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Anatomical Study of Ligamentum Flavum in Humans Cadaveric Thoracic Spine
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BASS 2017 Posters / The Spine Journal 17 (2017) S23–S32
Cervical Spine 77. Mortality Following Odontoid Fractures Donald Buchanan, Rebecca Yates, Marilyn Browne, Mark Brown, Vinay Jasani, El Nasri Ahmed; Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B21 2AP Background Context: Odontoid fractures are common in elderly patients with limited physiological reserve. Purpose: The aim is to assess outcome of treatment of these fractures and their mortality at 30 days. Study Design/Setting: Retrospective review. Patient Sample: One hundred and ten patients seen between 2007 and 2015. Outcome Measures: mortality. Methods: Electronic patient records and radiological investigations were reviewed. Charlson comorbidity scores, mechanism of injury, type of fracture and associated injuries of the deceased and survivors were compared. Results: The mean age was 73.9 (17.9–98) years. Sixty four fractures were caused by a simple fall, 26 fell downstairs, 17 a road traffic accident and 3 fell from a height. Sixty eight were isolated fractures, 29 had other cervical spine fractures, 6 had lumbar or thoracic spine fractures and 7 had multiorgan injuries. There was 1 Anderson & D’Alonso type 1, 77 type 2 and 32 type 3 fractures. Ninety three were treated in a cervical orthosis, 15 in a halo device and 2 had operative fixation.There were 4 nonunions, none required delayed fixation. Forty three of the patients died; the 30 days mortality was 23%.The mean Charlson comorbidity index was 1.6 which was not different from those who survived (p=.73).There was no difference in the mechanism of injury(p=.16) and fracture type (p=.318) between those who died and those who survived. Conclusions: The thirty day mortality exceded that for femoral neck fractures. Falling downstairs was exceeded only by simple falls as a cause of these fractures, use of bungalows by the elderly may be advisable. Non union of odontoid fractures was well tolerated. Conflicts of Interest: None. Funding Sources: None. http://dx.doi.org/10.1016/j.spinee.2016.12.086
78. Comparison of 1 & 2 Level Versus 3 & 4 Level Cervical Disc Arthroplasty: An Outcome Analysis—Results From a Single Centre Tai Friesem, S Khan, M Rajesh, A Berg, G Reddy, C Bhatia, K Aneiba; University Hospital of North Tees, Stockton on Tees TS19 8PE, UK Background Context: We know that reported clinical outcomes for single level and two-level cervical disc arthroplasty are favourable in the literature. But there is paucity of data on grouped comparison of outcomes between 1 & 2-level and 3 & 4-level cervical disc arthroplasty in the literature. We did a retrospective review of prospectively collected data comparing the outcomes in the 2 groups with a minimum 2 year follow up. Purpose: To look at the difference in clinical outcome of 1 & 2 versus 3 & 4 level Cervical Arthroplasty. Study Design/Setting: Case Series. Patient Sample: 42 single level, 50 2-levels, 42 patients with 3 & 4-level cervical arthroplasty. Outcome Measures: NDI (Neck Disability Index), Visual Analogue score for Neck (VAS Neck), and Visual Analogue score for Arm (VAS Arm). Methods: Retrospective review of prospectively collected data. Results: Duration of symptoms was 51.24 months for 1 and 2 levels patients and for 3 and 4 level patients was 62 months. Patients underwent surgery using NuNec (RTI Surgical), Discocerv (Alphatech Spine) and Prestige (Medtronics). The indication for surgery was radiculopathy and myelopathy. The NDI score improved from a mean of 49.69 to 34.95 for 1 & 2 levels and for 3 & 4 levels, it improved from 51.75 to 37.26 (p value: .932). The VAS Neck improved from a mean of 7.17 to 4.03 for 1 & 2 levels and for
3 & 4 levels, it improved from 7.08 to 3.80 (p value: .839). The mean improvement in VAS Arm scores for 1 & 2 levels were from 6.56 to 3.51 and for 3 & 4 levels were 6.55 to 3.77 (p value: .689). There was no statistically significant difference between the 2 groups (p>.05) for NDI, VAS Neck and VAS Arm. Conclusions: Our results suggest that though there was significant improvement in the NDI, VAS Neck and VAS Arm scores, the quantum of improvement was similar in both the groups. There does not seem to be a statistically significant difference between 1 & 2 level and 3 & 4 level cervical arthroplasty. It would appear that one group does not outperform the other. Conflicts of Interest: Education Consultant for MBA. Funding Sources: None. http://dx.doi.org/10.1016/j.spinee.2016.12.087
79. Anatomical Study of Ligamentum Flavum in Humans Cadaveric Thoracic Spine Sayed Ahmadi, Hidetomi Terai, MD, PhD, Jawid Akhgar, MD, Suhrab Rahmani, MD, Akinobu Suzuki, MD, PhD, Hiromitsu Toyoda, MD, PhD, Masatoshi Hoshino, MD, PhD, Kazunori Hayashi, MD, Shinji Takahashi, MD, PhD, Hiroaki Nakamura, MD, PhD; Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka 5458585 Background Context: Spinal decompression surgery in Thoracic region due to hypertrophied or calcified ligamentum flavum (LF) is most common. However, information on the precise borders and attachment of LF in Thoracic spine is still limited. Purpose: To verify the relations between attachment of LF and posterior bony landmarks in thoracic spine. Study Design/Setting: Anatomical study. Patient Sample: No relevant. Outcome Measures: No relevant. Methods: Whole spines were removed en bloc from 20 embalmed human cadavers. Plain radiographs and computed tomography (CT) scans of each whole spine were taken, and then the spine was divided in two parts along the pedicle bases. and manually measured the LF along the lumbar spine than LF painted with contrast day and taken CT and analysed by AZEE CT analyser. Results: The anatomical study showed that the right and left part of LF joined in midline and it had four borders and two surfaces, superiorly it was attached to the inferior edge and the posteroinferior surface of the lamina above and it had a close relation with superior pedicle in lateral side. Inferiorly it was attached to the superior edge and posterior superior surface of lamina. The main height of LF in center was 12–15 mm , the width of LF was13– 17 mm , the lateral border of LF attachment was different from upper levels to lower levels. In T1/T2 it was attached to the medial border of the pedicle and in other levels it was entering in foramen the main range of medial border of pedicle to lateral border of foramen was1-6 mm. Distance between the caudolateral border of LF and cranial edge of adjacent pedicle was not covered. Conclusions: Anatomical study of LF in thoracic spine revealed that lateral border of LF is in spinal canal and LF did not cover facet joints. Detachment of lateral border of LF in upper thoracic levels will be achieved by lesser bone resection as compared to lower levels. Conflicts of Interest: None. Funding Sources: Osaka City University. http://dx.doi.org/10.1016/j.spinee.2016.12.088
80. Long Term Follow Up of Multi-Level (Three & Four Levels) Cervical Disc Arthroplasty—Results From a Single Centre Tai Friesem, S Khan, M Rajesh, A Berg, G Reddy, C Bhatia; University Hospital of North Tees, Stockton on Tees TS19 8PE, UK Background Context: The clinical outcomes for single and 2-level Cervical Disc Arthroplasties are well documented. These are by and large favourable
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.
BASS 2017 Posters / The Spine Journal 17 (2017) S23–S32
Cervical Spine 77. Mortality Following Odontoid Fractures Donald Buchanan, Rebecca Yates, Marilyn Browne, Mark Brown, Vinay Jasani, El Nasri Ahmed; Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B21 2AP Background Context: Odontoid fractures are common in elderly patients with limited physiological reserve. Purpose: The aim is to assess outcome of treatment of these fractures and their mortality at 30 days. Study Design/Setting: Retrospective review. Patient Sample: One hundred and ten patients seen between 2007 and 2015. Outcome Measures: mortality. Methods: Electronic patient records and radiological investigations were reviewed. Charlson comorbidity scores, mechanism of injury, type of fracture and associated injuries of the deceased and survivors were compared. Results: The mean age was 73.9 (17.9–98) years. Sixty four fractures were caused by a simple fall, 26 fell downstairs, 17 a road traffic accident and 3 fell from a height. Sixty eight were isolated fractures, 29 had other cervical spine fractures, 6 had lumbar or thoracic spine fractures and 7 had multiorgan injuries. There was 1 Anderson & D’Alonso type 1, 77 type 2 and 32 type 3 fractures. Ninety three were treated in a cervical orthosis, 15 in a halo device and 2 had operative fixation.There were 4 nonunions, none required delayed fixation. Forty three of the patients died; the 30 days mortality was 23%.The mean Charlson comorbidity index was 1.6 which was not different from those who survived (p=.73).There was no difference in the mechanism of injury(p=.16) and fracture type (p=.318) between those who died and those who survived. Conclusions: The thirty day mortality exceded that for femoral neck fractures. Falling downstairs was exceeded only by simple falls as a cause of these fractures, use of bungalows by the elderly may be advisable. Non union of odontoid fractures was well tolerated. Conflicts of Interest: None. Funding Sources: None. http://dx.doi.org/10.1016/j.spinee.2016.12.086
78. Comparison of 1 & 2 Level Versus 3 & 4 Level Cervical Disc Arthroplasty: An Outcome Analysis—Results From a Single Centre Tai Friesem, S Khan, M Rajesh, A Berg, G Reddy, C Bhatia, K Aneiba; University Hospital of North Tees, Stockton on Tees TS19 8PE, UK Background Context: We know that reported clinical outcomes for single level and two-level cervical disc arthroplasty are favourable in the literature. But there is paucity of data on grouped comparison of outcomes between 1 & 2-level and 3 & 4-level cervical disc arthroplasty in the literature. We did a retrospective review of prospectively collected data comparing the outcomes in the 2 groups with a minimum 2 year follow up. Purpose: To look at the difference in clinical outcome of 1 & 2 versus 3 & 4 level Cervical Arthroplasty. Study Design/Setting: Case Series. Patient Sample: 42 single level, 50 2-levels, 42 patients with 3 & 4-level cervical arthroplasty. Outcome Measures: NDI (Neck Disability Index), Visual Analogue score for Neck (VAS Neck), and Visual Analogue score for Arm (VAS Arm). Methods: Retrospective review of prospectively collected data. Results: Duration of symptoms was 51.24 months for 1 and 2 levels patients and for 3 and 4 level patients was 62 months. Patients underwent surgery using NuNec (RTI Surgical), Discocerv (Alphatech Spine) and Prestige (Medtronics). The indication for surgery was radiculopathy and myelopathy. The NDI score improved from a mean of 49.69 to 34.95 for 1 & 2 levels and for 3 & 4 levels, it improved from 51.75 to 37.26 (p value: .932). The VAS Neck improved from a mean of 7.17 to 4.03 for 1 & 2 levels and for
3 & 4 levels, it improved from 7.08 to 3.80 (p value: .839). The mean improvement in VAS Arm scores for 1 & 2 levels were from 6.56 to 3.51 and for 3 & 4 levels were 6.55 to 3.77 (p value: .689). There was no statistically significant difference between the 2 groups (p>.05) for NDI, VAS Neck and VAS Arm. Conclusions: Our results suggest that though there was significant improvement in the NDI, VAS Neck and VAS Arm scores, the quantum of improvement was similar in both the groups. There does not seem to be a statistically significant difference between 1 & 2 level and 3 & 4 level cervical arthroplasty. It would appear that one group does not outperform the other. Conflicts of Interest: Education Consultant for MBA. Funding Sources: None. http://dx.doi.org/10.1016/j.spinee.2016.12.087
79. Anatomical Study of Ligamentum Flavum in Humans Cadaveric Thoracic Spine Sayed Ahmadi, Hidetomi Terai, MD, PhD, Jawid Akhgar, MD, Suhrab Rahmani, MD, Akinobu Suzuki, MD, PhD, Hiromitsu Toyoda, MD, PhD, Masatoshi Hoshino, MD, PhD, Kazunori Hayashi, MD, Shinji Takahashi, MD, PhD, Hiroaki Nakamura, MD, PhD; Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka 5458585 Background Context: Spinal decompression surgery in Thoracic region due to hypertrophied or calcified ligamentum flavum (LF) is most common. However, information on the precise borders and attachment of LF in Thoracic spine is still limited. Purpose: To verify the relations between attachment of LF and posterior bony landmarks in thoracic spine. Study Design/Setting: Anatomical study. Patient Sample: No relevant. Outcome Measures: No relevant. Methods: Whole spines were removed en bloc from 20 embalmed human cadavers. Plain radiographs and computed tomography (CT) scans of each whole spine were taken, and then the spine was divided in two parts along the pedicle bases. and manually measured the LF along the lumbar spine than LF painted with contrast day and taken CT and analysed by AZEE CT analyser. Results: The anatomical study showed that the right and left part of LF joined in midline and it had four borders and two surfaces, superiorly it was attached to the inferior edge and the posteroinferior surface of the lamina above and it had a close relation with superior pedicle in lateral side. Inferiorly it was attached to the superior edge and posterior superior surface of lamina. The main height of LF in center was 12–15 mm , the width of LF was13– 17 mm , the lateral border of LF attachment was different from upper levels to lower levels. In T1/T2 it was attached to the medial border of the pedicle and in other levels it was entering in foramen the main range of medial border of pedicle to lateral border of foramen was1-6 mm. Distance between the caudolateral border of LF and cranial edge of adjacent pedicle was not covered. Conclusions: Anatomical study of LF in thoracic spine revealed that lateral border of LF is in spinal canal and LF did not cover facet joints. Detachment of lateral border of LF in upper thoracic levels will be achieved by lesser bone resection as compared to lower levels. Conflicts of Interest: None. Funding Sources: Osaka City University. http://dx.doi.org/10.1016/j.spinee.2016.12.088
80. Long Term Follow Up of Multi-Level (Three & Four Levels) Cervical Disc Arthroplasty—Results From a Single Centre Tai Friesem, S Khan, M Rajesh, A Berg, G Reddy, C Bhatia; University Hospital of North Tees, Stockton on Tees TS19 8PE, UK Background Context: The clinical outcomes for single and 2-level Cervical Disc Arthroplasties are well documented. These are by and large favourable
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.