P88. Ketorolac Decreases Postoperative Pain and Morphine Requirements Following Decompressive Lumbar Laminectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial

Proceedings of the NASS 21st Annual Meetings / The Spine Journal 6 (2006) 1S–161S with the control. FACS analysis after 14 days of co-culture showed that 0.5% of cells were double fluorescent for GFP and RFP. However, both male and female cells were independently identified by FISH (Fig. 1). CONCLUSIONS: The results of this study demonstrate that the interaction between MSC and NPC may derive from a combination of MSC differentiation towards a more chondrogenic phenotype as well as stimulatory paracrine effects exerted by MSCs upon NPCs. The presence of few twocolor positive cells by FACS, without any qualitative observation of cells with tetraploid DNA by FISH, leads us to consider cell fusion a rare phenomenon. The ongoing study of mRNA expression of other gene will further clarify the interaction between MSC and NPC. This study further clarifies the mechanism of the interaction between MSCs and NPCs, and improves the understanding of the potential of MSCs to alter the course of intervertebral disc degeneration. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2006.06.232

P87. Trabecular Bone Micro-Architecture and Bone Mineral Density of Adolescent Idiopathic Scoliosis and Congenital Scoliosis Feng Zhu1, Yong Qiu, MD1, Hiu Yan Yeung2, Kwong Man Lee3, ChunYiu Cheng4; 1Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; 2Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China; 3Lee Hysan Clinical Research Laboratories, The Chinese University of Hong Kong, Hong Kong, China; 4Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China BACKGROUND CONTEXT: Previous study has shown that there exists bone mass insufficiency in certain parts of idiopathic scoliosis and the osteopenia could be one of the prognostic factors for the progression of spinal deformity. The microstructure of trabecular bone of AIS and congenital scoliosis (CS) were still unknown to us. PURPOSE: To evaluate the bone mineral status of CS patients compared with normal control and AIS patients. To investigate the microstructure of trabecular bone in adolescent idiopathic scoliosis (AIS) and age-matched congenital scoliosis (CS). STUDY DESIGN/SETTING: Biopsy of iliac crest was collected during autograft harvesting for spinal fusion from AIS and CS patients. Bone mineral status was assessed in every patient by DEXA (Norland XR-36, U.S.). Bone specimens were scanned by micro computer tomography (mCT40, Scanco Medical, Switzerland) to evaluate the microstructure of trabecular bone. PATIENT SAMPLE: 15 AIS patients with mean age 14.9 years (range 12–19 years), Cobb angle range 48-104  with mean 59  , were recruited into this study. Another group consisted of 16 CS patients aged 13–18 years with mean 14.6 years and Cobb 40-125  (mean 60.6  ). Normal control group consisted of 35 female adolescents with mean age of 14.6 (range 13–16 years). OUTCOME MEASURES: Corrective surgery was indicated in AIS and CS patients, and iliac crest biopsy was collected during autograft harvesting. Bone mineral status was assessed at the area of lumbar and hip in every patient by DEXA (Norland XR-36). Consent was obtained from patients and their parents. Bone specimens were scanned by micro computer tomography (mCT40, Scanco Medical, Switzerland). Reconstructed 3-D images at the resolution of 20 mm were achieved for morphometric analysis. METHODS: To collect the trabecular bone of iliac crest from AIS and CS patients, bone mineral status was assessed in every patient and the normal control group by DEXA (Norland XR-36, U.S.). Bone specimens were scanned by micro computer tomography (mCT40, Scanco Medical, Switzerland) to evaluate the microstructure of trabecular bone. The BMD values were compared between AIS, CS, and normal groups. Micro-

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structure values were compared between AIS and CS patients to determine the difference between them. RESULTS: Significantly lower lumbar and femur neck BMD were found in AIS patients compared with normal controls. All BMD and BMC parameters were significantly lower in CS patients compared with agematched normal controls. Significant association between BV/TV and the BMD values under DEXA assessment was observed. Femur neck BMD and BMC were significantly lower in CS than that in AIS. In the 3-D model BV/TV value was significantly higher in AIS (19. 63.4%) than that in CS (13.363.0%, p!.05). Significant differences between AIS and CS were also found in the parameters of trabecular thickness (Tb.Th) and bone surface/bone volume (BS/BV) (155.5654.9 mm vs. 108.1617.4 mm and 16.463.3% vs. 22.063.4% respectively, p!.05 in both). CONCLUSIONS: Lower bone mineral status and weak trabecular bone structure observed in CS justified further investigation on the bone mineral status in scoliosis with various etiology. This study further presented the feature of bone mineral density and micro-architecture in AIS patients which could have an etiopathogenetic significance. FDA DEVICE/DRUG STATUS: DEXA: Approved for this indication; micro computer tomography: Approved for this indication. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2006.06.233

P88. Ketorolac Decreases Postoperative Pain and Morphine Requirements Following Decompressive Lumbar Laminectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial Ezequiel Cassinelli, MD1, Clayton Dean, MD1, Raymond Graber, MD1, Christopher Furey, MD1, Nicholas Ahn, MD1, Henry Bohlman, MD2; 1 Case Western Reserve University, Cleveland, OH, USA; 2Spine Institute, University Hospitals of Cleveland, Cleveland, OH, USA BACKGROUND CONTEXT: Ketorolac is a potent nonsteroidal analgesic agent used to treat postoperative pain. Its efficacy has been demonstrated after general surgery and orthopedic outpatient procedures. PURPOSE: The purpose of this study was to examine the effect of ketorolac on postoperative pain and morphine requirements after decompressive lumbar laminectomy. STUDY DESIGN/SETTING: A prospective, randomized, double-blind, placebo-controlled trial. PATIENT SAMPLE: Ninteen patients undergoing primary two and three level decompressive laminectomy for lumbar stenosis. Patients with regular preoperative narcotic use were excluded. OUTCOME MEASURES: Visual Analog Scores, Postoperative morphine requirement. METHODS: Patients were randomized to receive either postoperative ketorolac (Group 1, n510) or placebo (Group 2, n59). The study medication was administered in a double-blinded fashion immediately postoperatively, as well as 6 and 12 hours postoperatively. A standardized general anesthesia protocol was used intraoperatively for all patients, and all were given IV morphine as needed for the first 24 hours. After 24 hours, patients were given oral pain medication with IV morphine for breakthrough pain. RESULTS: There were no differences between the two groups with regard to age, number of levels decompressed, surgical time, blood loss, or ASA class. VAS scores were lower in Group 1 at 0, 4, 8, 12, 16, 24, and 36 hours, but statistically significant only at 4 hours (p5.039) and 16 hours (p5.04). 24-hour morphine use was lower in Group 1 (6.4 mg vs. 20.1 mg, p5.052). Total morphine requirements were significantly lower in Group 1 (6.4 mg vs. 22.4 mg, p5.019). No significant differences were noted in oral pain medication requirements. Drain output was slightly lower in Group 1 (191 ml vs. 247.1 ml, p5.46). One epidural hematoma occurred in Group 2 (excluded from statistical analysis), and one postoperative ileus occurred in Group 1. Hospital stay was less in group 1 (56.5 hours vs. 70.4 hours), although this was not statistically significant (p5.23).

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Proceedings of the NASS 21st Annual Meetings / The Spine Journal 6 (2006) 1S–161S

CONCLUSIONS: Intravenous ketorolac appears to significantly decrease postoperative pain and morphine requirements after primary decompressive lumbar laminectomy. FDA DEVICE/DRUG STATUS: Ketorolac: Approved for this indication. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2006.06.234

P89. Workers’ Compensation Indemnity Settlement Costs Vary by Functional Outcome Following Sports Performance Based Rehabilitation in Spinal Fusion Patients Jamie Stark, PhD, CSCS, HFI1, Matthew Kruger, MS, CSCS2, Mike Zbreski, MS3, Dylan Bates, MS4, Gregory Steil, EP5; 1ATI Physical Therapy, Chicago, IL, USA; 2Athletic and Therapeutic Institute, Romeoville, IL, USA; 3ATI Physical Therapy, Romeoville, IL, USA; 4 Athletic and Therapeutic Institute, Joliet, IL, USA; 5ATI Physical Therapy, Willowbrook, IL, USA BACKGROUND CONTEXT: The total case cost of spinal fusion can be exceptionally high for worker’s compensation patients. The total case cost is a product of the medical and nonmedical (indemnity) costs. In Illinois, 55% of the total case costs are nonmedical. In our previous studies Sports Performance based Work Conditioning/Hardening (SPWC/H) has been shown to be effective in increasing the functional capabilities of subjects s/p lumbar fusion and produced return-to-work rates comparable to that of the general population. PURPOSE: The purpose of this study was to determine if differences in indemnity settlement costs were related to the functional outcome following SPWC/H for workers’ compensation spinal fusion patients in Illinois. STUDY DESIGN/SETTING: A 4-year multi-center study utilized retrospective review of patient programs to assess functional capabilities of subjects at SPWC/H completion. Data were collected in an outpatient interdisciplinary rehabilitation setting. PATIENT SAMPLE: Thirty-seven male subjects, s/p lumbar fusion, age range 26-55. Subjects were discharged from traditional physical therapy programs before entering the program. Subjects completed a minimum of 4 weeks in SPWC/H, were allowed full program progression, and had been discharged from the program for a minimum of 3 years. OUTCOME MEASURES: Physical demand level (PDL) following SPWC/H was determined by reviewing patient files. Return-to-work (RTW) and settlement value were assessed by telephone interview. METHODS: Subjects were contacted by telephone and completed a questionnaire. These results were compared with subject’s PDL following SPWC/H. PDL was categorized according to the U.S. Dept. of Labor’s Dictionary of Occupational Titles: MEDIUM (50 lbs), MEDIUM-HEAVY (75 lbs), HEAVY (100 lbs), VERY-HEAVY (O100 lbs). Student t tests and a one-way ANOVA were used to measure differences between groups. Significance was set at p!.05. Fisher Exact test was utilized for post hoc analysis. Data are mean 6SD. RESULTS: Overall RTW rate following SPWC/H was 84% (31/37). RTW rates by PDL were: MEDIUM 56% (5/9), MEDIUM-HEAVY 82% (9/11), HEAVY 100% (6/6), VERY-HEAVY 100% (11/11). Settlement values varied by RTW status ($393,333135,708 vs. $119,22653,786 for RTW and NO RTW respectively; p ! .05). For patients who did RTW, settlement values also varied by PDL (MEDIUM $205,00033,000; MEDIUM-HEAVY $140,00038,000; HEAVY $94,00014,000; VERY-HEAVY $77,00024,000; p ! .05 for all groups). CONCLUSIONS: During the settlement process for back injuries in Illinois a ‘Final Disability Rating’ is ascribed to patients. These data show that RTW status and PDL following SPWC/H affect worker’s compensation settlement values in spinal fusion patients in Illinois. These data suggest that functional capabilities following SPWC/H have a direct impact on settlement costs, thus providing an economic benefit to the workers’ compensation system. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.

CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2006.06.235 P90. An Outcome Study of Single-level Anterior Lumbar Interbody Fusions Utilizing rhBMP-2 Frank Bono, DO1, Douglas Geiger, MD2; 1Michigan Brain and Spine Institute, West Bloomfield, MI, USA; 2Michigan Brain and Spine Institute, Ypsilanti, MI, USA BACKGROUND CONTEXT: The purpose of this study was to measure the success rate of anterior lumbar interbody fusion using recombinant human morphogenic protein-2 for the treatment of degenerative disc disease as compared with autogenous iliac crest bone harvest graft. PURPOSE: The purpose of this study was to measure the success rate of anterior lumbar interbody fusions using recombinant human morphogenic protein-2 (rhBMP-2) for the treatment of degenerative disc disease as compared with autogenous iliac crest bone harvest graft and historic controls. Success was measured by examinging radiologic fusion rates, revision rates, length of stay, blood loss, hip pain (vs. iliac crest bone graft), operative time, and spinal alignment on xray. STUDY DESIGN/SETTING: This retrospective study compared the outcome of rhBMP-2 versus autogenous iliac crest bone graft for single-level anterior interbody fusion using threaded cages. PATIENT SAMPLE: A retrospective chart and radiograph review was performed for 101 patients who underwent anterior lumbar interbody fusion using threaded stand-alone cage. The patient population had a minimun of 2-year follow-up. OUTCOME MEASURES: Hospital charts, office charts, and radiographs were used to determine success of fusion, amount of blood loss, operative time, length of hospital stay, and number of weeks to return to work. METHODS: Thirty-three patients who underwent anterior lumbar interbody fusion with stand-alone cage with recombinant bone norphogenic protein-2 were compared with 68 patietns who underwent a similar procedure using autogenous iliac crest graft. These patients had a minimum follow-up of 2 years. The study focused on fusion rate, time to fusion, amount of blood loss, graft subsidence, graft site pain, number of weeks to return to work, length of hospital stay, and operative time. RESULTS: The fusion rate for the BMP group was 100%. The autogenous group had a statistically (p!.005) lower rate of fusion at 94%. Fusion rate, amount of blood loss, operative time, length of hospital stay, and number of weeks to return to work proved to be statistically significant in graft subsidence between the two groups. CONCLUSIONS: The results of this retrospective study confirm that anterior lumbar interbody fusion using rhBMP-2 significantly decreased operative blood loss, operative time, and length of hospital stay while achieving higher fusion rates over autogenous iliac crest bone graft. These factors may help to offset the greater cost of BMP. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2006.06.236 P91. Freeze-Dried versus Fresh-Frozen Allograft for Anterior Lumbar Interbody Fusion as Part of a Circumferential Fusion John Thalgott, MD1, James Giuffre2, Madilyne Fogarty, BS3, Stephani Christenson, BS3, Alex Epstein4, Chunhong Ni5, Charles Aprill, MD6; 1International Spinal Development & Research Foundation, Las Vegas, NV, USA; 2International Spinal Development and Research Foundation, Bridgewater, MA, USA; 3International Spinal Development and Research Foundation, NV, USA; 4NV, USA; 5Louisiana State University, China; 6Louisiana State University, New Orleans, LA, USA BACKGROUND CONTEXT: One of the most widely used ALIF components is femoral ring allograft. The femoral ring is allograph cut in the shape of a hollow cylinder to provide strength and load-bearing stability