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P168. Osteolysis in Posterior and Transforaminal Lumbar Interbody Fusion with Bone Morphogenic Protein-2
Proceedings of the NASS 24th Annual Meeting / The Spine Journal 9 (2009) 1S-205S P168. Osteolysis in Posterior and Transforaminal Lumbar Interbody Fusion with Bone Morphogenic Protein-2 Joseph Dai, III, MD1, Joseph Orchowski, MD2; 1Tripler AMC, HI, USA; 2 Tripler Army Medical Center, honolulu, HI, USA Abstract text not published at authors’ request. FDA DEVICE/DRUG STATUS: rhBMP-2: Investigational/Not approved. doi: 10.1016/j.spinee.2009.08.429
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CONCLUSIONS: Although most cases of new postoperative radiculopathy were transient in this series, this study is the first to show that use of intraoperative tEMG threshold testing of lumbar pedicle screws may reduce the rate of acute postoperative radicular symptoms potentially related to implant malposition. The findings are limited by small sample size and retrospective study design and should be confirmed in a larger prospective study. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.430
P169. Clinical Efficacy of Intraoperative Triggered EMG Testing of Lumbar Pedicle Screws Amanda Fantry, BA1, Ian Rodway, MD2, Ling Li1, Julia Martha1, Tal Katz1, Carolyn Schwartz, ScD3, David Hunter, MD, PhD1, David Kim, MD1; 1New England Baptist Hospital, Boston, MA, USA; 2University of Cincinnati, Cincinnati, OH, USA; 3Tufts University Medical School, Boston, MA, USA BACKGROUND CONTEXT: Use of intraoperative neurophysiologic monitoring during elective spinal surgery has been increasing despite lack of evidence demonstrating actual reduction in complication incidence during lumbar spinal surgery. Previous studies of tEMG threshold testing have demonstrated improved pedicle screw placement accuracy but have not shown a clinical benefit in terms of a reduction in postoperative symptomatic complications. PURPOSE: To determine whether use of tEMG threshold testing of pedicle screws is associated with a reduction in clinically symptomatic intraoperative implant-related complications. STUDY DESIGN/SETTING: Retrospective chart review at a single institution. PATIENT SAMPLE: 397 patients undergoing posterior lumbar fusion with pedicle screw implants. OUTCOME MEASURES: Documentation of new postoperative lower extremity radicular sensory change, weakness, or sciatica. METHODS: Medical records were reviewed for all patients undergoing instrumented lumbar surgery with or without tEMG monitoring over a two-year period during which monitoring equipment and protocols remained standardized but use of monitoring was at the discretion of the operating surgeons. The following demographic and clinical data were collected: age, gender, BMI, diagnoses, type of surgery, number of instrumented levels, and use of fluoroscopy, intraoperative plain radiographs, and tEMG screw testing. The primary outcome of interest was occurrence of new acute postoperative lower extremity radiculopathy or sciatica. RESULTS: The study population included 397 patients (age 59.1614.3 yrs; M:F5161:236; BMI529.065.9) undergoing lumbar pedicle screw instrumentation. 49 cases of new acute postoperative radicular sensory change (21), weakness (6) or sciatica (22) were observed, including 15 of 166 (22.7%) monitored patients and 34 of 231 (14.7%) unmonitored patients. All new radicular symptoms were observed within the first 48 hours following surgery. Most patients (15/21 with sensory change, 3/6 with weakness and 16/22 with sciatica) experienced complete resolution of symptoms by time of discharge. Comparing monitored to unmonitored patient groups, no difference was found in terms of demographics, BMI, performance of laminectomy, or percentage of revision procedures. Univariate analysis failed to demonstrate an association between any patient or surgery-specific variable and risk of developing acute postoperative radiculopathy. A nonsignificant trend was observed between no monitoring and postoperative neurological deficit (p50.09). Multiple logistic regression modeling of potential predictors from the univariate analyses (p!0.1) revealed that use of tEMG pedicle screw testing was associated with a decreased risk of acute postoperative radiculopathy (OR 0.519, 95% CI 0.270-0.994).
P170. Effect of Lumbar Decompression Surgery on Sexual Function Ryan Garcia, MD1, Sheeraz Qureshi, MD2, Patrick Messerschmitt1, Kasra Ahmadinia, MD1, Nicholas Ahn, MD1; 1Case Western Reserve University, Cleveland, OH, USA; 2Mount Sinai School of Medicine, New York, NY, USA BACKGROUND CONTEXT: Success following lumbar decompression for spinal stenosis is commonly reported in terms of pain relief and functional improvements without evaluating sexual health. The objective of this study was to evaluate whether lumbar decompression has an effect on the perception, attitude, or function of sexual activity. PURPOSE: The objective of this study was to evaluate whether lumbar decompression has an effect on the perception, attitude, or function of sexual activity. STUDY DESIGN/SETTING: Preoperative and postoperative sexual function questionnaires were evaluated. The Changes in Sexual Functioning Questionnaire short form (CSFQ-14) was used in all patients. PATIENT SAMPLE: A consecutive series of patients who underwent lumbar decompression for spinal stenosis were evaluated. OUTCOME MEASURES: Statistical differences in sexual function outcomes were evaluated by comparing patient preoperative and postoperative sexual function questionnaire answers. METHODS: Between 2004 and 2006, 95 patients (49 M/46F) (mean age 55.8 years) underwent lumbar decompression for spinal stenosis. A retrospective analysis was performed to compare preoperative and most recent follow-up Changes in Sexual Functioning Questionnaire short form (CSFQ-14) scores. This sexual-function questionnaire consists of 14 questions utilizing a 5-point Likert scale. Subdivision of the 14 questions and analysis of the 5 sexual response phases (pleasure achieved, desire/frequency, desire/interest, arousal, and orgasm) was also performed. Linear regression analysis was used to determine if changes in sexual function scores were associated with a patient’s current Modified Oswestry Disability Index (ODI) score. RESULTS: The total mean sexual function score postoperatively (45.9þ9.8) was significantly higher than the preoperative score (44.5þ9.0) (p50.04). All 5 phases of the sexual response showed higher scores at follow-up, however, only the desire/frequency (p!0.01) and desire/interest (p!0.01) subgroups were statistically significant. Linear regression demonstrated that CSFQ-14 scores were not associated with current ODI scores r250.00 (p50.97). CONCLUSIONS: Lumbar decompression appears to have a positive effect on overall sexual function. Significant improvements were noted in the desire/frequency and desire/interest subgroups of the CSFQ-14. Our data suggests the improved sexual function may be independent of overall improvement in pain and disability as demonstrated by ODI scores. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.431
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CONCLUSIONS: Although most cases of new postoperative radiculopathy were transient in this series, this study is the first to show that use of intraoperative tEMG threshold testing of lumbar pedicle screws may reduce the rate of acute postoperative radicular symptoms potentially related to implant malposition. The findings are limited by small sample size and retrospective study design and should be confirmed in a larger prospective study. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.430
P169. Clinical Efficacy of Intraoperative Triggered EMG Testing of Lumbar Pedicle Screws Amanda Fantry, BA1, Ian Rodway, MD2, Ling Li1, Julia Martha1, Tal Katz1, Carolyn Schwartz, ScD3, David Hunter, MD, PhD1, David Kim, MD1; 1New England Baptist Hospital, Boston, MA, USA; 2University of Cincinnati, Cincinnati, OH, USA; 3Tufts University Medical School, Boston, MA, USA BACKGROUND CONTEXT: Use of intraoperative neurophysiologic monitoring during elective spinal surgery has been increasing despite lack of evidence demonstrating actual reduction in complication incidence during lumbar spinal surgery. Previous studies of tEMG threshold testing have demonstrated improved pedicle screw placement accuracy but have not shown a clinical benefit in terms of a reduction in postoperative symptomatic complications. PURPOSE: To determine whether use of tEMG threshold testing of pedicle screws is associated with a reduction in clinically symptomatic intraoperative implant-related complications. STUDY DESIGN/SETTING: Retrospective chart review at a single institution. PATIENT SAMPLE: 397 patients undergoing posterior lumbar fusion with pedicle screw implants. OUTCOME MEASURES: Documentation of new postoperative lower extremity radicular sensory change, weakness, or sciatica. METHODS: Medical records were reviewed for all patients undergoing instrumented lumbar surgery with or without tEMG monitoring over a two-year period during which monitoring equipment and protocols remained standardized but use of monitoring was at the discretion of the operating surgeons. The following demographic and clinical data were collected: age, gender, BMI, diagnoses, type of surgery, number of instrumented levels, and use of fluoroscopy, intraoperative plain radiographs, and tEMG screw testing. The primary outcome of interest was occurrence of new acute postoperative lower extremity radiculopathy or sciatica. RESULTS: The study population included 397 patients (age 59.1614.3 yrs; M:F5161:236; BMI529.065.9) undergoing lumbar pedicle screw instrumentation. 49 cases of new acute postoperative radicular sensory change (21), weakness (6) or sciatica (22) were observed, including 15 of 166 (22.7%) monitored patients and 34 of 231 (14.7%) unmonitored patients. All new radicular symptoms were observed within the first 48 hours following surgery. Most patients (15/21 with sensory change, 3/6 with weakness and 16/22 with sciatica) experienced complete resolution of symptoms by time of discharge. Comparing monitored to unmonitored patient groups, no difference was found in terms of demographics, BMI, performance of laminectomy, or percentage of revision procedures. Univariate analysis failed to demonstrate an association between any patient or surgery-specific variable and risk of developing acute postoperative radiculopathy. A nonsignificant trend was observed between no monitoring and postoperative neurological deficit (p50.09). Multiple logistic regression modeling of potential predictors from the univariate analyses (p!0.1) revealed that use of tEMG pedicle screw testing was associated with a decreased risk of acute postoperative radiculopathy (OR 0.519, 95% CI 0.270-0.994).
P170. Effect of Lumbar Decompression Surgery on Sexual Function Ryan Garcia, MD1, Sheeraz Qureshi, MD2, Patrick Messerschmitt1, Kasra Ahmadinia, MD1, Nicholas Ahn, MD1; 1Case Western Reserve University, Cleveland, OH, USA; 2Mount Sinai School of Medicine, New York, NY, USA BACKGROUND CONTEXT: Success following lumbar decompression for spinal stenosis is commonly reported in terms of pain relief and functional improvements without evaluating sexual health. The objective of this study was to evaluate whether lumbar decompression has an effect on the perception, attitude, or function of sexual activity. PURPOSE: The objective of this study was to evaluate whether lumbar decompression has an effect on the perception, attitude, or function of sexual activity. STUDY DESIGN/SETTING: Preoperative and postoperative sexual function questionnaires were evaluated. The Changes in Sexual Functioning Questionnaire short form (CSFQ-14) was used in all patients. PATIENT SAMPLE: A consecutive series of patients who underwent lumbar decompression for spinal stenosis were evaluated. OUTCOME MEASURES: Statistical differences in sexual function outcomes were evaluated by comparing patient preoperative and postoperative sexual function questionnaire answers. METHODS: Between 2004 and 2006, 95 patients (49 M/46F) (mean age 55.8 years) underwent lumbar decompression for spinal stenosis. A retrospective analysis was performed to compare preoperative and most recent follow-up Changes in Sexual Functioning Questionnaire short form (CSFQ-14) scores. This sexual-function questionnaire consists of 14 questions utilizing a 5-point Likert scale. Subdivision of the 14 questions and analysis of the 5 sexual response phases (pleasure achieved, desire/frequency, desire/interest, arousal, and orgasm) was also performed. Linear regression analysis was used to determine if changes in sexual function scores were associated with a patient’s current Modified Oswestry Disability Index (ODI) score. RESULTS: The total mean sexual function score postoperatively (45.9þ9.8) was significantly higher than the preoperative score (44.5þ9.0) (p50.04). All 5 phases of the sexual response showed higher scores at follow-up, however, only the desire/frequency (p!0.01) and desire/interest (p!0.01) subgroups were statistically significant. Linear regression demonstrated that CSFQ-14 scores were not associated with current ODI scores r250.00 (p50.97). CONCLUSIONS: Lumbar decompression appears to have a positive effect on overall sexual function. Significant improvements were noted in the desire/frequency and desire/interest subgroups of the CSFQ-14. Our data suggests the improved sexual function may be independent of overall improvement in pain and disability as demonstrated by ODI scores. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.431