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A Questionnaire Survey of the Cervical Spine Research Society on the Use of Methylprednisolone for Acute Spinal Cord Injuries
Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S
115S
RESULTS: Both groups showed significant improvement of JOABPEQ, ODI and VAS values at follow-up without statistical difference between groups. However, there appeared to be somewhat better improvement of buttock pain and leg paresthesia VAS in the CBT group. Intraoperative blood loss was significantly higher in PPS group (280 vs 118ml, p50.002). Operation time was significantly higher in PPS group (137 vs 120 min, p50.02).POD1 CRP, POD1 CPK and POD7 CPK were significantly higher in PPS group (p!0.001). Screw loosening was significantly more frequent in the PPS group (6 pts. vs 0 pts.; p 5 0.01). There were 3 cases of radiologic nonunion in PPS and none in CBT group. Percentage slip loss of correction was significantly higher in PPS (2.3 vs 10.4 %slip, p50.0001). Slip angle loss of correction was significantly higher in PPS (2.3 vs 5.2 deg.,p50.0001). CONCLUSIONS: Single-level MIS posterior lumbar fusion with CBT screws demonstrated significantly lower rate of screw loosening, less loss of correction, and was less invasive compared to that with PPS. FDA DEVICE/DRUG STATUS: CBT screws (Approved for this indication), PS screws (Approved for this indication)
level 1 trauma center and those who practice at a lower level trauma center. Regarding belief in steroid efficacy, 25.6% thought it increased neurologic recovery; 19.2% used it because it is the protocol at their institution; and 25.6% stated they did not believe it was beneficial, but used it due to medicolegal concerns. If there were no medicolegal concerns, 71.1% of respondents reported they would not give steroids. Eleven surgeons reported having first-hand knowledge of a lawsuit over the use or lack of use of steroids in an acute spinal cord injury. CONCLUSIONS: The number of surgeons using high dose steroids in acute SCIs has decreased significantly. Sepsis, gastrointestinal bleeding and an injury occurring more than 8 hours prior to presentation were agreed upon as contraindications to steroid use. FDA DEVICE/DRUG STATUS: Methylprednisolone (Not approved for this indication)
http://dx.doi.org/10.1016/j.spinee.2014.08.286
P34. Comparative Study of Unilateral Minimal Invasive Transforaminal Lumbar Interbody Fusion and Mini-Open Posterior Lumbar Interbody Fusion for the Treatment of Single-Level Degenerative Lumbar Spine Diseases: Retrospective Matched Analysis of Clinical and Radiologic Results in Minimum Two-Year Follow-Up Jung-Woo Hur, MD; Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
P33. A Questionnaire Survey of the Cervical Spine Research Society on the Use of Methylprednisolone for Acute Spinal Cord Injuries Gregory D. Schroeder, MD1, Brian K. Kwon, MD, PhD, FRCSC2, Jason C. Eck, DO, MS3, Jason W. Savage, MD4, Wellington K. Hsu, MD1, Alpesh A. Patel, MD, FACS5; 1Northwestern University, Chicago, IL, US; 2 Blusson Spinal Cord Center, Vancouver, BC, Canada; 3University of MA Department of Orthopaedic Surgery, Chattanooga, TN, US; 4Chicago, IL, US; 5Northwestern Department of Orthopaedics, Chicago, IL, US BACKGROUND CONTEXT: The determinants of and complications associated with off-label steroid use for acute SCI remain controversial. PURPOSE: To characterize surgeons’ current perspectives on the administration of methylprednisolone for acute spinal cord injury (SCI) and determine how this has changed over the last seven years. STUDY DESIGN/SETTING: A questionnaire survey. PATIENT SAMPLE: Surgeon members of the Cervical Spine Research Society. OUTCOME MEASURES: Survey results. METHODS: A 16-question survey was sent to members of the Cervical Spine Research Society requesting information regarding the surgeon’s use of steroids in acute spinal cord injuries. (The use of high dose steroids for spinal cord injuries is not approved by the FDA.) Determinants included the surgeon’s specialty, the annual amount of spinal cord injuries treated per year, the trauma center level, the severity of injury, and the location of injury. A Chi-squared analysis was performed to analyze the categorical data with significance defined as p ! 0.05. RESULTS: Responses were received from 84 spine surgeons, 85.5% orthopedic surgeons and 14.5% neurosurgeons. While 62.7% of respondents worked at a level 1 trauma center, 54.8% stated they treated 10 or fewer spinal cord injuries per year. Use of steroids in a complete cervical spine injury was 47.4% compared to 56.4% for an incomplete injury. These results were similar for complete and incomplete thoracolumbar spine injuries, 46.2% and 55.1% respectively. There has been a significant (p ! 0.0001) decrease in the number of surgeons using high dose steroids in acute SCIs when compared to a previous report in 2006 (56% vs. 89%). While there was no consensus on age being a contraindication, more than 80% of respondents reported sepsis, active gastrointestinal bleeding and an injury that occurred greater than eight hours prior to presentation as contraindications. With regard to complications, 70.7% of respondents reported complications from the use of steroids, and 76.3% stated they felt the complications from steroids were severe enough to limit the use of steroids. Neurosurgeons were significantly (p ! 0.05) less likely to give steroids to both complete and incomplete acute cervical spinal cord injuries, but there was no difference (p O 0.05) between surgeons who practiced at a
http://dx.doi.org/10.1016/j.spinee.2014.08.287
BACKGROUND CONTEXT: A minimally invasive TLIF (MIS-TLIF) technique has recently been introduced with the aim of smaller wounds and faster recovery and proved its safety and effectiveness in treating degenerative lumbar spine diseases. On the other hand, the mini-open PLIF (mini-PLIF) procedure, in which pedicle screws are inserted via percutaneous technique after midline decompression, have also become popular based on the premise that a smaller, less traumatic incision should afford better recovery and outcomes. PURPOSE: The objective of this study is to retrospectively compare 2-year follow-up clinical and radiologic outcomes of MIS-TLIF with mini-PLIF for the treatment of degenerative lumbar spine diseases. To the author’s knowledge, there has been no direct comparison study of MIS-TLIF with mini-PLIF. STUDY DESIGN/SETTING: Retrospective matched analysis of clinical and radiologic results in minimum 2-year follow-up. PATIENT SAMPLE: From May 2011 to September 2013, 40 cases of single-level unilateral MIS-TLIF cases were matched paired with 40 cases of mini-PLIF for age, sex, body mass index, and the operated levels. OUTCOME MEASURES: Oswestry Disability Index (ODI), the 36-Item Short Form Health Survey (SF-36), and Visual Analog Scale (VAS) scores for back and leg pain were obtained before surgery, 6 months, 1 year and 2 years after surgery for each group. Radiographic measurements including preoperative and postoperative foraminal height and width, coronal and sagittal disc angle of index level, height of functional spinal unit (FSU) and global lumbar lordosis were obtained. Fusion rates were also assessed using Bridwell classification. METHODS: Retrospective analysis of perioperative parameters included factors such as operative time, fluoroscopic time, postoperative opioid use, blood loss, length of hospital stay, surgical drainage, transfusion and complication. RESULTS: Perioperative analysis revealed that operation time (MISTLIF: 117.4 min, mini-PLIF: 84.5 min, p!0.05) and fluoroscopic time (MIS-TLIF: 65.2 sec, mini-PLIF: 45.4 sec, p!0.05) was significantly longer in the MIS-TLIF group. MIS-TLIF had less blood loss (187.5 ml vs 401.4 ml, p50.00) and less postoperative surgical drainage (67 ml vs 184 ml, p!0.05) versus mini-PLIF procedures. None of the MIS-TLIF patients required blood transfusion whereas 6 (15%) patients in miniPLIF group required blood transfusion. Postoperative opioid use for MIS-TLIF cases (18.4 mg) was also less compared with mini-PLIF
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
115S
RESULTS: Both groups showed significant improvement of JOABPEQ, ODI and VAS values at follow-up without statistical difference between groups. However, there appeared to be somewhat better improvement of buttock pain and leg paresthesia VAS in the CBT group. Intraoperative blood loss was significantly higher in PPS group (280 vs 118ml, p50.002). Operation time was significantly higher in PPS group (137 vs 120 min, p50.02).POD1 CRP, POD1 CPK and POD7 CPK were significantly higher in PPS group (p!0.001). Screw loosening was significantly more frequent in the PPS group (6 pts. vs 0 pts.; p 5 0.01). There were 3 cases of radiologic nonunion in PPS and none in CBT group. Percentage slip loss of correction was significantly higher in PPS (2.3 vs 10.4 %slip, p50.0001). Slip angle loss of correction was significantly higher in PPS (2.3 vs 5.2 deg.,p50.0001). CONCLUSIONS: Single-level MIS posterior lumbar fusion with CBT screws demonstrated significantly lower rate of screw loosening, less loss of correction, and was less invasive compared to that with PPS. FDA DEVICE/DRUG STATUS: CBT screws (Approved for this indication), PS screws (Approved for this indication)
level 1 trauma center and those who practice at a lower level trauma center. Regarding belief in steroid efficacy, 25.6% thought it increased neurologic recovery; 19.2% used it because it is the protocol at their institution; and 25.6% stated they did not believe it was beneficial, but used it due to medicolegal concerns. If there were no medicolegal concerns, 71.1% of respondents reported they would not give steroids. Eleven surgeons reported having first-hand knowledge of a lawsuit over the use or lack of use of steroids in an acute spinal cord injury. CONCLUSIONS: The number of surgeons using high dose steroids in acute SCIs has decreased significantly. Sepsis, gastrointestinal bleeding and an injury occurring more than 8 hours prior to presentation were agreed upon as contraindications to steroid use. FDA DEVICE/DRUG STATUS: Methylprednisolone (Not approved for this indication)
http://dx.doi.org/10.1016/j.spinee.2014.08.286
P34. Comparative Study of Unilateral Minimal Invasive Transforaminal Lumbar Interbody Fusion and Mini-Open Posterior Lumbar Interbody Fusion for the Treatment of Single-Level Degenerative Lumbar Spine Diseases: Retrospective Matched Analysis of Clinical and Radiologic Results in Minimum Two-Year Follow-Up Jung-Woo Hur, MD; Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
P33. A Questionnaire Survey of the Cervical Spine Research Society on the Use of Methylprednisolone for Acute Spinal Cord Injuries Gregory D. Schroeder, MD1, Brian K. Kwon, MD, PhD, FRCSC2, Jason C. Eck, DO, MS3, Jason W. Savage, MD4, Wellington K. Hsu, MD1, Alpesh A. Patel, MD, FACS5; 1Northwestern University, Chicago, IL, US; 2 Blusson Spinal Cord Center, Vancouver, BC, Canada; 3University of MA Department of Orthopaedic Surgery, Chattanooga, TN, US; 4Chicago, IL, US; 5Northwestern Department of Orthopaedics, Chicago, IL, US BACKGROUND CONTEXT: The determinants of and complications associated with off-label steroid use for acute SCI remain controversial. PURPOSE: To characterize surgeons’ current perspectives on the administration of methylprednisolone for acute spinal cord injury (SCI) and determine how this has changed over the last seven years. STUDY DESIGN/SETTING: A questionnaire survey. PATIENT SAMPLE: Surgeon members of the Cervical Spine Research Society. OUTCOME MEASURES: Survey results. METHODS: A 16-question survey was sent to members of the Cervical Spine Research Society requesting information regarding the surgeon’s use of steroids in acute spinal cord injuries. (The use of high dose steroids for spinal cord injuries is not approved by the FDA.) Determinants included the surgeon’s specialty, the annual amount of spinal cord injuries treated per year, the trauma center level, the severity of injury, and the location of injury. A Chi-squared analysis was performed to analyze the categorical data with significance defined as p ! 0.05. RESULTS: Responses were received from 84 spine surgeons, 85.5% orthopedic surgeons and 14.5% neurosurgeons. While 62.7% of respondents worked at a level 1 trauma center, 54.8% stated they treated 10 or fewer spinal cord injuries per year. Use of steroids in a complete cervical spine injury was 47.4% compared to 56.4% for an incomplete injury. These results were similar for complete and incomplete thoracolumbar spine injuries, 46.2% and 55.1% respectively. There has been a significant (p ! 0.0001) decrease in the number of surgeons using high dose steroids in acute SCIs when compared to a previous report in 2006 (56% vs. 89%). While there was no consensus on age being a contraindication, more than 80% of respondents reported sepsis, active gastrointestinal bleeding and an injury that occurred greater than eight hours prior to presentation as contraindications. With regard to complications, 70.7% of respondents reported complications from the use of steroids, and 76.3% stated they felt the complications from steroids were severe enough to limit the use of steroids. Neurosurgeons were significantly (p ! 0.05) less likely to give steroids to both complete and incomplete acute cervical spinal cord injuries, but there was no difference (p O 0.05) between surgeons who practiced at a
http://dx.doi.org/10.1016/j.spinee.2014.08.287
BACKGROUND CONTEXT: A minimally invasive TLIF (MIS-TLIF) technique has recently been introduced with the aim of smaller wounds and faster recovery and proved its safety and effectiveness in treating degenerative lumbar spine diseases. On the other hand, the mini-open PLIF (mini-PLIF) procedure, in which pedicle screws are inserted via percutaneous technique after midline decompression, have also become popular based on the premise that a smaller, less traumatic incision should afford better recovery and outcomes. PURPOSE: The objective of this study is to retrospectively compare 2-year follow-up clinical and radiologic outcomes of MIS-TLIF with mini-PLIF for the treatment of degenerative lumbar spine diseases. To the author’s knowledge, there has been no direct comparison study of MIS-TLIF with mini-PLIF. STUDY DESIGN/SETTING: Retrospective matched analysis of clinical and radiologic results in minimum 2-year follow-up. PATIENT SAMPLE: From May 2011 to September 2013, 40 cases of single-level unilateral MIS-TLIF cases were matched paired with 40 cases of mini-PLIF for age, sex, body mass index, and the operated levels. OUTCOME MEASURES: Oswestry Disability Index (ODI), the 36-Item Short Form Health Survey (SF-36), and Visual Analog Scale (VAS) scores for back and leg pain were obtained before surgery, 6 months, 1 year and 2 years after surgery for each group. Radiographic measurements including preoperative and postoperative foraminal height and width, coronal and sagittal disc angle of index level, height of functional spinal unit (FSU) and global lumbar lordosis were obtained. Fusion rates were also assessed using Bridwell classification. METHODS: Retrospective analysis of perioperative parameters included factors such as operative time, fluoroscopic time, postoperative opioid use, blood loss, length of hospital stay, surgical drainage, transfusion and complication. RESULTS: Perioperative analysis revealed that operation time (MISTLIF: 117.4 min, mini-PLIF: 84.5 min, p!0.05) and fluoroscopic time (MIS-TLIF: 65.2 sec, mini-PLIF: 45.4 sec, p!0.05) was significantly longer in the MIS-TLIF group. MIS-TLIF had less blood loss (187.5 ml vs 401.4 ml, p50.00) and less postoperative surgical drainage (67 ml vs 184 ml, p!0.05) versus mini-PLIF procedures. None of the MIS-TLIF patients required blood transfusion whereas 6 (15%) patients in miniPLIF group required blood transfusion. Postoperative opioid use for MIS-TLIF cases (18.4 mg) was also less compared with mini-PLIF
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.