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Technique of Cervicothoracic Junction Pedicle Subtraction Osteotomy for Cervical Sagittal Imbalance: Report of 11 Cases
100S
Proceedings of the NASS 26th Annual Meeting / The Spine Journal 11 (2011) 1S–173S
STUDY DESIGN/SETTING: In vitro human cadaveric anatomic analysis. METHODS: 115 thoracic spine vertebral levels (n5230 pedicles) were individually disarticulated and dissected revealing each superior articular facet (SAF), lamina, ventral lamina, pedicle, and spinous process. The vertebral body was removed from each individual level at the junction of the ventral pedicle and body. Kirschner wires were inserted retrograde along the four boundaries of the pedicle (medial, lateral, caudad and cephalad). Using digital calipers, we measured in millimeters (mm) from the medial, lateral and cephalad borders of the SAF and the midline of the vertebra (cephalad ridge of the spinous process) to the boundaries of the pedicle. We measured the width of the SAF and the pedicle width at the isthmus. Measurements were analyzed to calculate the anatomic relationship of the ventral lamina and center of the pedicle, to the midline, medial border of the SAF and the superior border of the SAF. RESULTS: 229 pedicles were measured. The ventral lamina was clearly identifiable at all levels forming the roof of the spinal canal, and confluent with the medial pedicle wall (MPW). In all specimens, the ventral lamina was medial to the midline of the SAF. The mean distance from the midline of the SAF to the MPW was 1.34 mm medial (SD 1.25, CI 1.05–1.63). The MPW was lateral to the midline of the SAF in 34 (14.85%) pedicles, with a mean distance of only 0.52 mm lateral (SD 0.51, CI 0.35–0.69). The mean distance from the midline of the SAF to the center of the pedicle was 2.22 mm lateral (SD 1.49, CI 1.93–2.51); and to the medial border of the SAF was 8.45 mm (SD 1.70, CI 8.16–8.74). The center of the pedicle was medial to the midline of the SAF in only 9 (3.39%) pedicles. The mean distance from the superior border of the SAF to the center of the pedicle was 13.15 mm (SD 2.47, CI 12.86–13.44). CONCLUSIONS: The ventral lamina is an anatomically reproducible structure, and always lies medial to the midline superior articulating facet (SAF). The center of the pedicle was lateral to the midline of the SAF in 97% of pedicles. The starting point for thoracic pedicle screws should be 2–3 mm lateral to the midline, and 13 mm caudad to the superior border of the SAF (‘‘Superior Facet Rule’’). The ‘‘ventral lamina’’ and ‘‘superior facet rule’’ were valid and reproducible at every level in the thoracic spine. These findings should significantly improve the accuracy and safety of thoracic pedicle screw placement by avoiding penetration into the spinal canal. FDA DEVICE/DRUG STATUS: Pedicle Screw: Approved for this indication. doi: 10.1016/j.spinee.2011.08.247
191. Biomechanical Analysis of Crosslink and Lateral Offset Connectors for an Unstable Atlantoaxial Joint Using the C2 Intralaminar Technique Ronald Lehman, MD1, Kevin Wilson, MD2, Melvin Helgeson, MD3, Daniel Kang, MD4, Anton Dmitriev, PhD5; 1Potomac, MD, USA; 2Walter Reed Army Medical Center, Washington, DC, USA; 3Bowie, MD, USA; 4 Bethesda, MD, USA; 5Clarksville, MD, USA BACKGROUND CONTEXT: C2 intralaminar screws offer the advantages of avoiding the vertebral artery; however, biomechanical studies have demonstrated inferiority of C2 intralaminar screw fixation compared to intrapedicular fixation in the presence of an odontoid fracture. Transverse connectors require use of lateral offset connectors, but their contribution to stability is unknown. PURPOSE: The aims of this project are to 1) evaluate whether transverse crosslinks can add adequate stability to atlantoaxial constructs using C1 lateral mass and C2 intralaminar screw fixation, and 2) determine the biomechanical contribution of the C2 offset connectors. STUDY DESIGN/SETTING: In vitro human cadaveric biomechanical analysis. METHODS: Ten cadaveric specimens underwent nondestructive testing in axial rotation, flexion/extension (FE), and lateral bending. Specimens were then instrumented with C1 lateral mass, C2 pedicle, and C2
intralaminar screws in order to compare C2 intrapedicular technique to intralaminar techniques with and without the addition of offset connectors and a transverse crosslink. The odontoid was then resected and analyses were repeated. RESULTS: Post-reconstruction ROM in axial rotation, flexion/extension, and lateral bending showed no significant differences between the four fixation constructs in the stable specimens. After performing an odontoidectomy, transpedicular fixation at C2 proved superior to intralaminar techniques without a crosslink in axial rotation and lateral bending. The addition of a crosslink to the intralaminar construct improved segmental stability, making it comparable to transpedicular fixation in the unstable model in both axial rotation and lateral bending. Offset connectors appeared to marginally weaken the intralaminar fixation, but the findings were not significant. CONCLUSIONS: Coupled with an offset connector and a crosslink, C2 intralaminar screws offer similar segmental stability to intrapedicular fixation in the presence of an unstable dens fracture. Lateral offset connectors at C2 do not significantly compromise stability of C1 lateral mass – C2 intralaminar fixation. FDA DEVICE/DRUG STATUS: Pedicle Screw: Not approved for this indication. doi: 10.1016/j.spinee.2011.08.248
192. Technique of Cervicothoracic Junction Pedicle Subtraction Osteotomy for Cervical Sagittal Imbalance: Report of 11 Cases Justin Scheer1, Vedat Deviren, MD2, Christopher Ames, MD2; 1San Francisco General Hospital, San Francisco, CA, USA; 2University of California San Francisco, San Francisco, CA, USA BACKGROUND CONTEXT: Sagittal imbalance of the cervicothoracic spine often causes severe pain and loss of horizontal gaze. Historically, the Smith-Peterson osteotomy has been used to restore sagittal balance. Cervicothoracic junction pedicle subtraction osteotomy (PSO) offers more controlled closure and greater biomechanical stability but is infrequently reported in literature. PURPOSE: This study details the cervicothoracic pedicle subtraction osteotomy technique with 11 cases and correlates clinical kyphosis (chin brow vertical angle, CBVA) with radiographic measurements. STUDY DESIGN/SETTING: Case series. PATIENT SAMPLE: From February 2008 to September 2010, eleven patients underwent a modified PSO (ten at C7, one at T1) for cervicothoracic sagittal imbalance. OUTCOME MEASURES: Preoperative and postoperative sagittal plane radiographic measurements were made. Post operative CT scans at min 1 yr follow up was obtained in 4/9 patients. CBVA was measured on clinical photographs. Operative technique and perioperative correction was reported for all 11 patients and 9/11 patients were reported for long term follow up. Outcomes used for the 9/11 patients were the Neck Disability Index (NDI), SF36, and Visual Analogue Pain Scale (VAS). METHODS: Technique: After exposure, the spine was instrumented (C2 pedicle screws, cervical lateral mass screws, thoracic pedicle screws). Following instrumentation, facet release and C6-C7 and C7-T1 facet removal were performed. The C7 and C8 nerve roots were identified and traced out the foramen. The osteotomy was carried out laterally and the C7 pedicle was isolated. The lateral wall of the C7 vertebral body was then dissected out with a with a Penfield 1 retractor and visualized to the anterior vertebral body margin. The C7 pedicle was skeletonized and removed with a Lempert-Leksell. Sequential lumbar taps were used to decancellate the C7 vertebral body; osteotomes and down-pushing curettes were used to attempt a 30 wedge as a starting point. The C7 lateral wall, then medial column, were removed. The head was loosened from the table and the Mayfield was then used to lift the head and close the osteotomy. RESULTS: Results are averages (n511): age-70yrs, estimated blood loss 1100 cc, surgical time-4.3hrs, hospital stay-9.9 days, follow-up time for 9/11
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
Proceedings of the NASS 26th Annual Meeting / The Spine Journal 11 (2011) 1S–173S
101S
patients - 23mo, preop cervical sagittal imbalance – 7.961.4 cm, immediate post-op 3.461.7 cm, overall correction 4.561.5 cm (42.8%), PSO correction – 19.0deg, CBVA correction – 36.7deg. There was no correlation between pre-op C2-T1 radiographic kyphosis and pre-op CBVA (R250.0165). There was a larger correlation with PSO correction angle and post-op CBVA (R250.38). NDI decreased significantly (51.1 to 38.6, p5.03), and VAS (8.1 to 3.9, p5.0021). PCS increased by 18.4% (30.2 to 35.8) with no neurological complications. There was no evidence of psuedoarthrosis at min 1 yr follow up. CONCLUSIONS: The cervicothoracic junction PSO is a safe and effective procedure for the management of cervicothoracic kyphotic deformity. It results in excellent correction of cervical kyphosis and CBVA with a controlled closure and improvement in HRQOL scores even at early time points. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
complications were: 7 single nerve root distal lower extremity weakness (5 in lumbar, two in 2 in thoracic VCRs), 4 completely resolved and 3 had partial recovery. There were 2 deep wound infections treated with I&D, 2 patients had pleural effusions requiring chest tube insertion and one patient suffered respiratory failure requiring intubation. Only one patient developed a PE, one had pneumonia and one NSTEMI. Minor complications were: 8 incidental durotomies (6 in revision surgeries and two in primary cases), one superficial wound infection and two wound dehiscence all treated with I&D. CONCLUSIONS: VCR is a valuable technique in treating rigid adult spinal deformities. We encountered 15 major and 11 minor complications, which is comparable to other published spinal deformity series in adults without the use of VCR. All neurologic deficits occurred in the lumbar spine except one, all involved a single nerve root and most of them achieved complete recovery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
doi: 10.1016/j.spinee.2011.08.249
doi: 10.1016/j.spinee.2011.08.250
193. Vertebral Column Resection (VCR) for the Treatment of Adult Spinal Deformities: Outcomes and Complications Firas Chamas, MD, PhD1, Mostafa El Dafrawy, MD1, Hamid Hassanzadeh, MD1, Philip Neubauer, MD2, Khaled Kebaish, MD1; 1 Baltimore, MD, USA; 2White Hall, MD, USA
194. Direct Repair of Lumbar Spondylolysis by Segmental Pedicle Screw-Intralaminar Hook Construct Cagatay Ozturk, MD1, Ahmet Alanay, MD2, Azmi Hamzaoglu, MD3; 1 Istanbul Spine Center, Florence Nightingale Hospital, Istanbul, Turkey; 2 Florence Nightingale Hospital, Istanbul, Turkey; 3Turkey
BACKGROUND CONTEXT: Correction of severe rigid spinal deformities has been traditionally accompished via a combined anterior/posterior approach. Single incision, all posterior VCR offers a potentially superior alternative. There are few published studies on VCR with the largest series reporting on the pediatric population. PURPOSE: To analyze the effect of VCR in the treatment of rigid adult spinal deformities. STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: 50 consecutive adult patients (17 men and 33 women) with an average age of 50 yrs (21–81). OUTCOME MEASURES: We report on the patients’ radiographic parameters, functional outcomes (ODI, SF12 and SRS scores) and complications. METHODS: There were 28 lumbar and 26 thoracic VCRs (28 revisions & 22 primaries), 47 patients had a single level and 3 had two nonadjacent levels VCRs. The average number of levels fused was 8.5 (3–17), average EBL was 3039 cc (550–9000) and average operative time 415 min (220– 660). All patients were ASA class 2 (28) and 3 (22). The deformities were divided into three main groups: Coronal (10), sagittal (29) and combined (coronal and sagittal, 11). The average follow-up was 26 months. RESULTS: The average focal correction in the sagittal plane was 34.7 (6-76 ) and the average focal correction in the coronal plane was 39.5 (16-75 ) at the last follow up. The average preoperative thoracic kyphosis for thoracic deformity was 87.4 (38–137 ) and corrected to 53.3 (34– 72 ) at the last follow up . The average preoperative lumbar lordosis for lumbar deformity was -27.2 (þ30 to 65 ) and corrected to -40.3 (-11 to 87 ) at the last follow up. The average Cobb angle for coronal deformities was 73.5 (51–105 ) pre-op and corrected to 23 (8–25 ) at the last follow up. The average preoperative sagittal imbalance was 8.3 cm (6.1 to 35.1) pre-op and 2.9 cm (5.7 to 18.7) at the last follow-up. The average preoperative coronal imbalance was 4.6 cm (0-21) pre-op and 1.8 cm (0-6.3) at the last follow up. The average preoperative ODI was 76.3 (48 – 92) and 28.7 (21.9 – 36.4) at the last follow up (p5.001). The average preoperative SF-12 physical health was 32.1 (range 23.1 – 41.9) and 54.9 (39.7 – 71.3) at last follow-up (p5.012) and the average SF-12 mental health was 38.4 (range 28.2 – 47.7) and 56.8 (41.3 – 74.8) at the last follow up and (p5.032). Average preoperative SRS scores were: self image 2.29 (1.2 – 3.1), activity 2.15 (1.1 – 2.6), pain 2.10 (1.4 – 2.9) and mental 2.96 (2.0 – 3.7). At final follow-up the scores were: self image 4.29 (3.2 – 5.0), activity 4.23 (2.8 – 5.0), pain 4.35 (3.0 – 5.0), mental 4.22 (2.6 – 5.0) (Self Image, p5.012, Activity, p5.009, Pain, p5.013; and Mental, p5.031). Major
BACKGROUND CONTEXT: Symptoms usually resolve with nonoperative treatment in patients with spondylolysis. However, in some selected patients; operative treatment may be needed. Repair of pars defects is one of the surgical treatment alternatives and can be done by using several techniques. PURPOSE: The aim of this study is to analyse the safety and efficacy of direct pars repair by using segmental pedicle screw-infralaminar hook construct. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: Twenty-one patients (16 female and 5 male) who had been treated by direct pars repair with segmental pedicular screw-hook fixation and with minimum 2 years follow-up were included in this study. OUTCOME MEASURES: All patients had a preoperative CT scan and magnetic resonance imaging and all had Phirman class I healthy discs at the involved level. All patients had CT scans at the postoperative 1 year follow-up to evaluate healing. Two-year follow-up x-rays were analysed in terms of disc degeneration and collapse at the operated level and progression of existing deformities. METHODS: All patients had spondylolysis with isthmic defect at L5 (n519) or L4 (n52), and six (29%) of them had grade 1 spondylolysis. Six patients (29%) had mild scoliosis while 4(19%) had Schuermann kyphosis. One patient had both scoliosis and Schuerman kyphosis. All had low back pain unresponsive to conservative measures for at least 6 months. None had radiculopathy signs. RESULTS: The mean follow-up period was 38.8 (range; 24 to 84) months. Mean age was 16.4 (range; 14 to 18) years. CT scan revealed succesfull bony union in 20 (%96.1) patients while one patient had pseudoarthrosis with no symptoms and implant failure. None of the patients had degenerative findings at the disc level below the pars defect. All patients had successful clinical outcome including the patient with non-union. Two patients with Schuermann’s kyphosis underwent surgery while none of the other patients with scoliosis and kyphosis had a progression in their deformities. CONCLUSIONS: Surgical repair of spondylolysis in young patients by using pedicle screw-infralaminar hook technique resulted with satisfactory clinical and radiological outcome. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.251
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
Proceedings of the NASS 26th Annual Meeting / The Spine Journal 11 (2011) 1S–173S
STUDY DESIGN/SETTING: In vitro human cadaveric anatomic analysis. METHODS: 115 thoracic spine vertebral levels (n5230 pedicles) were individually disarticulated and dissected revealing each superior articular facet (SAF), lamina, ventral lamina, pedicle, and spinous process. The vertebral body was removed from each individual level at the junction of the ventral pedicle and body. Kirschner wires were inserted retrograde along the four boundaries of the pedicle (medial, lateral, caudad and cephalad). Using digital calipers, we measured in millimeters (mm) from the medial, lateral and cephalad borders of the SAF and the midline of the vertebra (cephalad ridge of the spinous process) to the boundaries of the pedicle. We measured the width of the SAF and the pedicle width at the isthmus. Measurements were analyzed to calculate the anatomic relationship of the ventral lamina and center of the pedicle, to the midline, medial border of the SAF and the superior border of the SAF. RESULTS: 229 pedicles were measured. The ventral lamina was clearly identifiable at all levels forming the roof of the spinal canal, and confluent with the medial pedicle wall (MPW). In all specimens, the ventral lamina was medial to the midline of the SAF. The mean distance from the midline of the SAF to the MPW was 1.34 mm medial (SD 1.25, CI 1.05–1.63). The MPW was lateral to the midline of the SAF in 34 (14.85%) pedicles, with a mean distance of only 0.52 mm lateral (SD 0.51, CI 0.35–0.69). The mean distance from the midline of the SAF to the center of the pedicle was 2.22 mm lateral (SD 1.49, CI 1.93–2.51); and to the medial border of the SAF was 8.45 mm (SD 1.70, CI 8.16–8.74). The center of the pedicle was medial to the midline of the SAF in only 9 (3.39%) pedicles. The mean distance from the superior border of the SAF to the center of the pedicle was 13.15 mm (SD 2.47, CI 12.86–13.44). CONCLUSIONS: The ventral lamina is an anatomically reproducible structure, and always lies medial to the midline superior articulating facet (SAF). The center of the pedicle was lateral to the midline of the SAF in 97% of pedicles. The starting point for thoracic pedicle screws should be 2–3 mm lateral to the midline, and 13 mm caudad to the superior border of the SAF (‘‘Superior Facet Rule’’). The ‘‘ventral lamina’’ and ‘‘superior facet rule’’ were valid and reproducible at every level in the thoracic spine. These findings should significantly improve the accuracy and safety of thoracic pedicle screw placement by avoiding penetration into the spinal canal. FDA DEVICE/DRUG STATUS: Pedicle Screw: Approved for this indication. doi: 10.1016/j.spinee.2011.08.247
191. Biomechanical Analysis of Crosslink and Lateral Offset Connectors for an Unstable Atlantoaxial Joint Using the C2 Intralaminar Technique Ronald Lehman, MD1, Kevin Wilson, MD2, Melvin Helgeson, MD3, Daniel Kang, MD4, Anton Dmitriev, PhD5; 1Potomac, MD, USA; 2Walter Reed Army Medical Center, Washington, DC, USA; 3Bowie, MD, USA; 4 Bethesda, MD, USA; 5Clarksville, MD, USA BACKGROUND CONTEXT: C2 intralaminar screws offer the advantages of avoiding the vertebral artery; however, biomechanical studies have demonstrated inferiority of C2 intralaminar screw fixation compared to intrapedicular fixation in the presence of an odontoid fracture. Transverse connectors require use of lateral offset connectors, but their contribution to stability is unknown. PURPOSE: The aims of this project are to 1) evaluate whether transverse crosslinks can add adequate stability to atlantoaxial constructs using C1 lateral mass and C2 intralaminar screw fixation, and 2) determine the biomechanical contribution of the C2 offset connectors. STUDY DESIGN/SETTING: In vitro human cadaveric biomechanical analysis. METHODS: Ten cadaveric specimens underwent nondestructive testing in axial rotation, flexion/extension (FE), and lateral bending. Specimens were then instrumented with C1 lateral mass, C2 pedicle, and C2
intralaminar screws in order to compare C2 intrapedicular technique to intralaminar techniques with and without the addition of offset connectors and a transverse crosslink. The odontoid was then resected and analyses were repeated. RESULTS: Post-reconstruction ROM in axial rotation, flexion/extension, and lateral bending showed no significant differences between the four fixation constructs in the stable specimens. After performing an odontoidectomy, transpedicular fixation at C2 proved superior to intralaminar techniques without a crosslink in axial rotation and lateral bending. The addition of a crosslink to the intralaminar construct improved segmental stability, making it comparable to transpedicular fixation in the unstable model in both axial rotation and lateral bending. Offset connectors appeared to marginally weaken the intralaminar fixation, but the findings were not significant. CONCLUSIONS: Coupled with an offset connector and a crosslink, C2 intralaminar screws offer similar segmental stability to intrapedicular fixation in the presence of an unstable dens fracture. Lateral offset connectors at C2 do not significantly compromise stability of C1 lateral mass – C2 intralaminar fixation. FDA DEVICE/DRUG STATUS: Pedicle Screw: Not approved for this indication. doi: 10.1016/j.spinee.2011.08.248
192. Technique of Cervicothoracic Junction Pedicle Subtraction Osteotomy for Cervical Sagittal Imbalance: Report of 11 Cases Justin Scheer1, Vedat Deviren, MD2, Christopher Ames, MD2; 1San Francisco General Hospital, San Francisco, CA, USA; 2University of California San Francisco, San Francisco, CA, USA BACKGROUND CONTEXT: Sagittal imbalance of the cervicothoracic spine often causes severe pain and loss of horizontal gaze. Historically, the Smith-Peterson osteotomy has been used to restore sagittal balance. Cervicothoracic junction pedicle subtraction osteotomy (PSO) offers more controlled closure and greater biomechanical stability but is infrequently reported in literature. PURPOSE: This study details the cervicothoracic pedicle subtraction osteotomy technique with 11 cases and correlates clinical kyphosis (chin brow vertical angle, CBVA) with radiographic measurements. STUDY DESIGN/SETTING: Case series. PATIENT SAMPLE: From February 2008 to September 2010, eleven patients underwent a modified PSO (ten at C7, one at T1) for cervicothoracic sagittal imbalance. OUTCOME MEASURES: Preoperative and postoperative sagittal plane radiographic measurements were made. Post operative CT scans at min 1 yr follow up was obtained in 4/9 patients. CBVA was measured on clinical photographs. Operative technique and perioperative correction was reported for all 11 patients and 9/11 patients were reported for long term follow up. Outcomes used for the 9/11 patients were the Neck Disability Index (NDI), SF36, and Visual Analogue Pain Scale (VAS). METHODS: Technique: After exposure, the spine was instrumented (C2 pedicle screws, cervical lateral mass screws, thoracic pedicle screws). Following instrumentation, facet release and C6-C7 and C7-T1 facet removal were performed. The C7 and C8 nerve roots were identified and traced out the foramen. The osteotomy was carried out laterally and the C7 pedicle was isolated. The lateral wall of the C7 vertebral body was then dissected out with a with a Penfield 1 retractor and visualized to the anterior vertebral body margin. The C7 pedicle was skeletonized and removed with a Lempert-Leksell. Sequential lumbar taps were used to decancellate the C7 vertebral body; osteotomes and down-pushing curettes were used to attempt a 30 wedge as a starting point. The C7 lateral wall, then medial column, were removed. The head was loosened from the table and the Mayfield was then used to lift the head and close the osteotomy. RESULTS: Results are averages (n511): age-70yrs, estimated blood loss 1100 cc, surgical time-4.3hrs, hospital stay-9.9 days, follow-up time for 9/11
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
Proceedings of the NASS 26th Annual Meeting / The Spine Journal 11 (2011) 1S–173S
101S
patients - 23mo, preop cervical sagittal imbalance – 7.961.4 cm, immediate post-op 3.461.7 cm, overall correction 4.561.5 cm (42.8%), PSO correction – 19.0deg, CBVA correction – 36.7deg. There was no correlation between pre-op C2-T1 radiographic kyphosis and pre-op CBVA (R250.0165). There was a larger correlation with PSO correction angle and post-op CBVA (R250.38). NDI decreased significantly (51.1 to 38.6, p5.03), and VAS (8.1 to 3.9, p5.0021). PCS increased by 18.4% (30.2 to 35.8) with no neurological complications. There was no evidence of psuedoarthrosis at min 1 yr follow up. CONCLUSIONS: The cervicothoracic junction PSO is a safe and effective procedure for the management of cervicothoracic kyphotic deformity. It results in excellent correction of cervical kyphosis and CBVA with a controlled closure and improvement in HRQOL scores even at early time points. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
complications were: 7 single nerve root distal lower extremity weakness (5 in lumbar, two in 2 in thoracic VCRs), 4 completely resolved and 3 had partial recovery. There were 2 deep wound infections treated with I&D, 2 patients had pleural effusions requiring chest tube insertion and one patient suffered respiratory failure requiring intubation. Only one patient developed a PE, one had pneumonia and one NSTEMI. Minor complications were: 8 incidental durotomies (6 in revision surgeries and two in primary cases), one superficial wound infection and two wound dehiscence all treated with I&D. CONCLUSIONS: VCR is a valuable technique in treating rigid adult spinal deformities. We encountered 15 major and 11 minor complications, which is comparable to other published spinal deformity series in adults without the use of VCR. All neurologic deficits occurred in the lumbar spine except one, all involved a single nerve root and most of them achieved complete recovery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
doi: 10.1016/j.spinee.2011.08.249
doi: 10.1016/j.spinee.2011.08.250
193. Vertebral Column Resection (VCR) for the Treatment of Adult Spinal Deformities: Outcomes and Complications Firas Chamas, MD, PhD1, Mostafa El Dafrawy, MD1, Hamid Hassanzadeh, MD1, Philip Neubauer, MD2, Khaled Kebaish, MD1; 1 Baltimore, MD, USA; 2White Hall, MD, USA
194. Direct Repair of Lumbar Spondylolysis by Segmental Pedicle Screw-Intralaminar Hook Construct Cagatay Ozturk, MD1, Ahmet Alanay, MD2, Azmi Hamzaoglu, MD3; 1 Istanbul Spine Center, Florence Nightingale Hospital, Istanbul, Turkey; 2 Florence Nightingale Hospital, Istanbul, Turkey; 3Turkey
BACKGROUND CONTEXT: Correction of severe rigid spinal deformities has been traditionally accompished via a combined anterior/posterior approach. Single incision, all posterior VCR offers a potentially superior alternative. There are few published studies on VCR with the largest series reporting on the pediatric population. PURPOSE: To analyze the effect of VCR in the treatment of rigid adult spinal deformities. STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: 50 consecutive adult patients (17 men and 33 women) with an average age of 50 yrs (21–81). OUTCOME MEASURES: We report on the patients’ radiographic parameters, functional outcomes (ODI, SF12 and SRS scores) and complications. METHODS: There were 28 lumbar and 26 thoracic VCRs (28 revisions & 22 primaries), 47 patients had a single level and 3 had two nonadjacent levels VCRs. The average number of levels fused was 8.5 (3–17), average EBL was 3039 cc (550–9000) and average operative time 415 min (220– 660). All patients were ASA class 2 (28) and 3 (22). The deformities were divided into three main groups: Coronal (10), sagittal (29) and combined (coronal and sagittal, 11). The average follow-up was 26 months. RESULTS: The average focal correction in the sagittal plane was 34.7 (6-76 ) and the average focal correction in the coronal plane was 39.5 (16-75 ) at the last follow up. The average preoperative thoracic kyphosis for thoracic deformity was 87.4 (38–137 ) and corrected to 53.3 (34– 72 ) at the last follow up . The average preoperative lumbar lordosis for lumbar deformity was -27.2 (þ30 to 65 ) and corrected to -40.3 (-11 to 87 ) at the last follow up. The average Cobb angle for coronal deformities was 73.5 (51–105 ) pre-op and corrected to 23 (8–25 ) at the last follow up. The average preoperative sagittal imbalance was 8.3 cm (6.1 to 35.1) pre-op and 2.9 cm (5.7 to 18.7) at the last follow-up. The average preoperative coronal imbalance was 4.6 cm (0-21) pre-op and 1.8 cm (0-6.3) at the last follow up. The average preoperative ODI was 76.3 (48 – 92) and 28.7 (21.9 – 36.4) at the last follow up (p5.001). The average preoperative SF-12 physical health was 32.1 (range 23.1 – 41.9) and 54.9 (39.7 – 71.3) at last follow-up (p5.012) and the average SF-12 mental health was 38.4 (range 28.2 – 47.7) and 56.8 (41.3 – 74.8) at the last follow up and (p5.032). Average preoperative SRS scores were: self image 2.29 (1.2 – 3.1), activity 2.15 (1.1 – 2.6), pain 2.10 (1.4 – 2.9) and mental 2.96 (2.0 – 3.7). At final follow-up the scores were: self image 4.29 (3.2 – 5.0), activity 4.23 (2.8 – 5.0), pain 4.35 (3.0 – 5.0), mental 4.22 (2.6 – 5.0) (Self Image, p5.012, Activity, p5.009, Pain, p5.013; and Mental, p5.031). Major
BACKGROUND CONTEXT: Symptoms usually resolve with nonoperative treatment in patients with spondylolysis. However, in some selected patients; operative treatment may be needed. Repair of pars defects is one of the surgical treatment alternatives and can be done by using several techniques. PURPOSE: The aim of this study is to analyse the safety and efficacy of direct pars repair by using segmental pedicle screw-infralaminar hook construct. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: Twenty-one patients (16 female and 5 male) who had been treated by direct pars repair with segmental pedicular screw-hook fixation and with minimum 2 years follow-up were included in this study. OUTCOME MEASURES: All patients had a preoperative CT scan and magnetic resonance imaging and all had Phirman class I healthy discs at the involved level. All patients had CT scans at the postoperative 1 year follow-up to evaluate healing. Two-year follow-up x-rays were analysed in terms of disc degeneration and collapse at the operated level and progression of existing deformities. METHODS: All patients had spondylolysis with isthmic defect at L5 (n519) or L4 (n52), and six (29%) of them had grade 1 spondylolysis. Six patients (29%) had mild scoliosis while 4(19%) had Schuermann kyphosis. One patient had both scoliosis and Schuerman kyphosis. All had low back pain unresponsive to conservative measures for at least 6 months. None had radiculopathy signs. RESULTS: The mean follow-up period was 38.8 (range; 24 to 84) months. Mean age was 16.4 (range; 14 to 18) years. CT scan revealed succesfull bony union in 20 (%96.1) patients while one patient had pseudoarthrosis with no symptoms and implant failure. None of the patients had degenerative findings at the disc level below the pars defect. All patients had successful clinical outcome including the patient with non-union. Two patients with Schuermann’s kyphosis underwent surgery while none of the other patients with scoliosis and kyphosis had a progression in their deformities. CONCLUSIONS: Surgical repair of spondylolysis in young patients by using pedicle screw-infralaminar hook technique resulted with satisfactory clinical and radiological outcome. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.251
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.