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P129. Quantitative Changes in the Cervical Neural Foramen Due to Axial Traction In Vivo Imaging Study
Proceedings of the NASS 22nd Annual Meeting / The Spine Journal 7 (2007) 1S–163S OUTCOME MEASURES: The height and area of the intervertebral foramen, the facet joint space, nerve root diameter and area, and vertebral alignment in both injured and normal scenarios were evaluated. METHODS: Eight embalmed cadaveric cervical spines ranging from C1T1 were used for this study. Following dissection, a modified method for creating cervical unilateral facet joint dislocation was performed. The nerve roots were wrapped using 0.12 mm diameter wire. CT scans were taken of these specimens in both a dislocated and non-dislocated position. A sagittal plane through the center of the pedicle and facet joint was reconstructed and used for measurement. RESULTS: In a comparison of the pre and post injury, the following results were recorded: The intervertebral foramen area changed from 50.7260.88 mm2 to 67.8264.77 mm2 on the non-dislocated side, and from 41.3961.11 mm2 to 113.7765.65 mm2 on the dislocated side. The foraminal heights changed from 9.0260.30 mm to 10.5260.50 mm on the non-dislocated side and 10.4360.50 mm to 17.0460.96 mm on the dislocated side. The facet space area in the sagittal plane changed from 6.8060.80 mm2 to 40.0261.40 mm2 on the non-dislocated side. The C-5 anterior displacement showed a great change from 0 mm to 5.4060.24 mm on the non-dislocated side, and from 0 mm to 3.4260.20 mm on the dislocated side. Neither of the nerve roots on either side showed a significant size change. CONCLUSIONS: It was discovered that the intervertebral foramen on both sides became larger after unilateral facet joint dislocation. The facet joint space on the non-dislocated side showed a significant increase following injury, which probably implies instability. The alignment change shows that both sides sustain displacement. The non-dislocated side showed a more severe displacement than the dislocated side. This inequality shows that the superior vertebral body undergoes axial rotation during unilateral dislocation. The lack of change in nerve root area reveals patients with unilateral facet joint dislocation with associated nerve injuries may have a distraction of the nerve root rather than direct nerve root compression. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2007.07.336
P128. Lumbar Intervertebral Disc Replacement: A Viable Alternative to Spinal Fusion in Patients Involved in Manual Work? Kevin Steyn1, Adriaan Liebenberg2, Jack A. Eksteen2; 1Cape Town, Western Province, South Africa; 2Paarl, Western Province, South Africa BACKGROUND CONTEXT: Spinal fusion is the gold standard in treatment of degenerative spinal disease in manual workers. Intervertebral disc replacement is now being used progressively more often in this group of patients. PURPOSE: To compare the clinical and subjective outcomes between two groups, the one having undergone an Intervertebral Disc Replacement (IVDR) and the other a Spinal Fusion (TLIF) in order to determine if IVDR is a viable alternative to spinal fusions in Patients involved in active manual work at the time of their back injury. STUDY DESIGN/SETTING: Retrospective review in single orthopaedic practice. PATIENT SAMPLE: 34 consecutive patients. OUTCOME MEASURES: Oswestry scores, Visual Analogue Scores and Patient Satisfaction Scores. METHODS: All Patients from the private practice of the senior author (JE), who were available for follow up, were assessed and their records retrospectively reviewed. Outcome questionnaires were completed at assessment. RESULTS: There were 23 IVDR patients and 11 Fusion patients (2:1 ratio). Two makes of IVDR were used (ProDisc & Maverick) while all the fusion patients underwent a TLIF procedure. Follow up averaged just over 2 years for both groups. The outcome scores comprised the following: Oswestry scores, Visual Analogue Scores and Patient Satisfaction Scores. Results showed no statistical difference between the groups for these
141S
scores. There was also no statistical difference between the groups regarding Work Outcome. The only significant finding was that the IVDR group had more major complications than the fusion group. CONCLUSIONS: IVDR offers no added benefit over Spinal Fusion in patients involved in active manual work at the time of their back injury. IVDRs have significantly more Major complications than do Fusion patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2007.07.337
P129. Quantitative Changes in the Cervical Neural Foramen Due to Axial Traction In Vivo Imaging Study Jiayong Liu, MD1, Nabil Ebraheim, MD1, Chris Sanford, Jr.1, Vishwas Patil1, Haitham Elsamaloty1, Carlos Gomez1, Steven Farrell1, Huilin Yang, MD2; 1University of Toledo Medical Center, Toledo, OH, USA; 2The First Affiliated Hospital of Suzhou University, Suzhou, Jiangsu, China BACKGROUND CONTEXT: Cervical traction has a long history as one method of conservative treatment for cervical spine diseases. However, information on quantitative changes in the cervical neural foramen due to axial traction in vivo is lacking. PURPOSE: To quantitatively evaluate the changes in the neural foramen of the cervical spine during axial traction in vivo. STUDY DESIGN/SETTING: A prospective radiographic analysis of the cervical neural foramen of adult volunteers. PATIENT SAMPLE: Fifteen healthy volunteers (10 males, 5 females) without any history of cervical spine disease. OUTCOME MEASURES: The changes in cervical cross-sectional foraminal areas and heights were measured. METHODS: Cervical MRI images of the volunteers were taken at the neutral position and were reconstructed in the oblique plane perpendicular to the long axis of each neural foramen from the C2-3 to the C6-7 level. The changes in the neural foraminal dimensions at incremental axial traction force (0 kg, 5 kg, 10 kg and 15 kg) were analyzed. RESULTS: Following each 5 kg increment in traction weight, there was a significant (p!0.05) increase in area and height of the intervertebral foramen compared to the position in which no weight was applied. There was an average increase of 5.81%, 16.56%, and 18.9% in the foraminal area and an average increase of 3.75%, 8.67%, and 10.43% in foraminal height compared to the position with no weight at traction of 5 kg, 10 kg, and 15 kg, respectively. There was no statistically significant difference for the increase in the foraminal area and height from 10 kg of traction to 15 kg (pO0.05). CONCLUSIONS: There was a significant increase in intervertebral foraminal area and height following each 5 kg increment in traction weight compared to the position in which no weight was applied. From 10 kg to 15 kg of traction, there was no significant change in the foraminal area and height. FDA DEVICE/DRUG STATUS: Over door traction device: Approved for this indication. doi: 10.1016/j.spinee.2007.07.338
P130. Breakage and Malposition of Banana Shaped Carbon Fiber Reinforced Polymer Cage during TLIF Procedure Ashok Biyani, MD1, Ian Rodway, MD1; 1University of Toledo Medical Center, Toledo, OH, USA BACKGROUND CONTEXT: Transforaminal lumbar interbody fusion (TLIF) is a commonly performed spinal procedure. Several designs of
P128. Lumbar Intervertebral Disc Replacement: A Viable Alternative to Spinal Fusion in Patients Involved in Manual Work? Kevin Steyn1, Adriaan Liebenberg2, Jack A. Eksteen2; 1Cape Town, Western Province, South Africa; 2Paarl, Western Province, South Africa BACKGROUND CONTEXT: Spinal fusion is the gold standard in treatment of degenerative spinal disease in manual workers. Intervertebral disc replacement is now being used progressively more often in this group of patients. PURPOSE: To compare the clinical and subjective outcomes between two groups, the one having undergone an Intervertebral Disc Replacement (IVDR) and the other a Spinal Fusion (TLIF) in order to determine if IVDR is a viable alternative to spinal fusions in Patients involved in active manual work at the time of their back injury. STUDY DESIGN/SETTING: Retrospective review in single orthopaedic practice. PATIENT SAMPLE: 34 consecutive patients. OUTCOME MEASURES: Oswestry scores, Visual Analogue Scores and Patient Satisfaction Scores. METHODS: All Patients from the private practice of the senior author (JE), who were available for follow up, were assessed and their records retrospectively reviewed. Outcome questionnaires were completed at assessment. RESULTS: There were 23 IVDR patients and 11 Fusion patients (2:1 ratio). Two makes of IVDR were used (ProDisc & Maverick) while all the fusion patients underwent a TLIF procedure. Follow up averaged just over 2 years for both groups. The outcome scores comprised the following: Oswestry scores, Visual Analogue Scores and Patient Satisfaction Scores. Results showed no statistical difference between the groups for these
141S
scores. There was also no statistical difference between the groups regarding Work Outcome. The only significant finding was that the IVDR group had more major complications than the fusion group. CONCLUSIONS: IVDR offers no added benefit over Spinal Fusion in patients involved in active manual work at the time of their back injury. IVDRs have significantly more Major complications than do Fusion patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2007.07.337
P129. Quantitative Changes in the Cervical Neural Foramen Due to Axial Traction In Vivo Imaging Study Jiayong Liu, MD1, Nabil Ebraheim, MD1, Chris Sanford, Jr.1, Vishwas Patil1, Haitham Elsamaloty1, Carlos Gomez1, Steven Farrell1, Huilin Yang, MD2; 1University of Toledo Medical Center, Toledo, OH, USA; 2The First Affiliated Hospital of Suzhou University, Suzhou, Jiangsu, China BACKGROUND CONTEXT: Cervical traction has a long history as one method of conservative treatment for cervical spine diseases. However, information on quantitative changes in the cervical neural foramen due to axial traction in vivo is lacking. PURPOSE: To quantitatively evaluate the changes in the neural foramen of the cervical spine during axial traction in vivo. STUDY DESIGN/SETTING: A prospective radiographic analysis of the cervical neural foramen of adult volunteers. PATIENT SAMPLE: Fifteen healthy volunteers (10 males, 5 females) without any history of cervical spine disease. OUTCOME MEASURES: The changes in cervical cross-sectional foraminal areas and heights were measured. METHODS: Cervical MRI images of the volunteers were taken at the neutral position and were reconstructed in the oblique plane perpendicular to the long axis of each neural foramen from the C2-3 to the C6-7 level. The changes in the neural foraminal dimensions at incremental axial traction force (0 kg, 5 kg, 10 kg and 15 kg) were analyzed. RESULTS: Following each 5 kg increment in traction weight, there was a significant (p!0.05) increase in area and height of the intervertebral foramen compared to the position in which no weight was applied. There was an average increase of 5.81%, 16.56%, and 18.9% in the foraminal area and an average increase of 3.75%, 8.67%, and 10.43% in foraminal height compared to the position with no weight at traction of 5 kg, 10 kg, and 15 kg, respectively. There was no statistically significant difference for the increase in the foraminal area and height from 10 kg of traction to 15 kg (pO0.05). CONCLUSIONS: There was a significant increase in intervertebral foraminal area and height following each 5 kg increment in traction weight compared to the position in which no weight was applied. From 10 kg to 15 kg of traction, there was no significant change in the foraminal area and height. FDA DEVICE/DRUG STATUS: Over door traction device: Approved for this indication. doi: 10.1016/j.spinee.2007.07.338
P130. Breakage and Malposition of Banana Shaped Carbon Fiber Reinforced Polymer Cage during TLIF Procedure Ashok Biyani, MD1, Ian Rodway, MD1; 1University of Toledo Medical Center, Toledo, OH, USA BACKGROUND CONTEXT: Transforaminal lumbar interbody fusion (TLIF) is a commonly performed spinal procedure. Several designs of