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7:54 5. Prospective Randomized Evaluation of Posterior Interbody Fusion in Degenerative Spondylolisthesis Patients Over 60 Years of Age: 5 Year Follow-up
Proceedings of the NASS 21st Annual Meeting / The Spine Journal 6 (2006) 1S–161S
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7:54 5. Prospective Randomized Evaluation of Posterior Interbody Fusion in Degenerative Spondylolisthesis Patients Over 60 Years of Age: 5 Year Follow-up Scott Kitchel, MD1, Richard Matteri, MD2, Judy Campbell, CRA1; 1 Orthopaedic Spine Associates, LLC, Eugene, OR, USA; 2Orthopedic HealthCare Northwest, Eugene, OR, USA
women. When examining the change in Frankel Grade after hematoma evacuation (HE), those with time from onset of symptoms to (HE) !6 hours had a mean improvement of 0.13 (SD 1.25), those with time from onset of symptoms to (HE) of 6–12 hours had a mean improvement of 0.38 (SD 0.52), and those from 12–24 hours had a mean improvement of 0.22 (SD 0.83). Conversely, those with time from onset of symptoms to (HE) O24 hours had a mean decline of 0.50 (SD 0.58). Mean change from baseline Frankel Grade was not significantly different across these four groups (F (3,28)50.92, p5.443). Using a decrease of Frankel Grade of greater than or equal to 1 point as an important event, there was a slight increase in the likelihood of this event for each hour increment in time from onset of symptoms to HE (OR51.03, 95% CI: 0.99, 1.07, p5.140), though this was not statistically significant. CONCLUSIONS: The incidence of postoperative spinal epidural hematoma requiring evacuation ranges from 0.1% to 3%. Neurologic recovery correlated with the time from the onset of neurologic symptoms to evacuation of the hematoma. There was no statistically significant difference in the degree of neurologic recovery if HE was performed within 24 hours. However, if hematoma evacuation was delayed beyond 24 hours, neurologic recovery was less likely to occur. FDA DEVICE/DRUG STATUS: Not applicable. CONFLICT OF INTEREST: No conflicts.
Author Declined Publication.
doi: 10.1016/j.spinee.2006.06.007
steroid group, although the numbers were small. It is possible that the avoidance of the operations was due, not to the beneficial responses to the medications, but rather placebo effects, or simply delaying the operation until the problem resolved itself. Regardless of the reason, 13% of these patients, all of whom would have had surgery, managed to avoid it. The patient and the treating physician can utilize these numbers when considering nerve root blocks as an alternative to surgery. FDA DEVICE/DRUG STATUS: Bupivacaine with betamethasone: Investigational/not approved. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2006.06.005
doi: 10.1016/j.spinee.2006.06.006
8:00 6. Correlation Between Neurologic Recovery and Timing of Surgical Decompression of Postoperative Spinal Epidural Hematoma (POSEH) Khaled Kebaish, MD, John Awad, MD, Jonathan Donigan, Richard Skolasky, Jr., MD; Johns Hopkins University, Baltimore, MD, USA BACKGROUND CONTEXT: The incidence of postoperative spinal epidural hematoma requiring evacuation ranges from 0.1% to 3%. Although rare, these hematomas can have devastating neurological consequences. In a series of investigations of spinal cord compression in dogs, Tarlov et al. concluded that recovery depended on both the magnitude and duration of compression. However, studies of the effect of the magnitude and duration of cord compression in humans have produced conflicting results. PURPOSE: Identify the correlation between neurologic recovery and timing of surgical decompression of postoperative spinal epidural hematoma. STUDY DESIGN/SETTING: Retrospective case series. PATIENT SAMPLE: The surgical log database, which contains details of all operations from August 1984 to 2002, was reviewed to identify patients undergoing all levels of spinal surgery. 14,932 patients underwent spinal surgery at our institution and met the inclusion criteria. 32 patients (0.2%) developed POSEH and had some degree of neurological compromise. 31 patients had complete follow-up data. OUTCOME MEASURES: Frankel grading was used to evaluate neurologic function preoperatively, after the index surgery, before and after evacuation of the hematoma and at the final follow-up. METHODS: The data were analyzed using logistic regression methods. RESULTS: The average time between the index surgery and evacuation of the hematoma was 79.9 hours. The average time from onset of symptoms of epidural hematoma to second operation was 18.6 hours. Using these two values, the average (SD) time from initial operation to symptoms of epidural hematoma was 61.3 hours. There were no significant differences in occurrence of incontinence to bowel and/or bladder across time categories at preoperative (chi-square (3 d.f.)55.00, p5.172) or at first day postoperative (chi-square (3 d.f.)53.41, p5.332). There was no correlation between time from index surgery to symptoms and neurologic recovery. There were no correlations between age at surgery and neurologic recovery (rho5.001, p5.995), time from index surgery to symptoms (rho50.064, p5.737). There were also no differences in these parameters between men and
Wednesday, September 27, 2006 1:06–1:49 PM General Session: Best Papers II 1:06 7. Prevalence of Lumbar Facet Arthrosis and Its Relationship to Age, Sex, and Race: An Anatomic Study of 647 Cadaveric Specimens Jason David Eubanks, MD, Michael Lee, MD, Ezequiel Cassinelli, MD, Nicholas Ahn, MD; Case Western Reserve University, Cleveland, OH, USA BACKGROUND CONTEXT: Arthrosis of lumbar facet joints is a common radiographic finding and has been linked to low back pain. However, no population studies have specifically defined the incidence of facet arthrosis in the lumbar spine and its relation to age, sex, and race. PURPOSE: The purpose of this study was to define the incidence of facet arthrosis in the lumbar spine and to describe the patterns of this arthrosis in relation to age, sex, and race. STUDY DESIGN/SETTING: Cadaveric lumbar spines were examined by a single examiner for evidence of lumbar facet arthrosis. PATIENT SAMPLE: The sample consisted of 647 cadaveric lumbar spines. Represented in this sample were black and white races, male and female sexes, and a broad distribution of ages. OUTCOME MEASURES: Facet arthrosis was examined and measured in severity from Grade 0 to 4. METHODS: Based on studies by Kettler, we used a grading system for facet arthrosis from Grade 0 to 4 on a continuum from no arthritis to complete ankylosis. Each facet (right and left) at each level was graded. This data was then coupled with information on race, age, and sex; a subsequent analysis was conducted on the incidence of lumbar facet arthrosis and the patterns of statistical significance. RESULTS: Facet arthrosis was present in 49% (L1-L2), 62% (L2-L3), 69% (L3-L4), 77% (L4-L5), and 56% (L5-S1). By decade, facet arthrosis was present in 32% of 20–29 year olds, 66% (30–39), 82% (40–49), 91% (50–59), 97% (60–69), and 97% (O70). Fisher exact test and t test demonstrated that men had a greater prevalence and degree of facet arthrosis than women at all lumbar levels (p!.001). This difference was greatest in the 40–49 age group. The lumbar level with the highest prevalence and degree of arthrosis was the L4-L5 level, as compared with each of the other levels
3S
7:54 5. Prospective Randomized Evaluation of Posterior Interbody Fusion in Degenerative Spondylolisthesis Patients Over 60 Years of Age: 5 Year Follow-up Scott Kitchel, MD1, Richard Matteri, MD2, Judy Campbell, CRA1; 1 Orthopaedic Spine Associates, LLC, Eugene, OR, USA; 2Orthopedic HealthCare Northwest, Eugene, OR, USA
women. When examining the change in Frankel Grade after hematoma evacuation (HE), those with time from onset of symptoms to (HE) !6 hours had a mean improvement of 0.13 (SD 1.25), those with time from onset of symptoms to (HE) of 6–12 hours had a mean improvement of 0.38 (SD 0.52), and those from 12–24 hours had a mean improvement of 0.22 (SD 0.83). Conversely, those with time from onset of symptoms to (HE) O24 hours had a mean decline of 0.50 (SD 0.58). Mean change from baseline Frankel Grade was not significantly different across these four groups (F (3,28)50.92, p5.443). Using a decrease of Frankel Grade of greater than or equal to 1 point as an important event, there was a slight increase in the likelihood of this event for each hour increment in time from onset of symptoms to HE (OR51.03, 95% CI: 0.99, 1.07, p5.140), though this was not statistically significant. CONCLUSIONS: The incidence of postoperative spinal epidural hematoma requiring evacuation ranges from 0.1% to 3%. Neurologic recovery correlated with the time from the onset of neurologic symptoms to evacuation of the hematoma. There was no statistically significant difference in the degree of neurologic recovery if HE was performed within 24 hours. However, if hematoma evacuation was delayed beyond 24 hours, neurologic recovery was less likely to occur. FDA DEVICE/DRUG STATUS: Not applicable. CONFLICT OF INTEREST: No conflicts.
Author Declined Publication.
doi: 10.1016/j.spinee.2006.06.007
steroid group, although the numbers were small. It is possible that the avoidance of the operations was due, not to the beneficial responses to the medications, but rather placebo effects, or simply delaying the operation until the problem resolved itself. Regardless of the reason, 13% of these patients, all of whom would have had surgery, managed to avoid it. The patient and the treating physician can utilize these numbers when considering nerve root blocks as an alternative to surgery. FDA DEVICE/DRUG STATUS: Bupivacaine with betamethasone: Investigational/not approved. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2006.06.005
doi: 10.1016/j.spinee.2006.06.006
8:00 6. Correlation Between Neurologic Recovery and Timing of Surgical Decompression of Postoperative Spinal Epidural Hematoma (POSEH) Khaled Kebaish, MD, John Awad, MD, Jonathan Donigan, Richard Skolasky, Jr., MD; Johns Hopkins University, Baltimore, MD, USA BACKGROUND CONTEXT: The incidence of postoperative spinal epidural hematoma requiring evacuation ranges from 0.1% to 3%. Although rare, these hematomas can have devastating neurological consequences. In a series of investigations of spinal cord compression in dogs, Tarlov et al. concluded that recovery depended on both the magnitude and duration of compression. However, studies of the effect of the magnitude and duration of cord compression in humans have produced conflicting results. PURPOSE: Identify the correlation between neurologic recovery and timing of surgical decompression of postoperative spinal epidural hematoma. STUDY DESIGN/SETTING: Retrospective case series. PATIENT SAMPLE: The surgical log database, which contains details of all operations from August 1984 to 2002, was reviewed to identify patients undergoing all levels of spinal surgery. 14,932 patients underwent spinal surgery at our institution and met the inclusion criteria. 32 patients (0.2%) developed POSEH and had some degree of neurological compromise. 31 patients had complete follow-up data. OUTCOME MEASURES: Frankel grading was used to evaluate neurologic function preoperatively, after the index surgery, before and after evacuation of the hematoma and at the final follow-up. METHODS: The data were analyzed using logistic regression methods. RESULTS: The average time between the index surgery and evacuation of the hematoma was 79.9 hours. The average time from onset of symptoms of epidural hematoma to second operation was 18.6 hours. Using these two values, the average (SD) time from initial operation to symptoms of epidural hematoma was 61.3 hours. There were no significant differences in occurrence of incontinence to bowel and/or bladder across time categories at preoperative (chi-square (3 d.f.)55.00, p5.172) or at first day postoperative (chi-square (3 d.f.)53.41, p5.332). There was no correlation between time from index surgery to symptoms and neurologic recovery. There were no correlations between age at surgery and neurologic recovery (rho5.001, p5.995), time from index surgery to symptoms (rho50.064, p5.737). There were also no differences in these parameters between men and
Wednesday, September 27, 2006 1:06–1:49 PM General Session: Best Papers II 1:06 7. Prevalence of Lumbar Facet Arthrosis and Its Relationship to Age, Sex, and Race: An Anatomic Study of 647 Cadaveric Specimens Jason David Eubanks, MD, Michael Lee, MD, Ezequiel Cassinelli, MD, Nicholas Ahn, MD; Case Western Reserve University, Cleveland, OH, USA BACKGROUND CONTEXT: Arthrosis of lumbar facet joints is a common radiographic finding and has been linked to low back pain. However, no population studies have specifically defined the incidence of facet arthrosis in the lumbar spine and its relation to age, sex, and race. PURPOSE: The purpose of this study was to define the incidence of facet arthrosis in the lumbar spine and to describe the patterns of this arthrosis in relation to age, sex, and race. STUDY DESIGN/SETTING: Cadaveric lumbar spines were examined by a single examiner for evidence of lumbar facet arthrosis. PATIENT SAMPLE: The sample consisted of 647 cadaveric lumbar spines. Represented in this sample were black and white races, male and female sexes, and a broad distribution of ages. OUTCOME MEASURES: Facet arthrosis was examined and measured in severity from Grade 0 to 4. METHODS: Based on studies by Kettler, we used a grading system for facet arthrosis from Grade 0 to 4 on a continuum from no arthritis to complete ankylosis. Each facet (right and left) at each level was graded. This data was then coupled with information on race, age, and sex; a subsequent analysis was conducted on the incidence of lumbar facet arthrosis and the patterns of statistical significance. RESULTS: Facet arthrosis was present in 49% (L1-L2), 62% (L2-L3), 69% (L3-L4), 77% (L4-L5), and 56% (L5-S1). By decade, facet arthrosis was present in 32% of 20–29 year olds, 66% (30–39), 82% (40–49), 91% (50–59), 97% (60–69), and 97% (O70). Fisher exact test and t test demonstrated that men had a greater prevalence and degree of facet arthrosis than women at all lumbar levels (p!.001). This difference was greatest in the 40–49 age group. The lumbar level with the highest prevalence and degree of arthrosis was the L4-L5 level, as compared with each of the other levels