- Email: [email protected]
Does Pelvic Fixation Increase Morbidity and Mortality in Patients undergoing Posterior Lumbar Fusion?
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S Questionnaire (RMDQ) and the Harris Hip Score (HHS). Comparisons were carried out among data collected from different visits, and between patients with and without LBP. RESULTS: Thirty-nine (56.5%) reported LBP before surgery. Significant relief of LBP and improvement function of lumbar spine and hip were observed at three month after surgery, showing significant decrease of VAS and RMDQ score, and increase of HHS, whereas no significant changes were observed on sagittal spine-pelvis-leg alignment. One year postoperatively, the LBP was completely resolved in 17 and significantly relieved in the remaining patients, whereas significant reductions in hip flexion and improvement in global spinal balance was shown on lateral spine-pelvisleg radiography. CONCLUSIONS: LBP secondary to hip osteoarthritis would be relieved by total hip arthroplasty, with improvements in range of hip motion and global spinal balance. The anteverted pelvis might not be restored by THA, and this should be considered in acetabular cup implantation. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.168
138. Novel Virtual Modeling of Alignment following ASD Surgery: Establishing Relationships between Compensatory Changes and Overcorrection Due to Proximal Junctional Kyphosis International Spine Study Group1, Renaud Lafage2, Shay Bess, MD3, Steven D. Glassman, MD4, Christopher P. Ames, MD5, Douglas C. Burton, MD6, Bradley Harris, JD2, Robert A. Hart, MD7, Han Jo Kim, MD8, Eric O. Klineberg, MD9, Breton Line3, Justin K. Scheer, BS10, Themistocles S. Protopsaltis, MD2, Frank J. Schwab, MD2, Virginie Lafage, PhD2; 1 Brighton, CO, US; 2New York University Hospital for Joint Diseases, New York, NY, US; 3Rocky Mountain Scoliosis and Spine, Denver, CO, US; 4 Norton Leatherman Spine Center, Louisville, KY, US; 5University of California San Francisco, San Francisco, CA, US; 6University of Kansas Medical Center, Kansas City, KS, US; 7Oregon Health & Science University, Portland, OR, US; 8Hospital for Special Surgery, New York, NY, US; 9University of California Davis School of Medicine, Sacramento, CA, US; 10University of California San Diego, San Diego, CA, US BACKGROUND CONTEXT: It is difficult to analyze patients’ postoperative sagittal alignment once they develop Proximal Junctional Kyphosis (PJK) since they often dramatically compensate for the deformity. Until now, there was no effective way to model postoperative alignment that was free of the compensatory influence of PJK. This study proposes a novel virtual modeling technique that eliminates the impact of PJK on global alignment. Examining these models will lead to a better understanding of alignment factors associated with PJK. PURPOSE: The purpose of this study is to develop a novel virtual model of the spine following ASD surgery that can help improve our understanding of postoperative alignment by removing the influence of PJK. Furthermore, the study will analyze whether PJK should be considered a compensatory mechanism or an alignment failure. STUDY DESIGN/SETTING: Modeling of retrospective cohort. PATIENT SAMPLE: 458 patients (78% female; mean age 57.9 years) were analyzed. OUTCOME MEASURES: Radiological parameters including sagittal vertical axis (SVA), PJK angle, PI-LL mismatch, thoracic kyphosis (TK), T1 pelvic angle (TPA) and pelvic tilt (PT) were calculated. METHODS: An ASD database was used to model virtual postoperative alignments (VIRTUAL) for patients with pelvic fusion. Patients were divided into groups with/without PJK (PJK vs NOPJK). VIRTUAL combined the 2-year postoperative alignment of the instrumented segments (pelvis to UIV-1) with the preoperative alignment of the unfused segments (C2 to UIV). Pelvic retroversion was corrected based on published predictive formula. VIRTUAL was validated by comparisons to actual 2-year postoperative alignment (REAL) in NOPJK patients.
153S
RESULTS: Initial validation of VIRTUAL versus REAL demonstrated coefficients of correlation above 0.880 for all measures except SVA (r50.604). At 2 years, 215 (47%) patients had PJK (PJK angle52269 ). PJK patients were older than non-PJK (62.6 vs 59.7y, p50.007). In REAL, PJK had smaller PI-LL mismatch and larger TK than NOPJK (resp. PI-LL: 3.1614.0 vs 8.2616.5 , TK: -44.6615.7 vs -37.3616.7 , all p!0.001), but similar SVA, TPA and PT. However, analysis of VIRTUAL demonstrated that PJK not only had less PI-LL (3.1614.0 vs 7.7616.1 ), but also less PT (19.668.8 vs 23.469.4 ), less SVA (10649mm vs 24657mm) and less TPA (15.3611.1 vs 18.2615.8 ) than NOPJK (p!0.05). CONCLUSIONS: This novel modeling technique demonstrates high correlations with actual postoperative alignment in patients without PJK. This modeling is utilized to understand the relationship between reciprocal changes and postoperative alignment as well as failure of realignment (PJK). Comparing REAL to VIRTUAL models indicates that PJK may be a component of the compensatory mechanism rather than simply a failure of alignment to counteract for an overcorrection. Further studies should investigate the difference in correction with regard to age-specific alignment target. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.169
139. Does Pelvic Fixation Increase Morbidity and Mortality in Patients undergoing Posterior Lumbar Fusion? Jeremy Steinberger, MD1, Javier Guzman, BS2, Parth Kothari, BS2, Branko Skovrlj, MD3, Nathan J. Lee, BS2, Dante M. Leven, DO, PT, John I. Shin, BS4, Samuel K. Cho, MD4; 1New York, NY, US; 2Mount Sinai School of Medicine, New York, NY, US; 3Mount Sinai School of Medicine Department of Neurosurgery, New York, NY, US; 4Icahn School of Medicine at Mount Sinai, New York, NY, US BACKGROUND CONTEXT: Pelvic fixation is utilized for various indications including lumbosacral fixation for long fusions to the sacrum, correction of pelvic obliquity and high-grade spondylolisthesis. Due to the complex nature of such a procedure there is the potential for considerable morbidity. PURPOSE: The aim of this study was to analyze whether patients undergoing spinal deformity surgery with pelvic fixation are at higher risk for increased morbidity using a large national database. STUDY DESIGN/SETTING: Retrospective cohort analysis of prospectively collected data. PATIENT SAMPLE: American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. All patients O 18 years old undergoing fusion for spinal deformity registered in the NSQIP database with and without pelvic fixation. OUTCOME MEASURES: Development of complications, mortality, reoperation or postoperative events within 30 days. METHODS: Patients greater than or equal to18 years of age undergoing nonemergent posterior lumbar fusion with and without pelvic fixation from 2005-2012 were identified by CPT (Current Procedural Terminology) code in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Propensity matching was done to accurately predict likelihood of complications in this cohort. Multivariate modeling was done to analyze if pelvic fixation was independently associated with morbidity in patients undergoing posterior lumbar fusion. RESULTS: There rate of pelvic fixation in patients undergoing posterior fusion was 3.6%. Patients with pelvic fixation more frequently had a history of previous cardiac surgery (7.90% vs 3.86%, p! 0.024) and a dependent functional health status prior to surgery (9.60% vs 3.50%, p ! 0.0001). Patients with pelvic fixation were also more likely to have length of stay O 5 days and were more likely to have an operative time O 4 hours. Patients undergoing pelvic fixation have increased risk of any morbidity (OR52.5, p50.002) and an increased risk of postoperative blood
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.
154S
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S
transfusion (OR53.9, p!0.0001). Multivariate analysis showed that pelvic fixation is a significant predictor of morbidity in patients undergoing posterior lumbar fusion (OR 2.6, p50.002). CONCLUSIONS: Pelvic fixation in patients undergoing posterior lumbar fusion is associated with increased morbidity. These patients are particularly at risk of postoperative blood transfusion likely secondary to excessive intraoperative blood loss. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.170
140. Lumbar Spine Disease Negatively Affects Outcomes after Total Hip Arthroplasty Daniel J. Blizzard, MD, Colin Penrose, BS, BA, Charles Sheets, PT, Thorsten Seyler, MD, Michael Bolognesi, MD, Mitchell Klement, MD, Abiram Bala, BA, Michael A. Gallizzi, MD, MS, Christopher R. Brown, MD; Duke University Medical Center, Durham, NC, US BACKGROUND CONTEXT: Concomitant lower back pain in patients undergoing total hip arthroplasty (THA) for osteoarthritis presents a difficult management challenge. Determination of the source of pain preoperatively in these patients is difficult and THA provides unreliable improvement in pain postoperatively. Large prospective studies have demonstrated inferior functional and pain relief in patients with pre-existing low back pain undergoing THA. Additionally, low back pain limits total body flexion and extension and alters ambulation kinematics. PURPOSE: The purpose of this study is to determine the effect of lumbar spine disorders on complications after primary THA. STUDY DESIGN/SETTING: This a retrospective review of the entire Medicare sample from 2005-2012. PATIENT SAMPLE: The control sample consisted of all patients in the Medicare sample from 2005-2012 who underwent total hip arthroplasty without lumbar spine disease. The experimental sample consisted of patients with a diagnosis of ankylosing spondylitis, lumbosacral spondylosis, lumbar disc herniation, degeneration of lumbar disc or acquired spondylolisthesis who underwent total hip arthroplasty. OUTCOME MEASURES: Incidence and risk ratios with 95% confidence intervals (CIs) were calculated for 30-day, 90-day, 1-year and last followup for complications including: hip dislocation, periprosthetic fracture, revision surgery and postoperative infection. METHODS: The PearlDiver database was used to search the Medicare data from 2005-2012 using International Classification of Disease, 9th Edition (ICD-9) codes. This search yielded 705,895 patients without a lumbar spine diagnosis that underwent THA. Additionally, ICD-9 codes for ankylosing spondylitis, lumbosacral spondylosis, lumbar disc herniation, degeneration of lumbar disc, and acquired spondylolisthesis were used to identify patients with lumbar spine disease prior to THA yielding 1,735, 95,237, 54,566, 112,662 and 22,426 patients, respectively. Incidence (IN), risk ratios (RRs) and respective 95% confidence intervals (CIs) for 30-day, 90-day, 1-year and overall complications were calculated. RESULTS: Eighty total comparisons were made for five diagnoses and four time points. When compared to patients without lumbar spine disease, risk of dislocation, revision, fracture and infection were higher for all low back pain diagnoses at all-time points with the exception of 30- and 90-day dislocation and fracture for ankylosing spondylitis. The average risk ratio was 1.49, with a minimum value of 1.16 and a maximum of 1.93. No systematic differences were noted between lumbar spine diagnoses for any outcome or time point. CONCLUSIONS: It is well known that lumbar spine disease can cause lumbar rigidity through lost flexibility through degenerated discs and pain-mediated guarding. This restricted motion requires increased motion through the hips for tasks requiring flexion and extension. The results of this study demonstrate that lumbar spine disease significantly impacts postoperative complication rates following THA. The increased rates of
dislocation, infection, and prosthesis-related complications in this population should be considered when determining component position and fixation as well as postoperative precautions following THA. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.171
Friday, October 16, 2015 11:00 am – 12:00 pm Deformity 141. Reducing Rod Breakage and Nonunion in Pedicle Subtraction Osteotomy: The Importance of Rod Number and Configuration in 264 patients with 2-Year Follow-Up International Spine Study Group1, Munish C. Gupta, MD2, Jensen Henry, BA3, Virginie Lafage, PhD4, Frank J. Schwab, MD4, Christopher P. Ames, MD5, Eric O. Klineberg, MD6, Justin S. Smith, MD, PhD7, Vedat Deviren, MD5, Christopher I. Shaffrey, MD8, Robert A. Hart, MD9, Richard A. Hostin, Jr., MD10, Gregory M. Mundis, Jr., MD11, Han Jo Kim, MD12, Douglas C. Burton, MD13; 1Brighton, CO, US; 2University of California Davis Orthopaedic Surgery, Sacramento, CA, US; 3New York, NY, US; 4 New York University Hospital for Joint Diseases, New York, NY, US; 5 University of California San Francisco, San Francisco, CA, US; 6 University of California Davis School of Medicine, Sacramento, CA, US; 7 UVA Health System, Charlottesville, VA, US; 8University of Virginia, Charlottesville, VA, US; 9Oregon Health & Science University, Portland, OR, US; 10Southwest Scoliosis Institute, Plano, TX, US; 11Scripps Clinic Medical Group Department of Orthopedics, La Jolla, CA, US; 12Hospital for Special Surgery, New York, NY, US; 13University of Kansas Medical Center, Kansas City, KS, US BACKGROUND CONTEXT: Pedicle subtraction osteotomies (PSO) provide substantial correction for sagittal and coronal plane deformities, but are also associated with nonunion and instrumentation breakage at the level of osteotomy. PURPOSE: To investigate if the addition of supplementary rods, IBF or rod material/diameter decrease the failure rate. STUDY DESIGN/SETTING: Multicenter retrospective review. PATIENT SAMPLE: 264 adult spinal deformity (ASD) patients who underwent $1 lumbar PSO. OUTCOME MEASURES: Sagittal radiographic parameters, incidence and causes of reoperation, radiographic evidence of rod breakage. METHODS: ASD patients with $1 lumbar PSO and 2-year follow-up were included. Demographic, operative, instrumentation and outcomes data were collected. Radiographs were measured and assessed for instrument failure, IBF, and the number, material, and diameter of the rods. Multiple rod configuration was described as accessory (A: connected to primary rods) or satellite (S: independently anchored). Potential risk factors were evaluated for PSO site failure (rod breakage or revision for nonunion). RESULTS: From 264 patients included, there were 190 with 2 rods (2R), 36 with 3R, and 38 with 4R. There were no differences in demographics or baseline radiographic parameters across groups. 2R-3R constructs had a trend of higher rates of failure at the PSO site (28%, 29%) than 4R constructs (18%; P50.128). The 3-4R patients had significantly fewer revisions for instrumentation failure and/or pseudarthrosis than the 2R group (15% vs 26%; P50.035). There were 45 A rods (61%) and 29 S rods (39%). S rods failed significantly less at the PSO site than A rods (10% vs 31%; P50.034). S configurations also had significantly fewer revisions for instrumentation/pseudarthrosis (0% vs 23%; P50.009) and fewer revisions for all causes (8% vs 50%; P!0.001) than A rods. 3-4A constructs were similar to 2R in failures (31% vs 29%; P50.452), revisions for instrumentation/pseudarthrosis (23% vs 26%; P50.388).There were no
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.
138. Novel Virtual Modeling of Alignment following ASD Surgery: Establishing Relationships between Compensatory Changes and Overcorrection Due to Proximal Junctional Kyphosis International Spine Study Group1, Renaud Lafage2, Shay Bess, MD3, Steven D. Glassman, MD4, Christopher P. Ames, MD5, Douglas C. Burton, MD6, Bradley Harris, JD2, Robert A. Hart, MD7, Han Jo Kim, MD8, Eric O. Klineberg, MD9, Breton Line3, Justin K. Scheer, BS10, Themistocles S. Protopsaltis, MD2, Frank J. Schwab, MD2, Virginie Lafage, PhD2; 1 Brighton, CO, US; 2New York University Hospital for Joint Diseases, New York, NY, US; 3Rocky Mountain Scoliosis and Spine, Denver, CO, US; 4 Norton Leatherman Spine Center, Louisville, KY, US; 5University of California San Francisco, San Francisco, CA, US; 6University of Kansas Medical Center, Kansas City, KS, US; 7Oregon Health & Science University, Portland, OR, US; 8Hospital for Special Surgery, New York, NY, US; 9University of California Davis School of Medicine, Sacramento, CA, US; 10University of California San Diego, San Diego, CA, US BACKGROUND CONTEXT: It is difficult to analyze patients’ postoperative sagittal alignment once they develop Proximal Junctional Kyphosis (PJK) since they often dramatically compensate for the deformity. Until now, there was no effective way to model postoperative alignment that was free of the compensatory influence of PJK. This study proposes a novel virtual modeling technique that eliminates the impact of PJK on global alignment. Examining these models will lead to a better understanding of alignment factors associated with PJK. PURPOSE: The purpose of this study is to develop a novel virtual model of the spine following ASD surgery that can help improve our understanding of postoperative alignment by removing the influence of PJK. Furthermore, the study will analyze whether PJK should be considered a compensatory mechanism or an alignment failure. STUDY DESIGN/SETTING: Modeling of retrospective cohort. PATIENT SAMPLE: 458 patients (78% female; mean age 57.9 years) were analyzed. OUTCOME MEASURES: Radiological parameters including sagittal vertical axis (SVA), PJK angle, PI-LL mismatch, thoracic kyphosis (TK), T1 pelvic angle (TPA) and pelvic tilt (PT) were calculated. METHODS: An ASD database was used to model virtual postoperative alignments (VIRTUAL) for patients with pelvic fusion. Patients were divided into groups with/without PJK (PJK vs NOPJK). VIRTUAL combined the 2-year postoperative alignment of the instrumented segments (pelvis to UIV-1) with the preoperative alignment of the unfused segments (C2 to UIV). Pelvic retroversion was corrected based on published predictive formula. VIRTUAL was validated by comparisons to actual 2-year postoperative alignment (REAL) in NOPJK patients.
153S
RESULTS: Initial validation of VIRTUAL versus REAL demonstrated coefficients of correlation above 0.880 for all measures except SVA (r50.604). At 2 years, 215 (47%) patients had PJK (PJK angle52269 ). PJK patients were older than non-PJK (62.6 vs 59.7y, p50.007). In REAL, PJK had smaller PI-LL mismatch and larger TK than NOPJK (resp. PI-LL: 3.1614.0 vs 8.2616.5 , TK: -44.6615.7 vs -37.3616.7 , all p!0.001), but similar SVA, TPA and PT. However, analysis of VIRTUAL demonstrated that PJK not only had less PI-LL (3.1614.0 vs 7.7616.1 ), but also less PT (19.668.8 vs 23.469.4 ), less SVA (10649mm vs 24657mm) and less TPA (15.3611.1 vs 18.2615.8 ) than NOPJK (p!0.05). CONCLUSIONS: This novel modeling technique demonstrates high correlations with actual postoperative alignment in patients without PJK. This modeling is utilized to understand the relationship between reciprocal changes and postoperative alignment as well as failure of realignment (PJK). Comparing REAL to VIRTUAL models indicates that PJK may be a component of the compensatory mechanism rather than simply a failure of alignment to counteract for an overcorrection. Further studies should investigate the difference in correction with regard to age-specific alignment target. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.169
139. Does Pelvic Fixation Increase Morbidity and Mortality in Patients undergoing Posterior Lumbar Fusion? Jeremy Steinberger, MD1, Javier Guzman, BS2, Parth Kothari, BS2, Branko Skovrlj, MD3, Nathan J. Lee, BS2, Dante M. Leven, DO, PT, John I. Shin, BS4, Samuel K. Cho, MD4; 1New York, NY, US; 2Mount Sinai School of Medicine, New York, NY, US; 3Mount Sinai School of Medicine Department of Neurosurgery, New York, NY, US; 4Icahn School of Medicine at Mount Sinai, New York, NY, US BACKGROUND CONTEXT: Pelvic fixation is utilized for various indications including lumbosacral fixation for long fusions to the sacrum, correction of pelvic obliquity and high-grade spondylolisthesis. Due to the complex nature of such a procedure there is the potential for considerable morbidity. PURPOSE: The aim of this study was to analyze whether patients undergoing spinal deformity surgery with pelvic fixation are at higher risk for increased morbidity using a large national database. STUDY DESIGN/SETTING: Retrospective cohort analysis of prospectively collected data. PATIENT SAMPLE: American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. All patients O 18 years old undergoing fusion for spinal deformity registered in the NSQIP database with and without pelvic fixation. OUTCOME MEASURES: Development of complications, mortality, reoperation or postoperative events within 30 days. METHODS: Patients greater than or equal to18 years of age undergoing nonemergent posterior lumbar fusion with and without pelvic fixation from 2005-2012 were identified by CPT (Current Procedural Terminology) code in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Propensity matching was done to accurately predict likelihood of complications in this cohort. Multivariate modeling was done to analyze if pelvic fixation was independently associated with morbidity in patients undergoing posterior lumbar fusion. RESULTS: There rate of pelvic fixation in patients undergoing posterior fusion was 3.6%. Patients with pelvic fixation more frequently had a history of previous cardiac surgery (7.90% vs 3.86%, p! 0.024) and a dependent functional health status prior to surgery (9.60% vs 3.50%, p ! 0.0001). Patients with pelvic fixation were also more likely to have length of stay O 5 days and were more likely to have an operative time O 4 hours. Patients undergoing pelvic fixation have increased risk of any morbidity (OR52.5, p50.002) and an increased risk of postoperative blood
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.
154S
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S
transfusion (OR53.9, p!0.0001). Multivariate analysis showed that pelvic fixation is a significant predictor of morbidity in patients undergoing posterior lumbar fusion (OR 2.6, p50.002). CONCLUSIONS: Pelvic fixation in patients undergoing posterior lumbar fusion is associated with increased morbidity. These patients are particularly at risk of postoperative blood transfusion likely secondary to excessive intraoperative blood loss. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.170
140. Lumbar Spine Disease Negatively Affects Outcomes after Total Hip Arthroplasty Daniel J. Blizzard, MD, Colin Penrose, BS, BA, Charles Sheets, PT, Thorsten Seyler, MD, Michael Bolognesi, MD, Mitchell Klement, MD, Abiram Bala, BA, Michael A. Gallizzi, MD, MS, Christopher R. Brown, MD; Duke University Medical Center, Durham, NC, US BACKGROUND CONTEXT: Concomitant lower back pain in patients undergoing total hip arthroplasty (THA) for osteoarthritis presents a difficult management challenge. Determination of the source of pain preoperatively in these patients is difficult and THA provides unreliable improvement in pain postoperatively. Large prospective studies have demonstrated inferior functional and pain relief in patients with pre-existing low back pain undergoing THA. Additionally, low back pain limits total body flexion and extension and alters ambulation kinematics. PURPOSE: The purpose of this study is to determine the effect of lumbar spine disorders on complications after primary THA. STUDY DESIGN/SETTING: This a retrospective review of the entire Medicare sample from 2005-2012. PATIENT SAMPLE: The control sample consisted of all patients in the Medicare sample from 2005-2012 who underwent total hip arthroplasty without lumbar spine disease. The experimental sample consisted of patients with a diagnosis of ankylosing spondylitis, lumbosacral spondylosis, lumbar disc herniation, degeneration of lumbar disc or acquired spondylolisthesis who underwent total hip arthroplasty. OUTCOME MEASURES: Incidence and risk ratios with 95% confidence intervals (CIs) were calculated for 30-day, 90-day, 1-year and last followup for complications including: hip dislocation, periprosthetic fracture, revision surgery and postoperative infection. METHODS: The PearlDiver database was used to search the Medicare data from 2005-2012 using International Classification of Disease, 9th Edition (ICD-9) codes. This search yielded 705,895 patients without a lumbar spine diagnosis that underwent THA. Additionally, ICD-9 codes for ankylosing spondylitis, lumbosacral spondylosis, lumbar disc herniation, degeneration of lumbar disc, and acquired spondylolisthesis were used to identify patients with lumbar spine disease prior to THA yielding 1,735, 95,237, 54,566, 112,662 and 22,426 patients, respectively. Incidence (IN), risk ratios (RRs) and respective 95% confidence intervals (CIs) for 30-day, 90-day, 1-year and overall complications were calculated. RESULTS: Eighty total comparisons were made for five diagnoses and four time points. When compared to patients without lumbar spine disease, risk of dislocation, revision, fracture and infection were higher for all low back pain diagnoses at all-time points with the exception of 30- and 90-day dislocation and fracture for ankylosing spondylitis. The average risk ratio was 1.49, with a minimum value of 1.16 and a maximum of 1.93. No systematic differences were noted between lumbar spine diagnoses for any outcome or time point. CONCLUSIONS: It is well known that lumbar spine disease can cause lumbar rigidity through lost flexibility through degenerated discs and pain-mediated guarding. This restricted motion requires increased motion through the hips for tasks requiring flexion and extension. The results of this study demonstrate that lumbar spine disease significantly impacts postoperative complication rates following THA. The increased rates of
dislocation, infection, and prosthesis-related complications in this population should be considered when determining component position and fixation as well as postoperative precautions following THA. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.171
Friday, October 16, 2015 11:00 am – 12:00 pm Deformity 141. Reducing Rod Breakage and Nonunion in Pedicle Subtraction Osteotomy: The Importance of Rod Number and Configuration in 264 patients with 2-Year Follow-Up International Spine Study Group1, Munish C. Gupta, MD2, Jensen Henry, BA3, Virginie Lafage, PhD4, Frank J. Schwab, MD4, Christopher P. Ames, MD5, Eric O. Klineberg, MD6, Justin S. Smith, MD, PhD7, Vedat Deviren, MD5, Christopher I. Shaffrey, MD8, Robert A. Hart, MD9, Richard A. Hostin, Jr., MD10, Gregory M. Mundis, Jr., MD11, Han Jo Kim, MD12, Douglas C. Burton, MD13; 1Brighton, CO, US; 2University of California Davis Orthopaedic Surgery, Sacramento, CA, US; 3New York, NY, US; 4 New York University Hospital for Joint Diseases, New York, NY, US; 5 University of California San Francisco, San Francisco, CA, US; 6 University of California Davis School of Medicine, Sacramento, CA, US; 7 UVA Health System, Charlottesville, VA, US; 8University of Virginia, Charlottesville, VA, US; 9Oregon Health & Science University, Portland, OR, US; 10Southwest Scoliosis Institute, Plano, TX, US; 11Scripps Clinic Medical Group Department of Orthopedics, La Jolla, CA, US; 12Hospital for Special Surgery, New York, NY, US; 13University of Kansas Medical Center, Kansas City, KS, US BACKGROUND CONTEXT: Pedicle subtraction osteotomies (PSO) provide substantial correction for sagittal and coronal plane deformities, but are also associated with nonunion and instrumentation breakage at the level of osteotomy. PURPOSE: To investigate if the addition of supplementary rods, IBF or rod material/diameter decrease the failure rate. STUDY DESIGN/SETTING: Multicenter retrospective review. PATIENT SAMPLE: 264 adult spinal deformity (ASD) patients who underwent $1 lumbar PSO. OUTCOME MEASURES: Sagittal radiographic parameters, incidence and causes of reoperation, radiographic evidence of rod breakage. METHODS: ASD patients with $1 lumbar PSO and 2-year follow-up were included. Demographic, operative, instrumentation and outcomes data were collected. Radiographs were measured and assessed for instrument failure, IBF, and the number, material, and diameter of the rods. Multiple rod configuration was described as accessory (A: connected to primary rods) or satellite (S: independently anchored). Potential risk factors were evaluated for PSO site failure (rod breakage or revision for nonunion). RESULTS: From 264 patients included, there were 190 with 2 rods (2R), 36 with 3R, and 38 with 4R. There were no differences in demographics or baseline radiographic parameters across groups. 2R-3R constructs had a trend of higher rates of failure at the PSO site (28%, 29%) than 4R constructs (18%; P50.128). The 3-4R patients had significantly fewer revisions for instrumentation failure and/or pseudarthrosis than the 2R group (15% vs 26%; P50.035). There were 45 A rods (61%) and 29 S rods (39%). S rods failed significantly less at the PSO site than A rods (10% vs 31%; P50.034). S configurations also had significantly fewer revisions for instrumentation/pseudarthrosis (0% vs 23%; P50.009) and fewer revisions for all causes (8% vs 50%; P!0.001) than A rods. 3-4A constructs were similar to 2R in failures (31% vs 29%; P50.452), revisions for instrumentation/pseudarthrosis (23% vs 26%; P50.388).There were no
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.