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P124. Cervical degenerative disc disease and subclinical discitis: cause or contaminant?
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S195−S231 cervical discectomy and fusion permits the introduction of a large graft surface area placed under compression. Also, with this approach associated cervical disk herniation can be removed and fusion can be performed in a single approach. Posterior approach is indispensable in cases associated with laminar and facetal fractures. PURPOSE: The aim of this article is to analyse the clinical outcome and complications in patients undergoing anterior cervical discectomy and fusion for cervical fracture dislocations. STUDY DESIGN/SETTING: Retrospective case series. PATIENT SAMPLE: A total of 41 patients (25 males and 16 females) average age 46.8 years who underwent anterior cervical discectomy/corpectomy and fusion (ACDF/ACCF) with bone graft/metallic cage indicated for traumatic fracture dislocation from January 2016 to July 2018 at AIIMS, Rishikesh were included in the study. OUTCOME MEASURES: ASIA scoreODI scoreVAS scoremJOA scoreNurick grading. METHODS: A total of 41 patients with radiology proven unilateral or bilateral fracture dislocation included in the study were managed with planned closed reduction under general anaesthesia followed by ACDF/ ACCF procedure in the same setting. All patients were followed up monthly for first 3 months and then 6 monthly till their last follow up visit and were evaluated on basis of radiological, clinical and patient reported outcomes with average follow up of 18.3 months (min 4 month, max 39 months). RESULTS: Out of 41 patients (35 ACDF, 6 ACCF) 30 had complete spinal cord injury while 11 had incomplete spinal cord injury (ASIA B,C AND D). At their final follow up all showed clinical improvements in pain assessed by Visual Analog Scale (VAS) (6.8 to 1.1). Other patient reported outcomes showed significant improvement: Oswestry Disability Index (ODI) score (56.7 to 23), Modified Japanese Orthopedics Association (mJOA) score (11.5 to 17.3), Nurick’s grading (4.8 to 3.4). There was no severe intraoperative complications like spinal cord/nerve root/thoracic duct/esophagus/vertebral artery injury with average blood loss of 253.1 ml. One patient of ACDF needed secondary posterior fixation in view of instability. CONCLUSIONS: Anterior approach to cervical spine in cervical fracture dislocation is an effective treatment of choice showing optimal recovery rate in terms of patient reported outcomes and structural stability with added advantages of less blood loss and less instrumentation. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.548
P124. Cervical degenerative disc disease and subclinical discitis: cause or contaminant? Louis J. Bivona, MD1, Farooq Usmani, MD2, Jael Camacho, MD2, Steven C. Ludwig, MD3; 1 University of Maryland Orthopaedics, Baltimore, MD, US; 2 University of Maryland, Baltimore, MD, US; 3 University of Maryland Medical Center, Baltimore, MD, US BACKGROUND CONTEXT: Lumbar degenerative disc disease has been associated with culture positive disc space infection and P. acnes is the mostly commonly identified organism. PURPOSE: This study aims to determine the prevalence of underlying infection in patients undergoing anterior cervical decompression and fusion (ACDF). STUDY DESIGN/SETTING: Prospective Study. PATIENT SAMPLE: A total of 96 patients. OUTCOME MEASURES: Rate of disc Infection. METHODS: After IRB approval, patients scheduled to undergo elective ACDF were prospectively enrolled. Samples of the longus colli muscle and disc tissues were obtained intraoperatively. Samples were homogenized, gram stained and cultured in both aerobic and anaerobic medium for 5 and 14 days, respectively. RESULTS: Of the 96 patients, 41.6% were male with an average age of 53.8§10.9 years and BMI of 29.7§5.9. Control cultures of longus colli
S215
muscle were positive in 48 (50.0%) patients. Compared to the 20.8% of male patients in negative control (NC) patients, there were significantly more (62.5%) male patients in the positive control (PC) group (p<0.0001). Disc cultures were positive in 52(54.2%) patients and 81 (48.8%) discs. Compared to the 20.5% of male ND patients, there were significantly more (59.6%) male patients in PDs (p=0.0002). Of the 44 ND patients, 73% also had NC. Likewise, of the 52 PDs, 69% also had PCs. P. acnes grew in 85.2% of the discs and 77.1% of the control cultures. Staphyloccoccus was the second most common organism and grew in 16.7% and 11.1% of PC and PDs respectively. CONCLUSIONS: The 54% infection rate of cervical spine discs correlates with infection rate in the lumbar spine reported by many studies. Our control cultures of longus colli muscle show a strong association with the disc culture. The strong correlation between disc cultures and longus colli cultures suggest possible contiguous spread of infection. Our findings show that infection of the disc space is a possible cause of degenerative disc disease of the cervical spine. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.549
P125. Rates and predictors of return to work after surgery for cervical spondylotic myelopathy: analysis from the Canadian Spine Outcomes and Research Network (CSORN) Jefferson Wilson, MD, PhD, FRCSC1, Jetan H. Badhiwala, MD2, Bradley Jacobs, MD, FRCSC3, Michael G. Johnson, MD, FRCSC4, Christopher S. Bailey, MD, FRCSC5, Sean D. Christie, MD6, Rapha€ ele Charest-Morin, MD7, Jerome Paquet, MD, FRCSC8, Andrew Nataraj, MSc, MD, FRCSC8, David W. Cadotte, MD, PhD9, Neil A. Manson, MD, FRCSC10, Hamilton Hall, MD, FRCSC11, Kenneth C. Thomas, MD, FRCS12, Raja Y. Rampersaud, MD, FRCSC13, Greg McIntosh, BS14, Charles G. Fisher, MD, FRCSC, MHS15, Nicolas Dea, MD, MSc, FRCSC16; 1 St. Michael’s Hospital, University of Toronto, Toronto, Canada; 2 Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; 3 University of Calgary, Foothills Hospital, Calgary, AB, Canada; 4 Health Sciences Centre Winnipeg Spine Program, Winnipeg, MB, Canada; 5 U of Western Ontario/London Health Sciences Centre, London, ON, Canada; 6 QE II Health Sciences Centre, Halifax, NS, Canada; 7 Quebec, QC, Canada; 8 Division of Neurosurgery, Edmonton, AB, Canada; 9 University of Toronto, Toronto, ON, Canada; 10 Canada East Spine Cantre, Saint John, NB, Canada; 11 Markdale, ON, Canada; 12 Foothills Medical Centre, Calgary, AB, Canada; 13 Toronto Western Hospital, Toronto, ON, Canada; 14 Canadian Spine Society, Oakville, ON, Canada; 15 Vancouver General Hospital, Vancouver, BC, Canada; 16 Blusson Spinal Cord Center, Vancouver, BC, Canada BACKGROUND CONTEXT: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction internationally; however, few studies have evaluated return to work (RTW) after CSM surgery. PURPOSE: Our goals were to determine rates and predictors of postoperative RTW and to compare postoperative rates to a lumbar spondylolisthesis cohort. STUDY DESIGN/SETTING: Retrospective review of prospectivelycollected data. PATIENT SAMPLE: Non-retired patients undergoing surgical decompression for CSM. OUTCOME MEASURES: Return to work (ie, active employment) at 1year following surgery. METHODS: Data were derived from the CSORN prospective, multi-center surgical CSM registry. From this cohort, we included all non-retired patients with at least 1-year follow-up. RTW rate was defined as the proportion of patients with active employment at 1-year from the time of surgery. Bivariable and multivariable logistic regression were used to identify patient, disease and treatment variables predicting RTW.
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.
P124. Cervical degenerative disc disease and subclinical discitis: cause or contaminant? Louis J. Bivona, MD1, Farooq Usmani, MD2, Jael Camacho, MD2, Steven C. Ludwig, MD3; 1 University of Maryland Orthopaedics, Baltimore, MD, US; 2 University of Maryland, Baltimore, MD, US; 3 University of Maryland Medical Center, Baltimore, MD, US BACKGROUND CONTEXT: Lumbar degenerative disc disease has been associated with culture positive disc space infection and P. acnes is the mostly commonly identified organism. PURPOSE: This study aims to determine the prevalence of underlying infection in patients undergoing anterior cervical decompression and fusion (ACDF). STUDY DESIGN/SETTING: Prospective Study. PATIENT SAMPLE: A total of 96 patients. OUTCOME MEASURES: Rate of disc Infection. METHODS: After IRB approval, patients scheduled to undergo elective ACDF were prospectively enrolled. Samples of the longus colli muscle and disc tissues were obtained intraoperatively. Samples were homogenized, gram stained and cultured in both aerobic and anaerobic medium for 5 and 14 days, respectively. RESULTS: Of the 96 patients, 41.6% were male with an average age of 53.8§10.9 years and BMI of 29.7§5.9. Control cultures of longus colli
S215
muscle were positive in 48 (50.0%) patients. Compared to the 20.8% of male patients in negative control (NC) patients, there were significantly more (62.5%) male patients in the positive control (PC) group (p<0.0001). Disc cultures were positive in 52(54.2%) patients and 81 (48.8%) discs. Compared to the 20.5% of male ND patients, there were significantly more (59.6%) male patients in PDs (p=0.0002). Of the 44 ND patients, 73% also had NC. Likewise, of the 52 PDs, 69% also had PCs. P. acnes grew in 85.2% of the discs and 77.1% of the control cultures. Staphyloccoccus was the second most common organism and grew in 16.7% and 11.1% of PC and PDs respectively. CONCLUSIONS: The 54% infection rate of cervical spine discs correlates with infection rate in the lumbar spine reported by many studies. Our control cultures of longus colli muscle show a strong association with the disc culture. The strong correlation between disc cultures and longus colli cultures suggest possible contiguous spread of infection. Our findings show that infection of the disc space is a possible cause of degenerative disc disease of the cervical spine. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.549
P125. Rates and predictors of return to work after surgery for cervical spondylotic myelopathy: analysis from the Canadian Spine Outcomes and Research Network (CSORN) Jefferson Wilson, MD, PhD, FRCSC1, Jetan H. Badhiwala, MD2, Bradley Jacobs, MD, FRCSC3, Michael G. Johnson, MD, FRCSC4, Christopher S. Bailey, MD, FRCSC5, Sean D. Christie, MD6, Rapha€ ele Charest-Morin, MD7, Jerome Paquet, MD, FRCSC8, Andrew Nataraj, MSc, MD, FRCSC8, David W. Cadotte, MD, PhD9, Neil A. Manson, MD, FRCSC10, Hamilton Hall, MD, FRCSC11, Kenneth C. Thomas, MD, FRCS12, Raja Y. Rampersaud, MD, FRCSC13, Greg McIntosh, BS14, Charles G. Fisher, MD, FRCSC, MHS15, Nicolas Dea, MD, MSc, FRCSC16; 1 St. Michael’s Hospital, University of Toronto, Toronto, Canada; 2 Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; 3 University of Calgary, Foothills Hospital, Calgary, AB, Canada; 4 Health Sciences Centre Winnipeg Spine Program, Winnipeg, MB, Canada; 5 U of Western Ontario/London Health Sciences Centre, London, ON, Canada; 6 QE II Health Sciences Centre, Halifax, NS, Canada; 7 Quebec, QC, Canada; 8 Division of Neurosurgery, Edmonton, AB, Canada; 9 University of Toronto, Toronto, ON, Canada; 10 Canada East Spine Cantre, Saint John, NB, Canada; 11 Markdale, ON, Canada; 12 Foothills Medical Centre, Calgary, AB, Canada; 13 Toronto Western Hospital, Toronto, ON, Canada; 14 Canadian Spine Society, Oakville, ON, Canada; 15 Vancouver General Hospital, Vancouver, BC, Canada; 16 Blusson Spinal Cord Center, Vancouver, BC, Canada BACKGROUND CONTEXT: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction internationally; however, few studies have evaluated return to work (RTW) after CSM surgery. PURPOSE: Our goals were to determine rates and predictors of postoperative RTW and to compare postoperative rates to a lumbar spondylolisthesis cohort. STUDY DESIGN/SETTING: Retrospective review of prospectivelycollected data. PATIENT SAMPLE: Non-retired patients undergoing surgical decompression for CSM. OUTCOME MEASURES: Return to work (ie, active employment) at 1year following surgery. METHODS: Data were derived from the CSORN prospective, multi-center surgical CSM registry. From this cohort, we included all non-retired patients with at least 1-year follow-up. RTW rate was defined as the proportion of patients with active employment at 1-year from the time of surgery. Bivariable and multivariable logistic regression were used to identify patient, disease and treatment variables predicting RTW.
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.