- Email: [email protected]
235. Refining risk-adjustment for bundled payment models in cervical fusions: an analysis of Medicare beneficiaries
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S101−S140 patients who might benefit from traditional PT or alternative rehabilitation approaches that are informed by a biopsychosocial model. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.249
https://doi.org/10.1016/j.spinee.2019.05.248
234. Residual arm numbness after laminoplasty for the patients with cervical spondylotic myelopathy Masayoshi Iwamae, MD1, Koji Tamai, MD2, Akinobu Suzuki, MD, PhD2, Hidetomi Terai, MD, PhD3, Masatoshi Hoshino, MD3, Hiromitsu Toyoda, MD, PhD2, Shinji Takahashi, MD2, Hiroaki Nakamura, MD, PhD4; 1 Shimada Hospital, Osaka, Japan; 2 Osaka City University, Osaka, Japan; 3 Dept. of Orthopaedic Surgery, Osaka City University, Graduate School of Medicine, Osaka, Japan; 4 Osaka City University, Graduate School of Medicine, Osaka, Japan BACKGROUND CONTEXT: Laminoplasty has been widely accepted as a standard treatment option for the patients with cervical spondylotic myelopathy (CSM) with good clinical outcomes. However, some patients suffered from the residual arm numbness postoperatively. But the preoperative factor relating to residual arm numbness and its impact on the outcomes of laminoplasty are not well established. PURPOSE: To identify the preoperative factor relating the residual arm numbness after laminoplasty, and to demonstrate the effect of the residual numbness on the change of clinical scores and radiographic parameters. STUDY DESIGN/SETTING: Retrospective cohort study PATIENT SAMPLE: One hundred three patients who underwent laminoplasty for CSM and were followed up over 2 years after surgery. OUTCOME MEASURES: Japanese Orthopedic Association (JOA) score including detailed component score (finger motion, upper extremity motion, lower extremity motion, upper extremity sensory, trunk sensory, lower extremity sensory, bladder function), visual analogue scale (VAS; arm pain, arm numbness and neck pain), 36-Item Short-Form Health Survey (SF-36; physical component summary and mental component summary), preoperative radiographic x-ray film parameters (C7 slope, C2-C7 lordotic angle, C2-C7 sagittal vertical axis and range of cervical motion) and preoperative Magnetic Resonance Imaging (MRI) findings (the severity of stenosis and the existence of snake-eye appearance). METHODS: Patients were divided into two groups; residual arm numbness group (postoperative VAS >40mm) and control group (≤40mm). Following to univariate analysis comparing the preoperative factors between groups, the variables of p<0.01 were included in the multivariate linear regression analysis (Dependent variable: VAS of arm numbness 2-year postoperatively). In addition, the changes of clinical score and radiographical parameters after 2 years of laminoplasty were compared using mixedeffect model. RESULTS: The residual arm numbness group included 42 patients (23 female, 67.5§11.3 years old) and the no numbness group included 61 patients (42 female, 65.1§12.7 years old). In the multivariate analysis after univariate comparison, gender and preoperative arm pain were demonstrated as the independent variables (p=0.017 and 0.046) correlating with the postoperative residual numbness. Contrary to our hypothesis, the preoperative arm numbness and intensity change of MRI were not significant factors relating to the residual arm numbness. In the comparison of the change after surgery, the improvement of physical component summary of SF-36 was significantly low in residual arm numbness group (0.040). CONCLUSIONS: In our data set, up to 40% of the CSM patients had residual arm numbness 2 years after laminoplasty. Female and preoperative severe arm pain was the independent predictor for the residual arm numbness. The patients with residual arm numbness showed the lower improvement of quality of life compared to the patient without numbness. These results can help physicians to provide adequate information to treat the CSM patients and help surgeons to predict the patients with poor surgical outcomes preoperatively.
235. Refining risk-adjustment for bundled payment models in cervical fusions: an analysis of Medicare beneficiaries Azeem T. Malik, MBBS1, Frank M. Phillips, MD2, Sheldon Retchin, MD3, Wendy Xu, PhD3, Elizabeth Yu, MD1, Jeffery Kim, MD1, Safdar N. Khan, MD1; 1 The Ohio State University Wexner Medical Center, Columbus, OH, US; 2 Midwest Orthopaedics At Rush, Chicago, IL, US; 3 Columbus, OH, US BACKGROUND CONTEXT: The current Bundle Payment for Care Improvement (BPCI) model relies on the use of ‘Diagnosis Related Groups (DRGs)’ to risk-adjust reimbursements/costs associated with a 90-day episode of care. Three distinct DRG groups exist for defining payments associated with cervical fusions - 1) DRG-471 (cervical fusions with major comorbidity/complications), 2) DRG-472 (with comorbidity/complications) and 3) DRG-473 (without any comorbidity/complications). However, this DRG system may not be entirely suitable in controlling the large amounts of cost-variation seen within cervical fusions. For instance, these DRGs do not account for area/location of surgery (upper cervical vs lower cervical), type of surgery (primary vs revision), surgical approach (anterior vs posterior), extent of fusion (1-3 level vs >3 level) and cause/indication of surgery (fracture vs degenerative pathology). PURPOSE: To understand factors responsible for cost-variation in a 90day episode of care following cervical fusions. STUDY DESIGN/SETTING: Retrospective study of a 5% national sample of Medicare claims from 2008-2014 (SAF5). PATIENT SAMPLE: The 2008-2014 Medicare 5% Standard Analytical Files (SAF5) was queried using DRG codes 471, 472 and 473 to identify patients receiving a cervical fusion. Patients undergoing noncervical fusions (thoracolumbar), surgery for deformity/malignancy and/or combined anteriorposterior fusions were excluded. Patients with missing data and/or those who died within 90-days of the postoperative follow up period were excluded. OUTCOME MEASURES: All payments made to service providers (surgeons, anesthesiologists and post-acute care) starting from day 0 of surgery to day 90 postoperatively were used to calculate 90-day costs. METHODS: Multi-variate linear regression modelling was performed to assess the independent marginal cost-impact of DRG, gender, age, state, procedure-level factors (including cause/indication of surgery) and comorbidities on total 90-day cost. RESULTS: Following application of inclusion/exclusion criteria, a total of 12,419 cervical fusions were included. The average 90-day cost for each DRG group was as follows:- 1) DRG-471= $54,314 § $32,643, 2) DRG472 = $28,535 § $17,271 and 3) DRG-473 = $18,492 § $10,706. The riskadjusted 90-day cost of a nongeriatric (age<65) female, with no major comorbidities, undergoing a primary 1-3 level anterior cervical fusion for degenerative cervical spine disease was $14,924 § $753. Male gender (+$922) and age 70-84 (+$1,007 to +$2,431) was associated with significant marginal increases in 90-day costs. Undergoing upper cervical surgery (-$1,678) had a negative marginal cost impact. Among other procedurelevel factors, posterior approach (+$3,164), >3 level fusion (+$2,561), interbody (+$667), use of intra-operative neuromonitoring (+$1,018), concurrent decompression/laminectomy (+$1,657) and undergoing fusion for cervical fracture (+$3,530) were associated higher 90-day costs. Severe individual comorbidities were associated with higher 90-day costs, with malnutrition (+$15,536), CVA/stroke (+$6,982), drug abuse/dependence (+$5,059), hyper-coagulopathy (+$5,436), and chronic kidney disease (+$4,925) having the highest marginal cost-impacts. Significant state-level variation was noted, with Maryland (+$8,790), Alaska (+$6,410), Massachusetts (+$6,389), California (+$5,603) and New Mexico (+$5,530) having the highest costs and Puerto Rico (-$7,492) and Iowa (-$3,393) having the lowest costs, as compared to the national average. CONCLUSIONS: The current cervical fusion bundled payment model fails to employ a robust-risk adjustment of prices resulting in the large
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S101−S140
amount of cost-variation seen within 90-day costs. Under the proposed DRG-based risk-adjustment model, providers would be reimbursed the same amount for cervical fusions regardless of the surgical approach (posterior vs anterior), the extent of fusion, use of adjunct procedures (decompressions) and cause/indication of surgery (fracture vs degenerative pathology), despite each of these factors having different resource utilization and associated costs. Our findings suggest that defining payments based on DRG codes only is an imperfect way of employing bundled payments for spinal fusions and will only end up creating major financial disincentives and barriers to access of care in the health care system. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.250
236. Laminoplasty vs laminectomy and fusion for multilevel cervical spondylotic myelopathy with increased signal intensity on magnetic resonance imaging Jia Nan Zhang, MD; Xi’an, Shaan’Xi, China BACKGROUND CONTEXT: Multilevel cervical spondylotic myelopathy (MCSM) has often a long course of disease, severe cervical spine degeneration, and rapid progress. It is still unclear whether preserving the mobility of the cervical spine will affect the recovery of neurological function in MCSM patients with or without ISI on T2WI. PURPOSE: This study aimed to compare the clinical outcomes and complications between laminectomy and fusion (LF) and laminoplasty (LP) for MCSM with increased signal intensity (ISI) on T2-weighted images (T2WI). STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: 90 patients. OUTCOME MEASURES: The Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS) score, the physical and mental component scores (PCS and MCS) of the Short-Form 36 (SF36), and the extension and flexion range of motion (ROM) were recorded. The indicators, surgery-related results and complications of the two groups were compared. METHODS: We analyzed 45 patients with MCSM with ISI on T2WI who underwent laminoplasty (LP group) from January 2014 to January 2016. The JOA score, VAS score, PCS and MCS of the SF36, and the extension and flexion ROM were recorded. Propensity score matching identified 45 patients underwent laminectomy and fusion (LF Group) as controls, from January 2014 to January 2016 using 7 independent variables (preoperation): age, sex, JOA, duration of preoperative symptoms, the high signal intensity ratio (HSIR), with ossification of the posterior longitudinal ligament and tobacco use. The indicators, surgery-related results and complications of the two groups were compared. RESULTS: No statistical difference in the baseline of the two groups. At the final follow-up, both groups demonstrated similar clinical improvement at the final follow-up. The extension and flexion ROM were lost in both groups, but the LP group was significantly better. The complication rate and operative time were found higher in the LF group. CONCLUSIONS: The present study demonstrated that laminoplasty for MCSM with ISI on T2WI achieved similar clinical improvement with LF. However, longer operation time, higher complication rate and lower extension and flexion ROM were found in the LF group. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.251
237. Robotic-guided placement of cervical pedicle screws: feasibility and accuracy Isador H. Lieberman, MD, FRCSC, MBA1, Xiaobang Hu, PhD1, Stanley Kisinde, MbChB2, Shea L. Hesselbacher3; 1 Scoliosis and Spine Tumor
Center, Texas Back Institute, Texas Health Presbyterian Hospital Plano, Plano, TX, US; 2 Scoliosis & Spine Tumor Center, Texas Back Institute, Plano, TX, US; 3 Texas Back Institute, Plano, TX, US BACKGROUND CONTEXT: It has been shown that pedicle screw instrumentation in the cervical spine has superior biomechanical pullout strength and stability. However, due to the complex and variable anatomy of the cervical pedicles and the risk of catastrophic complications, cervical pedicle screw placement is not widely utilized. PURPOSE: The purpose of this study is to review and report our experience with robotic guided cervical pedicle screw placement. STUDY DESIGN/SETTING: We retrospectively reviewed consecutive patients who underwent cervical pedicle screw fixation with robotic guidance using pre- and postoperative CT scans by the investigator. Medical charts were reviewed for technical issues and intraoperative complications. PATIENT SAMPLE: A total of 62 cervical pedicle screws were reviewed in eight consecutive patients. OUTCOME MEASURES: Screw placement and deviation (mm) from the preoperative plan were assessed.We also reviewed the Medical charts for technical issues and intra-operative complications. METHODS: Screw placement and deviation from the preoperative plan were assessed using the robotic system’s planning software by fusing the preoperative CT (with the planned cervical pedicle screws) to the postoperative CT. This process was carried out by manually aligning the anatomical landmarks on the two CTs. Once a satisfactory fusion was achieved, the software’s measurement tool was used manually to compare the planned vs actual screw placements in both axial and sagittal planes, at the midpoint of the pedicle in a resolution of 0.1 millimeters. Medical charts were reviewed for technical issues and intraoperative complications. RESULTS: A total of 62 cervical pedicle screws were reviewed in eight patients. The patients’ mean age was 65 years, M:F ratio was 1:1, and the mean BMI was 25.17. No intraoperative complications that related to the placement of cervical pedicle screws were reported and robotic-guidance was successful in all 62 screws. The number of screws placed were 8 at C2, 12 at both C3 and C4, 10 at C5, 11 at C6, and 9 at C7. Postoperative CT scans showed that there were ten pedicle screw breaches (16.1%), all were medial, all less than 1 mm, with no clinical consequences. No pedicle screw breached the foramen transversarium. In the axial plane, the left side screws deviated from the pre-operative plan by 1.2§0.76 mm and the right-side screws deviated from the preoperative plan by 1.4§1.16 mm. In the sagittal plane, the left side screw deviated from the pre-operative plan by 1.2§1.16 mm and the right-side screw deviated from the preoperative plan by 1.4§0.94 mm. CONCLUSIONS: This study indicates that robotic-guided cervical pedicle screw placement is feasible with clinically acceptable results. The medial breaches did not result in any clinical consequences akin to passing a sublaminar wire or placing a hook into the epidural space. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.252
238. Same-day surgical intervention dramatically minimizes complication occurrence and optimizes perioperative outcomes for central cord syndrome Cole Bortz, BA1, Avery Brown, BS2, Haddy Alas, BS2, Muhammad B. Janjua, MD3, Katherine E. Pierce, BS1, Paul Park, MD4, Charles Wang, MD5, Elizabeth L. Lord, MD2, Dimitrios C. Nikas, MD6, Aaron Hockley, MD, FRCSC7, Alexandra Soroceanu, MD, MPH8, Rafael De la Garza Ramos, MD9, Daniel M. Sciubba, MD10, Anthony K. Frempong-Boadu, MD11, Dennis Vasquez-Montes, MS, BA2, Bassel G. Diebo, MD12, Michael C. Gerling, MD13, Peter G. Passias, MD14; 1 New York, NY, US; 2 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 3 Dallas, TX, US; 4 University Of Michigan - Dept of Neurosurgery, Ann Arbor, MI, US; 5 NYU Langone Health, New York, NY, US; 6 University of Illinois at Chicago, Chicago, IL,
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
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FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.249
https://doi.org/10.1016/j.spinee.2019.05.248
234. Residual arm numbness after laminoplasty for the patients with cervical spondylotic myelopathy Masayoshi Iwamae, MD1, Koji Tamai, MD2, Akinobu Suzuki, MD, PhD2, Hidetomi Terai, MD, PhD3, Masatoshi Hoshino, MD3, Hiromitsu Toyoda, MD, PhD2, Shinji Takahashi, MD2, Hiroaki Nakamura, MD, PhD4; 1 Shimada Hospital, Osaka, Japan; 2 Osaka City University, Osaka, Japan; 3 Dept. of Orthopaedic Surgery, Osaka City University, Graduate School of Medicine, Osaka, Japan; 4 Osaka City University, Graduate School of Medicine, Osaka, Japan BACKGROUND CONTEXT: Laminoplasty has been widely accepted as a standard treatment option for the patients with cervical spondylotic myelopathy (CSM) with good clinical outcomes. However, some patients suffered from the residual arm numbness postoperatively. But the preoperative factor relating to residual arm numbness and its impact on the outcomes of laminoplasty are not well established. PURPOSE: To identify the preoperative factor relating the residual arm numbness after laminoplasty, and to demonstrate the effect of the residual numbness on the change of clinical scores and radiographic parameters. STUDY DESIGN/SETTING: Retrospective cohort study PATIENT SAMPLE: One hundred three patients who underwent laminoplasty for CSM and were followed up over 2 years after surgery. OUTCOME MEASURES: Japanese Orthopedic Association (JOA) score including detailed component score (finger motion, upper extremity motion, lower extremity motion, upper extremity sensory, trunk sensory, lower extremity sensory, bladder function), visual analogue scale (VAS; arm pain, arm numbness and neck pain), 36-Item Short-Form Health Survey (SF-36; physical component summary and mental component summary), preoperative radiographic x-ray film parameters (C7 slope, C2-C7 lordotic angle, C2-C7 sagittal vertical axis and range of cervical motion) and preoperative Magnetic Resonance Imaging (MRI) findings (the severity of stenosis and the existence of snake-eye appearance). METHODS: Patients were divided into two groups; residual arm numbness group (postoperative VAS >40mm) and control group (≤40mm). Following to univariate analysis comparing the preoperative factors between groups, the variables of p<0.01 were included in the multivariate linear regression analysis (Dependent variable: VAS of arm numbness 2-year postoperatively). In addition, the changes of clinical score and radiographical parameters after 2 years of laminoplasty were compared using mixedeffect model. RESULTS: The residual arm numbness group included 42 patients (23 female, 67.5§11.3 years old) and the no numbness group included 61 patients (42 female, 65.1§12.7 years old). In the multivariate analysis after univariate comparison, gender and preoperative arm pain were demonstrated as the independent variables (p=0.017 and 0.046) correlating with the postoperative residual numbness. Contrary to our hypothesis, the preoperative arm numbness and intensity change of MRI were not significant factors relating to the residual arm numbness. In the comparison of the change after surgery, the improvement of physical component summary of SF-36 was significantly low in residual arm numbness group (0.040). CONCLUSIONS: In our data set, up to 40% of the CSM patients had residual arm numbness 2 years after laminoplasty. Female and preoperative severe arm pain was the independent predictor for the residual arm numbness. The patients with residual arm numbness showed the lower improvement of quality of life compared to the patient without numbness. These results can help physicians to provide adequate information to treat the CSM patients and help surgeons to predict the patients with poor surgical outcomes preoperatively.
235. Refining risk-adjustment for bundled payment models in cervical fusions: an analysis of Medicare beneficiaries Azeem T. Malik, MBBS1, Frank M. Phillips, MD2, Sheldon Retchin, MD3, Wendy Xu, PhD3, Elizabeth Yu, MD1, Jeffery Kim, MD1, Safdar N. Khan, MD1; 1 The Ohio State University Wexner Medical Center, Columbus, OH, US; 2 Midwest Orthopaedics At Rush, Chicago, IL, US; 3 Columbus, OH, US BACKGROUND CONTEXT: The current Bundle Payment for Care Improvement (BPCI) model relies on the use of ‘Diagnosis Related Groups (DRGs)’ to risk-adjust reimbursements/costs associated with a 90-day episode of care. Three distinct DRG groups exist for defining payments associated with cervical fusions - 1) DRG-471 (cervical fusions with major comorbidity/complications), 2) DRG-472 (with comorbidity/complications) and 3) DRG-473 (without any comorbidity/complications). However, this DRG system may not be entirely suitable in controlling the large amounts of cost-variation seen within cervical fusions. For instance, these DRGs do not account for area/location of surgery (upper cervical vs lower cervical), type of surgery (primary vs revision), surgical approach (anterior vs posterior), extent of fusion (1-3 level vs >3 level) and cause/indication of surgery (fracture vs degenerative pathology). PURPOSE: To understand factors responsible for cost-variation in a 90day episode of care following cervical fusions. STUDY DESIGN/SETTING: Retrospective study of a 5% national sample of Medicare claims from 2008-2014 (SAF5). PATIENT SAMPLE: The 2008-2014 Medicare 5% Standard Analytical Files (SAF5) was queried using DRG codes 471, 472 and 473 to identify patients receiving a cervical fusion. Patients undergoing noncervical fusions (thoracolumbar), surgery for deformity/malignancy and/or combined anteriorposterior fusions were excluded. Patients with missing data and/or those who died within 90-days of the postoperative follow up period were excluded. OUTCOME MEASURES: All payments made to service providers (surgeons, anesthesiologists and post-acute care) starting from day 0 of surgery to day 90 postoperatively were used to calculate 90-day costs. METHODS: Multi-variate linear regression modelling was performed to assess the independent marginal cost-impact of DRG, gender, age, state, procedure-level factors (including cause/indication of surgery) and comorbidities on total 90-day cost. RESULTS: Following application of inclusion/exclusion criteria, a total of 12,419 cervical fusions were included. The average 90-day cost for each DRG group was as follows:- 1) DRG-471= $54,314 § $32,643, 2) DRG472 = $28,535 § $17,271 and 3) DRG-473 = $18,492 § $10,706. The riskadjusted 90-day cost of a nongeriatric (age<65) female, with no major comorbidities, undergoing a primary 1-3 level anterior cervical fusion for degenerative cervical spine disease was $14,924 § $753. Male gender (+$922) and age 70-84 (+$1,007 to +$2,431) was associated with significant marginal increases in 90-day costs. Undergoing upper cervical surgery (-$1,678) had a negative marginal cost impact. Among other procedurelevel factors, posterior approach (+$3,164), >3 level fusion (+$2,561), interbody (+$667), use of intra-operative neuromonitoring (+$1,018), concurrent decompression/laminectomy (+$1,657) and undergoing fusion for cervical fracture (+$3,530) were associated higher 90-day costs. Severe individual comorbidities were associated with higher 90-day costs, with malnutrition (+$15,536), CVA/stroke (+$6,982), drug abuse/dependence (+$5,059), hyper-coagulopathy (+$5,436), and chronic kidney disease (+$4,925) having the highest marginal cost-impacts. Significant state-level variation was noted, with Maryland (+$8,790), Alaska (+$6,410), Massachusetts (+$6,389), California (+$5,603) and New Mexico (+$5,530) having the highest costs and Puerto Rico (-$7,492) and Iowa (-$3,393) having the lowest costs, as compared to the national average. CONCLUSIONS: The current cervical fusion bundled payment model fails to employ a robust-risk adjustment of prices resulting in the large
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
S116
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S101−S140
amount of cost-variation seen within 90-day costs. Under the proposed DRG-based risk-adjustment model, providers would be reimbursed the same amount for cervical fusions regardless of the surgical approach (posterior vs anterior), the extent of fusion, use of adjunct procedures (decompressions) and cause/indication of surgery (fracture vs degenerative pathology), despite each of these factors having different resource utilization and associated costs. Our findings suggest that defining payments based on DRG codes only is an imperfect way of employing bundled payments for spinal fusions and will only end up creating major financial disincentives and barriers to access of care in the health care system. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.250
236. Laminoplasty vs laminectomy and fusion for multilevel cervical spondylotic myelopathy with increased signal intensity on magnetic resonance imaging Jia Nan Zhang, MD; Xi’an, Shaan’Xi, China BACKGROUND CONTEXT: Multilevel cervical spondylotic myelopathy (MCSM) has often a long course of disease, severe cervical spine degeneration, and rapid progress. It is still unclear whether preserving the mobility of the cervical spine will affect the recovery of neurological function in MCSM patients with or without ISI on T2WI. PURPOSE: This study aimed to compare the clinical outcomes and complications between laminectomy and fusion (LF) and laminoplasty (LP) for MCSM with increased signal intensity (ISI) on T2-weighted images (T2WI). STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: 90 patients. OUTCOME MEASURES: The Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS) score, the physical and mental component scores (PCS and MCS) of the Short-Form 36 (SF36), and the extension and flexion range of motion (ROM) were recorded. The indicators, surgery-related results and complications of the two groups were compared. METHODS: We analyzed 45 patients with MCSM with ISI on T2WI who underwent laminoplasty (LP group) from January 2014 to January 2016. The JOA score, VAS score, PCS and MCS of the SF36, and the extension and flexion ROM were recorded. Propensity score matching identified 45 patients underwent laminectomy and fusion (LF Group) as controls, from January 2014 to January 2016 using 7 independent variables (preoperation): age, sex, JOA, duration of preoperative symptoms, the high signal intensity ratio (HSIR), with ossification of the posterior longitudinal ligament and tobacco use. The indicators, surgery-related results and complications of the two groups were compared. RESULTS: No statistical difference in the baseline of the two groups. At the final follow-up, both groups demonstrated similar clinical improvement at the final follow-up. The extension and flexion ROM were lost in both groups, but the LP group was significantly better. The complication rate and operative time were found higher in the LF group. CONCLUSIONS: The present study demonstrated that laminoplasty for MCSM with ISI on T2WI achieved similar clinical improvement with LF. However, longer operation time, higher complication rate and lower extension and flexion ROM were found in the LF group. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.251
237. Robotic-guided placement of cervical pedicle screws: feasibility and accuracy Isador H. Lieberman, MD, FRCSC, MBA1, Xiaobang Hu, PhD1, Stanley Kisinde, MbChB2, Shea L. Hesselbacher3; 1 Scoliosis and Spine Tumor
Center, Texas Back Institute, Texas Health Presbyterian Hospital Plano, Plano, TX, US; 2 Scoliosis & Spine Tumor Center, Texas Back Institute, Plano, TX, US; 3 Texas Back Institute, Plano, TX, US BACKGROUND CONTEXT: It has been shown that pedicle screw instrumentation in the cervical spine has superior biomechanical pullout strength and stability. However, due to the complex and variable anatomy of the cervical pedicles and the risk of catastrophic complications, cervical pedicle screw placement is not widely utilized. PURPOSE: The purpose of this study is to review and report our experience with robotic guided cervical pedicle screw placement. STUDY DESIGN/SETTING: We retrospectively reviewed consecutive patients who underwent cervical pedicle screw fixation with robotic guidance using pre- and postoperative CT scans by the investigator. Medical charts were reviewed for technical issues and intraoperative complications. PATIENT SAMPLE: A total of 62 cervical pedicle screws were reviewed in eight consecutive patients. OUTCOME MEASURES: Screw placement and deviation (mm) from the preoperative plan were assessed.We also reviewed the Medical charts for technical issues and intra-operative complications. METHODS: Screw placement and deviation from the preoperative plan were assessed using the robotic system’s planning software by fusing the preoperative CT (with the planned cervical pedicle screws) to the postoperative CT. This process was carried out by manually aligning the anatomical landmarks on the two CTs. Once a satisfactory fusion was achieved, the software’s measurement tool was used manually to compare the planned vs actual screw placements in both axial and sagittal planes, at the midpoint of the pedicle in a resolution of 0.1 millimeters. Medical charts were reviewed for technical issues and intraoperative complications. RESULTS: A total of 62 cervical pedicle screws were reviewed in eight patients. The patients’ mean age was 65 years, M:F ratio was 1:1, and the mean BMI was 25.17. No intraoperative complications that related to the placement of cervical pedicle screws were reported and robotic-guidance was successful in all 62 screws. The number of screws placed were 8 at C2, 12 at both C3 and C4, 10 at C5, 11 at C6, and 9 at C7. Postoperative CT scans showed that there were ten pedicle screw breaches (16.1%), all were medial, all less than 1 mm, with no clinical consequences. No pedicle screw breached the foramen transversarium. In the axial plane, the left side screws deviated from the pre-operative plan by 1.2§0.76 mm and the right-side screws deviated from the preoperative plan by 1.4§1.16 mm. In the sagittal plane, the left side screw deviated from the pre-operative plan by 1.2§1.16 mm and the right-side screw deviated from the preoperative plan by 1.4§0.94 mm. CONCLUSIONS: This study indicates that robotic-guided cervical pedicle screw placement is feasible with clinically acceptable results. The medial breaches did not result in any clinical consequences akin to passing a sublaminar wire or placing a hook into the epidural space. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.252
238. Same-day surgical intervention dramatically minimizes complication occurrence and optimizes perioperative outcomes for central cord syndrome Cole Bortz, BA1, Avery Brown, BS2, Haddy Alas, BS2, Muhammad B. Janjua, MD3, Katherine E. Pierce, BS1, Paul Park, MD4, Charles Wang, MD5, Elizabeth L. Lord, MD2, Dimitrios C. Nikas, MD6, Aaron Hockley, MD, FRCSC7, Alexandra Soroceanu, MD, MPH8, Rafael De la Garza Ramos, MD9, Daniel M. Sciubba, MD10, Anthony K. Frempong-Boadu, MD11, Dennis Vasquez-Montes, MS, BA2, Bassel G. Diebo, MD12, Michael C. Gerling, MD13, Peter G. Passias, MD14; 1 New York, NY, US; 2 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 3 Dallas, TX, US; 4 University Of Michigan - Dept of Neurosurgery, Ann Arbor, MI, US; 5 NYU Langone Health, New York, NY, US; 6 University of Illinois at Chicago, Chicago, IL,
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.