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Early Outcomes following Percutaneous Sacroiliac Joint Fusion
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S PURPOSE: The objective of this study was to assess the frequency of imaging, tests and injections in spine surgery candidates in the six months prior to surgical booking. STUDY DESIGN/SETTING: We conducted a retrospective analysis of prospectively collected data from the Canadian Spine Outcomes and Research Network (CSORN). Twelve spine surgery sites across Canada contributed patient data for possible spine surgery cases between October 2008 and September 2014. PATIENT SAMPLE: All patients with complete data were included. Patients (n5527) had degenerative spinal pathology or deformity of the thoracolumbar region. OUTCOME MEASURES: Patients were asked to complete a table that read ‘‘In the past 6 months I have had...’’, and listed X-ray, CT scan, MRI, bone scan, EMG/nerve conduction, spinal injections with X-ray control, and spine injections without X-ray control. Patients were then asked to check ‘‘Never, 1 time, 2 times, 3 times, or O3 times’’ for each answer. METHODS: Frequencies were tabulated to estimate the patient-reported imaging, testing and spinal injection utilization by spine surgery candidates prior to surgeon consultation. The results were then compared between pathologies and also to patient-reported pain. RESULTS: Patients reported 836 counts of one use, 274 counts of 2 uses, 126 of 3 and 236 counts of O3 uses. This equals a conservative estimate (of O354) of 1,471 imaging, tests and/or injections. EMG/nerve conduction tests and bone scans were utilized the least. MRI had the highest prevalence of use, followed by X-ray imaging. There was no statistically significant difference in the frequency of X-ray utilization in those with deformity, fracture or spondylolisthesis compared to those with infection, tumor, disc herniation, degenerative disc disease or stenosis. There was a significant difference in pain ratings by imaging frequency. Those with no X-ray imaging had significantly higher leg pain ratings than those with O3 X-ray images (p!0.05). Patients with no CT imaging had the highest leg pain ratings; patients with O3 CT scans had the lowest leg pain ratings (p!0.05). Those with one MRI had significantly higher leg pain ratings than those with O3 X-ray images (p! 0.05). CONCLUSIONS: Despite numerous guidelines and published reports that suggest the limited value of X-raying patients with uncomplicated back pain, this imaging technique remains a popular choice. Patients requiring spine surgery demonstrate a high utilization of health care resources, including diagnostic imaging, on their pathway to the surgeon. Defining a Canadian strategy to manage and optimize the care and resource utilization for these patients is required. There is an inverse relationship between the amount of pain and the frequency of the imaging test, which may indicate that imaging and testing is being dictated by patient-reported pain rather than clinical findings. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.391
P154. Early Outcomes following Percutaneous Sacroiliac Joint Fusion Vamsi Kancherla, MD1, Shane McGowan2, Brittany Audley, MD3, Gbolabo O. Sokunbi, MD4, Steven T. Puccio, DO5; 1St. Luke’s University Health Network Department of Orthopaedics, Bethlehem, PA, US; 2St. Luke’s University Hospital Department of Orthopaedics, Bethlehem, PA, US; 3 Bethlehem, PA, US; 4St. Luke’s Orthopaedic Specialists, Easton, PA, US; 5 St. Luke’s Orthopaedic Surgical Group, Bethlehem, PA, US BACKGROUND CONTEXT: Sacroiliac (SI) dysfunction is often responsible for lumbar, sacral and pelvic pain. SI joint fixation/fusion utilizing percutaneous/MIS techniques can yield favorable clinical results while minimizing morbidity. PURPOSE: The purpose of this study is to determine early outcomes following MIS SI joint fusion in patients with this diagnosis.
255S
STUDY DESIGN/SETTING: Retrospective clinical; single institution. PATIENT SAMPLE: Our sample includes patients diagnosed with SI joint pain and dysfunction based on history, physical examination and CT-guided lidocaine-bupivacaine-steroid injection. OUTCOME MEASURES: Self-report: Oswestry Disability Index (ODI), Short Form Health Survey (SF-12), Visual Analog Score (VAS); physiologic: estimated blood loss (EBL), operative yime (minutes); functional: narcotic use, return to work, use of assistive devices. METHODS: Patients diagnosed by 3 or more positive physical examination maneuvers and subjective relief from a CT-guided lidocaine-bupivacaine-steroid injection underwent SI joint fusion after failing conservative management with a combination of oral anti-inflammatory medications, physical therapy and pelvic belt stabilization. All complications were noted. A student’s t-test was used to determine statistical significance. RESULTS: Forty-five cases (69% female) with mean age of 52.7 achieved clinical and survey follow-up of 6.7 months and 9.9 months, respectively. Follow-up scores were SF12-PCS 35.9, SF12-MCS 47.8, ODI 37.4, and VAS 4.6 which was improved from preoperative VAS 8.7 (p!.0001). Mean EBL and operative time were 22mL and 36 minutes, respectively. 64% of patients discontinued narcotics (29/45), 71% stopped using an assistive device (32/45), and 15.6% did not return to work due to pain (7/45). 73% of patients stated they would have the surgery again (33/45). A history of thoracolumbar instrumentation (16/45) did not significantly affect outcomes. Three complications described by screw malposition with neurologic deficit (6.7%) were treated with screw repositioning (one case) and removal of a single superior implant (two cases) with time to revision of 2.2 months. All three ultimately had resolution of radicular pain. CONCLUSIONS: MIS SI joint stabilization offers minimal morbidity and acceptable functional outcomes. Women and those with a history of thoracolumbar instrumentation may be at increased risk of having SI joint dysfunction requiring surgical intervention. While many patients reduced their narcotic intake, discontinued assistive device use, returned to work and expressed desire to have the surgery again, a subset remained with suboptimal outcomes. Accurate diagnosis remains essential in obtaining good outcomes. FDA DEVICE/DRUG STATUS: SI-Bone iFuse Implant System (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2015.07.392
P155. Saphenous Nerve Somatosensory Evoked Potentials Monitoring During Lateral Interbody Fusion Nick S. Jain, MD1, S. Samuel Bederman, MD, PhD, FRCSC2, Kevin Phan, BS3, Daniel S. Yanni, MD4, Heriberto Guillen1, Lilit Mnatsakanyan, MD1; 1 University of California Irvine, Orange, CA, US; 2University of California Irvine Department of Orthopaedic Surgery, Orange, CA, US; 3 University of California Irvine Department of General Surgery, Irvine, CA, US; 4University of California Irvine Department of Neurosurgery, Orange, CA, US BACKGROUND CONTEXT: Lateral trans-psoas interbody fusion (LIF) is a novel, minimally invasive technique that reduces risks related to traditional anterior approaches. Despite advantages, trans-psoas exposure carries up to a 30% risk of lumbar plexus injury. Intraoperative neuromonitoring, traditionally electromyography, is utilized to prevent postoperative deficits, but to date there is no reliable technique to detect upper lumbar plexus injury. PURPOSE: To evaluate saphenous nerve somatosensory evoked potentials (SSEPs) as a reliable and predictable way to detect upper lumbar plexus injury intraoperatively during trans-psoas lateral interbody fusion (LIF). STUDY DESIGN/SETTING: Retrospective chart review, single center.
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.
P154. Early Outcomes following Percutaneous Sacroiliac Joint Fusion Vamsi Kancherla, MD1, Shane McGowan2, Brittany Audley, MD3, Gbolabo O. Sokunbi, MD4, Steven T. Puccio, DO5; 1St. Luke’s University Health Network Department of Orthopaedics, Bethlehem, PA, US; 2St. Luke’s University Hospital Department of Orthopaedics, Bethlehem, PA, US; 3 Bethlehem, PA, US; 4St. Luke’s Orthopaedic Specialists, Easton, PA, US; 5 St. Luke’s Orthopaedic Surgical Group, Bethlehem, PA, US BACKGROUND CONTEXT: Sacroiliac (SI) dysfunction is often responsible for lumbar, sacral and pelvic pain. SI joint fixation/fusion utilizing percutaneous/MIS techniques can yield favorable clinical results while minimizing morbidity. PURPOSE: The purpose of this study is to determine early outcomes following MIS SI joint fusion in patients with this diagnosis.
255S
STUDY DESIGN/SETTING: Retrospective clinical; single institution. PATIENT SAMPLE: Our sample includes patients diagnosed with SI joint pain and dysfunction based on history, physical examination and CT-guided lidocaine-bupivacaine-steroid injection. OUTCOME MEASURES: Self-report: Oswestry Disability Index (ODI), Short Form Health Survey (SF-12), Visual Analog Score (VAS); physiologic: estimated blood loss (EBL), operative yime (minutes); functional: narcotic use, return to work, use of assistive devices. METHODS: Patients diagnosed by 3 or more positive physical examination maneuvers and subjective relief from a CT-guided lidocaine-bupivacaine-steroid injection underwent SI joint fusion after failing conservative management with a combination of oral anti-inflammatory medications, physical therapy and pelvic belt stabilization. All complications were noted. A student’s t-test was used to determine statistical significance. RESULTS: Forty-five cases (69% female) with mean age of 52.7 achieved clinical and survey follow-up of 6.7 months and 9.9 months, respectively. Follow-up scores were SF12-PCS 35.9, SF12-MCS 47.8, ODI 37.4, and VAS 4.6 which was improved from preoperative VAS 8.7 (p!.0001). Mean EBL and operative time were 22mL and 36 minutes, respectively. 64% of patients discontinued narcotics (29/45), 71% stopped using an assistive device (32/45), and 15.6% did not return to work due to pain (7/45). 73% of patients stated they would have the surgery again (33/45). A history of thoracolumbar instrumentation (16/45) did not significantly affect outcomes. Three complications described by screw malposition with neurologic deficit (6.7%) were treated with screw repositioning (one case) and removal of a single superior implant (two cases) with time to revision of 2.2 months. All three ultimately had resolution of radicular pain. CONCLUSIONS: MIS SI joint stabilization offers minimal morbidity and acceptable functional outcomes. Women and those with a history of thoracolumbar instrumentation may be at increased risk of having SI joint dysfunction requiring surgical intervention. While many patients reduced their narcotic intake, discontinued assistive device use, returned to work and expressed desire to have the surgery again, a subset remained with suboptimal outcomes. Accurate diagnosis remains essential in obtaining good outcomes. FDA DEVICE/DRUG STATUS: SI-Bone iFuse Implant System (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2015.07.392
P155. Saphenous Nerve Somatosensory Evoked Potentials Monitoring During Lateral Interbody Fusion Nick S. Jain, MD1, S. Samuel Bederman, MD, PhD, FRCSC2, Kevin Phan, BS3, Daniel S. Yanni, MD4, Heriberto Guillen1, Lilit Mnatsakanyan, MD1; 1 University of California Irvine, Orange, CA, US; 2University of California Irvine Department of Orthopaedic Surgery, Orange, CA, US; 3 University of California Irvine Department of General Surgery, Irvine, CA, US; 4University of California Irvine Department of Neurosurgery, Orange, CA, US BACKGROUND CONTEXT: Lateral trans-psoas interbody fusion (LIF) is a novel, minimally invasive technique that reduces risks related to traditional anterior approaches. Despite advantages, trans-psoas exposure carries up to a 30% risk of lumbar plexus injury. Intraoperative neuromonitoring, traditionally electromyography, is utilized to prevent postoperative deficits, but to date there is no reliable technique to detect upper lumbar plexus injury. PURPOSE: To evaluate saphenous nerve somatosensory evoked potentials (SSEPs) as a reliable and predictable way to detect upper lumbar plexus injury intraoperatively during trans-psoas lateral interbody fusion (LIF). STUDY DESIGN/SETTING: Retrospective chart review, single center.
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.