumbar fusion with pedicle screw fixation (1-4 levels of fixation) for LDD. OUTCOME MEASURES: Pedicle screw loosening: presence of a radiolucent zone ≥ 1mm thick around the screw in lumbar x-ray at 12 months follow-up. METHODS: The DXA criterion for osteoporosis: lowest T-score≤ -2.5. The HU criterion for osteoporosis: L1≤110HU or L2≤100HU or L3≤85HU or L1≤80HU. ROC analysis was used to evaluate the validity of predicting screw loosening
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
281. C5 palsy and neurological complications after cervical spine surgery Dominic J. Carusillo1, Ali Siddiqui2, Blake G. Formanek, BA2, Raymond J. Hah, MD1, Zorica Buser, PhD1, Jeffrey C. Wang, MD3; 1 Keck School of Medicine of USC, Los Angeles, CA, US; 2 Los Angeles, CA, US; 3 USC Spine Center, Los Angeles, CA, US BACKGROUND CONTEXT: Neurologic complications of cervical spine surgery include C5 palsy, monoplegia, paraplegia and quadriplegia and can have significant impact on quality of life. C5 palsy has a reported incidence of 0-30% with few well-established risk factors. Postoperative cervical spine iatrogenic monoplegia, paraplegia and quadriplegia have little literature supporting their incidence. The Charlson Comorbidity Index is a measure of comorbidity in patients that is associated with surgical outcomes. PURPOSE: The objective of this study was to identify the incidence and risk factors for severe neurological complications including C5 palsy after cervical spine surgery using a nationwide patient database. STUDY DESIGN/SETTING: Retrospective database study. PATIENT SAMPLE: Patients from the Humana national database who underwent cervical spine surgery between 2007 and 2016. OUTCOME MEASURES: Neurological complications, CCI, patient demographics. METHODS: The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9), The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10), and Current
S137
Procedural Terminology (CPT) codes were used to identify and evaluate patients from the Humana national database for neurological complications following posterior fusion cervical spine surgery, anterior fusion cervical spine surgery, laminectomy/laminotomy of the cervical spine, and artificial disc replacement of the cervical spine. Neurological complications were evaluated over a 14-day postoperative period. Using Chi-squared testing, complication incidences and relative risk ratios were calculated with respect to type of cervical spine surgery, CCI, patient age, and patient sex. RESULTS: A total of 45,373 patients from the Humana database fit the inclusion criteria for cervical spine surgery. Of these, 732 (1.61%) patients experienced a neurological complication within 14 days after cervical spine surgery. C5 palsy had an incidence of 0.06% across all cervical spine surgeries (29 of 45,373 patients). A CCI >3 had a 5.44 times relative risk for any neurological complication (RR: 5.44; 95% CI: 4.70 - 6.30; p<<0.001) and a 2.85 times relative risk of C5 palsy complications (RR: 2.85; 95% CI: 1.37 - 5.92; p <0.05). The incidence of neurological complications varied by surgery: posterior fusion (4.56%), anterior fusion (1.10%), laminotomy (1.84%) and artificial disc replacement (1.08%). Compared to female patients, male patients had a 1.43x increased risk of neurological complications (RR: 1.43; 95% CI: 1.23-1.65; p<<0.001), but not C5 palsy (RR: 1.23, 95% CI: 0.592.56, p=0.57314). Patients 90 years of age and over had the highest incidence of neurological complications (10.26%). Incidence of neurological complications followed a linear increase as age increased. CONCLUSIONS: Patients who underwent cervical spine surgery and had a CCI > 3 were at a significantly increased relative risk for neurological complications including C5 palsy within 14 days after surgery. Compared to female patients, male patients had a statistically significant increased incidence in neurological complications, but no significant increase in incidence for C5 palsy. Posterior fusion cervical spine surgery had the highest incidence of neurological complications. Age was correlated with greater incidence of neurological complications. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.297
Friday, September 27, 2019 4:05 − 5:05 PM Complication Avoidance 282. Vertebral Hounsfield unit is a better predictor of pedicle screw loosening than the t-score of DXA in patients with lumbar degenerative diseases Da Zou, MD, Weishi Li, MD; Peking University Third Hospital, Beijing, China BACKGROUND CONTEXT: Pedicle screw loosening is a common complication after pedicle screw fixation in osteoporotic patients. The Tscore of DXA is widely used to identify osteoporosis preoperatively, but it can be falsely overestimated because of lumbar degenerative changes. Vertebral Hounsfield unit (HU) has proven to be a better tool for evaluating bone mineral density (BMD) in patients with lumbar degenerative diseases (LDD). PURPOSE: To compare the performance of using HU and T-score of DXA to evaluate the risk of pedicle screw loosening. STUDY DESIGN/SETTING: This is a retrospective study PATIENT SAMPLE: We reviewed 252 patients ≥ 50 years old who underwent posterior lumbar fusion with pedicle screw fixation (1-4 levels of fixation) for LDD. OUTCOME MEASURES: Pedicle screw loosening: presence of a radiolucent zone ≥ 1mm thick around the screw in lumbar x-ray at 12 months follow-up. METHODS: The DXA criterion for osteoporosis: lowest T-score≤ -2.5. The HU criterion for osteoporosis: L1≤110HU or L2≤100HU or L3≤85HU or L1≤80HU. ROC analysis was used to evaluate the validity of predicting screw loosening
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.