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256. What is actually happening inside the Cone of Econonomy (CoE): an innovative method to quantify the CoE
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S101−S140 FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.269
255. Preoperative opioid dosage and duration are associated with increased long-term opioid use after adult spinal deformity surgery Mark Ren, BS1, Barry R. Bryant, BS2, Andrew B. Harris, BS3, Richard L. Skolasky, ScD4, Khaled M. Kebaish, MD4, Lee H. Riley III, MD5, David B. Cohen, MD, MPH4, Brian J. Neuman, MD6; 1 Baltimore, NY, US; 2 The Johns Hopkins School of Medicine, Baltimore, MD, US; 3 Johns Hopkins Hospital, Baltimore, MD, US; 4 Johns Hopkins University, Baltimore, MD, US; 5 Johns Hopkins Outpatient Ctr/Dept Ortho Surgery, Baltimore, MD, US; 6 Baltimore, MD, US BACKGROUND CONTEXT: Opioid use is prevalent among adult spinal deformity patients. Long-term opioid use can result in negative effects on health and quality of life. Preoperative opioid use has been linked to longterm postoperative use, but there is little data whether dose and duration are significant contributors to this effect in this population. PURPOSE: This study aims to evaluate the effects of preoperative opioid dosage and duration on opioid cessation two years after surgery. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Retrospective review of all adult spinal deformity surgical patients treated at a single center with 2-year follow-up. OUTCOME MEASURES: Self-reported opioid use at 2-year follow-up following adult spinal deformity surgery. METHODS: Patient demographics, surgical details and self-reported daily opioid use at each visit were collected. Preoperative opioid dose was defined as the self-reported dose of all combined opioid medications at the preoperative evaluation, converted into MEDs. Patients who restarted opioid medications during the follow-up period due to a revision or other surgery were excluded. Multivariate logistic regression analysis controlling for age, sex, ASA score and number of vertebral levels fused was used to evaluate preoperative opioid dose and duration as risk factors for longterm opioid use. RESULTS: A total of 60 ASD patients had 2-year follow-up including self-reported opioid intake. Of these, 77% (n = 46) of patients reported taking opioids preoperatively, with a mean MED of 142 mg. Patients reporting preoperative opioid usage were more likely to report opioid usage 2 years following surgery (adjusted OR = 14.2, p < 0.05). Preoperative MEDs > 90 were associated with higher odds of 2-year postoperative opioid use compared to lower MEDs (adjusted OR = 10.4, p < 0.01). In patients with known duration of opioid use (n = 21), preoperative use for at least 6 months was associated with higher odds of continued use at 2-year follow-up compared to use for less than 6 months (adjusted OR = 14.2, p < 0.05). CONCLUSIONS: Preoperative opioid use in adult spinal deformity patients is associated with increased rates of long-term postoperative opioid use at 2 years postsurgery. This effect is significantly related with increased opioid dose (> 90 mg MED) and duration (> 6 months) of preoperative opioid therapy. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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method that quantifies the CoE for a specific patient using 3D video kinematic and electromyography (EMG) data was developed. The present study further develops the method by evaluating what occurs inside the CoE using an analysis of balance control strategies. The postural control system uses distinct strategies such as the ankle, hip and suspensory strategies. Ankle strategy involves postural sway control from the ankles and feet. Hip strategy involves postural sway control from the pelvis and trunk. The suspensory strategy involves an adjustment of the center of mass (CoM) toward the base of support by bilateral lower-extremity flexion or a slight squatting motion. PURPOSE: This study provides a method to quantify the CoE, neuromuscular energy expenditure, and balance control strategies associated with maintaining a balanced posture, in a group of adult degenerative scoliosis (ADS) patients. STUDY DESIGN/SETTING: Nonrandomized, prospective, concurrent cohort study. PATIENT SAMPLE: Fifteen ADS patients and 15 nonscoliotic volunteers. OUTCOME MEASURES: Dimensions of CoE, overall sway inside the CoE, spine and lower extremity angles and neuromuscular activity at the minimum and maximum point of sway (sagittal and coronal). METHODS: All patients were fitted with 51 external reflective markers. Surface EMG electrodes were placed on spine and lower extremity muscles. Patients performed a functional balance test that was similar to a Romberg’s test, in which the patients were required to stand erect with their feet together and eyes open in their self-perceived balanced and natural position for a full minute. Data analyzed with repeated measurement ANOVA. RESULTS: ADS patients presented larger CoE dimensions (Head - Sagittal: ADS: 3.36 vs H: 1.39 cm; p=0.021; Coronal: ADS: 6.18 vs H: 3.31 cm; p=0.039; CoM - Sagittal: ADS: 2.16 vs H: 0.68 cm; p=0.023; Coronal: ADS: 3.46 vs H: 2.18 cm; p=0.010) along with more head (ADS: 56.19 vs 36.10 cm; p=0.003) and CoM (ADS: 36.37 vs 19.19 cm; p=0.002) overall sway inside the CoE in comparison to the nonscoliotic controls. At the peak sagittal sway for the head and CoM, ADS patients presented with more trunk and head flexion (p<0.005). At the peak coronal sway for the head and CoM, ADS patients presented with more knee and hip flexion (p<0.005). Scoliosis patients expended more muscle activity to maintain static standing, as manifest by increased muscle activity in their erector spinae (ADS: 39.21 mV vs H: 18.31 mV; p=0.010), and gluteus maximus (ADS: 31.89 mV vs H: 15.09 mV; p=0.029) muscles in comparison to the nonscoliotic controls. At the peak sagittal sway for the head and CoM, ADS patients presented with more erector spinae and gluteus maximus but less external oblique and tibialis anterior muscles activity (p<0.005). At the peak coronal sway for the head and CoM, ADS patients presented with more erector spinae and gluteus (p<0.005). CONCLUSIONS: ADS patients have larger CoE dimensions, increased sway and neuromuscular activity while using more hip and suspensory strategies in comparison to the nonscoliotic controls in their effort to maintain balance. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.271
https://doi.org/10.1016/j.spinee.2019.05.270
256. What is actually happening inside the Cone of Econonomy (CoE): an innovative method to quantify the CoE Ram Haddas, PhD, MSc, MEng1, Isador H. Lieberman, MD, FRCSC, MBA2; 1 Texas Back Institute, Plano, TX, US; 2 Scoliosis and Spine Tumor Center, Texas Back Institute, Texas Health Presbyterian Hospital Plano, Plano, TX, US BACKGROUND CONTEXT: The term Cone of Economy (CoE) is commonly used when assessing balance in deformity patients. Recently a
257. A simpler, modified frailty index weighted by complication occurrence correlates to pain and disability for adult spinal deformity patients Peter G. Passias, MD1, Cole Bortz, BA2, Katherine E. Pierce, BS2, Haddy Alas, BS3, Avery Brown, BS3, Dennis Vasquez-Montes, MS, BA3, Bassel G. Diebo, MD4, Tina Raman, MD2, Themistocles S. Protopsaltis, MD3, Aaron J. Buckland, MBBS, FRACS3, Michael C. Gerling, MD5, Renaud Lafage, MSc6, Virginie Lafage, PhD6; 1 NY Spine Institute, NYU Langone Health, New York, NY, US; 2 New York, NY, US; 3 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, US; 4 Department of Orthopaedic Surgery, SUNY Downstate
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.
255. Preoperative opioid dosage and duration are associated with increased long-term opioid use after adult spinal deformity surgery Mark Ren, BS1, Barry R. Bryant, BS2, Andrew B. Harris, BS3, Richard L. Skolasky, ScD4, Khaled M. Kebaish, MD4, Lee H. Riley III, MD5, David B. Cohen, MD, MPH4, Brian J. Neuman, MD6; 1 Baltimore, NY, US; 2 The Johns Hopkins School of Medicine, Baltimore, MD, US; 3 Johns Hopkins Hospital, Baltimore, MD, US; 4 Johns Hopkins University, Baltimore, MD, US; 5 Johns Hopkins Outpatient Ctr/Dept Ortho Surgery, Baltimore, MD, US; 6 Baltimore, MD, US BACKGROUND CONTEXT: Opioid use is prevalent among adult spinal deformity patients. Long-term opioid use can result in negative effects on health and quality of life. Preoperative opioid use has been linked to longterm postoperative use, but there is little data whether dose and duration are significant contributors to this effect in this population. PURPOSE: This study aims to evaluate the effects of preoperative opioid dosage and duration on opioid cessation two years after surgery. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Retrospective review of all adult spinal deformity surgical patients treated at a single center with 2-year follow-up. OUTCOME MEASURES: Self-reported opioid use at 2-year follow-up following adult spinal deformity surgery. METHODS: Patient demographics, surgical details and self-reported daily opioid use at each visit were collected. Preoperative opioid dose was defined as the self-reported dose of all combined opioid medications at the preoperative evaluation, converted into MEDs. Patients who restarted opioid medications during the follow-up period due to a revision or other surgery were excluded. Multivariate logistic regression analysis controlling for age, sex, ASA score and number of vertebral levels fused was used to evaluate preoperative opioid dose and duration as risk factors for longterm opioid use. RESULTS: A total of 60 ASD patients had 2-year follow-up including self-reported opioid intake. Of these, 77% (n = 46) of patients reported taking opioids preoperatively, with a mean MED of 142 mg. Patients reporting preoperative opioid usage were more likely to report opioid usage 2 years following surgery (adjusted OR = 14.2, p < 0.05). Preoperative MEDs > 90 were associated with higher odds of 2-year postoperative opioid use compared to lower MEDs (adjusted OR = 10.4, p < 0.01). In patients with known duration of opioid use (n = 21), preoperative use for at least 6 months was associated with higher odds of continued use at 2-year follow-up compared to use for less than 6 months (adjusted OR = 14.2, p < 0.05). CONCLUSIONS: Preoperative opioid use in adult spinal deformity patients is associated with increased rates of long-term postoperative opioid use at 2 years postsurgery. This effect is significantly related with increased opioid dose (> 90 mg MED) and duration (> 6 months) of preoperative opioid therapy. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
S125
method that quantifies the CoE for a specific patient using 3D video kinematic and electromyography (EMG) data was developed. The present study further develops the method by evaluating what occurs inside the CoE using an analysis of balance control strategies. The postural control system uses distinct strategies such as the ankle, hip and suspensory strategies. Ankle strategy involves postural sway control from the ankles and feet. Hip strategy involves postural sway control from the pelvis and trunk. The suspensory strategy involves an adjustment of the center of mass (CoM) toward the base of support by bilateral lower-extremity flexion or a slight squatting motion. PURPOSE: This study provides a method to quantify the CoE, neuromuscular energy expenditure, and balance control strategies associated with maintaining a balanced posture, in a group of adult degenerative scoliosis (ADS) patients. STUDY DESIGN/SETTING: Nonrandomized, prospective, concurrent cohort study. PATIENT SAMPLE: Fifteen ADS patients and 15 nonscoliotic volunteers. OUTCOME MEASURES: Dimensions of CoE, overall sway inside the CoE, spine and lower extremity angles and neuromuscular activity at the minimum and maximum point of sway (sagittal and coronal). METHODS: All patients were fitted with 51 external reflective markers. Surface EMG electrodes were placed on spine and lower extremity muscles. Patients performed a functional balance test that was similar to a Romberg’s test, in which the patients were required to stand erect with their feet together and eyes open in their self-perceived balanced and natural position for a full minute. Data analyzed with repeated measurement ANOVA. RESULTS: ADS patients presented larger CoE dimensions (Head - Sagittal: ADS: 3.36 vs H: 1.39 cm; p=0.021; Coronal: ADS: 6.18 vs H: 3.31 cm; p=0.039; CoM - Sagittal: ADS: 2.16 vs H: 0.68 cm; p=0.023; Coronal: ADS: 3.46 vs H: 2.18 cm; p=0.010) along with more head (ADS: 56.19 vs 36.10 cm; p=0.003) and CoM (ADS: 36.37 vs 19.19 cm; p=0.002) overall sway inside the CoE in comparison to the nonscoliotic controls. At the peak sagittal sway for the head and CoM, ADS patients presented with more trunk and head flexion (p<0.005). At the peak coronal sway for the head and CoM, ADS patients presented with more knee and hip flexion (p<0.005). Scoliosis patients expended more muscle activity to maintain static standing, as manifest by increased muscle activity in their erector spinae (ADS: 39.21 mV vs H: 18.31 mV; p=0.010), and gluteus maximus (ADS: 31.89 mV vs H: 15.09 mV; p=0.029) muscles in comparison to the nonscoliotic controls. At the peak sagittal sway for the head and CoM, ADS patients presented with more erector spinae and gluteus maximus but less external oblique and tibialis anterior muscles activity (p<0.005). At the peak coronal sway for the head and CoM, ADS patients presented with more erector spinae and gluteus (p<0.005). CONCLUSIONS: ADS patients have larger CoE dimensions, increased sway and neuromuscular activity while using more hip and suspensory strategies in comparison to the nonscoliotic controls in their effort to maintain balance. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.271
https://doi.org/10.1016/j.spinee.2019.05.270
256. What is actually happening inside the Cone of Econonomy (CoE): an innovative method to quantify the CoE Ram Haddas, PhD, MSc, MEng1, Isador H. Lieberman, MD, FRCSC, MBA2; 1 Texas Back Institute, Plano, TX, US; 2 Scoliosis and Spine Tumor Center, Texas Back Institute, Texas Health Presbyterian Hospital Plano, Plano, TX, US BACKGROUND CONTEXT: The term Cone of Economy (CoE) is commonly used when assessing balance in deformity patients. Recently a
257. A simpler, modified frailty index weighted by complication occurrence correlates to pain and disability for adult spinal deformity patients Peter G. Passias, MD1, Cole Bortz, BA2, Katherine E. Pierce, BS2, Haddy Alas, BS3, Avery Brown, BS3, Dennis Vasquez-Montes, MS, BA3, Bassel G. Diebo, MD4, Tina Raman, MD2, Themistocles S. Protopsaltis, MD3, Aaron J. Buckland, MBBS, FRACS3, Michael C. Gerling, MD5, Renaud Lafage, MSc6, Virginie Lafage, PhD6; 1 NY Spine Institute, NYU Langone Health, New York, NY, US; 2 New York, NY, US; 3 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, US; 4 Department of Orthopaedic Surgery, SUNY Downstate
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.