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Lumbar Decompression for Tandem Spinal Stenosis
252S
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S
METHODS: A review of surgical and medical records for outcome measures of patients surgically treated from first day of implementing roboticguidance in December 2011 to end of 2014, and consecutive control cases surgically treated between July 2010 and November 2011. RESULTS: A total of 824 screws were placed in 154 patients with robotic guidance, and 925 screws were placed using an image-guided, landmarkbased technique. Procedure time was 2:00 hours in the robotic arm vs 2:13 in the freehand arm (p50.013), but there were also fewer screws per case on average in the robotic arm (p!0.001). The amount of fluoroscopy used per screw was 3.4 seconds in the robotic arm, compared to 9.3 in the control arm (p!0.00001). There was 1 case of an implant related durotomy in the robotic arm vs 7 in the control arm (p50.034). Incidence of deep wound infections (none in robotic vs 2 in control), new neurological deficits (none in both groups), instrumentation failures (5 in robotic vs 4 in the control) or revision surgeries (12 in robotic vs 16 in control) did not differ significantly, though the follow-up period in the Robotic cases was 5.4 months compared to 12.1 in the control arm (p!0.00001). CONCLUSIONS: Robotic guidance reduces the utilization of radiation by over 60% and demonstrated significant reduction in incidence of implant-related durotomies, but not in revisions and other surgical complications. Longer follow-up periods and larger cohorts are needed to adequately assess the impact on complications and revision rates. FDA DEVICE/DRUG STATUS: Mazor Robotics Renaissance (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2015.07.383
P147. Lumbar Decompression for Tandem Spinal Stenosis Vincent J. Alentado, BS, Matthew D. Alvin, MA1, Daniel Lubelski, BA2, Edward C. Benzel, MD1, Thomas E. Mroz, MD3; 1Cleveland Clinic Foundation, Cleveland, OH, US; 2Johns Hopkins Hospital Department of Neurosurgery, Baltimore, MD, US; 3Cleveland Clinic Foundation Departments of Orthopaedic and Neurological Surgery, Cleveland, OH, US BACKGROUND CONTEXT: As the population ages, tandem spinal stenosis (TSS) is becoming increasingly common among patients with low back pain. However, few studies have examined the impact of various surgical approaches on patients with TSS. PURPOSE: To determine the impact of lumbar spine surgery on outcomes in patients with symptomatic TSS. STUDY DESIGN/SETTING: Retrospective review at a single tertiary care institution. PATIENT SAMPLE: Eight hundred and three patients with clinical and imaging evidence of TSS were identified between 2008 and 2014. Of those identified, 157 underwent lumbar spine surgery alone, 113 underwent both cervical and lumbar surgery, and 533 received only conservative treatment. OUTCOME MEASURES: Outcomes measures used include Visual Analog Scale (VAS) for low back pain, Pain Disability Questionnaire (PDQ), Patient Health Questionnaire-9 (PHQ-9) and EuroQOL-5 Dimensions (EQ-5D). METHODS: The medical records of patients who were identified clinically as having both cervical and lumbar spinal stenosis were retrospectively reviewed. Patients with radiographic evidence of cervical and lumbar spinal stenosis were included in the study. Surgical records were then examined to identify levels of surgery, if applicable. Quality of life (QOL) data were acquired at baseline (preoperative), and 6 months, 1 year and 2 years postoperatively via an institutional prospectively collected database. RESULTS: A total of 803 patients fit the inclusion criteria. There were no significant differences in regards to baseline VAS scores among the three cohorts (p50.3). Patients who were conservatively managed had statistically better QOL scores across all other measurements at baseline. However, conservatively managed patients showed no improvement in QOL scores at any follow-up interval. In contrast, both surgical cohorts showed statistically significant improvement in VAS, PDQ and EQ-5D scores with the cervical and lumbar surgery cohort also showing improvement in PHQ-
9 scores. Two years postoperatively, both surgical cohorts demonstrated significant improvement in PDQ scale scores with the lumbar surgery-only group also demonstrating a statistically significant improvement in EQ-5D index scores and patients in the cervical and lumbar surgery cohort trending toward improvement (p50.04 and 0.07, respectively). CONCLUSIONS: Lumbar spine surgery with or without preceding cervical surgery significantly improves low back pain and quality of life outcomes in patients with TSS. Original surgical level can therefore be chosen based on degree of cervical symptoms. Future prospective studies are necessary to further validate these findings and examine the impact of cervical decompression alone on outcomes in patients with TSS. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.384
P148. Influence of Smoking on Wound Complications in Adults Undergoing Elective Posterior Lumbar Fusion Javier Guzman, BS1, Nathan J. Lee, BS1, John I. Shin, BS2, Dante M. Leven, DO, PT2, Branko Skovrlj, MD3, Jeremy Steinberger, MD4, Parth Kothari, BS1, Samuel K. Cho, MD5; 1Mount Sinai School of Medicine, New York, NY, US; 2Icahn School of Medicine at Mount Sinai, New York, NY, US; 3Mount Sinai School of Medicine Department of Neurosurgery, New York, NY, US; 4New York, NY, US; 5Icahn School of Medicine at Mount Sinai, New York, NY, US BACKGROUND CONTEXT: Smoking has been shown to increase the risk of pseudoarthrosis after fusion and has been linked to complications after spinal surgery. However, it is unclear to what extent smoking status has on the development on wound infections in patients undergoing posterior lumbar fusion. PURPOSE: To analyze the risks of smoking on posterior lumbar fusion. STUDY DESIGN/SETTING: Retrospective cohort analysis. PATIENT SAMPLE: Patients $18 years age who underwent elective posterior lumbar fusion from 2005-2012. OUTCOME MEASURES: Demographics, comorbidities and wound complications were measured. METHODS: Patients were identified by CPT (Current Procedural Terminology) code in the American College of Surgeon’s National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were divided into those with and without current smoking history. Univariate (chi-square and Student t-test) analysis was performed on demographics, comorbidities and operative variables (including procedure subtypes). Only variables with p!0.2 were evaluated for inclusion in the final step-wise multivariate logistic regression to determine if smoking was an independent risk factor for wound complications (Superficial Surgical Site infection [SSI], Deep SSI, Wound Dehiscence, Organ space SSI). Level of significance was set at p50.05. RESULTS: Smokers were likely to be younger and male (50.18% vs 43.38%, p!0.0001) than nonsmokers. Patients who smoked were less likely to be diabetic (12.44% vs 18.61%, p!0.0001) and also less likely to be identified as obese class III (6.47% vs 7.69%, p!0.0001) than nonsmokers. Smokers were observed to have a significantly increased rate of pulmonary, cardiac and peripheral vascular disease than their nonsmoking counterparts. Despite some increased comorbidities in smokers, ASA $ 3 was more commonly seen in nonsmokers than smokers (47.04% vs 42.84%, p50.006). Prior to undergoing surgery, nonsmokers were more likely to have a dependent functional status than smokers (4.39 vs 2.98%, p50.020). Multivariate logistic regression did not show smoking to be an independent predictor of wound complication [odds ratio (OR)51.00, p50.994)]. CONCLUSIONS: Smoking is not an independent predictor of surgical site infection when adjusted for other risk factors. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.385
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
METHODS: A review of surgical and medical records for outcome measures of patients surgically treated from first day of implementing roboticguidance in December 2011 to end of 2014, and consecutive control cases surgically treated between July 2010 and November 2011. RESULTS: A total of 824 screws were placed in 154 patients with robotic guidance, and 925 screws were placed using an image-guided, landmarkbased technique. Procedure time was 2:00 hours in the robotic arm vs 2:13 in the freehand arm (p50.013), but there were also fewer screws per case on average in the robotic arm (p!0.001). The amount of fluoroscopy used per screw was 3.4 seconds in the robotic arm, compared to 9.3 in the control arm (p!0.00001). There was 1 case of an implant related durotomy in the robotic arm vs 7 in the control arm (p50.034). Incidence of deep wound infections (none in robotic vs 2 in control), new neurological deficits (none in both groups), instrumentation failures (5 in robotic vs 4 in the control) or revision surgeries (12 in robotic vs 16 in control) did not differ significantly, though the follow-up period in the Robotic cases was 5.4 months compared to 12.1 in the control arm (p!0.00001). CONCLUSIONS: Robotic guidance reduces the utilization of radiation by over 60% and demonstrated significant reduction in incidence of implant-related durotomies, but not in revisions and other surgical complications. Longer follow-up periods and larger cohorts are needed to adequately assess the impact on complications and revision rates. FDA DEVICE/DRUG STATUS: Mazor Robotics Renaissance (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2015.07.383
P147. Lumbar Decompression for Tandem Spinal Stenosis Vincent J. Alentado, BS, Matthew D. Alvin, MA1, Daniel Lubelski, BA2, Edward C. Benzel, MD1, Thomas E. Mroz, MD3; 1Cleveland Clinic Foundation, Cleveland, OH, US; 2Johns Hopkins Hospital Department of Neurosurgery, Baltimore, MD, US; 3Cleveland Clinic Foundation Departments of Orthopaedic and Neurological Surgery, Cleveland, OH, US BACKGROUND CONTEXT: As the population ages, tandem spinal stenosis (TSS) is becoming increasingly common among patients with low back pain. However, few studies have examined the impact of various surgical approaches on patients with TSS. PURPOSE: To determine the impact of lumbar spine surgery on outcomes in patients with symptomatic TSS. STUDY DESIGN/SETTING: Retrospective review at a single tertiary care institution. PATIENT SAMPLE: Eight hundred and three patients with clinical and imaging evidence of TSS were identified between 2008 and 2014. Of those identified, 157 underwent lumbar spine surgery alone, 113 underwent both cervical and lumbar surgery, and 533 received only conservative treatment. OUTCOME MEASURES: Outcomes measures used include Visual Analog Scale (VAS) for low back pain, Pain Disability Questionnaire (PDQ), Patient Health Questionnaire-9 (PHQ-9) and EuroQOL-5 Dimensions (EQ-5D). METHODS: The medical records of patients who were identified clinically as having both cervical and lumbar spinal stenosis were retrospectively reviewed. Patients with radiographic evidence of cervical and lumbar spinal stenosis were included in the study. Surgical records were then examined to identify levels of surgery, if applicable. Quality of life (QOL) data were acquired at baseline (preoperative), and 6 months, 1 year and 2 years postoperatively via an institutional prospectively collected database. RESULTS: A total of 803 patients fit the inclusion criteria. There were no significant differences in regards to baseline VAS scores among the three cohorts (p50.3). Patients who were conservatively managed had statistically better QOL scores across all other measurements at baseline. However, conservatively managed patients showed no improvement in QOL scores at any follow-up interval. In contrast, both surgical cohorts showed statistically significant improvement in VAS, PDQ and EQ-5D scores with the cervical and lumbar surgery cohort also showing improvement in PHQ-
9 scores. Two years postoperatively, both surgical cohorts demonstrated significant improvement in PDQ scale scores with the lumbar surgery-only group also demonstrating a statistically significant improvement in EQ-5D index scores and patients in the cervical and lumbar surgery cohort trending toward improvement (p50.04 and 0.07, respectively). CONCLUSIONS: Lumbar spine surgery with or without preceding cervical surgery significantly improves low back pain and quality of life outcomes in patients with TSS. Original surgical level can therefore be chosen based on degree of cervical symptoms. Future prospective studies are necessary to further validate these findings and examine the impact of cervical decompression alone on outcomes in patients with TSS. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.384
P148. Influence of Smoking on Wound Complications in Adults Undergoing Elective Posterior Lumbar Fusion Javier Guzman, BS1, Nathan J. Lee, BS1, John I. Shin, BS2, Dante M. Leven, DO, PT2, Branko Skovrlj, MD3, Jeremy Steinberger, MD4, Parth Kothari, BS1, Samuel K. Cho, MD5; 1Mount Sinai School of Medicine, New York, NY, US; 2Icahn School of Medicine at Mount Sinai, New York, NY, US; 3Mount Sinai School of Medicine Department of Neurosurgery, New York, NY, US; 4New York, NY, US; 5Icahn School of Medicine at Mount Sinai, New York, NY, US BACKGROUND CONTEXT: Smoking has been shown to increase the risk of pseudoarthrosis after fusion and has been linked to complications after spinal surgery. However, it is unclear to what extent smoking status has on the development on wound infections in patients undergoing posterior lumbar fusion. PURPOSE: To analyze the risks of smoking on posterior lumbar fusion. STUDY DESIGN/SETTING: Retrospective cohort analysis. PATIENT SAMPLE: Patients $18 years age who underwent elective posterior lumbar fusion from 2005-2012. OUTCOME MEASURES: Demographics, comorbidities and wound complications were measured. METHODS: Patients were identified by CPT (Current Procedural Terminology) code in the American College of Surgeon’s National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were divided into those with and without current smoking history. Univariate (chi-square and Student t-test) analysis was performed on demographics, comorbidities and operative variables (including procedure subtypes). Only variables with p!0.2 were evaluated for inclusion in the final step-wise multivariate logistic regression to determine if smoking was an independent risk factor for wound complications (Superficial Surgical Site infection [SSI], Deep SSI, Wound Dehiscence, Organ space SSI). Level of significance was set at p50.05. RESULTS: Smokers were likely to be younger and male (50.18% vs 43.38%, p!0.0001) than nonsmokers. Patients who smoked were less likely to be diabetic (12.44% vs 18.61%, p!0.0001) and also less likely to be identified as obese class III (6.47% vs 7.69%, p!0.0001) than nonsmokers. Smokers were observed to have a significantly increased rate of pulmonary, cardiac and peripheral vascular disease than their nonsmoking counterparts. Despite some increased comorbidities in smokers, ASA $ 3 was more commonly seen in nonsmokers than smokers (47.04% vs 42.84%, p50.006). Prior to undergoing surgery, nonsmokers were more likely to have a dependent functional status than smokers (4.39 vs 2.98%, p50.020). Multivariate logistic regression did not show smoking to be an independent predictor of wound complication [odds ratio (OR)51.00, p50.994)]. CONCLUSIONS: Smoking is not an independent predictor of surgical site infection when adjusted for other risk factors. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.385
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.