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140. Pseudoarthrosis of Vertebral Fracture: Radiographical and Characteristic Clinical Features and Natural History
Proceedings of the NASS 22nd Annual Meeting / The Spine Journal 7 (2007) 1S–163S a classic progression from sharp peri-incisional pain to bilateral neurologic deficits has been described. No prior study has correlated MRI hematoma features with postoperative symptoms. PURPOSE: We propose and evaluate a new measurement (the critical ratio) to assess the extent of compression by hematoma and the potential for symptom development. STUDY DESIGN/SETTING: A prospective study of an asymptomatic population in relation to a symptomatic population within our institutional database. PATIENT SAMPLE: The study population consisted of 3 patient groups who underwent MRI evaluation within 3-5 days of lumbar decompression with or without fusion. Fifty consecutive patients on whom MRI data was prospectively collected comprised the ‘‘asymptomatic’’ group. No patient developed severe post-operative pain or neurologic deficit. Eleven additional patients who had developed immediate postoperative symptoms within the last 24 months were identified within our institutional database. The ‘‘painful’’ group included 6 patients with severe peri-incisional pain without neurologic deficit. The ‘‘cauda equina’’ group included 5 patients with post-operative cauda equina syndrome. OUTCOME MEASURES: Thecal sac cross-sectional area (CSA) was measured on pre- and post-operative MRI at each level. The critical ratio was defined as the smallest ratio of postoperative to preoperative CSA at any level within the lumbar spine. METHODS: For each patient, digital imaging software was used to examine pre- and postoperative MRI data and calculate: critical ratio, hematoma volume, and volume per level decompressed. Mean values for each of the 3 patient groups were compared for statistically significant differences (p!.05). RESULTS: Mean critical ratios were asymptomatic (0.73), painful (0.48), cauda equina (0.22). Statistical significance (p!.05) was achieved between all populations for the critical ratio calculation. Neither mean hematoma volume nor volume per level decompressed differed significantly between the studied patient groups. CONCLUSIONS: The critical ratio correlates more closely with the presence or absence of postoperative symptoms than hematoma volume, and is consistent with the clinical expectation that greater thecal compression is likely to result in more severe symptoms. Few guidelines exist for MRI interpretation in the post-operative lumbar decompression patient. The critical ratio may be of greater value in interpreting postoperative imaging than measures of volume. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2007.07.165
140. Pseudoarthrosis of Vertebral Fracture: Radiographical and Characteristic Clinical Features and Natural History Hiroyuki Hashidate, MD1, Mikio Kamimura2, Hiroyuki Nakagawa, MD3, Kenji Takahara4, Hiroyuki Kato1; 1Department of Orthopaedic Surgery, Shinshu University, School of Medicine, Matsumoto, Nagano, Japan; 2 Kamimura clinic, Matsumoto, Nagano, Japan; 3 Suwa Red Cross Hospital, Suwa, Nagano, Japan; 4Ina Central Hospital, Ina, Nagano, Japan BACKGROUND CONTEXT: The incidences of reports of delayed collapse or vertebral pseudoarthrosis (VPA) have increased. However, the number of reported VPA still be small. We considered conventional stress XP cannot reveal instability of VPA, and some back pain associated with VPA decreased despite the presence of vertebral instability. PURPOSE: The purpose of this study is to assess the mobility on radiographical appearance, clinical feartures, and natural course of osteoporotic VPA. STUDY DESIGN/SETTING: Prospective study in 27 patients of VPA with osteoporosis. PATIENT SAMPLE: When back pain continued for at least 3 months after the onset of pain and apparent vertebral cleft or vertebral instability
67S
which means the difference in vertebral body height between conventional and supine cross-table lateral radiography (XP) was present, a diagnosis of VPA was made. We examined in 34 consecutive cases of VPA in 27 patients with osteoporosis. The study population consisted of 22 women and 5 men ranging in age from 56-88 years (mean age, 74.7 years). Lumbar spine bone mineral density was 4.161.4 in T-score (young adult). OUTCOME MEASURES: Vertebral mobility on anterior vertebral body height, kyphotic angle and the number of clefts. Clinical course of VPA using the pain scale of Denis. METHODS: Conventional lateral, lateral extension stress and supine cross-table lateralradiography (XP) were performed. Anterior vertebral body height and vertebral kyphotic angle were measured to assess vertebral mobility. Vertebral cleft or vertebral instability which means the difference in vertebral body height between conventional and supine cross-table lateral XP was present, a diagnosis of VPA was made. Back pain was classified into five grades according to the pain scale of Denis. RESULTS: Average anterior vertebral height was 9.965.6 millimeter (mm) in conventional lateral XP, increased to 11.466.5 mm in extension stress XP (not significant), and 18.365.7 mm in cross-table lateral XP (significant). Vertebral kyphotic angle was 24.169.7 in conventional lateral XP, decreased to 21.669.8 in extension stress XP (not significant), and 11.868.5 in cross-table lateral XP (significant). Intravertebral clefts were detected by conventional lateral XP, extension stress XP, and supine cross-table XP in 3 of 34 (8.8%), 7 of 21 (33.3%), and 28 of 34 (82.4%) vertebral compression fractures (VCFs), respectively. Surgical treatment was performed in 7 patients (2 due to severe pain, 5 due to neurological deficits), and 1 patient died. Except these 8 patients, back pain decreased by at least one grade with time in 18 of 19 patients (95%) in whom clinical course was analyzed. Radiographic follow up using supine cross-table XP was performed in 15 of 19 patients. Although 11 of these 15 patients (73%) showed vertebral instability on supine cross-table lateral XP, 10 of 11 patients (91%) did not complain of intolerable back pain in daily activity at final follow up. CONCLUSIONS: VPA are often detected on supine cross-table lateral XP, but not usually on extension stress XP. Despite the presence of vertebral instability many patients did not complain of intolerable back pain in their daily activity. Surgical treatment to improve back pain should be performed in painful VPA after enough conservative treatment. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
doi: 10.1016/j.spinee.2007.07.166
141. A Prospective Comparison of Magnetic Resonance or Computed Tomographic Grading vs Histological Grading of Facet Joint Degeneration in Lumbar Fusion Candidates Jae Chul Lee, MD1, Jang-Kyu Cha, MD2, Yon-Il Kim, MD1, ByungJoon Shin, MD1; 1Soonchunhyang University College of Medicine, Seoul, South Korea; 2Soonchunhyang University College of Medicine, Bucheon, South Korea BACKGROUND CONTEXT: Current interest in total disc arthroplasty revisits a need for more accurate radiologic evaluation on the degree of facet degeneration. In the presence of severe facet degeneration, a surgeon cannot ensure a positive outcome even after a successful total disc replacement arthroplasty. Generally, a grade of 3 or 4 in ‘fourpoint grading’ of facet joint degeneration is regarded as a contraindication of disc arthroplasty. To the best of our knowledge, there is no prospective study compares the accuracy of grading facet degeneration by CT or MR to the accuracy attained through real histological evaluation.
140. Pseudoarthrosis of Vertebral Fracture: Radiographical and Characteristic Clinical Features and Natural History Hiroyuki Hashidate, MD1, Mikio Kamimura2, Hiroyuki Nakagawa, MD3, Kenji Takahara4, Hiroyuki Kato1; 1Department of Orthopaedic Surgery, Shinshu University, School of Medicine, Matsumoto, Nagano, Japan; 2 Kamimura clinic, Matsumoto, Nagano, Japan; 3 Suwa Red Cross Hospital, Suwa, Nagano, Japan; 4Ina Central Hospital, Ina, Nagano, Japan BACKGROUND CONTEXT: The incidences of reports of delayed collapse or vertebral pseudoarthrosis (VPA) have increased. However, the number of reported VPA still be small. We considered conventional stress XP cannot reveal instability of VPA, and some back pain associated with VPA decreased despite the presence of vertebral instability. PURPOSE: The purpose of this study is to assess the mobility on radiographical appearance, clinical feartures, and natural course of osteoporotic VPA. STUDY DESIGN/SETTING: Prospective study in 27 patients of VPA with osteoporosis. PATIENT SAMPLE: When back pain continued for at least 3 months after the onset of pain and apparent vertebral cleft or vertebral instability
67S
which means the difference in vertebral body height between conventional and supine cross-table lateral radiography (XP) was present, a diagnosis of VPA was made. We examined in 34 consecutive cases of VPA in 27 patients with osteoporosis. The study population consisted of 22 women and 5 men ranging in age from 56-88 years (mean age, 74.7 years). Lumbar spine bone mineral density was 4.161.4 in T-score (young adult). OUTCOME MEASURES: Vertebral mobility on anterior vertebral body height, kyphotic angle and the number of clefts. Clinical course of VPA using the pain scale of Denis. METHODS: Conventional lateral, lateral extension stress and supine cross-table lateralradiography (XP) were performed. Anterior vertebral body height and vertebral kyphotic angle were measured to assess vertebral mobility. Vertebral cleft or vertebral instability which means the difference in vertebral body height between conventional and supine cross-table lateral XP was present, a diagnosis of VPA was made. Back pain was classified into five grades according to the pain scale of Denis. RESULTS: Average anterior vertebral height was 9.965.6 millimeter (mm) in conventional lateral XP, increased to 11.466.5 mm in extension stress XP (not significant), and 18.365.7 mm in cross-table lateral XP (significant). Vertebral kyphotic angle was 24.169.7 in conventional lateral XP, decreased to 21.669.8 in extension stress XP (not significant), and 11.868.5 in cross-table lateral XP (significant). Intravertebral clefts were detected by conventional lateral XP, extension stress XP, and supine cross-table XP in 3 of 34 (8.8%), 7 of 21 (33.3%), and 28 of 34 (82.4%) vertebral compression fractures (VCFs), respectively. Surgical treatment was performed in 7 patients (2 due to severe pain, 5 due to neurological deficits), and 1 patient died. Except these 8 patients, back pain decreased by at least one grade with time in 18 of 19 patients (95%) in whom clinical course was analyzed. Radiographic follow up using supine cross-table XP was performed in 15 of 19 patients. Although 11 of these 15 patients (73%) showed vertebral instability on supine cross-table lateral XP, 10 of 11 patients (91%) did not complain of intolerable back pain in daily activity at final follow up. CONCLUSIONS: VPA are often detected on supine cross-table lateral XP, but not usually on extension stress XP. Despite the presence of vertebral instability many patients did not complain of intolerable back pain in their daily activity. Surgical treatment to improve back pain should be performed in painful VPA after enough conservative treatment. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
doi: 10.1016/j.spinee.2007.07.166
141. A Prospective Comparison of Magnetic Resonance or Computed Tomographic Grading vs Histological Grading of Facet Joint Degeneration in Lumbar Fusion Candidates Jae Chul Lee, MD1, Jang-Kyu Cha, MD2, Yon-Il Kim, MD1, ByungJoon Shin, MD1; 1Soonchunhyang University College of Medicine, Seoul, South Korea; 2Soonchunhyang University College of Medicine, Bucheon, South Korea BACKGROUND CONTEXT: Current interest in total disc arthroplasty revisits a need for more accurate radiologic evaluation on the degree of facet degeneration. In the presence of severe facet degeneration, a surgeon cannot ensure a positive outcome even after a successful total disc replacement arthroplasty. Generally, a grade of 3 or 4 in ‘fourpoint grading’ of facet joint degeneration is regarded as a contraindication of disc arthroplasty. To the best of our knowledge, there is no prospective study compares the accuracy of grading facet degeneration by CT or MR to the accuracy attained through real histological evaluation.