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Current Evidence Regarding Diagnostic Methods for Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence Based Medicine Committee
Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S anterior/posterior direction (p50.419). Step-wise logistic regression showed a significant positive relationship between presence of a new postoperative nerve injury and total retraction time (p!0.001) and change in center-blade reading over time (p!0.001). Figure 1 depicts the relationship between the change in initial center-blade threshold reading over time between patients with and without a corresponding postoperative motor neuropraxia. CONCLUSIONS: The results of this study provide evidence that prolonged retraction time and increasing evoked EMG thresholds throughout retraction are predictors of declining nerve integrity. In addition to a careful approach using dynamically evoked discrete-threshold EMG, limiting retraction time and monitoring evoked EMG readings consistently throughout retraction, may prove effective for reducing the incidence of postoperative motor neuropraxia. It should be noted that the average cranial caudal opening of the retractor aperture was less than 9mm in patients with and without neuropraxia. While these results do not imply that retraction aperture is directly related to postoperative neuropraxia, the authors caution that wide retractor openings are not recommended. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.341
P88. The Effects of Cage Size on Motor and Sensory Nerve Function during the XLIFÒ Procedure: Preliminary Results from a Prospective, Multicenter Study SOLAS Deformity Study Group1, Robert E. Isaacs, MD2, Jim A. Youssef, MD3, Juan S. Uribe, MD4, SOLAS Degenerative Study Group5; 1SOLAS, San Diego, CA, US; 2Duke University Medical Center, Durham, NC, US; 3 Durango Orthopedic Associates, Durango, CO, US; 4University of South Florida, Tampa, FL, US; 5San Diego, CA, US BACKGROUND CONTEXT: Few studies have examined the relationship between cage dimensions and nerve function after XLIF. PURPOSE: The purpose of this study is to evaluate the effect of L4-5 cage size on postoperative changes in nerve function. STUDY DESIGN/SETTING: Prospective, nonrandomized, multicenter, institutional review board (IRB)-approved, clinical study. PATIENT SAMPLE: Patients from 21 sites who were undergoing XLIF at L4-5. Only cage dimensions at L4-5 were included in the analysis. OUTCOME MEASURES: Pre-and postoperative 0-5 lower-extremity motor function were collected to identify new postoperative motor deficits. METHODS: Intraoperative data collection included the interbody cage sizes and retraction size in the anterior/posterior and cranial/caudal directions. RESULTS: Three hundred eighteen (318) patients were enrolled and 283 had complete motor exam and intraoperative data collection available for analysis. Postoperatively, 13 (4.6%) patients had symptomatic motor neuropraxia on the approach side. The most prevalent cage dimensions were 22mm width (59.2%), 55mm length (44.8%), and 10mm height (54.9%). Retractor clicks in the anterior-posterior direction were positively correlated with cage width (p!0.001), and clicks in the cranialcaudal direction were positively correlated with cage length (p50.008) and height (p!0.001). Nerve injury, postop motor weakness distal to the psoas, and postop sensory reduction were not correlated with cage dimensions. CONCLUSIONS: The results of this study provide evidence that longer and wider interbody cages are predictors of larger retraction in the cranial-caudal direction, but not risk for increasing incidence of motor neuropraxia. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.342
141S
P89. Current Evidence Regarding Diagnostic Methods for Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence Based Medicine Committee Charles Gerald T. Ledonio, MD1, Charles H. Crawford, III, MD2, Shay Bess, MD3, Jacob M. Buchowski, MD, MS4, Douglas C. Burton, MD5, Serena S. Hu, MD6, Baron S. Lonner, MD7, David W. Polly, Jr., MD8, Justin S. Smith, MD, PhD9, James O. Sanders, MD10; 1Minneapolis, MN, US; 2 Louisville, KY, US; 3Rocky Mountain Scoliosis and Spine, Denver, CO, US; 4Washington University in St. Louis, St. Louis, MO, US; 5University of Kansas Medical Center, Kansas City, KS, US; 6Stanford University School of Medicine, Redwood City, CA, US; 7New York, NY, US; 8University of Minnesota Physicians, Minneapolis, MN, US; 9University of Virginia Health System, Charlottesville, VA, US; 10Rochester, NY, US BACKGROUND CONTEXT: The SRS requested an assessment of the current state of peer reviewed evidence regarding pediatric spondylolysis with the goal of identifying both what is really known and what research remains essential to further understanding. Spondylolysis is common among children and adolescents and no formal synthesis of the published literature regarding diagnostic imaging has been previously performed. PURPOSE: Perform a structured literature review on diagnostic methods for pediatric spondylolysis to assess the current evidence both to make diagnostic recommendations and identify areas requiring further research. STUDY DESIGN/SETTING: Structured literature review. OUTCOME MEASURES: Level of evidence. METHODS: A comprehensive literature search was performed with the assistance of a medical librarian. Citations and abstracts were retrieved. Abstracts were reviewed for exclusions and data from included studies were analyzed by committee. Consistent Level I studies were considered to provide Good Evidence, Level II or III studies Fair Evidence and Level IV studies Poor Evidence. RESULTS: From 947 initial citations with abstract, 383 articles underwent full text review. The best available evidence for the questions of diagnostic methods was provided by 26 included studies. There were no randomized validation or sensitivity/specificity studies. Five studies were graded as Level II and two as Level III evidence. Nineteen of the studies were graded as Level IV evidence. No Level V (expert opinion) studies were included in the final list. CONCLUSIONS: Plain radiography is still considered a good screening tool for pars defect, but the evidence is unclear as to its validity and accuracy. The evidence is fair when multislice CT with multiplanar reformats is considered as the gold standard and most accurate modality for detecting the bony defect and assessment of osseous healing; however, it exposes the pediatric patient to high ionizing radiation. There is poor to fair evidence that magnetic resonance imaging has been reported to be as accurate as CT imaging and useful in detecting early edematous stress reactions of the lumbar pars interarticularis without a fracture line. Optimal MR sequences (and interpretation) should be the focus of future investigations. The evidence is unclear as to the diagnostic accuracy of single-photon emission computed tomography (SPECT) and scintigraphy. There are conflicting reports on the rate of false-positive and false-negative results. However, it is clear that the radiation dose is high compared to MRI and plain radiographs. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.343
P90. Does the Change of Weather Condition Influence Pain Level of Symptoms in the Patients with Lumbar Diseases? Ken Ishii, MD, PhD1, Naobumi Hosogane2, Tomohiro Hikata, MD, PhD3, Yuta Shiono, MD4, Yohei Takahashi, MD5, Mitsuru Furukawa3, Shingo Iizuka6, Ejiiro Okada, MD7, Yasuhito Kaneko, MD, PhD8, Nobuyuki Fujita, MD9, Hiroyuki Katoh, MD, PhD10, Daisuke Ichihara, PhD3, Kota Watanabe, MD11, Kentaro Fukuda, MD12, Hitoshi Kono, MD,
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.
P88. The Effects of Cage Size on Motor and Sensory Nerve Function during the XLIFÒ Procedure: Preliminary Results from a Prospective, Multicenter Study SOLAS Deformity Study Group1, Robert E. Isaacs, MD2, Jim A. Youssef, MD3, Juan S. Uribe, MD4, SOLAS Degenerative Study Group5; 1SOLAS, San Diego, CA, US; 2Duke University Medical Center, Durham, NC, US; 3 Durango Orthopedic Associates, Durango, CO, US; 4University of South Florida, Tampa, FL, US; 5San Diego, CA, US BACKGROUND CONTEXT: Few studies have examined the relationship between cage dimensions and nerve function after XLIF. PURPOSE: The purpose of this study is to evaluate the effect of L4-5 cage size on postoperative changes in nerve function. STUDY DESIGN/SETTING: Prospective, nonrandomized, multicenter, institutional review board (IRB)-approved, clinical study. PATIENT SAMPLE: Patients from 21 sites who were undergoing XLIF at L4-5. Only cage dimensions at L4-5 were included in the analysis. OUTCOME MEASURES: Pre-and postoperative 0-5 lower-extremity motor function were collected to identify new postoperative motor deficits. METHODS: Intraoperative data collection included the interbody cage sizes and retraction size in the anterior/posterior and cranial/caudal directions. RESULTS: Three hundred eighteen (318) patients were enrolled and 283 had complete motor exam and intraoperative data collection available for analysis. Postoperatively, 13 (4.6%) patients had symptomatic motor neuropraxia on the approach side. The most prevalent cage dimensions were 22mm width (59.2%), 55mm length (44.8%), and 10mm height (54.9%). Retractor clicks in the anterior-posterior direction were positively correlated with cage width (p!0.001), and clicks in the cranialcaudal direction were positively correlated with cage length (p50.008) and height (p!0.001). Nerve injury, postop motor weakness distal to the psoas, and postop sensory reduction were not correlated with cage dimensions. CONCLUSIONS: The results of this study provide evidence that longer and wider interbody cages are predictors of larger retraction in the cranial-caudal direction, but not risk for increasing incidence of motor neuropraxia. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.342
141S
P89. Current Evidence Regarding Diagnostic Methods for Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence Based Medicine Committee Charles Gerald T. Ledonio, MD1, Charles H. Crawford, III, MD2, Shay Bess, MD3, Jacob M. Buchowski, MD, MS4, Douglas C. Burton, MD5, Serena S. Hu, MD6, Baron S. Lonner, MD7, David W. Polly, Jr., MD8, Justin S. Smith, MD, PhD9, James O. Sanders, MD10; 1Minneapolis, MN, US; 2 Louisville, KY, US; 3Rocky Mountain Scoliosis and Spine, Denver, CO, US; 4Washington University in St. Louis, St. Louis, MO, US; 5University of Kansas Medical Center, Kansas City, KS, US; 6Stanford University School of Medicine, Redwood City, CA, US; 7New York, NY, US; 8University of Minnesota Physicians, Minneapolis, MN, US; 9University of Virginia Health System, Charlottesville, VA, US; 10Rochester, NY, US BACKGROUND CONTEXT: The SRS requested an assessment of the current state of peer reviewed evidence regarding pediatric spondylolysis with the goal of identifying both what is really known and what research remains essential to further understanding. Spondylolysis is common among children and adolescents and no formal synthesis of the published literature regarding diagnostic imaging has been previously performed. PURPOSE: Perform a structured literature review on diagnostic methods for pediatric spondylolysis to assess the current evidence both to make diagnostic recommendations and identify areas requiring further research. STUDY DESIGN/SETTING: Structured literature review. OUTCOME MEASURES: Level of evidence. METHODS: A comprehensive literature search was performed with the assistance of a medical librarian. Citations and abstracts were retrieved. Abstracts were reviewed for exclusions and data from included studies were analyzed by committee. Consistent Level I studies were considered to provide Good Evidence, Level II or III studies Fair Evidence and Level IV studies Poor Evidence. RESULTS: From 947 initial citations with abstract, 383 articles underwent full text review. The best available evidence for the questions of diagnostic methods was provided by 26 included studies. There were no randomized validation or sensitivity/specificity studies. Five studies were graded as Level II and two as Level III evidence. Nineteen of the studies were graded as Level IV evidence. No Level V (expert opinion) studies were included in the final list. CONCLUSIONS: Plain radiography is still considered a good screening tool for pars defect, but the evidence is unclear as to its validity and accuracy. The evidence is fair when multislice CT with multiplanar reformats is considered as the gold standard and most accurate modality for detecting the bony defect and assessment of osseous healing; however, it exposes the pediatric patient to high ionizing radiation. There is poor to fair evidence that magnetic resonance imaging has been reported to be as accurate as CT imaging and useful in detecting early edematous stress reactions of the lumbar pars interarticularis without a fracture line. Optimal MR sequences (and interpretation) should be the focus of future investigations. The evidence is unclear as to the diagnostic accuracy of single-photon emission computed tomography (SPECT) and scintigraphy. There are conflicting reports on the rate of false-positive and false-negative results. However, it is clear that the radiation dose is high compared to MRI and plain radiographs. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.343
P90. Does the Change of Weather Condition Influence Pain Level of Symptoms in the Patients with Lumbar Diseases? Ken Ishii, MD, PhD1, Naobumi Hosogane2, Tomohiro Hikata, MD, PhD3, Yuta Shiono, MD4, Yohei Takahashi, MD5, Mitsuru Furukawa3, Shingo Iizuka6, Ejiiro Okada, MD7, Yasuhito Kaneko, MD, PhD8, Nobuyuki Fujita, MD9, Hiroyuki Katoh, MD, PhD10, Daisuke Ichihara, PhD3, Kota Watanabe, MD11, Kentaro Fukuda, MD12, Hitoshi Kono, MD,
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.