- Email: [email protected]
GeneXpert Polymerase Chain Reaction (PCR) Test: Role in the Diagnosis of Tubercular Spondylodiscitis
200S
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S
CONCLUSIONS: Kyphotic segmental alignment (CARDS D) is a relatively rare subset of degenerative spondylolisthesis. Our results indicate that CARDS type D may be a clinically distinct subset of DS characterized by worse preoperative back pain. These results further validate the usefulness of the CARDS classification system. Future studies with larger sample sizes may identify other factors predictive of specific subtypes of DS as well as the prognostic value of these radiographic subtypes. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.269
P35. Pedicle Screw Malposition in Revision Spine Surgery: Efficacy of Intraoperative CT Based Navigation Juliet N. Batke, BS1, Andrew Pennington, BS1, Nicolas Dea, MD, FRCSC2, Melissa Nadeau, MD, MHS, FRCSC3, Charles G. Fisher, MD4, Marcel F. Dvorak, MD, FRCSC3, John Street, MD, PhD3; 1Vancouver, BC, Canada; 2CHUS Service de Neurochirurgie, Sherbrooke, QC, Canada; 3 Blusson Spinal Cord Center, Vancouver, BC, Canada; 4Vancouver General Hospital, Vancouver, BC, Canada BACKGROUND CONTEXT: The improved screw accuracy of intra-operative 3D imaging with navigation has been primarily reported in cadaveric studies and spinal deformity surgeries. Revision surgery poses unique technical challenges for pedicle screw instrumentation because of an established fusion mass, lack of reliable anatomical landmarks and limited fixation options. PURPOSE: To examine our early experience of pedicle screw malposition rates in revision surgeries comparing intra-operative CT navigated cases to the traditional freehand technique and evaluate the impact on patient outcome. STUDY DESIGN/SETTING: Ambispective review. PATIENT SAMPLE: 56 consecutive patients who underwent intra-operative CT navigation assisted pedicle screw instrumentation (NAV) between January 1, 2008 and December 31, 2012, and 34 matched controls who underwent spinal surgery between January 1, 2006 and December 31, 2008, using traditional (free hand or fluoroscopy), non-navigated techniques (nonNAV). OUTCOME MEASURES: Operative time, estimated blood loss, readmissions and reoperations, postoperative surgical-site infections, and screw positioning accuracy. METHODS: Medical records were reviewed for demographics, co-morbidities, preoperative neurologic status, operative time, estimated blood loss, intra-operative screw revisions and readmission or reoperations. Postoperative imaging studies were used to grade pedicle screw positioning accuracy. RESULTS: 52 patients underwent revision surgery with intraoperative navigation and 30 without navigation. A total of 1,074 pedicle screws were instrumented: 752 NAV and 322 non-NAV. A significant difference existed in the number of misplaced screws 28 and 49 respectively (P!0.001). Mean number of misplaced screws per case was 0.54 (SD50.92) NAV and 1.69 (SD52.44) nonNAV (P50.02). Number of screws revised intraoperatively was not significant (10 vs 7, P50.50). One NAV patient and one non-NAV patient required early postoperative screw revision during the same admission (P51.00). No difference was observed in grade of screw malposition (P50.34), anatomical location of malposition (P50.26), duration of surgery (P50.12), incidence of intraoperative dural tear (P50.70), wound infection (P50.30) or length of stay (P50.73). A significant difference in intra-operative massive (O2L in 3 hours) blood loss existed; 5.8% of NAV cases compared to 23.33% of non-NAV cases. CONCLUSIONS: This early analysis of revision surgery demonstrates an increased accuracy of pedicle screw placement utilizing intraoperative CT navigation without an increase in operative time. Clinical outcomes between NAV and non-NAV cases were similar. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.270
P36. The Effect of Bone Mineral Density on Proximal Junctional Failure in Thoracolumbar Fusion William F. Lavelle, MD1, Tarush Rustagi, MD2, Richard A. Tallarico, MD3, Nikhil A. Thakur, MD3, Mike H. Sun, MD4, Ian A. Madom, MD3; 1East Syracuse, NY, US; 2Suny Upstate Hospital, Syracuse, NY, US; 3Upstate Orthopedics, East Syracuse, NY, US; 4State University of New York Upstate, Syracuse, NY, US BACKGROUND CONTEXT: Proximal junctional failure can be a catastrophic complication associated with adult spinal deformity surgery. Osteoporosis has been associated with increased risk of proximal failure. Due to regional sclerosis, spinal DEXA (Dual-energy X-ray absorptiometry) scan scores have been reported as flawed and unreliable. Recently, investigators have reported on the use of CT scans as surrogates in place of spinal DEXA scores. PURPOSE: The purpose of our study was to investigate if CT based assessments of bone mineral density can predict the possibility of proximal junctional failures. STUDY DESIGN/SETTING: Records of spinal deformity patients (n526) operated on between 2007-2012 were retrospectively reviewed from a single center. PATIENT SAMPLE: 26 patients. OUTCOME MEASURES: CT based assessments of bone mineral density predicting proximal junctional failure. METHODS: All patients included constructs involving fusions to the pelvis and encompassing at least five lumbar levels. Indications included flat back, positive sagittal balance and degenerative lumbar scoliosis. All patients underwent preoperative standing X-ray images and CT scans. The patients were divided into groups with proximal junctional failure (PJF) as either having progression in kyphosis over 10 (proximal junctional kyphosis; PJK) or having a fracture at the proximal level. Three groups were created: Group 1 consisted of patients with no proximal junctional failure (n516); Group 2 with PJK (n56); and Group 3 with proximal level fracture (n54). Demographic data recorded included age, gender, past medical/surgical history, diagnosed osteoporosis and chronic steroid use. The CT based bone mineral density was calculated by defining a region of interest within the vertebral body in the sagittal plane. Hounsfield units (HU) were measured within this region of interest. The vertebra at the most cranial end of the final construct was defined as the upper instrumented vertebra (UIV). Measurements were made at UIV, UIV þ 1 (proximal), and UIV -1 (distal), which is a level above and below the upper instrumented vertebra. RESULTS: Statistical analysis was completed using SPSS v18. The comparison between patients with and without proximal junctional failure shows that 10/26 had failure. T5-9 were the most proximal levels for PJF (50%) and without PJF (62.5%). There was no significance comparing mean BMD between Group 1 and 2, but between Group 1 and Group 3, UIV þ1 showed significance (p50.041). The mean proximal kyphosis was 13.8 (10-32 ). Of the four patients with proximal level fracture, two involved the vertebral body with implant back-out and two had an endplate fracture. CONCLUSIONS: Bone mineral density measured from a CT scan was an effective tool in planning the proximal extent of fusion in adult deformities. The bone mineral density values of less than 130 HU at the planned upper instrumented vertebra was a risk factor for a proximal junctional fracture. For proximal junctional kyphosis, our study found no statistical significance. FDA DEVICE/DRUG STATUS: DEXA scan, CT scan, pedicle screws (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2015.07.271 P37. GeneXpert Polymerase Chain Reaction (PCR) Test: Role in the Diagnosis of Tubercular Spondylodiscitis Justin Arockiaraj, MD1, Rohit Amritanand, MD2, Venkatesh Krishnan, DNB, MBBS3, Gabriel Sundararaj, MD, MBBS4, Joy Michael, MD, MBBS5; 1Spinal Disorders Surgery Unit Department of Orthopaedics,
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.
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S 2
3
Vellore, Tamil Nadu, India; Toronto, ON, Canada; Vellore, India; 4 Department of Orthopaedics, Vellore, India; 5Christian Medical College & Hospital Department of Microbiology, Vellore, India BACKGROUND CONTEXT: GeneXpert is an automated polymerase chain reaction test, which has been recommended by World Health Organization, for rapid diagnosis of pulmonary tuberculosis especially in areas with high prevalence of drug resistance and HIV. Numerous studies have been done to report the validity of the test to rapidly detect pulmonary tuberculosis. However only one study has been published so far regarding the accuracy of the GeneXpert test to detect tubercular spondylodiscitis. PURPOSE: 1. To assess the validity of the GeneXpert PCR test in the diagnosis of tubercular spondylodiscitis. 2. To identify and assess its role in detecting rifampicin resistant tuberculosis (RR-TB) in our center. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: 348 patients. OUTCOME MEASURES: Sensitivity specificity. METHODS: In this retrospective study, only patients with active haematogenous infective spondylodiscitis were included. Tissue/pus samples were obtained for all patients who suspected to have ‘‘infective spondylodiscitis’’ based on clinical and radiological features. The samples were sent for histopathological evaluation, acid fast bacilli smear, bacteriological, mycobacteriological, fungal culture and GeneXpert test. The patients were divided into three categories. They were defined as ‘‘definite tuberculosis’’ when growth in Lowenstein Jensen culture medium was diagnostic of Mycobacterium tuberculosis, with or without presence of acid fast bacilli (AFB) in smear using Ziehl Neelsen staining. Patients with negative culture and smear were termed ‘‘probable tuberculosis’’ when the histopathology was reported for Tuberculous granuloma. ‘‘Composite reference standard’’ was the group of patients started on antituberculous treatment (ATT) based on either culture, smear positivity or histopathology positivity. When the three above-mentioned tests were negative, ATT was started on basis of clinical and radiological suspicion of tubercular spondylodiscitis. Statistical analysis was done using 2 x 2 contingency table, to check the sensitivity and specificity of the GeneXpert Test in relation to all the above-mentioned groups. RESULTS: In the period of 24 months from January 2012 to December 2014, a total of 348 patients (210 males and 138 females with an average age of 42 years) were treated for infective spondylodiscitis. Out of the 348 patients, 264 were diagnosed to have tubercular spondylitis and of the remaining 84, 79 patients had pyogenic spondylodiscitis and 5 had fungal spondylodiscitis. The sensitivity and specificity of the GeneXpert test when compared with ‘‘gold standard’’ culture is 88.4% and 63.6% and when compared to the composite reference standard is 70.1% and 100% respectively. The sensitivity and specificity of the GeneXpert test when compared with drug susceptibility test for multi-drug resistance is 100% and 92.3%. The rate of rifampicin resistance in our study was 4.02%. CONCLUSIONS: Based on the above findings, we recommend GeneXpert test, as a primary detection test for detection of tubercular spondylodiscitis. GeneXpert positivity is a valid indication to commence a patient on ATT. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
201S
mild symptoms, remains particularly controversial since select patients can stabilize clinically without operative intervention. PURPOSE: To compare the recovery of neuronal metabolism and functional reorganization using proton magnetic resonance spectroscopy and functional MRI in the primary motor cortex (M1) between mild and moderate CSM following surgical intervention. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: 28 CSM patients and 10 healthy controls. OUTCOME MEASURES: modified Japanese Orthopaedic Association (mJOA) questionnaire scores; metabolite concentrations, volume and location of activation. METHODS: Twenty-eight CSM patients had two separate imaging sessions on a 3.0 T Siemens Magnetom Tim Trio that included spectroscopy and functional MRI before and six months following surgery. The classification of CSM was based on the modified Japanese Orthopaedic Association (mJOA) questionnaire. Mild CSM was defined by a mJOA score of O12 out of 18 (n515) and moderate CSM by a score of 9–12 (n513). Ten healthy controls underwent two MRI scans six months apart. Functional MRI scans of a right handed finger-tapping paradigm were acquired using an echo planar imaging sequence (FOV 5 256x256mm, 45 slices, 3mm isotropic, TR/ TE52500/30ms, flip angle590o,iPAT52). Functional images were analyzed using BrainVoyager QX software where for each contrast, a volume of activation (VOA), corrected p-value, and Brodmann area (BA) were produced. A 20mm isotropic spectroscopy voxel was placed on the hand area of the M1 contralateral to the greater deficit side in the CSM group and on both sides in the controls. Spectroscopic data were localized using PRESS (TR/ TE52000/135ms, 192 averages, voxel size58cm3). The ratio of N-acetylaspartate (NAA) to creatine (Cr) was measured. RESULTS: At baseline, mild CSM patients had a lower NAA/Cr ratio in the hand area of M1 compared to healthy controls (p!0.05) and moderate CSM (p!0.05) suggesting neuronal loss or mitochondrial dysfunction. Following successful surgery and clinical improvement, NAA/Cr levels did not recover in mild CSM (p50.50). The moderate CSM patients, who had significantly worse preoperative mJOA scores and the largest functional improvement, demonstrated a decline in NAA/Cr levels (p!0.05). Preoperatively, mild CSM had a larger functional VOA than moderate CSM (p50.05; BA 5). Following surgery, the VOAs were comparable between mild and moderate CSM groups and had shifted towards the primary sensory cortex (p!0.001; BA 3). CONCLUSIONS: NAA/Cr levels and the size of the VOA in the motor cortex can be used to discriminate between mild and moderate CSM. Following surgery, the metabolic profile of the M1 did not recover in either group, despite significant clinical improvement. We propose that metabolic impairment in M1 may trigger recruitment of adjacent healthy cortex to achieve functional recovery. Further work is needed to determine whether these distinct patterns of remote injury in the sensorimotor cortex in mild and moderate CSM patients could be used to determine the timing and need for intervention. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.273
P39. Removed from Program
http://dx.doi.org/10.1016/j.spinee.2015.07.272
http://dx.doi.org/10.1016/j.spinee.2015.07.274
P38. Investigating Metabolic and Functional Profiles of Mild and Moderate Cervical Spondylotic Myelopathy: A MRS and fMRI Study Izabela K. Aleksanderek, PhD1, Todd Stevens, PhD2, Sandy Goncalves, BHSc, MSc2, Neil Duggal, MD, FRCSC3, Robert Bartha, PhD2; 1 University Hospital, London, ON, Canada; 2London, ON, Canada; 3 London Health Sciences Centre Western University, London, ON, Canada
P40. Oblique Sagittal Reconstructions of Cervical CT Scans: An Accurate and Efficient Method for Assessing True Foramina Dimensions Ehsan Tabaraee, MD1, Mark F. Kurd, MD2, Howard S. An, MD3; 1 University of California San Francisco, San Francisco, CA, US; 2 Rothman Institute, Bryn Mawr, PA, US; 3Rush Hospital Orthopedic Surgery Department, Chicago, IL, US
BACKGROUND CONTEXT: The ideal timing of surgical intervention for cervical spondylotic myelopathy (CSM) patients, especially with early,
BACKGROUND CONTEXT: Axial and sagittal computer tomography (CT) scans have been used to diagnose bony cervical stenosis. The cervical
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.
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S
CONCLUSIONS: Kyphotic segmental alignment (CARDS D) is a relatively rare subset of degenerative spondylolisthesis. Our results indicate that CARDS type D may be a clinically distinct subset of DS characterized by worse preoperative back pain. These results further validate the usefulness of the CARDS classification system. Future studies with larger sample sizes may identify other factors predictive of specific subtypes of DS as well as the prognostic value of these radiographic subtypes. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.269
P35. Pedicle Screw Malposition in Revision Spine Surgery: Efficacy of Intraoperative CT Based Navigation Juliet N. Batke, BS1, Andrew Pennington, BS1, Nicolas Dea, MD, FRCSC2, Melissa Nadeau, MD, MHS, FRCSC3, Charles G. Fisher, MD4, Marcel F. Dvorak, MD, FRCSC3, John Street, MD, PhD3; 1Vancouver, BC, Canada; 2CHUS Service de Neurochirurgie, Sherbrooke, QC, Canada; 3 Blusson Spinal Cord Center, Vancouver, BC, Canada; 4Vancouver General Hospital, Vancouver, BC, Canada BACKGROUND CONTEXT: The improved screw accuracy of intra-operative 3D imaging with navigation has been primarily reported in cadaveric studies and spinal deformity surgeries. Revision surgery poses unique technical challenges for pedicle screw instrumentation because of an established fusion mass, lack of reliable anatomical landmarks and limited fixation options. PURPOSE: To examine our early experience of pedicle screw malposition rates in revision surgeries comparing intra-operative CT navigated cases to the traditional freehand technique and evaluate the impact on patient outcome. STUDY DESIGN/SETTING: Ambispective review. PATIENT SAMPLE: 56 consecutive patients who underwent intra-operative CT navigation assisted pedicle screw instrumentation (NAV) between January 1, 2008 and December 31, 2012, and 34 matched controls who underwent spinal surgery between January 1, 2006 and December 31, 2008, using traditional (free hand or fluoroscopy), non-navigated techniques (nonNAV). OUTCOME MEASURES: Operative time, estimated blood loss, readmissions and reoperations, postoperative surgical-site infections, and screw positioning accuracy. METHODS: Medical records were reviewed for demographics, co-morbidities, preoperative neurologic status, operative time, estimated blood loss, intra-operative screw revisions and readmission or reoperations. Postoperative imaging studies were used to grade pedicle screw positioning accuracy. RESULTS: 52 patients underwent revision surgery with intraoperative navigation and 30 without navigation. A total of 1,074 pedicle screws were instrumented: 752 NAV and 322 non-NAV. A significant difference existed in the number of misplaced screws 28 and 49 respectively (P!0.001). Mean number of misplaced screws per case was 0.54 (SD50.92) NAV and 1.69 (SD52.44) nonNAV (P50.02). Number of screws revised intraoperatively was not significant (10 vs 7, P50.50). One NAV patient and one non-NAV patient required early postoperative screw revision during the same admission (P51.00). No difference was observed in grade of screw malposition (P50.34), anatomical location of malposition (P50.26), duration of surgery (P50.12), incidence of intraoperative dural tear (P50.70), wound infection (P50.30) or length of stay (P50.73). A significant difference in intra-operative massive (O2L in 3 hours) blood loss existed; 5.8% of NAV cases compared to 23.33% of non-NAV cases. CONCLUSIONS: This early analysis of revision surgery demonstrates an increased accuracy of pedicle screw placement utilizing intraoperative CT navigation without an increase in operative time. Clinical outcomes between NAV and non-NAV cases were similar. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.270
P36. The Effect of Bone Mineral Density on Proximal Junctional Failure in Thoracolumbar Fusion William F. Lavelle, MD1, Tarush Rustagi, MD2, Richard A. Tallarico, MD3, Nikhil A. Thakur, MD3, Mike H. Sun, MD4, Ian A. Madom, MD3; 1East Syracuse, NY, US; 2Suny Upstate Hospital, Syracuse, NY, US; 3Upstate Orthopedics, East Syracuse, NY, US; 4State University of New York Upstate, Syracuse, NY, US BACKGROUND CONTEXT: Proximal junctional failure can be a catastrophic complication associated with adult spinal deformity surgery. Osteoporosis has been associated with increased risk of proximal failure. Due to regional sclerosis, spinal DEXA (Dual-energy X-ray absorptiometry) scan scores have been reported as flawed and unreliable. Recently, investigators have reported on the use of CT scans as surrogates in place of spinal DEXA scores. PURPOSE: The purpose of our study was to investigate if CT based assessments of bone mineral density can predict the possibility of proximal junctional failures. STUDY DESIGN/SETTING: Records of spinal deformity patients (n526) operated on between 2007-2012 were retrospectively reviewed from a single center. PATIENT SAMPLE: 26 patients. OUTCOME MEASURES: CT based assessments of bone mineral density predicting proximal junctional failure. METHODS: All patients included constructs involving fusions to the pelvis and encompassing at least five lumbar levels. Indications included flat back, positive sagittal balance and degenerative lumbar scoliosis. All patients underwent preoperative standing X-ray images and CT scans. The patients were divided into groups with proximal junctional failure (PJF) as either having progression in kyphosis over 10 (proximal junctional kyphosis; PJK) or having a fracture at the proximal level. Three groups were created: Group 1 consisted of patients with no proximal junctional failure (n516); Group 2 with PJK (n56); and Group 3 with proximal level fracture (n54). Demographic data recorded included age, gender, past medical/surgical history, diagnosed osteoporosis and chronic steroid use. The CT based bone mineral density was calculated by defining a region of interest within the vertebral body in the sagittal plane. Hounsfield units (HU) were measured within this region of interest. The vertebra at the most cranial end of the final construct was defined as the upper instrumented vertebra (UIV). Measurements were made at UIV, UIV þ 1 (proximal), and UIV -1 (distal), which is a level above and below the upper instrumented vertebra. RESULTS: Statistical analysis was completed using SPSS v18. The comparison between patients with and without proximal junctional failure shows that 10/26 had failure. T5-9 were the most proximal levels for PJF (50%) and without PJF (62.5%). There was no significance comparing mean BMD between Group 1 and 2, but between Group 1 and Group 3, UIV þ1 showed significance (p50.041). The mean proximal kyphosis was 13.8 (10-32 ). Of the four patients with proximal level fracture, two involved the vertebral body with implant back-out and two had an endplate fracture. CONCLUSIONS: Bone mineral density measured from a CT scan was an effective tool in planning the proximal extent of fusion in adult deformities. The bone mineral density values of less than 130 HU at the planned upper instrumented vertebra was a risk factor for a proximal junctional fracture. For proximal junctional kyphosis, our study found no statistical significance. FDA DEVICE/DRUG STATUS: DEXA scan, CT scan, pedicle screws (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2015.07.271 P37. GeneXpert Polymerase Chain Reaction (PCR) Test: Role in the Diagnosis of Tubercular Spondylodiscitis Justin Arockiaraj, MD1, Rohit Amritanand, MD2, Venkatesh Krishnan, DNB, MBBS3, Gabriel Sundararaj, MD, MBBS4, Joy Michael, MD, MBBS5; 1Spinal Disorders Surgery Unit Department of Orthopaedics,
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.
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S 2
3
Vellore, Tamil Nadu, India; Toronto, ON, Canada; Vellore, India; 4 Department of Orthopaedics, Vellore, India; 5Christian Medical College & Hospital Department of Microbiology, Vellore, India BACKGROUND CONTEXT: GeneXpert is an automated polymerase chain reaction test, which has been recommended by World Health Organization, for rapid diagnosis of pulmonary tuberculosis especially in areas with high prevalence of drug resistance and HIV. Numerous studies have been done to report the validity of the test to rapidly detect pulmonary tuberculosis. However only one study has been published so far regarding the accuracy of the GeneXpert test to detect tubercular spondylodiscitis. PURPOSE: 1. To assess the validity of the GeneXpert PCR test in the diagnosis of tubercular spondylodiscitis. 2. To identify and assess its role in detecting rifampicin resistant tuberculosis (RR-TB) in our center. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: 348 patients. OUTCOME MEASURES: Sensitivity specificity. METHODS: In this retrospective study, only patients with active haematogenous infective spondylodiscitis were included. Tissue/pus samples were obtained for all patients who suspected to have ‘‘infective spondylodiscitis’’ based on clinical and radiological features. The samples were sent for histopathological evaluation, acid fast bacilli smear, bacteriological, mycobacteriological, fungal culture and GeneXpert test. The patients were divided into three categories. They were defined as ‘‘definite tuberculosis’’ when growth in Lowenstein Jensen culture medium was diagnostic of Mycobacterium tuberculosis, with or without presence of acid fast bacilli (AFB) in smear using Ziehl Neelsen staining. Patients with negative culture and smear were termed ‘‘probable tuberculosis’’ when the histopathology was reported for Tuberculous granuloma. ‘‘Composite reference standard’’ was the group of patients started on antituberculous treatment (ATT) based on either culture, smear positivity or histopathology positivity. When the three above-mentioned tests were negative, ATT was started on basis of clinical and radiological suspicion of tubercular spondylodiscitis. Statistical analysis was done using 2 x 2 contingency table, to check the sensitivity and specificity of the GeneXpert Test in relation to all the above-mentioned groups. RESULTS: In the period of 24 months from January 2012 to December 2014, a total of 348 patients (210 males and 138 females with an average age of 42 years) were treated for infective spondylodiscitis. Out of the 348 patients, 264 were diagnosed to have tubercular spondylitis and of the remaining 84, 79 patients had pyogenic spondylodiscitis and 5 had fungal spondylodiscitis. The sensitivity and specificity of the GeneXpert test when compared with ‘‘gold standard’’ culture is 88.4% and 63.6% and when compared to the composite reference standard is 70.1% and 100% respectively. The sensitivity and specificity of the GeneXpert test when compared with drug susceptibility test for multi-drug resistance is 100% and 92.3%. The rate of rifampicin resistance in our study was 4.02%. CONCLUSIONS: Based on the above findings, we recommend GeneXpert test, as a primary detection test for detection of tubercular spondylodiscitis. GeneXpert positivity is a valid indication to commence a patient on ATT. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
201S
mild symptoms, remains particularly controversial since select patients can stabilize clinically without operative intervention. PURPOSE: To compare the recovery of neuronal metabolism and functional reorganization using proton magnetic resonance spectroscopy and functional MRI in the primary motor cortex (M1) between mild and moderate CSM following surgical intervention. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: 28 CSM patients and 10 healthy controls. OUTCOME MEASURES: modified Japanese Orthopaedic Association (mJOA) questionnaire scores; metabolite concentrations, volume and location of activation. METHODS: Twenty-eight CSM patients had two separate imaging sessions on a 3.0 T Siemens Magnetom Tim Trio that included spectroscopy and functional MRI before and six months following surgery. The classification of CSM was based on the modified Japanese Orthopaedic Association (mJOA) questionnaire. Mild CSM was defined by a mJOA score of O12 out of 18 (n515) and moderate CSM by a score of 9–12 (n513). Ten healthy controls underwent two MRI scans six months apart. Functional MRI scans of a right handed finger-tapping paradigm were acquired using an echo planar imaging sequence (FOV 5 256x256mm, 45 slices, 3mm isotropic, TR/ TE52500/30ms, flip angle590o,iPAT52). Functional images were analyzed using BrainVoyager QX software where for each contrast, a volume of activation (VOA), corrected p-value, and Brodmann area (BA) were produced. A 20mm isotropic spectroscopy voxel was placed on the hand area of the M1 contralateral to the greater deficit side in the CSM group and on both sides in the controls. Spectroscopic data were localized using PRESS (TR/ TE52000/135ms, 192 averages, voxel size58cm3). The ratio of N-acetylaspartate (NAA) to creatine (Cr) was measured. RESULTS: At baseline, mild CSM patients had a lower NAA/Cr ratio in the hand area of M1 compared to healthy controls (p!0.05) and moderate CSM (p!0.05) suggesting neuronal loss or mitochondrial dysfunction. Following successful surgery and clinical improvement, NAA/Cr levels did not recover in mild CSM (p50.50). The moderate CSM patients, who had significantly worse preoperative mJOA scores and the largest functional improvement, demonstrated a decline in NAA/Cr levels (p!0.05). Preoperatively, mild CSM had a larger functional VOA than moderate CSM (p50.05; BA 5). Following surgery, the VOAs were comparable between mild and moderate CSM groups and had shifted towards the primary sensory cortex (p!0.001; BA 3). CONCLUSIONS: NAA/Cr levels and the size of the VOA in the motor cortex can be used to discriminate between mild and moderate CSM. Following surgery, the metabolic profile of the M1 did not recover in either group, despite significant clinical improvement. We propose that metabolic impairment in M1 may trigger recruitment of adjacent healthy cortex to achieve functional recovery. Further work is needed to determine whether these distinct patterns of remote injury in the sensorimotor cortex in mild and moderate CSM patients could be used to determine the timing and need for intervention. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.273
P39. Removed from Program
http://dx.doi.org/10.1016/j.spinee.2015.07.272
http://dx.doi.org/10.1016/j.spinee.2015.07.274
P38. Investigating Metabolic and Functional Profiles of Mild and Moderate Cervical Spondylotic Myelopathy: A MRS and fMRI Study Izabela K. Aleksanderek, PhD1, Todd Stevens, PhD2, Sandy Goncalves, BHSc, MSc2, Neil Duggal, MD, FRCSC3, Robert Bartha, PhD2; 1 University Hospital, London, ON, Canada; 2London, ON, Canada; 3 London Health Sciences Centre Western University, London, ON, Canada
P40. Oblique Sagittal Reconstructions of Cervical CT Scans: An Accurate and Efficient Method for Assessing True Foramina Dimensions Ehsan Tabaraee, MD1, Mark F. Kurd, MD2, Howard S. An, MD3; 1 University of California San Francisco, San Francisco, CA, US; 2 Rothman Institute, Bryn Mawr, PA, US; 3Rush Hospital Orthopedic Surgery Department, Chicago, IL, US
BACKGROUND CONTEXT: The ideal timing of surgical intervention for cervical spondylotic myelopathy (CSM) patients, especially with early,
BACKGROUND CONTEXT: Axial and sagittal computer tomography (CT) scans have been used to diagnose bony cervical stenosis. The cervical
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.