- Email: [email protected]
Disc Height Change Following Thoracolumbar Burst Fractures Treated with Pedicle Screw Fixation without Fusion
Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S RESULTS: All patients completed 12-month follow-up. Overall, a significant improvement in VAS-leg, VAS-back, ODI, and SF-36 PCS was observed by 6 weeks after surgery. Improvements in all outcomes were maintained throughout 12 months. Increasing pre-op depression (Zung score) was associated with a decreased likelihood of achieving MCID in disability (p 5 0.006) and quality of life (p 5 0.04) but not associated with leg (p 5 0.96) or back pain (p 5 0.85) by 12 months, Table 1, Figure 1. Increasing preoperative somatic anxiety (MSPQ score) associated with decreased likelihood of achieving MCID in disability (p 5 0.002) and quality of life (p 5 0.03) but was not associated with leg (p 5 0.64) or back pain (p 5 0.77) by 12 months, Table 2, Figure 2. CONCLUSIONS: Zung and MSPQ are valuable tools at risk stratifying patients who may not experience clinically relevant improvement in disability and quality of life after discectomy. Efforts to address these confounding and underlying contributors of depression and heightened somatic anxiety may improve overall outcomes after lumbar discectomy. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BDI, increased AA SPL, and increased lateral AA height. On MRI, these three patients had intact OC joint capsules and disrupted CC ligaments. These patients were found to be ASIA D according to medical record documentation. CONCLUSIONS: On the basis of imaging and neurological status, two distinct patterns of injury were identified: isolated AA injuries (Type I) and combined OC and AA injuries (Type II). All of the patients had disrupted CC ligaments and therefore the CC ligament integrity did not correspond to joint diastasis. The integrity of the OC joint capsule was the only factor that differentiated the two subsets of patients. Figures 1 and 2 demonstrate a type II injury with a disrupted OC capsule and disrupted CC ligaments. Figures 3 and 4 illustrate a type I injury with an intact OC anterior OC joint capsule and disrupted CC ligament complex. Type II injuries have worse neurological status compared to type I injuries due to horizontal and vertical instability in the former. In conclusion, the OC joint capsules may be an important stabilizer of the OC joint. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
doi: 10.1016/j.spinee.2010.07.047 doi: 10.1016/j.spinee.2010.07.050
Wednesday, October 6, 2010 5:15–6:15 PM Focused Paper Presentations 1: Trauma 36. Classification of Craniocervical Dissociative Injuries Based on CT and MRI Kristen E. Radcliff, MD1, Joseph Hong, DO1, Charles Reitman, MD2, D. Greg Anderson, MD1, Alan Hilibrand, MD1, Todd Albert, MD1, Alex Vaccaro, MD, PhD1; 1Rothman Institute/Thomas Jefferson University Department of Orthopedic Surgery, Philadelphia, PA, USA; 2Baylor College of Medicine, Houston, TX, USA BACKGROUND CONTEXT: Craniocervical dissociative injuries are rare, devastating injuries. Previous classifications focus on radiographic displacement or midline structures. PURPOSE: The purpose of this study was to determine and classify occipitocervical dissociative injuries based on CT and MRI characteristics. STUDY DESIGN/SETTING: Retrospective Analysis of Prospectively Collected Data. PATIENT SAMPLE: Patients evaluated between 2000 and 2009 at Thomas Jefferson Hospital and the Delaware Valley Regional Spinal Cord Injury Center was searched. Inclusion criteria were acute, traumatic distractive injury of the OC or atlantoaxial joints. Exclusion criteria include patients with a traumatic, postsurgical, infectious, neoplastic, rheumatic, degenerative, or congenital instability. OUTCOME MEASURES: Clinical and radiographic outcome measures were assessed. METHODS: After approval by the IRB, medical records were evaluated for diagnosis, neurological exam at presentation and discharge, associated injuries, operative details. CT and MRI were evaluated for diastasis of the OC and atlantoaxial (AA) joints, basion dental interval (BDI), AA spinolaminar line and integrity of the craniocervical (CC) ligaments and OC joint capsules. RESULTS: Seven patients were identified with craniocervical dissociative Injuries. CT evaluation revealed that four patients presented abnormal OC joint diastasis, abnormal large BDIs, abnormal AA spinolaminar line (SPL), and increased lateral AA height. MRI evaluation of these patients revealed disrupted CC ligament complex and OC joint capsules. Three patients were ASIA A and one was ASIA B neurological status according to orthopedic spine, neurosurgery, and rehabilitation attending examination. Three patients were found to have normal OC joint height, increased
37. A Spinal Cord Pressure-Displacement Model of Posterior Wall Burst Fracture Peter F. Jarzem, MD, Jerod Hines, MD, Mahdi Bassi, MD; McGill University Health Centre, Montreal, QC, Canada BACKGROUND CONTEXT: Spinal Trauma can injure the spinal cord through two mechanisms 1) direct injury from displaced bone/disc at the time of injury/impact and 2) residual pressure on the spinal cord from ongoing spinal canal compromise. This paper describes a model of traumatic residual SC compression. PURPOSE: To determine amount of compression required to cause pressure elevation in spinal cord in an animal cadaver model. STUDY DESIGN/SETTING: We used a novel plunger device connected to a pressure transducer via intravenous solution tubing to measure pressures within the spinal canal. The dural sac was injected with radio-opaque dye and a portable fluoroscopy unit was utilized to verify amount of cord compression. PATIENT SAMPLE: All porcine specimens. METHODS: 6 Porcine spinal sections: 6 thoracic, and 6 lumbar were harvested from 30 kg pigs. Myelographic dye was then injected in the subarachnoid space. A plunger with a sensing probe was then advanced through the vertebral body in the spinal canal through a previously prepared hole. AP and lateral fluoroscopic images were obtained to determine the extent of canal compromise. The plunger was advanced in 0.25 mm increments at a rate of on 0.25 mm/2 min. Pressure was measured at each increment. Pressure versus displacement curves were then determined. RESULTS: Initial cord compromise does not lead to significant pressure elevation. After an initial low pressure plateau, pressure rises rapidly to high levels that can cause cord damage. This elevation in cord pressure occurs when 60% of the canal has been compromised and rises abruptly with little further canal transgression. CONCLUSIONS: These pressure displacement relationships demonstrate that the spinal canal can initially sustain 60% reductions in canal volume before having abrupt and dangerous spinal cord pressure elevations. Further work needs to be done to determine if stress relaxation will occur (and reduce cord pressure) and to determine if the same pressure displacement relationships exist in live animal models and human cadaver specimens. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.051
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
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Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S
38. Disc Height Change Following Thoracolumbar Burst Fractures Treated with Pedicle Screw Fixation without Fusion Huilin Yang, MD, PhD1, Jiayong Liu, MD2, Jinhui Shi, MD1, Molly Ebraheim, BS2, Joseph Konrad, BS2, Xiaochen Liu, BS2, Ibrahim T. Husain, MS2, Tiansi Tang, MD1; 1The First Affiliated Hospital of Soochow University, Suzhou, China; 2University of Toledo Medical Center, Toledo, OH, USA BACKGROUND CONTEXT: Indirect reduction and posterior pedicle screw fixation have been reported with variable outcomes. However, there is no study that reports on disc space height change following short segment pedicle screw instrumentation without fusion. PURPOSE: To evaluate the change in the injury level disc height following thoracolumbar burst fractures treated with short segment pedicle screw instrumentation without fusion. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: Sixty-four patients with single-level thoracolumbar burst fractures treated between 1998 and 2005 were identified. OUTCOME MEASURES: Outcome was analyzed by the Mumira disc classification, the Frankel method, the Denis Pain Grades, and radiographic measurements. METHODS: The all patients underwent fluoroscopy guided indirect, posterior reduction without fusion. All patients had instrumentation removal at 9 -12 months post-operation. The Mumira disc classification was used to track disc degeneration pre-operatively and at latest follow-up using radiographs while neurological status was tracked using the Frankel Method. At latest follow-up, pain scale and lumbar function were evaluated. RESULTS: Disc degeneration was common in both the cranial and caudal disc around the fracture, but more degeneration was seen at the cranial disc. Neurological status significantly improved or stayed normal in 61 patients, except for 3 paraplegic patients. 52 of 64 patients had excellent or good function. At the latest follow-up, 57 patients had no or minimal amount of pain, P1 or P2, 6 patients had moderate pain, P3, and only one patient had severe pain, P4. Generally, an increase in pain results in an increase in disability. CONCLUSIONS: Medium-term results show that the injury level disc space height significantly decreases after instrumentation removal, and the cranial level disc height degenerates more rapidly than the caudal level disc space height. However, middle term back pain and function results are largely satisfactory. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.052
39. A Novel Method for the Reproducible Production of Burst Fractures in Human Cadaveric Lumbar Spines Bradley K. Weiner, MD, Hugh Jones, Phil Noble, PhD, Harvey Smith, MD; The Methodist Hospital, Houston, TX, USA BACKGROUND CONTEXT: Currently, there is no reproducible method which produces thoracolumbar burst fractures in human cadavers wherein the fracture configuration mirrors that seen naturally and soft tissues are maintained. PURPOSE: To describe a novel method of burst fracture production. STUDY DESIGN/SETTING: Basic Science. Biomechanically engineered. OUTCOME MEASURES: Production of burst fracture. METHODS: Seven cadaveric specimens were potted in PMMA at T10 and L4; T10 to T12 and L2 to L4 were encased in pourable rigid foam; flexion of 15 degrees was created focused at L1; and a drop tower weight of 25 kg via ‘free-fall’ was used. Upon load delivery, the spine was allowed to flex without restriction (native bony and soft-tissue constraints). X-ray, CT Scan, and open dissection were used to confirm burst configuration.
RESULTS: All seven specimens were found to have the ‘classic’ burst configuration characterized by superior endplate comminution, depression of the anterior column, middle column burst with three to five fragments; the classic central fragment retropulsed into the canal; and pedicular spread via basilar fracture. CONCLUSIONS: This novel method affords true burst fracture reproduction without notching/osteotomies or stripping used in previous methods. This should allow greater accuracy for the translation of biomechanical testing to clinical applications. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.053
40. Predictors of Patient Satisfaction Following Treatment for Spine Injuries John R. Dimar, II, MD1, Jean Hanson, PhD2, Beverly E. Diamond, PhD2, Stefan Parent, MD, PhD3, Y Raja Rampersaud, MD4, Charles Fisher, MD, FRCSC5, Leah Y. Carreon, MD, MSc1; 1Norton Leatherman Spine Center, Louisville, KY, USA; 2PhDx Systems, Albuquerque, NM, USA; 3Service Orthope´die, Hoˆpital Sainte-Justine, Montreal, QC, Canada; 4Division of Orthopedic Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; 5Vancouver Coastal Health Research Institute, Vancouver, BC, Canada BACKGROUND CONTEXT: With the increased emphasis on patientcentered care, identification of factors that play a role in patient satisfaction is important. Patient satisfaction with both care and outcomes after spinal trauma has not been addressed in the literature. PURPOSE: The purpose of this study is to determine factors that predict satisfaction with treatment in patients with spine trauma. STUDY DESIGN/SETTING: Longitudinal Cohort. PATIENT SAMPLE: 233 patients enrolled in a multicenter database for spine trauma. OUTCOME MEASURES: Medical Outcomes Short Form 12 (SF-12), Satisfaction Scores. METHODS: A retrospective review of subjects enrolled in a multicenter database for spine trauma was conducted. Patients were classified into two groups: those who were satisfied with their treatment and those who were not, two-years after injury. Satisfaction with treatment was based on three questions: (1) I am continuing to improve following my injury; (2) I have been successful adapting to life with my injury; and (3) Overall I am satisfied with the care I am receiving for my injury; to which a patient can respond from ‘Definitely false (1)’ to ‘Definitely true (5)’ on a five-point Likert scale. The mean of the responses to these three questions was used as the Satisfaction score. Patients were classified as ‘‘Satisfied’’ if the Satisfaction score was 4.0 or higher, this indicated they rated the questions as definitely or mostly true; or ‘‘Not Satisfied’’ if the Satisfaction score was below 4.0; this indicated they rated the questions as don’t know, mostly or definitively false. Age, sex, presence or absence of co-morbidities, type of treatment received (operative vs. non-operative) ASIA Score, SF-12, Pain VAS score, mechanism of injury (MVA, sports, falls), type of energy (high energy vs. low energy) and the level of injury were compared between the two groups using student’s t-test for continuous variables and Fisher’s exact test for categorical variables. Factors meeting a significance level of .20 were entered into a multiple logistic linear regression model to determine factors predictive of Satisfaction with treatment two years after injury. RESULTS: There were 233 patients (171 male, 62 female) with a mean age of 46 years old. 131 (56.2%) patients had injury to the spinal cord. The majority of patients (68%) were satisfied with their treatment. There were no statistically significant differences between patients who were satisfied and those who were not based on age, sex, presence of co-morbidities, type of treatment received, ASIA motor score, mechanism of injury and type or level of injury. Two years after injury, patients who were satisfied had significantly
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
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BDI, increased AA SPL, and increased lateral AA height. On MRI, these three patients had intact OC joint capsules and disrupted CC ligaments. These patients were found to be ASIA D according to medical record documentation. CONCLUSIONS: On the basis of imaging and neurological status, two distinct patterns of injury were identified: isolated AA injuries (Type I) and combined OC and AA injuries (Type II). All of the patients had disrupted CC ligaments and therefore the CC ligament integrity did not correspond to joint diastasis. The integrity of the OC joint capsule was the only factor that differentiated the two subsets of patients. Figures 1 and 2 demonstrate a type II injury with a disrupted OC capsule and disrupted CC ligaments. Figures 3 and 4 illustrate a type I injury with an intact OC anterior OC joint capsule and disrupted CC ligament complex. Type II injuries have worse neurological status compared to type I injuries due to horizontal and vertical instability in the former. In conclusion, the OC joint capsules may be an important stabilizer of the OC joint. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
doi: 10.1016/j.spinee.2010.07.047 doi: 10.1016/j.spinee.2010.07.050
Wednesday, October 6, 2010 5:15–6:15 PM Focused Paper Presentations 1: Trauma 36. Classification of Craniocervical Dissociative Injuries Based on CT and MRI Kristen E. Radcliff, MD1, Joseph Hong, DO1, Charles Reitman, MD2, D. Greg Anderson, MD1, Alan Hilibrand, MD1, Todd Albert, MD1, Alex Vaccaro, MD, PhD1; 1Rothman Institute/Thomas Jefferson University Department of Orthopedic Surgery, Philadelphia, PA, USA; 2Baylor College of Medicine, Houston, TX, USA BACKGROUND CONTEXT: Craniocervical dissociative injuries are rare, devastating injuries. Previous classifications focus on radiographic displacement or midline structures. PURPOSE: The purpose of this study was to determine and classify occipitocervical dissociative injuries based on CT and MRI characteristics. STUDY DESIGN/SETTING: Retrospective Analysis of Prospectively Collected Data. PATIENT SAMPLE: Patients evaluated between 2000 and 2009 at Thomas Jefferson Hospital and the Delaware Valley Regional Spinal Cord Injury Center was searched. Inclusion criteria were acute, traumatic distractive injury of the OC or atlantoaxial joints. Exclusion criteria include patients with a traumatic, postsurgical, infectious, neoplastic, rheumatic, degenerative, or congenital instability. OUTCOME MEASURES: Clinical and radiographic outcome measures were assessed. METHODS: After approval by the IRB, medical records were evaluated for diagnosis, neurological exam at presentation and discharge, associated injuries, operative details. CT and MRI were evaluated for diastasis of the OC and atlantoaxial (AA) joints, basion dental interval (BDI), AA spinolaminar line and integrity of the craniocervical (CC) ligaments and OC joint capsules. RESULTS: Seven patients were identified with craniocervical dissociative Injuries. CT evaluation revealed that four patients presented abnormal OC joint diastasis, abnormal large BDIs, abnormal AA spinolaminar line (SPL), and increased lateral AA height. MRI evaluation of these patients revealed disrupted CC ligament complex and OC joint capsules. Three patients were ASIA A and one was ASIA B neurological status according to orthopedic spine, neurosurgery, and rehabilitation attending examination. Three patients were found to have normal OC joint height, increased
37. A Spinal Cord Pressure-Displacement Model of Posterior Wall Burst Fracture Peter F. Jarzem, MD, Jerod Hines, MD, Mahdi Bassi, MD; McGill University Health Centre, Montreal, QC, Canada BACKGROUND CONTEXT: Spinal Trauma can injure the spinal cord through two mechanisms 1) direct injury from displaced bone/disc at the time of injury/impact and 2) residual pressure on the spinal cord from ongoing spinal canal compromise. This paper describes a model of traumatic residual SC compression. PURPOSE: To determine amount of compression required to cause pressure elevation in spinal cord in an animal cadaver model. STUDY DESIGN/SETTING: We used a novel plunger device connected to a pressure transducer via intravenous solution tubing to measure pressures within the spinal canal. The dural sac was injected with radio-opaque dye and a portable fluoroscopy unit was utilized to verify amount of cord compression. PATIENT SAMPLE: All porcine specimens. METHODS: 6 Porcine spinal sections: 6 thoracic, and 6 lumbar were harvested from 30 kg pigs. Myelographic dye was then injected in the subarachnoid space. A plunger with a sensing probe was then advanced through the vertebral body in the spinal canal through a previously prepared hole. AP and lateral fluoroscopic images were obtained to determine the extent of canal compromise. The plunger was advanced in 0.25 mm increments at a rate of on 0.25 mm/2 min. Pressure was measured at each increment. Pressure versus displacement curves were then determined. RESULTS: Initial cord compromise does not lead to significant pressure elevation. After an initial low pressure plateau, pressure rises rapidly to high levels that can cause cord damage. This elevation in cord pressure occurs when 60% of the canal has been compromised and rises abruptly with little further canal transgression. CONCLUSIONS: These pressure displacement relationships demonstrate that the spinal canal can initially sustain 60% reductions in canal volume before having abrupt and dangerous spinal cord pressure elevations. Further work needs to be done to determine if stress relaxation will occur (and reduce cord pressure) and to determine if the same pressure displacement relationships exist in live animal models and human cadaver specimens. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.051
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
18S
Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S
38. Disc Height Change Following Thoracolumbar Burst Fractures Treated with Pedicle Screw Fixation without Fusion Huilin Yang, MD, PhD1, Jiayong Liu, MD2, Jinhui Shi, MD1, Molly Ebraheim, BS2, Joseph Konrad, BS2, Xiaochen Liu, BS2, Ibrahim T. Husain, MS2, Tiansi Tang, MD1; 1The First Affiliated Hospital of Soochow University, Suzhou, China; 2University of Toledo Medical Center, Toledo, OH, USA BACKGROUND CONTEXT: Indirect reduction and posterior pedicle screw fixation have been reported with variable outcomes. However, there is no study that reports on disc space height change following short segment pedicle screw instrumentation without fusion. PURPOSE: To evaluate the change in the injury level disc height following thoracolumbar burst fractures treated with short segment pedicle screw instrumentation without fusion. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: Sixty-four patients with single-level thoracolumbar burst fractures treated between 1998 and 2005 were identified. OUTCOME MEASURES: Outcome was analyzed by the Mumira disc classification, the Frankel method, the Denis Pain Grades, and radiographic measurements. METHODS: The all patients underwent fluoroscopy guided indirect, posterior reduction without fusion. All patients had instrumentation removal at 9 -12 months post-operation. The Mumira disc classification was used to track disc degeneration pre-operatively and at latest follow-up using radiographs while neurological status was tracked using the Frankel Method. At latest follow-up, pain scale and lumbar function were evaluated. RESULTS: Disc degeneration was common in both the cranial and caudal disc around the fracture, but more degeneration was seen at the cranial disc. Neurological status significantly improved or stayed normal in 61 patients, except for 3 paraplegic patients. 52 of 64 patients had excellent or good function. At the latest follow-up, 57 patients had no or minimal amount of pain, P1 or P2, 6 patients had moderate pain, P3, and only one patient had severe pain, P4. Generally, an increase in pain results in an increase in disability. CONCLUSIONS: Medium-term results show that the injury level disc space height significantly decreases after instrumentation removal, and the cranial level disc height degenerates more rapidly than the caudal level disc space height. However, middle term back pain and function results are largely satisfactory. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.052
39. A Novel Method for the Reproducible Production of Burst Fractures in Human Cadaveric Lumbar Spines Bradley K. Weiner, MD, Hugh Jones, Phil Noble, PhD, Harvey Smith, MD; The Methodist Hospital, Houston, TX, USA BACKGROUND CONTEXT: Currently, there is no reproducible method which produces thoracolumbar burst fractures in human cadavers wherein the fracture configuration mirrors that seen naturally and soft tissues are maintained. PURPOSE: To describe a novel method of burst fracture production. STUDY DESIGN/SETTING: Basic Science. Biomechanically engineered. OUTCOME MEASURES: Production of burst fracture. METHODS: Seven cadaveric specimens were potted in PMMA at T10 and L4; T10 to T12 and L2 to L4 were encased in pourable rigid foam; flexion of 15 degrees was created focused at L1; and a drop tower weight of 25 kg via ‘free-fall’ was used. Upon load delivery, the spine was allowed to flex without restriction (native bony and soft-tissue constraints). X-ray, CT Scan, and open dissection were used to confirm burst configuration.
RESULTS: All seven specimens were found to have the ‘classic’ burst configuration characterized by superior endplate comminution, depression of the anterior column, middle column burst with three to five fragments; the classic central fragment retropulsed into the canal; and pedicular spread via basilar fracture. CONCLUSIONS: This novel method affords true burst fracture reproduction without notching/osteotomies or stripping used in previous methods. This should allow greater accuracy for the translation of biomechanical testing to clinical applications. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.053
40. Predictors of Patient Satisfaction Following Treatment for Spine Injuries John R. Dimar, II, MD1, Jean Hanson, PhD2, Beverly E. Diamond, PhD2, Stefan Parent, MD, PhD3, Y Raja Rampersaud, MD4, Charles Fisher, MD, FRCSC5, Leah Y. Carreon, MD, MSc1; 1Norton Leatherman Spine Center, Louisville, KY, USA; 2PhDx Systems, Albuquerque, NM, USA; 3Service Orthope´die, Hoˆpital Sainte-Justine, Montreal, QC, Canada; 4Division of Orthopedic Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; 5Vancouver Coastal Health Research Institute, Vancouver, BC, Canada BACKGROUND CONTEXT: With the increased emphasis on patientcentered care, identification of factors that play a role in patient satisfaction is important. Patient satisfaction with both care and outcomes after spinal trauma has not been addressed in the literature. PURPOSE: The purpose of this study is to determine factors that predict satisfaction with treatment in patients with spine trauma. STUDY DESIGN/SETTING: Longitudinal Cohort. PATIENT SAMPLE: 233 patients enrolled in a multicenter database for spine trauma. OUTCOME MEASURES: Medical Outcomes Short Form 12 (SF-12), Satisfaction Scores. METHODS: A retrospective review of subjects enrolled in a multicenter database for spine trauma was conducted. Patients were classified into two groups: those who were satisfied with their treatment and those who were not, two-years after injury. Satisfaction with treatment was based on three questions: (1) I am continuing to improve following my injury; (2) I have been successful adapting to life with my injury; and (3) Overall I am satisfied with the care I am receiving for my injury; to which a patient can respond from ‘Definitely false (1)’ to ‘Definitely true (5)’ on a five-point Likert scale. The mean of the responses to these three questions was used as the Satisfaction score. Patients were classified as ‘‘Satisfied’’ if the Satisfaction score was 4.0 or higher, this indicated they rated the questions as definitely or mostly true; or ‘‘Not Satisfied’’ if the Satisfaction score was below 4.0; this indicated they rated the questions as don’t know, mostly or definitively false. Age, sex, presence or absence of co-morbidities, type of treatment received (operative vs. non-operative) ASIA Score, SF-12, Pain VAS score, mechanism of injury (MVA, sports, falls), type of energy (high energy vs. low energy) and the level of injury were compared between the two groups using student’s t-test for continuous variables and Fisher’s exact test for categorical variables. Factors meeting a significance level of .20 were entered into a multiple logistic linear regression model to determine factors predictive of Satisfaction with treatment two years after injury. RESULTS: There were 233 patients (171 male, 62 female) with a mean age of 46 years old. 131 (56.2%) patients had injury to the spinal cord. The majority of patients (68%) were satisfied with their treatment. There were no statistically significant differences between patients who were satisfied and those who were not based on age, sex, presence of co-morbidities, type of treatment received, ASIA motor score, mechanism of injury and type or level of injury. Two years after injury, patients who were satisfied had significantly
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.