Comparative Analysis of Sagittal Spinopelvic Parameters between Young & Old Aged Groups

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Proceedings of the NASS 26th Annual Meeting / The Spine Journal 11 (2011) 1S–173S

and 32 to have fair or fair-to-poor outcome (Group F). Group F had significantly worse overall outcome, were less satisfaction with surgery, had higher pain levels, lower levels of functional ability, and higher levels of depression, anger and irritability. MMPI-2-RF scales most strongly and significantly correlated with overall outcome and patient satisfaction were demoralization (Rcd), Dysfunctional negative emotions (Rc7), Malaise (MAL), Stress/Worry (STW) and Self-doubt (SFD)Cluster analyses revealed 4 distinct MMPI-2-RF clusters (see Figure 1) Much worse overall outcome was obtained in patients from Cluster 1, whose profiles had relatively elevated scale scores on demoralization (Rcd), Somatic complaints (Rc1), and low positive emotions (Rc2) and dysfunctional negative emotions (Rc7). CONCLUSIONS: The PPS algorithm was effective in predicting surgical outcomes. Patients in the G and FG groups obtain much better surgical results than those in the F or FP groups. Several MMPI-2-RF scales were strongly associated with reduced surgery results, particularly for patients with MMPI-2-RF profile displaying the highest overall level of emotional distress. Current results suggest that systematic PPS should be considered more frequently in the evaluation of patients being considered for spine surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.333

P32. Adjacent Segment Degenerative Disease: Is It Due to Disease Progression or a Fusion-Associated Phenomenon? Byung Wan Choi, MD1, Kyung-Jin Song, MD2, Kwang-Bok Lee, MD3; 1 Gwangju, South Korea; 2Department of Orthopedic Surgery, Jeonju, South Korea; 3Chonbuk National University Hospital, Jeonju, South Korea BACKGROUND CONTEXT: Anterior cervical discectomy and fusion is regarded as a gold standard treatment for degenerative cervical spine disease. However, it is believed that arthrodesis of spinal segments lead to excessive stress at unfused adjacent levels.It is still difficult to make conclusions regarding adjacent segment problems because comparative data on segments adjacent to fused and non-fused segment is not available. PURPOSE: We evaluated whether fusion per se can affect adjacent segment degeneration by comparing the radiological and clinical findings of segments adjacent and not adjacent to fused segments in single level anterior cervical fusion cases. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: We evaluated 457 levels in 87 patients (cases) with at least 5 years of follow-up that had undergone single level anterior diskectomy and fusion from Feb 1999 to Mar 2004. OUTCOME MEASURES: Radiological degenerative changes was evaluated by comparing preoperative and last follow up (mean 64.8 months postop) lateral, flexion/extension lateral plain radiographs. Radiological evaluations included; 1) disc degeneration, 2) anterior ossification formation, and 3) segmental instability.To evaluate the development of adjacent segment disease, newly generated radicular or myelopathic symptoms were evaluated clinically. METHODS: Eighty-seven patients had undergone single level anterior cervical decompression and fusions with at least 5 years of follow-up were enrolled in this study. Segments adjacent to fusion levels, either above or below, were allocated to Group A, and the others to Group B. Radiographic evaluations of adjacent level changes included; assessments of disc degenerative change, anterior ossification formation, and segmental instability. The developments of new clinical symptoms were also evaluated.Legend for FiguresDiagram showing the segments which were included for the evaluation according to each Group (O: included, X: excluded). Figure 1. Group A Figure 2. Group B RESULTS: In groups A, adjacent segment degenerative change developed in 28 segments (16%) and two cases (2%) developed new clinical

symptoms. In group B, adjacent segment degenerative change developed in 10 segments (3%), and as occurred in group A, two cases (0.7%) developed new clinical symptoms. Additional operations were performed in one patient in each group. CONCLUSIONS: Fusion per se can accelerate the severity of adjacent level degeneration. However, no significant difference was observed between adjacent and non-adjacent segments in terms of the incidence of symptomatic disease. The authors conclude that adjacent segment disease is more a result of the natural history of cervical spondylosis than the presence of fusion. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.334

P33. Comparative Analysis of Sagittal Spinopelvic Parameters between Young & Old Aged Groups Youngbae Kim, MD, PhD1, Yongjung Kim, MD2, Young Joon Ahn, MD3, Kyu Bok Kang, MD1, Hyungtae Lim, MD1; 1Seoul Veterans Hospital, Seoul, South Korea; 2New York Orthopaedic Hospital Associates, New York, NY, USA; 3National Pelice Hospital, Seoul, South Korea BACKGROUND CONTEXT: To the best of our knowledge, there is no published study that compares the sagittal spinopelvic parameters between normal asymptomatic young adults who are skeletally mature without the appearance of vertebral modification and asymptomatic old ones without structural problems over the sixth decade. PURPOSE: To compare the sagittal spinopelvic alignment of the spine between young normal asymptomatic adults and older asymptomatic adults. STUDY DESIGN/SETTING: A prospective comparative study. PATIENT SAMPLE: 342 healthy adult male volunteers (Group 1: n5184, average age 21.2, range: 19–28 vs. Group 2: n5158, average age 63.8, range: 53–79) without history of spine operation, spinal disease, pain on their back or legs, scoliosis, spondylolisthesis, disc space narrowing, or compression fracture in radiographs. OUTCOME MEASURES: Radiographic analysis in a standing lateral spine X-ray. METHODS: Parameters included were: thoracic kyphosis (T5-T12), T12 lower end plate (EP)-horizontal (H) angle (Minus denote EP above the H line), lumbar lordosis (T12-S1), lower lumbar lordosis (L4 upper EP-S1), sacral slope, pelvic incidence and distances from C7 plumb/T12 plumb to the posterosuperior endplate of S1. RESULTS: Group 2 demonstrated larger total lumbar lordosis ( 57.368.8 vs. 52.269.2 in group 1, p!.001), lower lumbar lordosis ( 39.466.7 vs. 32.466.4 in group 1, p!.001), more thoracic kyphosis (30.168.6 vs. 21.167.8 in group1, p!.001), and T12 Lower EP-H angle ( 2065.7 vs. 15.765.1 in group 1, p!.001). The ratio of lower to total lumbar lordosis in Group 2 (69.5611.6% vs. 62.7610.6% in group 1, p!.01) was also higher. There were no significant differences in sacral slope (36.567.3 in group 1 vs. 36.866.7 in group 2, p5.674). There were no significant differences in C7 plumb to posterosuperior endplate of S1 ( 0.662.4 cm in group 1 vs. 0.362.7 cm in group 2, p5.197). T12 plumb to posterosuperior endplate of S1 (-0.761.7 cm vs. 2.261.7 cm, p!.001) demonstrated significant difference. CONCLUSIONS: The radiographic measurement of sagittal spinopelvic alignment in 342 adult male asymptomatic volunteers (young, n5184 vs. older, n5158) were compared. Total lumbar lordosis, especially lower lumbar lordosis and thoracic kyphosis were significantly increased in older male compared to younger ones with a similar sagittal vertical axis and sacral slope. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.335

All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.