- Email: [email protected]
Current Practice for Traumatic Spinal Cord Injury in Canada
Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S The primary outcome was the Oswestry Disability Index (ODI) score at 12 weeks after compression fracture. The non-inferior margin of ODI was set at d 5 10 points. This study is registered at ClinicalTrials.gov, number NCT02049931. RESULTS: The ODI score (primary outcome) at 12 weeks after compression fracture in the no brace group was not inferior to that in the soft or rigid brace groups: no brace and soft brace, 38.66 6 22.58 and 36.30 6 19.12, respectively (95% CI; -7.02 to 9.38); no brace and rigid brace, 38.66 6 22.58 and 30.94 6 18.84, respectively (95% CI; -3.62 to 11.34). The overall ODI, Visual Analog Pain Scale (VAS) score for back pain, and anterior body compression ratios did not differ significantly among the groups during the follow-up assessment period. However, the ODI scores and VAS scores for back pain significantly improved with time after the fractures (follow-up assessment time: P ! 0.001 for the ODI scores, P ! 0.001 for the VAS scores for back pain), and the body compression ratios significantly decreased with time in all three groups (P ! 0.001). CONCLUSIONS: The ODI scores for the treatment of compression fractures without a brace are not inferior to those with soft or rigid braces. Moreover, the improvement in back pain and progression of anterior body compression were similar among the three groups. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.023
9. Blood Pressure Management in Acute Spinal Cord Injury Pre- and Post-Decompression Surgery Farhaan Altaf, MD, FRCS1, Lise Belanger, RN2, Juan Ronco, MD1, Nicolas Dea, MD, FRCSC3, Scott J. Paquette, MD1, Michael Boyd, MD3, John Street, PhD, MD3, Charles G. Fisher, MD4, Marcel F. Dvorak, MD, FRCSC3, Brian K. Kwon, MD, PhD, FRCSC3; 1Vancouver, BC, Canada; 2 Memphis, TN, US; 3Blusson Spinal Cord Centre, Vancouver, BC, Canada; 4 Vancouver General Hospital, Vancouver, BC, Canada BACKGROUND CONTEXT: In clinical practice, attempts to provide sufficient perfusion to the injured cord by supporting mean arterial blood pressure are generally considered to be beneficial. Haemodynamic support to avoid hypotension and ensure spinal cord perfusion may reduce ischaemic damage to the injured spinal cord.[1,2] A number of investigators have reported on clinical protocols in which MAP targets of at least 85 or 90mm Hg have been employed in acute spinal cord injury (SCI) patients. Vasopressors are commonly used to augment mean arterial pressure (MAP) after acute spinal cord injury (SCI). While many vasopressors with different pharmacologic activities are available, there are no formal recommendations for the acute SCI setting. Furthermore, their effects on intrathecal pressure (ITP) have not been previously evaluated, even though spinal cord perfusion pressure (SCPP) is the difference between the MAP and ITP. PURPOSE: Our goal was to characterize how well MAP was documented and managed from the point of arrival at the primary receiving hospital to the time of their definitive surgical stabilization in a tertiary spine unit. In the second part of this study, we evaluated the effects of two vasopressors on MAP and ITP in acute SCI patients: norepinephrine (NE) and dopamine (DA). STUDY DESIGN/SETTING: Study part 1: Retrospective cohort study of blood pressure management prior to decompression surgery in the setting of spinal cord injury. Study part 2: Prospective study of blood pressure management using vasopressors post decompression surgery in the setting of spinal cord injury. PATIENT SAMPLE: Study part 1: management of blood pressure prior to surgery. Sixteen acute cervical and thoracic SCI patients with ASIA impairment scale (AIS) A, B, or C injuries were included. Study part 2: management of blood pressure postsurgery. Ten patients with acute SCI (either AIS A or B) were evaluated. ITP was continuously measured using a lumbar intrathecal catheter residing caudal to the injury site. OUTCOME MEASURES: Study part 1: management of blood pressure prior to surgery. We evaluated the MAP recordings at three preoperative stages: (1) the primary receiving hospital, (2) during transfer and (3) in
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the emergency room or stepdown unit of the tertiary hospital (prior to surgery). The total number of MAP recordings for each patient was documented and the percentages below 80 or 70 mm Hg were calculated. Study part 2: management of blood pressure post-surgery. ITP was continuously measured using a lumbar intrathecal catheter residing caudal to the injury site. The outcome measure was change in ITP and therefore SCPP with each type of vasopressor. METHODS: Study part 1: management of blood pressure prior to surgery. Sixteen acute cervical and thoracic SCI patients with ASIA impairment scale (AIS) A, B, or C injuries were included. We evaluated the MAP recordings at three preoperative stages: (1) the primary receiving hospital, (2) during transfer and (3) in the emergency room or stepdown unit of the tertiary hospital (prior to surgery). The total number of MAP recordings for each patient was documented and the percentages below 80 or 70 mm Hg were calculated. Study part 2: management of blood pressure post-surgery. Ten patients with acute SCI (either AIS A or B) were evaluated. ITP was continuously measured using a lumbar intrathecal catheter residing caudal to the injury site. The patients underwent a ‘‘cross-over’’ in which they were switched from NE to DA, or vice-versa, while keeping the MAP constant. RESULTS: Study part 1: At the primary hospital, 51% of MAP recordings were below 80 mmHg and 40% were below 70 mmHg. During patient transfer, 31% of MAP recordings were below 80mmHg and 17% were below 70mmHg. While awaiting surgery in the emergency room or stepdown of the specialist centre, 49% of MAP recordings were below 80mmHg and 20% of readings were below 70mmHg. It was also noted that blood pressure readings were taken infrequently at each of these settings. The average time spent at the primary receiving hospital was 4hrs 28minutes; 1hr 7minutes during transfer; and 8hrs 44minutes at the tertiary hospital. Study part 2: There were 20 interventions in which patients receiving norepinephrine were changed to dopamine. There was one intervention where the patient on dopamine was crossed over to norepinephrine. There was an average increase in ITP of 3.37 (range 0.27-8.6) when there was a crossover from noepinephrine to dopamine. CONCLUSIONS: While experienced spine surgeons may take an aggressive approach to maintaining MAP in acute SCI, our results show that there are many hours before patients arrive in the operating room where hypotension is common. This study highlights the need for greater awareness around blood pressure in the preoperative period, where there may be an opportunity for vigilance to improve neurologic outcome. The second part of this study suggests that the choice of vasopressor can affect the intrathecal pressure which is an important parameter post spinal cord injury. We have found that both norepinephrine and dopamine are able to achieve MAP’s above 80mmHg but norepinephrine is able to achieve this at a lower intrathecal pressure. References: 1. Levi L, Wolf A, Belzberg H. Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention, and prediction of outcome. Neurosurgery 1993; 33: 1007-1016. (discussion 1016-7). 2. Vale FL, Burns J, Jackson AB, Hadley MN. Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg 1997; 87: 239-246. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.024
10. Current Practice for Traumatic Spinal Cord Injury in Canada Brian M. Drew, FRCSC, PT1, Michael G. Fehlings, MD, PhD, FRCSC2, Jerome Paquet, MD, FRCSC3, Henry Ahn, MD, PhD, FRCSC4, Najmedden Attabib, FRCSC5, Christopher S. Bailey, MD, FRCSC6, Sean D. Christie, MD7, Neil Duggal, MD, FRCSC8, Joel A. Finkelstein, MD9, Daryl R. Fourney V, MD, FRCS10, R. John Hurlbert, MD, PhD11, Michael G. Johnson, MD, FRCSC12, Brian K. Kwon, MD, PhD, FRCSC13, Stefan Parent, MD, Eve C. Tsai, MD14, Marcel F. Dvorak, MD, FRCSC13, Vanessa K. Noonan, PT15, Carly S. Rivers, PhD, MSc, BS16; 1Hamilton, ON, Canada; 2Toronto Western Hospital, Toronto, ON, Canada; 3Quebec, QC, Canada; 4University of Toronto Spine Program, Toronto, ON, CA;
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.
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Saint John, NB, Canada; University of Western Ontario, London Health Sciences Centre, London, ON, Canada; 7QE II Health Sciences Centre, Halifax, NS, Canada; 8University of Western Ontario, London, ON, Canada; 9Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 10 Royal University Hospital, Saskatoon, SK, Canada; 11University of Calgary Spine Program, Calgary, AB, Canada; 12Health Sciences Centre Winnipeg Spine Program, Winnipeg, MB, Canada; 13Blusson Spinal Cord Centre, Vancouver, BC, Canada; 14C2 Neurosciences Unit, Ottawa, ON, Canada; 15Vancouver, BC, Canada; 16Rick Hansen Institute, Vancouver, BC, Canada BACKGROUND CONTEXT: Traumatic spinal cord injury (tSCI) is often treated surgically. However, there is no consensus on indications and timing. Published data on rates of surgery for SCI patients vary widely internationally. PURPOSE: The objective of this study was to determine surgery rates for tSCI in Canada and describe the demographic and clinical characteristics of operative and nonoperative patients. STUDY DESIGN/SETTING: tSCI patients with complete records from the Rick Hansen Spinal Cord Injury Registry (RHSCIR), prospectively recruited from 2004-2013 from 18 acute care centres across Canada were studied. PATIENT SAMPLE: 1,440 participants had complete data; 1,250 (86.8%) had surgery. OUTCOME MEASURES: Patient demographics (age, gender) and injury characteristics (severity and level of injury) were compared. METHODS: Data on patient characteristics (eg, age, ethnicity, neurology) were analyzed using chi-squared tests. RESULTS: 1,440 participants had complete data; 1,250 (86.8%) had surgery. Those with thoracic (T2-T10) injuries were most likely to undergo surgery (94.1%), followed by thoracolumbar (T11-L2; 91.6%), low cervical (C5-T1; 86.8%) and high cervical (C1-C4; 81.1%) injuries (p!0.0001). There was no difference between surgically and nonsurgically treated groups with regard to gender, ethnicity, injury year, time from injury to first neurologic examination, admission Glasgow Coma Scale, or admission Charlson Comorbidity Index. Patients with AIS A /B at admission were more likely to have surgery than patients with AIS C/D (95.1% vs 80.7%, p!0.0001). Those having surgery were younger (44.6 vs 52.1y, p!0.0001) and were more likely to have been injured by a high energy mechanism (88.9% v 84.3%, p50.0115). Participants with one or more comorbidities were less likely to receive surgery (88.8% v 82.2%, p50.0033). Participants with Central Cord Syndrome (CCS) were less likely to receive surgery (75.2% v 92.7%, p!0.0001). Acute LOS was significantly affected by AIS (A/B 51.5d vs C/D 26.5d, p!0.0001) and neurologic level (p!0.0001). CONCLUSIONS: The surgical rates for both cervical and thoracolumbar injuries are higher than published data. Ongoing analyses will determine if surgical intervention produces superior outcomes and provide evidence to promote the standardization of care. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.025
11. The Relation between Depression, PTSD and the Likelihood of Returning to Work After Spine Trauma Alexander C. Ching, MD1, Lauren Wessler2, Sabina R. Blizzard, BA2, Natalie L. Zusman2, Jung U. Yoo, MD2; 1Portland, OR, US; 2Oregon Health and Science University, Portland, OR, US BACKGROUND CONTEXT: Post-traumatic stress disorder (PTSD) is a widely recognized anxiety disorder which can lead to considerable difficulty with social and occupational functioning. After traumatic injury, some patients have difficulty returning to work, resulting in substantial societal costs in the form of lost productivity and wages. To our knowledge,
the relation between PTSD and patients’ likelihood of returning to work after injury has not been documented among spine trauma patients. PURPOSE: To describe the relation of PTSD to mental health and patients’ ability to return to work one year after spine trauma. STUDY DESIGN/SETTING: Prospective cohort study at a Level 1 Trauma Center. PATIENT SAMPLE: Adult spine trauma patients admitted between October 2009 and November 2013. OUTCOME MEASURES: PTSD associated symptoms were measured using the PTSD Check List – Civilian (PCL-C). This scale is validated to assess for PTSD and PTSD symptoms. Short Form 12 (SF-12) survey was used to assess global health. The SF-12 yields a Mental Component Summary Score (MCS) and a Physical Component Summary Score (PCS) as measures of functioning in each domain. METHODS: Patients were asked their preinjury and current work status at hospital admission and 12 months. PCL-C and SF-12 survey responses were collected via interview or mail at 3 months and 6 months. Scores of 35 and higher on the PCL-C were defined as positive for PTSD associated symptoms. Depression was defined as MCS #45. Patients were divided into depressed/ not depressed and PTSD symptoms/no PTSD symptoms groups based on MCS and PCL-C cutoff scores at 3 months and 6 months. Differences in employment status at 1 year were compared between these groups and analyzed using Chi-Square tests. Patients who were retired prior to hospital admission were excluded from analysis. A sub-group, excluding patients who were of working age but unemployed prior to injury, was separately analyzed. RESULTS: Among patients with depression 6 months after injury, 52% (17/33) were working one year after presentation; among patients without depression at the same time point, 73% (30/41) were working (p50.046). Among patients with PTSD symptoms at 6 months, 47% (16/34) were working at one year; among patients without PTSD, 78% (31/40) were working (p50.007). When we performed a similar analysis at 3 months, these relationships yielded no significant relations. When patients who were unemployed prior to their injury were excluded, we found a strong trend toward statistical significance at both 3 and 6 months. In this subgroup, those who were depressed versus not depressed at 6 months had a likelihood of working at one year of 64% and 85%, respectively (p50.09). Those with PTSD symptoms versus those without PTSD symptoms at 6 months had a working rate of 60% and 88% (p50.02). At three months, the findings were similar and again had a strong trend toward significance (p50.057 and p50.058 respectively). CONCLUSIONS: Presence of PTSD or depression after spine trauma is associated with a lower likelihood of returning to work one year after injury. These findings suggest that interventions to improve return-to-work rates should focus on patients with PTSD symptoms or depression at either 3 or 6 months after spine trauma. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.026
12. Subaxial Injury Classification (SLIC) Scoring System Treatment Recommendations for Cervical Spine Trauma: Retrospective Review of 193 Patients Sumant Samuel, MBBS, MS1, Jiun-lih J. Lin, MBBS2, Margaret M. Smith, PhD3, Nathan Hartin, MD4, Andrew Cree, MD, FRACS5, Con Vasili, FACS6, Randolph Gray, FRACS; 1Christian Medical College, Vellore, India; 2Royal North Shore Hospital, St. Leonards, Australia; 3Kolling Institute, St. Leonards, Australia; 4Twin Cities Spine Centre, Minneapolis, MN, US; 5The Children’s Hospital at Westmead and Westmead Hospital, Westmead, NSW, Australia; 6Sydney, Australia BACKGROUND CONTEXT: The management of patients with subaxial cervical spinal injury lacks consensus among spinal surgeons with regard to the decision to operate and choice of surgical approach. Subaxial injury classification (SLIC) scoring system introduced in 2007 by the
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.
9. Blood Pressure Management in Acute Spinal Cord Injury Pre- and Post-Decompression Surgery Farhaan Altaf, MD, FRCS1, Lise Belanger, RN2, Juan Ronco, MD1, Nicolas Dea, MD, FRCSC3, Scott J. Paquette, MD1, Michael Boyd, MD3, John Street, PhD, MD3, Charles G. Fisher, MD4, Marcel F. Dvorak, MD, FRCSC3, Brian K. Kwon, MD, PhD, FRCSC3; 1Vancouver, BC, Canada; 2 Memphis, TN, US; 3Blusson Spinal Cord Centre, Vancouver, BC, Canada; 4 Vancouver General Hospital, Vancouver, BC, Canada BACKGROUND CONTEXT: In clinical practice, attempts to provide sufficient perfusion to the injured cord by supporting mean arterial blood pressure are generally considered to be beneficial. Haemodynamic support to avoid hypotension and ensure spinal cord perfusion may reduce ischaemic damage to the injured spinal cord.[1,2] A number of investigators have reported on clinical protocols in which MAP targets of at least 85 or 90mm Hg have been employed in acute spinal cord injury (SCI) patients. Vasopressors are commonly used to augment mean arterial pressure (MAP) after acute spinal cord injury (SCI). While many vasopressors with different pharmacologic activities are available, there are no formal recommendations for the acute SCI setting. Furthermore, their effects on intrathecal pressure (ITP) have not been previously evaluated, even though spinal cord perfusion pressure (SCPP) is the difference between the MAP and ITP. PURPOSE: Our goal was to characterize how well MAP was documented and managed from the point of arrival at the primary receiving hospital to the time of their definitive surgical stabilization in a tertiary spine unit. In the second part of this study, we evaluated the effects of two vasopressors on MAP and ITP in acute SCI patients: norepinephrine (NE) and dopamine (DA). STUDY DESIGN/SETTING: Study part 1: Retrospective cohort study of blood pressure management prior to decompression surgery in the setting of spinal cord injury. Study part 2: Prospective study of blood pressure management using vasopressors post decompression surgery in the setting of spinal cord injury. PATIENT SAMPLE: Study part 1: management of blood pressure prior to surgery. Sixteen acute cervical and thoracic SCI patients with ASIA impairment scale (AIS) A, B, or C injuries were included. Study part 2: management of blood pressure postsurgery. Ten patients with acute SCI (either AIS A or B) were evaluated. ITP was continuously measured using a lumbar intrathecal catheter residing caudal to the injury site. OUTCOME MEASURES: Study part 1: management of blood pressure prior to surgery. We evaluated the MAP recordings at three preoperative stages: (1) the primary receiving hospital, (2) during transfer and (3) in
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the emergency room or stepdown unit of the tertiary hospital (prior to surgery). The total number of MAP recordings for each patient was documented and the percentages below 80 or 70 mm Hg were calculated. Study part 2: management of blood pressure post-surgery. ITP was continuously measured using a lumbar intrathecal catheter residing caudal to the injury site. The outcome measure was change in ITP and therefore SCPP with each type of vasopressor. METHODS: Study part 1: management of blood pressure prior to surgery. Sixteen acute cervical and thoracic SCI patients with ASIA impairment scale (AIS) A, B, or C injuries were included. We evaluated the MAP recordings at three preoperative stages: (1) the primary receiving hospital, (2) during transfer and (3) in the emergency room or stepdown unit of the tertiary hospital (prior to surgery). The total number of MAP recordings for each patient was documented and the percentages below 80 or 70 mm Hg were calculated. Study part 2: management of blood pressure post-surgery. Ten patients with acute SCI (either AIS A or B) were evaluated. ITP was continuously measured using a lumbar intrathecal catheter residing caudal to the injury site. The patients underwent a ‘‘cross-over’’ in which they were switched from NE to DA, or vice-versa, while keeping the MAP constant. RESULTS: Study part 1: At the primary hospital, 51% of MAP recordings were below 80 mmHg and 40% were below 70 mmHg. During patient transfer, 31% of MAP recordings were below 80mmHg and 17% were below 70mmHg. While awaiting surgery in the emergency room or stepdown of the specialist centre, 49% of MAP recordings were below 80mmHg and 20% of readings were below 70mmHg. It was also noted that blood pressure readings were taken infrequently at each of these settings. The average time spent at the primary receiving hospital was 4hrs 28minutes; 1hr 7minutes during transfer; and 8hrs 44minutes at the tertiary hospital. Study part 2: There were 20 interventions in which patients receiving norepinephrine were changed to dopamine. There was one intervention where the patient on dopamine was crossed over to norepinephrine. There was an average increase in ITP of 3.37 (range 0.27-8.6) when there was a crossover from noepinephrine to dopamine. CONCLUSIONS: While experienced spine surgeons may take an aggressive approach to maintaining MAP in acute SCI, our results show that there are many hours before patients arrive in the operating room where hypotension is common. This study highlights the need for greater awareness around blood pressure in the preoperative period, where there may be an opportunity for vigilance to improve neurologic outcome. The second part of this study suggests that the choice of vasopressor can affect the intrathecal pressure which is an important parameter post spinal cord injury. We have found that both norepinephrine and dopamine are able to achieve MAP’s above 80mmHg but norepinephrine is able to achieve this at a lower intrathecal pressure. References: 1. Levi L, Wolf A, Belzberg H. Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention, and prediction of outcome. Neurosurgery 1993; 33: 1007-1016. (discussion 1016-7). 2. Vale FL, Burns J, Jackson AB, Hadley MN. Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg 1997; 87: 239-246. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.024
10. Current Practice for Traumatic Spinal Cord Injury in Canada Brian M. Drew, FRCSC, PT1, Michael G. Fehlings, MD, PhD, FRCSC2, Jerome Paquet, MD, FRCSC3, Henry Ahn, MD, PhD, FRCSC4, Najmedden Attabib, FRCSC5, Christopher S. Bailey, MD, FRCSC6, Sean D. Christie, MD7, Neil Duggal, MD, FRCSC8, Joel A. Finkelstein, MD9, Daryl R. Fourney V, MD, FRCS10, R. John Hurlbert, MD, PhD11, Michael G. Johnson, MD, FRCSC12, Brian K. Kwon, MD, PhD, FRCSC13, Stefan Parent, MD, Eve C. Tsai, MD14, Marcel F. Dvorak, MD, FRCSC13, Vanessa K. Noonan, PT15, Carly S. Rivers, PhD, MSc, BS16; 1Hamilton, ON, Canada; 2Toronto Western Hospital, Toronto, ON, Canada; 3Quebec, QC, Canada; 4University of Toronto Spine Program, Toronto, ON, CA;
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.
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Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S 6
Saint John, NB, Canada; University of Western Ontario, London Health Sciences Centre, London, ON, Canada; 7QE II Health Sciences Centre, Halifax, NS, Canada; 8University of Western Ontario, London, ON, Canada; 9Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 10 Royal University Hospital, Saskatoon, SK, Canada; 11University of Calgary Spine Program, Calgary, AB, Canada; 12Health Sciences Centre Winnipeg Spine Program, Winnipeg, MB, Canada; 13Blusson Spinal Cord Centre, Vancouver, BC, Canada; 14C2 Neurosciences Unit, Ottawa, ON, Canada; 15Vancouver, BC, Canada; 16Rick Hansen Institute, Vancouver, BC, Canada BACKGROUND CONTEXT: Traumatic spinal cord injury (tSCI) is often treated surgically. However, there is no consensus on indications and timing. Published data on rates of surgery for SCI patients vary widely internationally. PURPOSE: The objective of this study was to determine surgery rates for tSCI in Canada and describe the demographic and clinical characteristics of operative and nonoperative patients. STUDY DESIGN/SETTING: tSCI patients with complete records from the Rick Hansen Spinal Cord Injury Registry (RHSCIR), prospectively recruited from 2004-2013 from 18 acute care centres across Canada were studied. PATIENT SAMPLE: 1,440 participants had complete data; 1,250 (86.8%) had surgery. OUTCOME MEASURES: Patient demographics (age, gender) and injury characteristics (severity and level of injury) were compared. METHODS: Data on patient characteristics (eg, age, ethnicity, neurology) were analyzed using chi-squared tests. RESULTS: 1,440 participants had complete data; 1,250 (86.8%) had surgery. Those with thoracic (T2-T10) injuries were most likely to undergo surgery (94.1%), followed by thoracolumbar (T11-L2; 91.6%), low cervical (C5-T1; 86.8%) and high cervical (C1-C4; 81.1%) injuries (p!0.0001). There was no difference between surgically and nonsurgically treated groups with regard to gender, ethnicity, injury year, time from injury to first neurologic examination, admission Glasgow Coma Scale, or admission Charlson Comorbidity Index. Patients with AIS A /B at admission were more likely to have surgery than patients with AIS C/D (95.1% vs 80.7%, p!0.0001). Those having surgery were younger (44.6 vs 52.1y, p!0.0001) and were more likely to have been injured by a high energy mechanism (88.9% v 84.3%, p50.0115). Participants with one or more comorbidities were less likely to receive surgery (88.8% v 82.2%, p50.0033). Participants with Central Cord Syndrome (CCS) were less likely to receive surgery (75.2% v 92.7%, p!0.0001). Acute LOS was significantly affected by AIS (A/B 51.5d vs C/D 26.5d, p!0.0001) and neurologic level (p!0.0001). CONCLUSIONS: The surgical rates for both cervical and thoracolumbar injuries are higher than published data. Ongoing analyses will determine if surgical intervention produces superior outcomes and provide evidence to promote the standardization of care. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.025
11. The Relation between Depression, PTSD and the Likelihood of Returning to Work After Spine Trauma Alexander C. Ching, MD1, Lauren Wessler2, Sabina R. Blizzard, BA2, Natalie L. Zusman2, Jung U. Yoo, MD2; 1Portland, OR, US; 2Oregon Health and Science University, Portland, OR, US BACKGROUND CONTEXT: Post-traumatic stress disorder (PTSD) is a widely recognized anxiety disorder which can lead to considerable difficulty with social and occupational functioning. After traumatic injury, some patients have difficulty returning to work, resulting in substantial societal costs in the form of lost productivity and wages. To our knowledge,
the relation between PTSD and patients’ likelihood of returning to work after injury has not been documented among spine trauma patients. PURPOSE: To describe the relation of PTSD to mental health and patients’ ability to return to work one year after spine trauma. STUDY DESIGN/SETTING: Prospective cohort study at a Level 1 Trauma Center. PATIENT SAMPLE: Adult spine trauma patients admitted between October 2009 and November 2013. OUTCOME MEASURES: PTSD associated symptoms were measured using the PTSD Check List – Civilian (PCL-C). This scale is validated to assess for PTSD and PTSD symptoms. Short Form 12 (SF-12) survey was used to assess global health. The SF-12 yields a Mental Component Summary Score (MCS) and a Physical Component Summary Score (PCS) as measures of functioning in each domain. METHODS: Patients were asked their preinjury and current work status at hospital admission and 12 months. PCL-C and SF-12 survey responses were collected via interview or mail at 3 months and 6 months. Scores of 35 and higher on the PCL-C were defined as positive for PTSD associated symptoms. Depression was defined as MCS #45. Patients were divided into depressed/ not depressed and PTSD symptoms/no PTSD symptoms groups based on MCS and PCL-C cutoff scores at 3 months and 6 months. Differences in employment status at 1 year were compared between these groups and analyzed using Chi-Square tests. Patients who were retired prior to hospital admission were excluded from analysis. A sub-group, excluding patients who were of working age but unemployed prior to injury, was separately analyzed. RESULTS: Among patients with depression 6 months after injury, 52% (17/33) were working one year after presentation; among patients without depression at the same time point, 73% (30/41) were working (p50.046). Among patients with PTSD symptoms at 6 months, 47% (16/34) were working at one year; among patients without PTSD, 78% (31/40) were working (p50.007). When we performed a similar analysis at 3 months, these relationships yielded no significant relations. When patients who were unemployed prior to their injury were excluded, we found a strong trend toward statistical significance at both 3 and 6 months. In this subgroup, those who were depressed versus not depressed at 6 months had a likelihood of working at one year of 64% and 85%, respectively (p50.09). Those with PTSD symptoms versus those without PTSD symptoms at 6 months had a working rate of 60% and 88% (p50.02). At three months, the findings were similar and again had a strong trend toward significance (p50.057 and p50.058 respectively). CONCLUSIONS: Presence of PTSD or depression after spine trauma is associated with a lower likelihood of returning to work one year after injury. These findings suggest that interventions to improve return-to-work rates should focus on patients with PTSD symptoms or depression at either 3 or 6 months after spine trauma. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.026
12. Subaxial Injury Classification (SLIC) Scoring System Treatment Recommendations for Cervical Spine Trauma: Retrospective Review of 193 Patients Sumant Samuel, MBBS, MS1, Jiun-lih J. Lin, MBBS2, Margaret M. Smith, PhD3, Nathan Hartin, MD4, Andrew Cree, MD, FRACS5, Con Vasili, FACS6, Randolph Gray, FRACS; 1Christian Medical College, Vellore, India; 2Royal North Shore Hospital, St. Leonards, Australia; 3Kolling Institute, St. Leonards, Australia; 4Twin Cities Spine Centre, Minneapolis, MN, US; 5The Children’s Hospital at Westmead and Westmead Hospital, Westmead, NSW, Australia; 6Sydney, Australia BACKGROUND CONTEXT: The management of patients with subaxial cervical spinal injury lacks consensus among spinal surgeons with regard to the decision to operate and choice of surgical approach. Subaxial injury classification (SLIC) scoring system introduced in 2007 by the
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.