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P73. A novel preoperative MRI-based lumbar muscle health calculation to predict patient-reported health-related quality of life scores
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S158−S194
p=0.004), then skilled nursing facilities ($1,822, p=0.007) and home health ($785, p=0.007). CONCLUSIONS: Post-acute care, especially inpatient rehabilitation, is the primary driver of variation in 90-day episode payments for non-cervical spine fusions. Strategies for success in bundled payment initiatives will require attention to potentially discretionary use of post-acute care after index hospitalization. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
muscle health), 2 (adequate muscle health) and 3 (good muscle health). Higher scores corresponded to better VAS back (p=0.014), VAS leg (p=0.01), SF-12 PHS (0.027), ODI (p=0.022) and PROMIS (=0.001) scores. CONCLUSIONS: Muscle health contributes significantly to preoperative disability. When patients have combined low PL-CSA/BMI, goutallier classification and LIV this corresponds to significantly worse HRQOLs. This lumbar muscle health score is a valid screen for patients with poor muscle health which may be contributing to their disability. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
https://doi.org/10.1016/j.spinee.2019.05.496 https://doi.org/10.1016/j.spinee.2019.05.497 P73. A novel preoperative MRI-based lumbar muscle health calculation to predict patient-reported health-related quality of life scores Sohrab Virk, MD1, Joshua Wright-Chisem, MD1, Avani S. Vaishnav, MBBS1, Jung Mok, BS2, Steven J. McAnany, MD3, Sravisht Iyer, MD4, Todd J. Albert, MD2, Catherine Himo Gang, MPH2, Sheeraz A. Qureshi, MD, MBA2; 1 Hospital for Special Surgery, New York City, NY, US; 2 New York, US; 3 Hospital for Special Surgery, Stamford, CT, US; 4 Rush University Medical Center, Chicago, IL, US BACKGROUND CONTEXT: Poor lumbar muscle health has been implicated as a source of disability for patients with low back/radicular pain. We wanted to evaluate the relationship between muscle health and patient reported quality of life scores. PURPOSE: Determine how preoperative muscle health impacts patient reported health related quality of life scores. STUDY DESIGN/SETTING: Retrospective review of imaging and outcome scores. PATIENT SAMPLE: A total of 92 adult patients with lumbar spine pathology requiring MIS lumbar decompression/fusion. OUTCOME MEASURES: Health-related-quality of life (HRQL) scores, paralumbar muscle cross sectional area (PL-CSA), lumbar indentation value (LIV), Goutallier classification. METHODS: We performed a retrospective review of patients that had lumbar decompression and/or fusion surgery after failing nonop management for degenerative pathologies. We quantified muscle health using PL-CSA, LIV and lumbar muscle fat atrophy using the Goutallier classification. T2 MRI axial slices from the disc space at the operative level were analyzed. We graded fat atrophy on a 1-4 scale and the LIV was calculated using a published technique of measuring the distance from the tip of a spinous process and a line across the muscular fascia. We used a standardized protocol of measuring cross sectional area of the paralumbar muscle (PL-CSA). We scaled the PLCSA by finding the ratio of PL-CSA/BMI. HRQOL scores collected included VAS leg, VAS back, ODI, SF-12 mental and physical health and PROMIS. We performed a linear regression analysis to determine the relationship of LIV, PL-CSA, PL-CSA/BMI and the HRQOLs. We performed an ANOVA analysis to identify the relationship between Goutallier classification and HRQOLs listed. We combined our measurements to create a score to quantify muscle health and determined whether this score correlated with HRQOLs based on an ANOVA analysis. RESULTS: A total of 92 patients were included within our analysis. The average age was 57.9+/-14.4 years old (49 men and 43 women). There were 104 levels operated on within this cohort. The most common preoperative diagnosis was lumbar spinal stenosis (58 patients). We found that the average LIV, PL-CSA and PL-CSA/BMI was 16.1 +/-7.5 mm, 4004 +/-1210 mm^2 and 153.5 +/- 45.0 mm^2/BMI. The PL-CSA/BMI ratio significantly correlated with preop SF-12 PHS (p = 0.03), VAS back (0.007) and VAS Leg (p = 0.002). Patients with less than 130 of the PL-CSA/BMI ratio had statistically significant worse PROMIS (35.9 vs 29.7, p=0.007), ODI (39.4 vs 50.2, p=0.01), SF-12 PHS (35.5 vs 28.7, =0.001), VAS leg (7.3 vs 5.5, p=0.007) and VAS back (7.9 vs 4.9, p=0.002) scores. We combined our results and scored each patient from 1-3 based upon whether there LIV <10mm or >10mm (0 or 1), Goutallier Classification >2 or <=2 (0 or 1) and whether PLCSA/BMI was >130 or <130 (0 or 1). Patients were stratified from 0-1 (poor
P74. Preoperative muscle health impacts the time taken to reach minimally clinically important differences in health-related quality of life scores for one-level lumbar fusions Sohrab Virk, MD1, Joshua Wright-Chisem, MD1, Jung Mok, BS2, Avani S. Vaishnav, MBBS1, Yahya A. Othman3, Steven J. McAnany, MD4, Sravisht Iyer, MD5, Todd J. Albert, MD2, Catherine Himo Gang, MPH2, Sheeraz A. Qureshi, MD, MBA2; 1 Hospital for Special Surgery, New York City, NY, US; 2 New York, US; 3 Weill Cornell Medicine, Qatar Foundation, Rayyan, Qatar; 4 Hospital for Special Surgery, Stamford, CT, US; 5 Rush University Medical Center, Chicago, IL, US BACKGROUND CONTEXT: There is evidence that degenerative changes in paralumbar musculature impact conditions like low back pain, and lumbar spinal stenosis. For patients undergoing spinal surgery we hypothesized that paralumbar muscle health would alter the time it took for patients to reach minimal clinically important differences (MCIDs) in health-related quality of life scores (HRQOLs). PURPOSE: Determine how preoperative muscle health impacts the time to MCID for one level MIS TLIF and/or decompression. STUDY DESIGN/SETTING: Retrospective review of a prospectively collected database PATIENT SAMPLE: Eighty-five adult patients with lumbar spine pathology requiring MIS lumbar decompression/fusion. OUTCOME MEASURES: Health-related-quality of life (HRQL) scores, lumbar indentation value (LIV). METHODS: We performed a retrospective review of patients that eventually went on to undergo either a lumbar decompressive surgery or a 1-level lumbar spinal fusion. We analyzed magnetic resonance imaging (MRI) to quantify muscle health using the lumbar indentation value (LIV) which is a validated method of measuring the relative cross-sectional area of lumbar musculature. T2 axial slices from the disc space at the operative level were analyzed. We separated our cohort of patients into whether they had a lumbar decompression alone or 1-level TLIF. Health related quality of life (HRQOL) scores were collected on these patients in the pre-operative period and the postoperative period up to 1 year out from surgery. These scores included the Visual analog back and leg scores (VAS leg and VAS back), the oswestry disability index (ODI), short form 12 (SF-12) mental health scores (MHS) and physical health scores (PHS). We defined MCID as has been previously reported in the literature. We then correlated the LIV calculated off preoperative MRI and correlated this finding with time to MCID using a linear regression analysis. RESULTS: A total of 85 patients were included within our analysis. The average age was 58.4+/-15.7 years old and there were 45 men and 40 women. There were 93 disc spaces operated on within this cohort. The majority of patients undergoing a lumbar decompression (LD) had a diagnosis of disc herniation (49.2%) and the majority of patients that had a lumbar fusion (LF) were diagnosed with lumbar spinal stenosis (93.1%). We found that the average LIV for LD patients was 16.2+/-6.5mm and for LF patients was 17.1+/-6.6mm. There was no statistically significant correlation between time to MCID for ODI, SF-12 MHS. SF-12 PHS, VAS leg, or VAS back scores and LIV for patients undergoing a lumbar decompression. There was a statistically significant inverse relationship between time to MCID for ODI (p =0.02) and LIV and time to MCID for SF-12 MHS
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.
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S158−S194
p=0.004), then skilled nursing facilities ($1,822, p=0.007) and home health ($785, p=0.007). CONCLUSIONS: Post-acute care, especially inpatient rehabilitation, is the primary driver of variation in 90-day episode payments for non-cervical spine fusions. Strategies for success in bundled payment initiatives will require attention to potentially discretionary use of post-acute care after index hospitalization. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
muscle health), 2 (adequate muscle health) and 3 (good muscle health). Higher scores corresponded to better VAS back (p=0.014), VAS leg (p=0.01), SF-12 PHS (0.027), ODI (p=0.022) and PROMIS (=0.001) scores. CONCLUSIONS: Muscle health contributes significantly to preoperative disability. When patients have combined low PL-CSA/BMI, goutallier classification and LIV this corresponds to significantly worse HRQOLs. This lumbar muscle health score is a valid screen for patients with poor muscle health which may be contributing to their disability. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
https://doi.org/10.1016/j.spinee.2019.05.496 https://doi.org/10.1016/j.spinee.2019.05.497 P73. A novel preoperative MRI-based lumbar muscle health calculation to predict patient-reported health-related quality of life scores Sohrab Virk, MD1, Joshua Wright-Chisem, MD1, Avani S. Vaishnav, MBBS1, Jung Mok, BS2, Steven J. McAnany, MD3, Sravisht Iyer, MD4, Todd J. Albert, MD2, Catherine Himo Gang, MPH2, Sheeraz A. Qureshi, MD, MBA2; 1 Hospital for Special Surgery, New York City, NY, US; 2 New York, US; 3 Hospital for Special Surgery, Stamford, CT, US; 4 Rush University Medical Center, Chicago, IL, US BACKGROUND CONTEXT: Poor lumbar muscle health has been implicated as a source of disability for patients with low back/radicular pain. We wanted to evaluate the relationship between muscle health and patient reported quality of life scores. PURPOSE: Determine how preoperative muscle health impacts patient reported health related quality of life scores. STUDY DESIGN/SETTING: Retrospective review of imaging and outcome scores. PATIENT SAMPLE: A total of 92 adult patients with lumbar spine pathology requiring MIS lumbar decompression/fusion. OUTCOME MEASURES: Health-related-quality of life (HRQL) scores, paralumbar muscle cross sectional area (PL-CSA), lumbar indentation value (LIV), Goutallier classification. METHODS: We performed a retrospective review of patients that had lumbar decompression and/or fusion surgery after failing nonop management for degenerative pathologies. We quantified muscle health using PL-CSA, LIV and lumbar muscle fat atrophy using the Goutallier classification. T2 MRI axial slices from the disc space at the operative level were analyzed. We graded fat atrophy on a 1-4 scale and the LIV was calculated using a published technique of measuring the distance from the tip of a spinous process and a line across the muscular fascia. We used a standardized protocol of measuring cross sectional area of the paralumbar muscle (PL-CSA). We scaled the PLCSA by finding the ratio of PL-CSA/BMI. HRQOL scores collected included VAS leg, VAS back, ODI, SF-12 mental and physical health and PROMIS. We performed a linear regression analysis to determine the relationship of LIV, PL-CSA, PL-CSA/BMI and the HRQOLs. We performed an ANOVA analysis to identify the relationship between Goutallier classification and HRQOLs listed. We combined our measurements to create a score to quantify muscle health and determined whether this score correlated with HRQOLs based on an ANOVA analysis. RESULTS: A total of 92 patients were included within our analysis. The average age was 57.9+/-14.4 years old (49 men and 43 women). There were 104 levels operated on within this cohort. The most common preoperative diagnosis was lumbar spinal stenosis (58 patients). We found that the average LIV, PL-CSA and PL-CSA/BMI was 16.1 +/-7.5 mm, 4004 +/-1210 mm^2 and 153.5 +/- 45.0 mm^2/BMI. The PL-CSA/BMI ratio significantly correlated with preop SF-12 PHS (p = 0.03), VAS back (0.007) and VAS Leg (p = 0.002). Patients with less than 130 of the PL-CSA/BMI ratio had statistically significant worse PROMIS (35.9 vs 29.7, p=0.007), ODI (39.4 vs 50.2, p=0.01), SF-12 PHS (35.5 vs 28.7, =0.001), VAS leg (7.3 vs 5.5, p=0.007) and VAS back (7.9 vs 4.9, p=0.002) scores. We combined our results and scored each patient from 1-3 based upon whether there LIV <10mm or >10mm (0 or 1), Goutallier Classification >2 or <=2 (0 or 1) and whether PLCSA/BMI was >130 or <130 (0 or 1). Patients were stratified from 0-1 (poor
P74. Preoperative muscle health impacts the time taken to reach minimally clinically important differences in health-related quality of life scores for one-level lumbar fusions Sohrab Virk, MD1, Joshua Wright-Chisem, MD1, Jung Mok, BS2, Avani S. Vaishnav, MBBS1, Yahya A. Othman3, Steven J. McAnany, MD4, Sravisht Iyer, MD5, Todd J. Albert, MD2, Catherine Himo Gang, MPH2, Sheeraz A. Qureshi, MD, MBA2; 1 Hospital for Special Surgery, New York City, NY, US; 2 New York, US; 3 Weill Cornell Medicine, Qatar Foundation, Rayyan, Qatar; 4 Hospital for Special Surgery, Stamford, CT, US; 5 Rush University Medical Center, Chicago, IL, US BACKGROUND CONTEXT: There is evidence that degenerative changes in paralumbar musculature impact conditions like low back pain, and lumbar spinal stenosis. For patients undergoing spinal surgery we hypothesized that paralumbar muscle health would alter the time it took for patients to reach minimal clinically important differences (MCIDs) in health-related quality of life scores (HRQOLs). PURPOSE: Determine how preoperative muscle health impacts the time to MCID for one level MIS TLIF and/or decompression. STUDY DESIGN/SETTING: Retrospective review of a prospectively collected database PATIENT SAMPLE: Eighty-five adult patients with lumbar spine pathology requiring MIS lumbar decompression/fusion. OUTCOME MEASURES: Health-related-quality of life (HRQL) scores, lumbar indentation value (LIV). METHODS: We performed a retrospective review of patients that eventually went on to undergo either a lumbar decompressive surgery or a 1-level lumbar spinal fusion. We analyzed magnetic resonance imaging (MRI) to quantify muscle health using the lumbar indentation value (LIV) which is a validated method of measuring the relative cross-sectional area of lumbar musculature. T2 axial slices from the disc space at the operative level were analyzed. We separated our cohort of patients into whether they had a lumbar decompression alone or 1-level TLIF. Health related quality of life (HRQOL) scores were collected on these patients in the pre-operative period and the postoperative period up to 1 year out from surgery. These scores included the Visual analog back and leg scores (VAS leg and VAS back), the oswestry disability index (ODI), short form 12 (SF-12) mental health scores (MHS) and physical health scores (PHS). We defined MCID as has been previously reported in the literature. We then correlated the LIV calculated off preoperative MRI and correlated this finding with time to MCID using a linear regression analysis. RESULTS: A total of 85 patients were included within our analysis. The average age was 58.4+/-15.7 years old and there were 45 men and 40 women. There were 93 disc spaces operated on within this cohort. The majority of patients undergoing a lumbar decompression (LD) had a diagnosis of disc herniation (49.2%) and the majority of patients that had a lumbar fusion (LF) were diagnosed with lumbar spinal stenosis (93.1%). We found that the average LIV for LD patients was 16.2+/-6.5mm and for LF patients was 17.1+/-6.6mm. There was no statistically significant correlation between time to MCID for ODI, SF-12 MHS. SF-12 PHS, VAS leg, or VAS back scores and LIV for patients undergoing a lumbar decompression. There was a statistically significant inverse relationship between time to MCID for ODI (p =0.02) and LIV and time to MCID for SF-12 MHS
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.