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Harvest of Iliac Crest Autograft Not Associated with Localized Pain
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Proceedings of the NASS 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S
claudication group had neuropathic pain. The LANSS pain score was not significantly correlated with the VAS score for back pain, but did correlate with the VAS score for leg pain (R50.73, p!0.001) and ODI back pain score (R50.54, p!0.01). CONCLUSIONS: One third of patients with LSS had a neuropathic pain component. The presence of radicular pain correlated strongly with neurogenic claudication. The severity of leg pain and ODI scores were also closely related to having a neuropathic pain component. This data will be useful in understanding the pain characteristics of LSS and in better designing clinical trials for neuropathic pain treatment in patients with LSS. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.308 P35. Harvest of Iliac Crest Autograft Not Associated with Localized Pain Geoffrey Stewart, MD1, Ronald W. Mercer, BA2; 1Orlando, FL, US; 2 Kissimmee, FL, US BACKGROUND CONTEXT: There exist a wide variety of bone grafts, substitutes and extenders which are utilized in spinal arthrodesis surgery. There is considerable discrepancy in the literature and common wisdom regarding the complications associated with the use of iliac crest autograft. Chief among these is the perception that the procedure is painful and has a high infection rate. PURPOSE: The purpose of this study was to determine if patients experience more pain postoperatively on the donor side of their pelvis than on the contralateral side. STUDY DESIGN/SETTING: All patients of one surgeon who underwent elective surgery to include lumbar fusion were asked to fill out a pain diagram at their preoperative and each postoperative visit. These diagrams included a VAS pain scale for 5 regions, including each iliac crest. PATIENT SAMPLE: Seventy six patients were identified who had fusion surgery incorporating iliac crest autograft, and who had completed preoperative diagrams and had follow up data to one year postop. All were included. OUTCOME MEASURES: Outcome was measured by site-specific VAS score as reported by the patients at various time points. Additionally, complications were noted when they occurred. METHODS: The surgical approach involved a midline skin incision in all patients, with an epifascial dissection to the posterior superior iliac spine and then subperiosteal exposure of the prominence. The prominence was resected with an osteotomy and cancellous bone removed from between the tables with Capener gauges. Care was taken to avoid penetration of the cortex or sacroiliac joint. The defect was then irrigated and back filled with tricalcium phosphate, and the fascia closed. Patient reported pain data were compared from harvest and non-donor side and trends over time. RESULTS: There were no significant differences in reported pain between donor and non-donor side. There were no cases of donor site complications. CONCLUSIONS: Iliac crest harvest and reconstruction via this method does not result in increased pain on the side of the harvest. The complication rate would be anticipated to be very low as no complications were seen in this series. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.309 P36. Cervical Spondylosis Surgery Level and Age: A Comparative Analysis Mohsin Ali, BHSc, Edward Kachur, MD, Michael R. Bennardo, MSc, Asma’a A. Yassin, MD, Kesava K. Reddy, MD, Aleksa Cenic, MD, MSc; Division of Neurosurgery, Department of Surgery, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada BACKGROUND CONTEXT: Many authors have reported C5–6 and C6–7, followed by C4–5 as the most common levels of degeneration,
particularly in younger patients, whereas C3–4 is stated to be less frequently involved. However, some radiographic studies have described a higher incidence of C3–4 degeneration in the elderly. PURPOSE: To determine the relationship between age and the spinal level(s) operated upon in a series of cervical spondylosis patients. STUDY DESIGN/SETTING: A prospective/retrospective surgical case series conducted at Hamilton General Hospital, affiliated with McMaster University, Hamilton, Canada. PATIENT SAMPLE: We selected for patients whose cervical spondylosis was of strictly degenerative etiology, and warranted surgical intervention. Inclusion criteria were patients: operated on by the authors (EK, KR or AC) over six years (January 2007 to December 2012) for cervical spondylosis involving myelopathy and/or radiculopathy; and aged 18 years and above at time of surgery. Exclusion criteria were patients: whose cervical spine surgery was done for reasons other than spondylosis (i.e., tumor, infection, or trauma); or with previous surgery on the cervical spine; or with the following conditions: ankylosing spondylitis, spinal deformity, or a concurrent neurological condition (e.g., multiple sclerosis). METHODS: When reviewing each patient we noted: the patient’s age; sex; which spinal level(s) were operated on; the surgical procedure employed; the presence of three cofactorsdhistory of smoking, hypertension, and diabetes mellitus; and, for patients with multiple-level surgeries, the most severe level(s), as determined by the radiologist’s report. We investigated the relationship between age and spinal level, by comparing the mean age of patients per spinal level operated on; the spinal levels examined were C3–C4, C4–C5, C5–C6 and C6–C7. Potential confounding factors were also examined. We investigated the relationship between three cofactorsdsmoking, hypertension, and diabetes mellitusdand spinal level. We applied all analyses before and after stratifying data into two groupsdthose patients who had single-level surgeries (Group I) and those with multiple-level surgeries (Group II). RESULTS: 268 patients were reviewed. Overall, before and after stratification, a clear trend emerged in our data when comparing age to spinal level(s) operated upon: as ones ages, higher cervical spinal levels (that is, C3–C4 and C4–C5) are more likely to degenerate warranting surgical intervention. With respect to cofactors, the analyses bore consistent results with and without stratification: smoking and diabetes mellitus were not related to spinal level, whereas patients with an involvement of a higher spinal level were more likely to be hypertensive. CONCLUSIONS: This surgical case series complements previous radiographic analyses demonstrating higher incidence of C3–C4 involvement in elderly cervical spondylosis patients. Our analyses show that as ones ages, higher spinal levels are more likely to degenerate warranting surgical intervention. This knowledge is important for practicing spine surgeons when caring for elderly patients afflicted with cervical spondylosis. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.310
P37. Mechanical Versus Chemical Prophylaxis for Deep Venous Thrombosis in Patients Undergoing Lumbar Spinal Fusion: Comparative Effectiveness and Cost-Benefit Saniya S. Godil, MD1, Michael C. Dewan, MD1, Scott L. Parker, MD2, Clinton J. Devin, MD3, Matthew J. McGirt, MD1; 1Vanderbilt University Medical Center, Nashville, TN, US; 2Vanderbilt University, Nashville, TN, US; 3Nashville, TN, US BACKGROUND CONTEXT: Venous thromboembolism is a common preventable cause of morbidity after surgery with an incidence ranging from 0.3-31% in elective spinal surgery patients. Therefore, patients undergoing any surgical procedure receive routine prophylaxis for DVT. Recently, the added utility of chemical DVT prophylaxis in addition to mechanical DVT prophylaxis has been questioned.
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 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S
claudication group had neuropathic pain. The LANSS pain score was not significantly correlated with the VAS score for back pain, but did correlate with the VAS score for leg pain (R50.73, p!0.001) and ODI back pain score (R50.54, p!0.01). CONCLUSIONS: One third of patients with LSS had a neuropathic pain component. The presence of radicular pain correlated strongly with neurogenic claudication. The severity of leg pain and ODI scores were also closely related to having a neuropathic pain component. This data will be useful in understanding the pain characteristics of LSS and in better designing clinical trials for neuropathic pain treatment in patients with LSS. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.308 P35. Harvest of Iliac Crest Autograft Not Associated with Localized Pain Geoffrey Stewart, MD1, Ronald W. Mercer, BA2; 1Orlando, FL, US; 2 Kissimmee, FL, US BACKGROUND CONTEXT: There exist a wide variety of bone grafts, substitutes and extenders which are utilized in spinal arthrodesis surgery. There is considerable discrepancy in the literature and common wisdom regarding the complications associated with the use of iliac crest autograft. Chief among these is the perception that the procedure is painful and has a high infection rate. PURPOSE: The purpose of this study was to determine if patients experience more pain postoperatively on the donor side of their pelvis than on the contralateral side. STUDY DESIGN/SETTING: All patients of one surgeon who underwent elective surgery to include lumbar fusion were asked to fill out a pain diagram at their preoperative and each postoperative visit. These diagrams included a VAS pain scale for 5 regions, including each iliac crest. PATIENT SAMPLE: Seventy six patients were identified who had fusion surgery incorporating iliac crest autograft, and who had completed preoperative diagrams and had follow up data to one year postop. All were included. OUTCOME MEASURES: Outcome was measured by site-specific VAS score as reported by the patients at various time points. Additionally, complications were noted when they occurred. METHODS: The surgical approach involved a midline skin incision in all patients, with an epifascial dissection to the posterior superior iliac spine and then subperiosteal exposure of the prominence. The prominence was resected with an osteotomy and cancellous bone removed from between the tables with Capener gauges. Care was taken to avoid penetration of the cortex or sacroiliac joint. The defect was then irrigated and back filled with tricalcium phosphate, and the fascia closed. Patient reported pain data were compared from harvest and non-donor side and trends over time. RESULTS: There were no significant differences in reported pain between donor and non-donor side. There were no cases of donor site complications. CONCLUSIONS: Iliac crest harvest and reconstruction via this method does not result in increased pain on the side of the harvest. The complication rate would be anticipated to be very low as no complications were seen in this series. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.309 P36. Cervical Spondylosis Surgery Level and Age: A Comparative Analysis Mohsin Ali, BHSc, Edward Kachur, MD, Michael R. Bennardo, MSc, Asma’a A. Yassin, MD, Kesava K. Reddy, MD, Aleksa Cenic, MD, MSc; Division of Neurosurgery, Department of Surgery, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada BACKGROUND CONTEXT: Many authors have reported C5–6 and C6–7, followed by C4–5 as the most common levels of degeneration,
particularly in younger patients, whereas C3–4 is stated to be less frequently involved. However, some radiographic studies have described a higher incidence of C3–4 degeneration in the elderly. PURPOSE: To determine the relationship between age and the spinal level(s) operated upon in a series of cervical spondylosis patients. STUDY DESIGN/SETTING: A prospective/retrospective surgical case series conducted at Hamilton General Hospital, affiliated with McMaster University, Hamilton, Canada. PATIENT SAMPLE: We selected for patients whose cervical spondylosis was of strictly degenerative etiology, and warranted surgical intervention. Inclusion criteria were patients: operated on by the authors (EK, KR or AC) over six years (January 2007 to December 2012) for cervical spondylosis involving myelopathy and/or radiculopathy; and aged 18 years and above at time of surgery. Exclusion criteria were patients: whose cervical spine surgery was done for reasons other than spondylosis (i.e., tumor, infection, or trauma); or with previous surgery on the cervical spine; or with the following conditions: ankylosing spondylitis, spinal deformity, or a concurrent neurological condition (e.g., multiple sclerosis). METHODS: When reviewing each patient we noted: the patient’s age; sex; which spinal level(s) were operated on; the surgical procedure employed; the presence of three cofactorsdhistory of smoking, hypertension, and diabetes mellitus; and, for patients with multiple-level surgeries, the most severe level(s), as determined by the radiologist’s report. We investigated the relationship between age and spinal level, by comparing the mean age of patients per spinal level operated on; the spinal levels examined were C3–C4, C4–C5, C5–C6 and C6–C7. Potential confounding factors were also examined. We investigated the relationship between three cofactorsdsmoking, hypertension, and diabetes mellitusdand spinal level. We applied all analyses before and after stratifying data into two groupsdthose patients who had single-level surgeries (Group I) and those with multiple-level surgeries (Group II). RESULTS: 268 patients were reviewed. Overall, before and after stratification, a clear trend emerged in our data when comparing age to spinal level(s) operated upon: as ones ages, higher cervical spinal levels (that is, C3–C4 and C4–C5) are more likely to degenerate warranting surgical intervention. With respect to cofactors, the analyses bore consistent results with and without stratification: smoking and diabetes mellitus were not related to spinal level, whereas patients with an involvement of a higher spinal level were more likely to be hypertensive. CONCLUSIONS: This surgical case series complements previous radiographic analyses demonstrating higher incidence of C3–C4 involvement in elderly cervical spondylosis patients. Our analyses show that as ones ages, higher spinal levels are more likely to degenerate warranting surgical intervention. This knowledge is important for practicing spine surgeons when caring for elderly patients afflicted with cervical spondylosis. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.310
P37. Mechanical Versus Chemical Prophylaxis for Deep Venous Thrombosis in Patients Undergoing Lumbar Spinal Fusion: Comparative Effectiveness and Cost-Benefit Saniya S. Godil, MD1, Michael C. Dewan, MD1, Scott L. Parker, MD2, Clinton J. Devin, MD3, Matthew J. McGirt, MD1; 1Vanderbilt University Medical Center, Nashville, TN, US; 2Vanderbilt University, Nashville, TN, US; 3Nashville, TN, US BACKGROUND CONTEXT: Venous thromboembolism is a common preventable cause of morbidity after surgery with an incidence ranging from 0.3-31% in elective spinal surgery patients. Therefore, patients undergoing any surgical procedure receive routine prophylaxis for DVT. Recently, the added utility of chemical DVT prophylaxis in addition to mechanical DVT prophylaxis has been questioned.
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.