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Symptomatic Vertebral Body Compression Fractures Requiring Intervention Following Single Fraction Stereotactic Radiosurgery for Spinal Metastases
Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S 144. Symptomatic Vertebral Body Compression Fractures Requiring Intervention Following Single Fraction Stereotactic Radiosurgery for Spinal Metastases Michael S. Virk, MD, PhD; New York, NY, US BACKGROUND CONTEXT: Single-fraction stereotactic radiosurgery (SRS) 24 Gy dose provides excellent tumor control in patients with spinal metastases. A 12%-40% radiographic vertebral compression fracture (VCF) rate has been reported after SRS. No studies have identified the rate of symptomatic fractures. PURPOSE: The purpose of this study is to determine the rate of post-SRS symptomatic VCF requiring treatment with kyphoplasty or surgery. METHODS: 291 patients who received single-fraction SRS between T4-L5 were included. Charts and imaging were reviewed for post-SRS kyphoplasty or surgery for mechanical instability. All patients had a minimum of 30-month follow-up from time of SRS. RESULTS: Twenty-five patients (9%) with 34 levels treated with SRS (24Gy) progressed to symptomatic VCF requiring treatment with either kyphoplasty (10) or surgery (15). The median time to symptomatic VCF was 28 months (2-51 months). Thirty VCF occurred at the level treated with SRS and 16 VCF occurred adjacent to the level of previous SRS. Twenty-seven VCF were de novo. Median SINS changed from 5 at SRS (1-10) to 11 at stabilization (7-16). Twenty-three patients had biopsy at the time of stabilization that showed no evidence of tumor. The remaining two patients had no specimen taken at the time of stabilization but had no evidence of radiographic or clinical progression. CONCLUSIONS: After receiving ablative single-fraction SRS to spinal lesions, 9% of patients progressed to symptomatic VCF at the treated level in the absence of tumor recurrence. This includes a total of 46 VCF, with sixteen occurring at adjacent, untreated levels. These results may prove useful in discussions with patients regarding treatment risk and when considering early intervention when imaging evidence of pending VCF is detected. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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PATIENT SAMPLE: 2208 subjects receiving medical benefits from the Ohio Bureau of Worker’s Compensation that underwent lumbar fusion surgery after WC-qualifying injury for the primary indication of either spondylolisthesis or DDD between the years of 1993-2010. OUTCOME MEASURES: We determined which subjects were diagnosed with failed back surgery syndrome within 3 years of index lumbar fusion surgery after WC-qualifying injury. METHODS: We used ICD-9 diagnosis and CPT procedural codes to identify WC subjects that fit our study design, all with at least 3 years of follow-up. We eliminated from consideration subjects with a positive smoking history or pre-fusion diagnosis of FBSS, as defined by ICD-9 codes. Logistic regression analysis was performed, with the dependent variable being whether or not FBSS was diagnosed within 3 years after fusion. We corrected for age, gender, obesity, approximated income, number of levels fused, and additional fusion surgeries within 3 years of initial fusion. RESULTS: Subjects who underwent lumbar fusion for spondylolisthesis had significantly lower rates of FBSS development than subjects undergoing fusion for DDD (p50.03; OR 0.69). 53 of 656 (8.1%) subjects who underwent fusion for spondylolisthesis developed FBSS. 165 of 1499 (11.0%) subjects undergoing fusion for DDD developed FBSS. Lower income also was significantly associated with higher rates of FBSS (p50.05; OR 0.99). Age, gender, number of levels fused at index fusion, number of fusion surgeries within 3 years of index fusion, and obesity did not significantly impact FBSS rates. CONCLUSIONS: Failed back surgery syndrome is a relatively debilitating and feared complication of back surgery. We demonstrated that within a worker’s compensation setting, undergoing lumbar fusion for the indication of DDD without co-existing spinal deformity of instability is associated with significantly higher rates of FBSS within 3 years of surgery when compared to subjects undergoing fusion for spondylolisthesis. Subjects that underwent fusion for DDD were approximately 1.45 times more likely to develop FBSS than subjects that underwent fusion for spondylolisthesis. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
http://dx.doi.org/10.1016/j.spinee.2014.08.183 http://dx.doi.org/10.1016/j.spinee.2014.08.184
145. Lumbar Fusion for Degenerative Disc Disease is Associated with Significantly Higher Rates of Failed Back Surgery Syndrome Compared to Fusion for Spondylolisthesis in a Workers’ Compensation Setting Joshua T. Anderson, BS1,2, Ryan J. Duff3, Uri M. Ahn, MD4, Nicholas U. Ahn, MD1; 1University Hospitals Case Medical Center Department of Orthopaedic Surgery, Cleveland, OH, US; 2Case Western Reserve University School of Medicine, Cleveland, OH, US; 3University of Minnesota Twin Cities, Minneapolis, MN, US; 4New Hampshire Spine Institute, Bedford, NH, US BACKGROUND CONTEXT: Worker’s compensation (WC) subjects undergoing lumbar fusion surgery consistently have worse outcomes when compared to the general population. Fusion for degenerative disc disease (DDD) is associated with reportedly variable outcomes, while fusion for spondylolisthesis consistently yields good results. Failed back surgery syndrome (FBSS) is a feared complication of back surgery that leaves the patient with decreased functional capacity, morale and productivity. It is also associated with psychosocial problems and addiction to pain medication. Few studies have evaluated predictors of poor fusion outcomes specifically in WC subjects, a clinically distinct subset of patients. PURPOSE: To compare rates of FBSS development between WC subjects that underwent lumbar fusion for the primary indication of spondylolisthesis and WC subjects that underwent fusion for DDD. STUDY DESIGN/SETTING: Retrospective cohort.
146. Patient Characteristics Associated with Length of Stay and Readmission after Laminectomy for Lumbar Spinal Stenosis Bryce Basques1, Arya G. Varthi, MD2, Nicholas Golinvaux2, Daniel D. Bohl, MPH2, Jonathan N. Grauer, MD2; 1New Haven, CT, US; 2Yale University School of Medicine, New Haven, CT, US BACKGROUND CONTEXT: Lumbar spinal stenosis (LSS) is a common pathology that is traditionally treated with decompressive laminectomy. Risk factors associated with increased postoperative length of stay (LOS) and readmission have not been fully characterized for laminectomy. PURPOSE: To identify factors that were independently associated with increased LOS and readmission in patients who underwent elective laminectomy for LSS. STUDY DESIGN/SETTING: Retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. PATIENT SAMPLE: Patients who underwent laminectomy for LSS during 2011 and 2012 were identified from the ACS-NSQIP. OUTCOME MEASURES: The primary outcome measures were length of stay and readmission. Length of stay was treated as a continuous variable for analysis. Readmission was treated as a binary variable for analysis. METHODS: Patient characteristics were tested for association with LOS and readmission using multivariate analyses. Patients with LOS O 10 days were excluded from the readmission analysis as the ACS-NSQIP only captures readmissions within 30 postoperative days, and the window for
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.
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PATIENT SAMPLE: 2208 subjects receiving medical benefits from the Ohio Bureau of Worker’s Compensation that underwent lumbar fusion surgery after WC-qualifying injury for the primary indication of either spondylolisthesis or DDD between the years of 1993-2010. OUTCOME MEASURES: We determined which subjects were diagnosed with failed back surgery syndrome within 3 years of index lumbar fusion surgery after WC-qualifying injury. METHODS: We used ICD-9 diagnosis and CPT procedural codes to identify WC subjects that fit our study design, all with at least 3 years of follow-up. We eliminated from consideration subjects with a positive smoking history or pre-fusion diagnosis of FBSS, as defined by ICD-9 codes. Logistic regression analysis was performed, with the dependent variable being whether or not FBSS was diagnosed within 3 years after fusion. We corrected for age, gender, obesity, approximated income, number of levels fused, and additional fusion surgeries within 3 years of initial fusion. RESULTS: Subjects who underwent lumbar fusion for spondylolisthesis had significantly lower rates of FBSS development than subjects undergoing fusion for DDD (p50.03; OR 0.69). 53 of 656 (8.1%) subjects who underwent fusion for spondylolisthesis developed FBSS. 165 of 1499 (11.0%) subjects undergoing fusion for DDD developed FBSS. Lower income also was significantly associated with higher rates of FBSS (p50.05; OR 0.99). Age, gender, number of levels fused at index fusion, number of fusion surgeries within 3 years of index fusion, and obesity did not significantly impact FBSS rates. CONCLUSIONS: Failed back surgery syndrome is a relatively debilitating and feared complication of back surgery. We demonstrated that within a worker’s compensation setting, undergoing lumbar fusion for the indication of DDD without co-existing spinal deformity of instability is associated with significantly higher rates of FBSS within 3 years of surgery when compared to subjects undergoing fusion for spondylolisthesis. Subjects that underwent fusion for DDD were approximately 1.45 times more likely to develop FBSS than subjects that underwent fusion for spondylolisthesis. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
http://dx.doi.org/10.1016/j.spinee.2014.08.183 http://dx.doi.org/10.1016/j.spinee.2014.08.184
145. Lumbar Fusion for Degenerative Disc Disease is Associated with Significantly Higher Rates of Failed Back Surgery Syndrome Compared to Fusion for Spondylolisthesis in a Workers’ Compensation Setting Joshua T. Anderson, BS1,2, Ryan J. Duff3, Uri M. Ahn, MD4, Nicholas U. Ahn, MD1; 1University Hospitals Case Medical Center Department of Orthopaedic Surgery, Cleveland, OH, US; 2Case Western Reserve University School of Medicine, Cleveland, OH, US; 3University of Minnesota Twin Cities, Minneapolis, MN, US; 4New Hampshire Spine Institute, Bedford, NH, US BACKGROUND CONTEXT: Worker’s compensation (WC) subjects undergoing lumbar fusion surgery consistently have worse outcomes when compared to the general population. Fusion for degenerative disc disease (DDD) is associated with reportedly variable outcomes, while fusion for spondylolisthesis consistently yields good results. Failed back surgery syndrome (FBSS) is a feared complication of back surgery that leaves the patient with decreased functional capacity, morale and productivity. It is also associated with psychosocial problems and addiction to pain medication. Few studies have evaluated predictors of poor fusion outcomes specifically in WC subjects, a clinically distinct subset of patients. PURPOSE: To compare rates of FBSS development between WC subjects that underwent lumbar fusion for the primary indication of spondylolisthesis and WC subjects that underwent fusion for DDD. STUDY DESIGN/SETTING: Retrospective cohort.
146. Patient Characteristics Associated with Length of Stay and Readmission after Laminectomy for Lumbar Spinal Stenosis Bryce Basques1, Arya G. Varthi, MD2, Nicholas Golinvaux2, Daniel D. Bohl, MPH2, Jonathan N. Grauer, MD2; 1New Haven, CT, US; 2Yale University School of Medicine, New Haven, CT, US BACKGROUND CONTEXT: Lumbar spinal stenosis (LSS) is a common pathology that is traditionally treated with decompressive laminectomy. Risk factors associated with increased postoperative length of stay (LOS) and readmission have not been fully characterized for laminectomy. PURPOSE: To identify factors that were independently associated with increased LOS and readmission in patients who underwent elective laminectomy for LSS. STUDY DESIGN/SETTING: Retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. PATIENT SAMPLE: Patients who underwent laminectomy for LSS during 2011 and 2012 were identified from the ACS-NSQIP. OUTCOME MEASURES: The primary outcome measures were length of stay and readmission. Length of stay was treated as a continuous variable for analysis. Readmission was treated as a binary variable for analysis. METHODS: Patient characteristics were tested for association with LOS and readmission using multivariate analyses. Patients with LOS O 10 days were excluded from the readmission analysis as the ACS-NSQIP only captures readmissions within 30 postoperative days, and the window for
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.