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Friday, September 28, 2018 4:05 PM–5:05 PM abstracts: new concepts: cervical spine
The Spine Journal 18 (2018) S70 S128 2
Hospital, Manhattan, NY, USA; NY Spine Institute, NYU Langone Health, New York, NY, USA; 3 Hospital for Special Surgery, New York, NY, USA; 4 UVA Health System, Charlottesville, VA, USA; 5 Denver International Spine Center, Denver, CO, USA; 6 Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA; 7 Washington University, Saint Louis, MO, USA; 8 Scripps Clinic Medical Group, Department of Orthopedics, La Jolla, CA, USA; 9 Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, NY, USA; 10 University of Calgary, Calgary, Canada; 11 UC, Davis School of Medicine, Sacramento, CA, USA; 12 University of Kansas Medical Center, Kansas City, KS, USA; 13 Swedish Neuroscience Institute, Seattle, WA, USA; 14 Denver, CO, USA; 15 University of Virginia, Charlottesville, VA, USA; 16 University of California, San Francisco, San Francisco, CA, USA; 17 Brighton, CO, USA BACKGROUND CONTEXT: Frailty, a decrease in physiologic reserve and increased vulnerability to adverse outcomes, falls, disability, and hospitalization, is a new area of study for patients with cervical deformity (CD). Previously, a cervical deformity frailty index (CD-FI) was described for utilization in preoperative risk stratification. Little is known about how operative intervention influences frailty status in CD patients. PURPOSE: The goal of this study was to investigate drivers of postoperative frailty score, and which component variables within the CD-FI algorithm respond to surgical intervention most greatly. STUDY DESIGN/SETTING: Retrospective review of a prospective adult cervical deformity database. PATIENT SAMPLE: A total of 138 CD patients. OUTCOME MEASURES: Patient Reported Outcome Measures (PROMS): EQ5D, SWAL, NDI, and CSDI questionnaires. METHODS: CD patients (cervical kyphosis>10°, coronal scoliosis >10°, cSVA >4cm, TS-CL >10°, or CBVA >25°) ≥18 years old, undergoing multilevel fusions with complete baseline (BL) and 1Y CD-FI scores. The CD-FI is scored on a scale between 0 and 1 (no frailty: 0–0.2, frailty: 0.2–0.4, severe frailty: >0.4). Descriptive analysis identified cohort demographics, radiographic parameters, and surgical details. Pearson bivariate correlations, independent and paired t-tests gauged associations between complication occurrence, radiographic parameters, and postoperative Δ in CD-FI total and component scores. Forward hierarchal linear regression models determined the effect of successful surgical intervention (achieving lowest level Ames classification modifiers) on change in frailty total and component scores. RESULTS: A total of 138 patients were included (Mean age: 61.0, 61.5% F, 91.6% White, mean BMI: 29.9, CCI: 1.2). BL radiographic parameters: cervical lordosis: −6.1, cSVA 39.8, TS-CL 38.7, CBVA 2.9, SVA −6.1, PI-LL 1.6, and PT 19.9. Surgical approaches included 48.4% posterior, 34% combined, 17.6% anterior; mean levels fused was 3.4 anteriorly, 9.0 posteriorly; mean op time was 489.4 minutes, mean EBL was 822.5ccs. Following surgical correction, CD-FI score improved at 1Y (BL:0.44 vs. 1Y:0.27, p<.05). Patients who experienced a minor intraoperative complication displayed significantly worse Δ in CD-FI score (Δ−0.06 vs. Δ−0.15, p=.045). Of the CD-FI components, 13/40 variables (32.5%) improved with operative intervention; including weakness, bladder issues, impaired gait, EQ5D anxiety, activity, mobility, mJOA lower extremity, SWAL 9A-E, NDI concentration and recreation (all P<.05). Correlations between frailty improvement, Δ in CBVA (R:0.876, p=.022), PI-LL (R:0.358, p=.001), PT (R:0.243, p=.021), and SVA (R:.237, p=.029) were observed. CDFI components of CSDI Reading (R: 0.998), SWAL 9C feeling tired (R: 0.574), SWAL 9E feeling exhausted (R: 0.574), and NDI driving (R: 0.523) were the greatest component drivers of postoperative Δ in frailty (all p<.001). Achieving lowest level Ames modifiers significantly predicted postoperative Δ in frailty (R2: 0.173, p=.036), with achieving lowest level Ames TS-CL Modifier as the strongest independent predictor (B: 0.274 p=.024). CONCLUSIONS: Intraoperative complications, correction of sagittal alignment, and improving a patient's ability to read, drive, and chronic exhaustion all significantly influenced postoperative frailty
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status. This analysis is a first step toward a greater understanding of the dynamic relationship between frailty and correction of cervical deformity. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.505
241. Improvements in pain and physical function after cervical spine surgery predict betterment in other areas of health and wellness Nicholas S. Andrade, BS1, Brian J. Neuman, MD1, Khaled M. Kebaish, MD1, Lee H. Riley III, MD2, David B. Cohen, MD, MPH3, Richard L. Skolasky, ScD3; 1 Baltimore, MD, USA; 2 Johns Hopkins Outpatient Center, Department Orthopedic Surgery, Baltimore, MD, USA; 3 Johns Hopkins University, Baltimore, MD, USA BACKGROUND CONTEXT: The primary goal of surgery for cervical degenerative disease is to reduce pain and improve physical function. However, patients often experience problems in other areas of health and wellness. In setting expectations for outcomes of cervical spine surgery, it would be beneficial to understand how improvements in pain and physical function may influence these other health domains. PROMIS is a multidimensional assessment that measures spine patients’ pain, physical function, fatigue, anxiety, depression, sleep disturbance, and social participation with a population mean of 50 (SD 10). PURPOSE: To investigate whether pain and physical limitation with surgery for cervical degenerative disease will result in improvements in other domains of health and wellness. STUDY DESIGN/SETTING: Longitudinal study. PATIENT SAMPLE: A total of 561 visits of 220 unique patients. OUTCOME MEASURES: PROMIS domain change scores (preoperative vs. postoperative). METHODS: Patients undergoing surgery for degenerative cervical disease completed PROMIS surveys preoperatively and 6 weeks and 3, 6 and 12 months postoperatively. Between December 2014 and January 2018, PROMIS data was collected for 561 visits of 220 unique patients. Repeated measures logistic regression was used to calculate the odds of a meaningful improvement (MCID) in PROMIS domains given a 5-point improvement in either pain or physical function. RESULTS: A 5-point decrease in pain was associated with 76% increased odds of MCID in fatigue (95% CI 1.18, 2.62 p=.006), 57% increased odds for anxiety (CI 1.02, 2.42, p=.039), 76% increased odds for sleep disturbance (CI 1.33–2.33, p<.001), and 197% increased odds for social participation (CI 1.38, 3.48, p=.001). Similarly, a 5-point gain in physical function predicted 83% increased odds of MCID in social participation (CI 1.06–3.15, p=.030). CONCLUSIONS: Decreases in pain yield meaningful improvements in fatigue, anxiety, sleep disturbance, and social participation. Additionally, gains in physical function result in meaningful improvements in social role participation. Although patients present for cervical spine surgery primarily due to pain and limitations in physical function, our results suggest that improvement in these domains will lead to improvements in other areas of health and wellness. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.506
242. Rigid cervical plate fixation is associated with greater restoration and maintenance of cervical lordosis compared to semi-rigid plate fixation in anterior cervical discectomy and fusion Philip Louie, MD1, Arya G. Varthi, MD2, Bryce Basques, MD, MHS2, Justin C. Paul, MD, PhD3, Michael T. Nolte, MD4, Jonathan Markowitz, BS5, Jeremy D. Mormol, BS5, Edward J. Goldberg, MD6, Howard S. An, MD4; 1 Rush University Medical Center, Chicago, IL, USA; 2 Yale University
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
Hospital, Manhattan, NY, USA; NY Spine Institute, NYU Langone Health, New York, NY, USA; 3 Hospital for Special Surgery, New York, NY, USA; 4 UVA Health System, Charlottesville, VA, USA; 5 Denver International Spine Center, Denver, CO, USA; 6 Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA; 7 Washington University, Saint Louis, MO, USA; 8 Scripps Clinic Medical Group, Department of Orthopedics, La Jolla, CA, USA; 9 Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, NY, USA; 10 University of Calgary, Calgary, Canada; 11 UC, Davis School of Medicine, Sacramento, CA, USA; 12 University of Kansas Medical Center, Kansas City, KS, USA; 13 Swedish Neuroscience Institute, Seattle, WA, USA; 14 Denver, CO, USA; 15 University of Virginia, Charlottesville, VA, USA; 16 University of California, San Francisco, San Francisco, CA, USA; 17 Brighton, CO, USA BACKGROUND CONTEXT: Frailty, a decrease in physiologic reserve and increased vulnerability to adverse outcomes, falls, disability, and hospitalization, is a new area of study for patients with cervical deformity (CD). Previously, a cervical deformity frailty index (CD-FI) was described for utilization in preoperative risk stratification. Little is known about how operative intervention influences frailty status in CD patients. PURPOSE: The goal of this study was to investigate drivers of postoperative frailty score, and which component variables within the CD-FI algorithm respond to surgical intervention most greatly. STUDY DESIGN/SETTING: Retrospective review of a prospective adult cervical deformity database. PATIENT SAMPLE: A total of 138 CD patients. OUTCOME MEASURES: Patient Reported Outcome Measures (PROMS): EQ5D, SWAL, NDI, and CSDI questionnaires. METHODS: CD patients (cervical kyphosis>10°, coronal scoliosis >10°, cSVA >4cm, TS-CL >10°, or CBVA >25°) ≥18 years old, undergoing multilevel fusions with complete baseline (BL) and 1Y CD-FI scores. The CD-FI is scored on a scale between 0 and 1 (no frailty: 0–0.2, frailty: 0.2–0.4, severe frailty: >0.4). Descriptive analysis identified cohort demographics, radiographic parameters, and surgical details. Pearson bivariate correlations, independent and paired t-tests gauged associations between complication occurrence, radiographic parameters, and postoperative Δ in CD-FI total and component scores. Forward hierarchal linear regression models determined the effect of successful surgical intervention (achieving lowest level Ames classification modifiers) on change in frailty total and component scores. RESULTS: A total of 138 patients were included (Mean age: 61.0, 61.5% F, 91.6% White, mean BMI: 29.9, CCI: 1.2). BL radiographic parameters: cervical lordosis: −6.1, cSVA 39.8, TS-CL 38.7, CBVA 2.9, SVA −6.1, PI-LL 1.6, and PT 19.9. Surgical approaches included 48.4% posterior, 34% combined, 17.6% anterior; mean levels fused was 3.4 anteriorly, 9.0 posteriorly; mean op time was 489.4 minutes, mean EBL was 822.5ccs. Following surgical correction, CD-FI score improved at 1Y (BL:0.44 vs. 1Y:0.27, p<.05). Patients who experienced a minor intraoperative complication displayed significantly worse Δ in CD-FI score (Δ−0.06 vs. Δ−0.15, p=.045). Of the CD-FI components, 13/40 variables (32.5%) improved with operative intervention; including weakness, bladder issues, impaired gait, EQ5D anxiety, activity, mobility, mJOA lower extremity, SWAL 9A-E, NDI concentration and recreation (all P<.05). Correlations between frailty improvement, Δ in CBVA (R:0.876, p=.022), PI-LL (R:0.358, p=.001), PT (R:0.243, p=.021), and SVA (R:.237, p=.029) were observed. CDFI components of CSDI Reading (R: 0.998), SWAL 9C feeling tired (R: 0.574), SWAL 9E feeling exhausted (R: 0.574), and NDI driving (R: 0.523) were the greatest component drivers of postoperative Δ in frailty (all p<.001). Achieving lowest level Ames modifiers significantly predicted postoperative Δ in frailty (R2: 0.173, p=.036), with achieving lowest level Ames TS-CL Modifier as the strongest independent predictor (B: 0.274 p=.024). CONCLUSIONS: Intraoperative complications, correction of sagittal alignment, and improving a patient's ability to read, drive, and chronic exhaustion all significantly influenced postoperative frailty
S119
status. This analysis is a first step toward a greater understanding of the dynamic relationship between frailty and correction of cervical deformity. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.505
241. Improvements in pain and physical function after cervical spine surgery predict betterment in other areas of health and wellness Nicholas S. Andrade, BS1, Brian J. Neuman, MD1, Khaled M. Kebaish, MD1, Lee H. Riley III, MD2, David B. Cohen, MD, MPH3, Richard L. Skolasky, ScD3; 1 Baltimore, MD, USA; 2 Johns Hopkins Outpatient Center, Department Orthopedic Surgery, Baltimore, MD, USA; 3 Johns Hopkins University, Baltimore, MD, USA BACKGROUND CONTEXT: The primary goal of surgery for cervical degenerative disease is to reduce pain and improve physical function. However, patients often experience problems in other areas of health and wellness. In setting expectations for outcomes of cervical spine surgery, it would be beneficial to understand how improvements in pain and physical function may influence these other health domains. PROMIS is a multidimensional assessment that measures spine patients’ pain, physical function, fatigue, anxiety, depression, sleep disturbance, and social participation with a population mean of 50 (SD 10). PURPOSE: To investigate whether pain and physical limitation with surgery for cervical degenerative disease will result in improvements in other domains of health and wellness. STUDY DESIGN/SETTING: Longitudinal study. PATIENT SAMPLE: A total of 561 visits of 220 unique patients. OUTCOME MEASURES: PROMIS domain change scores (preoperative vs. postoperative). METHODS: Patients undergoing surgery for degenerative cervical disease completed PROMIS surveys preoperatively and 6 weeks and 3, 6 and 12 months postoperatively. Between December 2014 and January 2018, PROMIS data was collected for 561 visits of 220 unique patients. Repeated measures logistic regression was used to calculate the odds of a meaningful improvement (MCID) in PROMIS domains given a 5-point improvement in either pain or physical function. RESULTS: A 5-point decrease in pain was associated with 76% increased odds of MCID in fatigue (95% CI 1.18, 2.62 p=.006), 57% increased odds for anxiety (CI 1.02, 2.42, p=.039), 76% increased odds for sleep disturbance (CI 1.33–2.33, p<.001), and 197% increased odds for social participation (CI 1.38, 3.48, p=.001). Similarly, a 5-point gain in physical function predicted 83% increased odds of MCID in social participation (CI 1.06–3.15, p=.030). CONCLUSIONS: Decreases in pain yield meaningful improvements in fatigue, anxiety, sleep disturbance, and social participation. Additionally, gains in physical function result in meaningful improvements in social role participation. Although patients present for cervical spine surgery primarily due to pain and limitations in physical function, our results suggest that improvement in these domains will lead to improvements in other areas of health and wellness. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.506
242. Rigid cervical plate fixation is associated with greater restoration and maintenance of cervical lordosis compared to semi-rigid plate fixation in anterior cervical discectomy and fusion Philip Louie, MD1, Arya G. Varthi, MD2, Bryce Basques, MD, MHS2, Justin C. Paul, MD, PhD3, Michael T. Nolte, MD4, Jonathan Markowitz, BS5, Jeremy D. Mormol, BS5, Edward J. Goldberg, MD6, Howard S. An, MD4; 1 Rush University Medical Center, Chicago, IL, USA; 2 Yale University
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.