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237. Robotic-guided placement of cervical pedicle screws: feasibility and accuracy
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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.
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.