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Sagittal Alignment Two Years After Selective and Nonselective Thoracic Fusion for Lenke 1C Adolescent Idiopathic Scoliosis
102S
Proceedings of the NASS 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S
ePosters P1. Sagittal Alignment Two Years After Selective and Nonselective Thoracic Fusion for Lenke 1C Adolescent Idiopathic Scoliosis Paul C. Celestre, MD1, Leah Y. Carreon, MD, MSc2, Lawrence G. Lenke, MD3, Daniel J. Sucato, MD4, Steven D. Glassman, MD5; 1Louisville, KY, US; 2Spine Institute, Louisville, KY, US; 3Washington University Medical Center Department of Orthopedic Surgery, St. Louis, MO, US; 4Texas Scottish Rite Hospital for Children, Dallas, TX, US; 5Norton Leatherman Spine Center, Louisville, KY, US BACKGROUND CONTEXT: Sagittal balance is a major predictor of outcomes in adults with scoliosis, but this is rarely a problem in children with AIS. In patients with Lenke 1C AIS, the impact of sagittal curve parameters after selective thoracic fusion (STF) versus fusion of both curves (non-selective thoracic fusion, NSTF) has not been well studied. Sagittal balance appears to be adequately maintained following STF for up to 20 yrs postop. However, moderate kyphosis may not become clinically relevant until the patient loses the ability to compensate through pelvic retroversion. PURPOSE: The purpose of this study is to compare the thoracic and thoracolumbar sagittal alignment after STF versus NSTF in Lenke 1C AIS curves. STUDY DESIGN/SETTING: Longitudinal cohort. PATIENT SAMPLE: Patients enrolled in a multi-center database of AIS patients treated surgically. OUTCOME MEASURES: Radiographic parameters, Scoliosis Research Society 22 R (SRS22R). METHODS: A multi-center database of AIS patients was queried for patients with right sided Lenke 1C curves treated with posterior correction and fusion. Independent t-tests were used to compare continuous variables and Fisher’s test was used to compare categorical variables between the STF (LIV at L1 or higher) and NSTF (LIV at L3 or L4) groups. RESULTS: Ninety-four patients had STF and 78 had NSTF. Mean preoperative T5-T12 sagittal Cobb was 23.9 in the STF and 19.5 in the NSTF group (p50.036). Two years postoperative, the T5-T12 sagittal Cobb was statistically significantly greater in the STF than the NSTF group, 25.2 and 20.6 respectively (p50.003).Mean preoperative T10-L2 sagittal Cobb was -1.3 in the STF and -1.2 in the NSTF group (p50.943).Two years postoperative, the mean T10-L2 sagittal Cobb was 3.0 in the STF and -7.9 in the NSTF group (p!0.000).There was no significant difference in C7-S1 sagittal balance or SRS22R domain scores between the groups either pre- or postoperatively. CONCLUSIONS: Compared to NSTF, STF for Lenke 1C AIS resulted in greater T5-T12 kyphosis and greater thoracolumbar kyphosis two years from surgery. It is unknown whether this may predispose these patients to later problems associated with sagittal imbalance as these patients eventually lose the ability to compensate through pelvic retroversion. While it is unlikely that the risk of a small increase in thoracolumbar kyphosis will outweigh the well accepted advantages of leaving the lumbar spine unfused, this study highlights the need to study AIS patients throughout the aging process. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.275
P2. Magnetic Resonance Imaging in Follow-Up Assessment of Sciatica Abdelilah El Barzouhi, MD, MSc1, Carmen Vleggeert-Lankamp, MD, PhD2, Wilco C. Jacobs, MS1, Wilco C. Peul, MD, PhD1; 1Leiden University Medical Center, Leiden, Netherlands; 2Netherlands BACKGROUND CONTEXT: Magnetic resonance imaging (MRI) is frequently performed in the follow-up evaluation of patients with known
lumbar disc herniation and persistent or recurrent symptoms of sciatica. The association between findings on MRI and clinical course is controversial. PURPOSE: To report on the radiological findings, their changes over time, and their correlation with clinical outcome. STUDY DESIGN/SETTING: A randomized clinical trial with one-year follow-up. PATIENT SAMPLE: Patients for this study were participants in a multicentre randomized trial among patients with 6-12 weeks sciatica and disc herniation on MRI: an early surgery strategy was compared to prolonged conservative care. Participants underwent MRI at baseline and after one year. OUTCOME MEASURES: Favorable outcome at one year was defined as ‘‘complete’’ or ‘‘nearly complete disappearance of symptoms’’ on the patient-reported 7-point Likert scale for global perceived recovery. Other outcome measures were the Roland Disability Questionnaire (RDQ) for Sciatica and the 100-mm visual-analogue scale (VAS) for leg pain. METHODS: Two radiologists and a neurosurgeon used a four point scale to assess the presence of disc herniation on MRI at baseline and one year (15definitely present, 45definitely absent). We compared proportions with favorable outcomes among those with definite absence of a disc herniation and those with definite, probable, or possible presence of disc herniation at 1 year. Mean RDQ and VAS-leg pain were compared between patients with and without disc herniation. We used the area under the receiver operating characteristic (ROC) curve to assess how well MRI assessors’ 4 point scores for disc herniation at 1 year discriminated patients with favorable and unfavorable outcomes (15perfect discrimination; !50.55 no discriminatory value). RESULTS: One year after randomization 84% of the patients reported favorable outcome. A disc herniation at one year was visible in 35% with favorable and in 33% with unfavorable outcome (P50.70). Favorable outcome was reported in 85% with and 83% without disc herniation (P50.70). Patients with a disc herniation reported a mean RDQ of 3.4 and VAS-leg pain of 11.7 compared to an RDQ of 3.4 and VAS-leg pain of 10.5 in patients without a disc herniation (P50.98 and P50.66 respectively). Readers’ assessments of disc herniation on MRI did not discriminate between subjects with and without favorable outcome (area under ROC50.48). CONCLUSIONS: In this one year study of patients treated for sciatica and lumbar disc herniation, MRI did not discriminate between patients who recovered and those who did not recover from sciatica. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.276
P3. T1 Intralaminar Screws: An Anatomic, Morphologic Study of 112 Cadaveric Specimens and the Feasibility of T1 Intralaminar Screw Placement John Weaver1, Jason Eubanks, MD2; 1Warren, OH, US; 2Willoughby Hills, OH, US BACKGROUND CONTEXT: Laminar screw placement is generally reserved for use as a salvage or alternative technique when pedicle screw placement is contraindicated in the setting of a complex revision, tumor, or anomolous anatomy. Pedicle screws have proven to be the most biomechanically stable screws, but laminar screws are a reliable alternative when necessary. The mean pullout forces between laminar and pedicle screws are similar; however, the mean lamina screw peak insertion torque is lower than the mean index pedicle screw peak insertion torque. Advantages of laminar screw placement as opposed to pedicle screws include a decrease in possible neurovascular complications secondary to the proximity of these structures to the pedicle. Another important advantage of laminar screw fixation is that the use of a fluoroscope or navigation system is no longer necessary because the screw can be placed under direct vision of
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
Proceedings of the NASS 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S
ePosters P1. Sagittal Alignment Two Years After Selective and Nonselective Thoracic Fusion for Lenke 1C Adolescent Idiopathic Scoliosis Paul C. Celestre, MD1, Leah Y. Carreon, MD, MSc2, Lawrence G. Lenke, MD3, Daniel J. Sucato, MD4, Steven D. Glassman, MD5; 1Louisville, KY, US; 2Spine Institute, Louisville, KY, US; 3Washington University Medical Center Department of Orthopedic Surgery, St. Louis, MO, US; 4Texas Scottish Rite Hospital for Children, Dallas, TX, US; 5Norton Leatherman Spine Center, Louisville, KY, US BACKGROUND CONTEXT: Sagittal balance is a major predictor of outcomes in adults with scoliosis, but this is rarely a problem in children with AIS. In patients with Lenke 1C AIS, the impact of sagittal curve parameters after selective thoracic fusion (STF) versus fusion of both curves (non-selective thoracic fusion, NSTF) has not been well studied. Sagittal balance appears to be adequately maintained following STF for up to 20 yrs postop. However, moderate kyphosis may not become clinically relevant until the patient loses the ability to compensate through pelvic retroversion. PURPOSE: The purpose of this study is to compare the thoracic and thoracolumbar sagittal alignment after STF versus NSTF in Lenke 1C AIS curves. STUDY DESIGN/SETTING: Longitudinal cohort. PATIENT SAMPLE: Patients enrolled in a multi-center database of AIS patients treated surgically. OUTCOME MEASURES: Radiographic parameters, Scoliosis Research Society 22 R (SRS22R). METHODS: A multi-center database of AIS patients was queried for patients with right sided Lenke 1C curves treated with posterior correction and fusion. Independent t-tests were used to compare continuous variables and Fisher’s test was used to compare categorical variables between the STF (LIV at L1 or higher) and NSTF (LIV at L3 or L4) groups. RESULTS: Ninety-four patients had STF and 78 had NSTF. Mean preoperative T5-T12 sagittal Cobb was 23.9 in the STF and 19.5 in the NSTF group (p50.036). Two years postoperative, the T5-T12 sagittal Cobb was statistically significantly greater in the STF than the NSTF group, 25.2 and 20.6 respectively (p50.003).Mean preoperative T10-L2 sagittal Cobb was -1.3 in the STF and -1.2 in the NSTF group (p50.943).Two years postoperative, the mean T10-L2 sagittal Cobb was 3.0 in the STF and -7.9 in the NSTF group (p!0.000).There was no significant difference in C7-S1 sagittal balance or SRS22R domain scores between the groups either pre- or postoperatively. CONCLUSIONS: Compared to NSTF, STF for Lenke 1C AIS resulted in greater T5-T12 kyphosis and greater thoracolumbar kyphosis two years from surgery. It is unknown whether this may predispose these patients to later problems associated with sagittal imbalance as these patients eventually lose the ability to compensate through pelvic retroversion. While it is unlikely that the risk of a small increase in thoracolumbar kyphosis will outweigh the well accepted advantages of leaving the lumbar spine unfused, this study highlights the need to study AIS patients throughout the aging process. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.275
P2. Magnetic Resonance Imaging in Follow-Up Assessment of Sciatica Abdelilah El Barzouhi, MD, MSc1, Carmen Vleggeert-Lankamp, MD, PhD2, Wilco C. Jacobs, MS1, Wilco C. Peul, MD, PhD1; 1Leiden University Medical Center, Leiden, Netherlands; 2Netherlands BACKGROUND CONTEXT: Magnetic resonance imaging (MRI) is frequently performed in the follow-up evaluation of patients with known
lumbar disc herniation and persistent or recurrent symptoms of sciatica. The association between findings on MRI and clinical course is controversial. PURPOSE: To report on the radiological findings, their changes over time, and their correlation with clinical outcome. STUDY DESIGN/SETTING: A randomized clinical trial with one-year follow-up. PATIENT SAMPLE: Patients for this study were participants in a multicentre randomized trial among patients with 6-12 weeks sciatica and disc herniation on MRI: an early surgery strategy was compared to prolonged conservative care. Participants underwent MRI at baseline and after one year. OUTCOME MEASURES: Favorable outcome at one year was defined as ‘‘complete’’ or ‘‘nearly complete disappearance of symptoms’’ on the patient-reported 7-point Likert scale for global perceived recovery. Other outcome measures were the Roland Disability Questionnaire (RDQ) for Sciatica and the 100-mm visual-analogue scale (VAS) for leg pain. METHODS: Two radiologists and a neurosurgeon used a four point scale to assess the presence of disc herniation on MRI at baseline and one year (15definitely present, 45definitely absent). We compared proportions with favorable outcomes among those with definite absence of a disc herniation and those with definite, probable, or possible presence of disc herniation at 1 year. Mean RDQ and VAS-leg pain were compared between patients with and without disc herniation. We used the area under the receiver operating characteristic (ROC) curve to assess how well MRI assessors’ 4 point scores for disc herniation at 1 year discriminated patients with favorable and unfavorable outcomes (15perfect discrimination; !50.55 no discriminatory value). RESULTS: One year after randomization 84% of the patients reported favorable outcome. A disc herniation at one year was visible in 35% with favorable and in 33% with unfavorable outcome (P50.70). Favorable outcome was reported in 85% with and 83% without disc herniation (P50.70). Patients with a disc herniation reported a mean RDQ of 3.4 and VAS-leg pain of 11.7 compared to an RDQ of 3.4 and VAS-leg pain of 10.5 in patients without a disc herniation (P50.98 and P50.66 respectively). Readers’ assessments of disc herniation on MRI did not discriminate between subjects with and without favorable outcome (area under ROC50.48). CONCLUSIONS: In this one year study of patients treated for sciatica and lumbar disc herniation, MRI did not discriminate between patients who recovered and those who did not recover from sciatica. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.276
P3. T1 Intralaminar Screws: An Anatomic, Morphologic Study of 112 Cadaveric Specimens and the Feasibility of T1 Intralaminar Screw Placement John Weaver1, Jason Eubanks, MD2; 1Warren, OH, US; 2Willoughby Hills, OH, US BACKGROUND CONTEXT: Laminar screw placement is generally reserved for use as a salvage or alternative technique when pedicle screw placement is contraindicated in the setting of a complex revision, tumor, or anomolous anatomy. Pedicle screws have proven to be the most biomechanically stable screws, but laminar screws are a reliable alternative when necessary. The mean pullout forces between laminar and pedicle screws are similar; however, the mean lamina screw peak insertion torque is lower than the mean index pedicle screw peak insertion torque. Advantages of laminar screw placement as opposed to pedicle screws include a decrease in possible neurovascular complications secondary to the proximity of these structures to the pedicle. Another important advantage of laminar screw fixation is that the use of a fluoroscope or navigation system is no longer necessary because the screw can be placed under direct vision of
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.