- Email: [email protected]
P23. Comparison of Mesenchymal Stem Cell Yield in Rabbit Lumbar Posterior Elements vs. Iliac Crest
112S
Proceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S
Adequacy of decompression, size of the construct footprint, sagittal and coronal balance, fusion success rates, clinical success rates, and instrumentation outcomes were assessed by postoperative clinical and radiographic evaluations. RESULTS: 40 consecutive patients (27M, 13F; mean age- 41 years) underwent thoracolumbar corpectomies. Mean follow-up was 38 months. 85% had neurological impairment preoperatively. Single level corpectomy was performed in 78% and multilevel in 22%. Three sizes of cage footprints were used based on the vertebral level treated. On CT scan analysis, the mean percent coverage of the adjacent vertebral bodies was 60%. There were no cage failures, instrumentation breakages, or permanent neurological deteriorations. One patient had revision surgery for pseudarthrosis with cage subsidence and another required a revision for transient neurological worsening. The average width of decompression was 20mm and the sagittal correction averaged 10 degrees. Successful fusions were demonstrated in 97.5%. CONCLUSIONS: Providing endplate coverage of 60% following thoracolumbar corpectomies led to satisfactory clinical and radiographic outcomes in a consecutive series of 40 patients at greater than 3 years mean follow-up. This footprint analysis, documenting that 60% coverage of the involved vertebra by the cage leads to long-term success, is an objective measurement not previously available following this type of surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.263
P22. Safety of the Extreme Lateral Interbody Fusion (XLIF) Procedure: Complication Rates in a Series of 300 Surgeries Wm B. Rodgers, MD, Curtis S. Cox, MD, Edward J. Gerber, PA-C; Spine Midwest Inc., Jefferson CIty, MO, USA BACKGROUND CONTEXT: The XLIF procedure is performed through two small skin incisions. Safe passage to the retroperitoneal space is assured by gentle blunt dissection. The psoas muscle is traversed and the lumbosacral plexus is protected by the use of automated dynamic electrophysiology. Exposure is achieved with an expandable three-bladed retractor, which allows for direct illuminated visualization facilitating diskectomy and complete anterior column stabilization. XLIF allows for minimally invasive placement of a large anterior graft, disk height and alignment restoration, and indirect decompression. Because it is minimally invasive, XLIF can be performed on a wide range of at-risk populations, including smokers, the elderly and obese patients. However, complication rates in a large cohort have not yet been presented. PURPOSE: The peri- and post-operative complications associated with the XLIF procedure are reported to demonstrate the feasibility, safety, and effectiveness of the approach. STUDY DESIGN/ SETTING: Prospective, nonrandomized safety assessment. PATIENT SAMPLE: Data is presented from our single-site consecutive series consisting of over 300 XLIF procedures. OUTCOME MEASURES: Peri- and post-operative complications and their relation to clinical and radiographic outcomes were evaluated. METHODS: All XLIF patients were prospectively followed to evaluate clinical and radiographic outcomes, including surgical details, hospital stay, pain scores, changes in disk height and alignment, and fusion. Surgical and postoperative complications were also documented and highlighted here, with respect to type and severity. RESULTS: The total series of cases included patients aged 27–87 years (average 61 years). Diagnoses included stenosis (41%), spondylolisthesis (17%), HNP (13%), DDD (11%), post-laminectomy instability (10%), and scoliosis (8%). 73% had one or more pre-existing comorbidities, including diabetes, CAD, COPD, smoking, and chronic steroid use. 38% had prior lumbar surgery. 150 (50%) were obese or morbidly obese. 375
levels were treated: 80% single-level; 56% at L4-5. All but 4 included supplemental instrumentation. Hospital stay averaged 1.3days. There were a total of 21 complications (6.9% complication rate): 1 wound hernia; 5 GI (4 ileus, 1 gastric volvulus); 2 renal (1 urinary retention, 1 peritoneal catheter occlusion); 4 respiratory (2 pneumonia, 1 pulmonary embolism, 1 re-intubation); 3 cardiac (2 atrial fibrillations, 1 MI at 6 wks postop); 4 neural (2 quad weakness, 2 anterior tibialis weakness); 1 endplate fracture; and 1 cage fracture on insertion. There were no infections. All complications were repaired or resolved without incident.One patient with post op quadricep weakness had incomplete recovery at latest follow up (6 weeks). No patient required revision or reoperation. Average VAS pain scores, radiographic measures, and fusion scores were not different between the group with complications and the total series. CONCLUSIONS: XLIF is a safe and effective minimally invasive treatment option for multiple thoracolumbar degenerative conditions. This large series of prospective patient data shows that XLIF surgery can be performed in a wide variety of conditions with an acceptably low complication rate. Identification of these occurrences allows for educated discussions with patients and surgeons alike. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.264
P23. Comparison of Mesenchymal Stem Cell Yield in Rabbit Lumbar Posterior Elements vs. Iliac Crest Kamal Dagly, MD1, Nicholas Renaldo, MD1, Robert Daher, MD1, Daniel Grande, Phd2, Jeff Silber, MD3; 1North Shore Long Island Jewish Medical Center, New Hyde Park, NY, USA; 2North Shore Research Laboratory, Manahsset, NY, USA; 3North Shore Long Island Jewish Medical Center, Great Neck, NY, USA BACKGROUND CONTEXT: Autologous iliac crest bone graft remains the gold standard for spinal fusion surgery. The high incidence of donor site morbidity has prompted practitioners to seek alternatives to this adjunct procedure. PURPOSE: The purpose of this study was to compare the total number of mesenchymal stem cell (MSC) yield (cells needed to obtain bony fusion) from the iliac crest versus local lumbar posterior elements (spinous process and lamina). STUDY DESIGN/ SETTING: Comparison of Mesenchymal Stem Cell Yield in Rabbit Lumbar Posterior Elements versus Iliac Crest. PATIENT SAMPLE: N.A. New Zealand White rabbits were used in this study. OUTCOME MEASURES: Mesenchymal stem cell yield. METHODS: Under sterile conditions, the posterior elements from five lumbar levels were harvested as well as both iliac crests from four adult New Zealand White rabbits. The iliac crests were clam-shelled and the cancellous bone and marrow was curetted out. The posterior elements were enzymatically digested in a spinner flask, then washed three times. An initial total cell count was obtained for each rabbit and tissue type. The cells were then evenly distributed into six well plates. Media was aspirated daily for two weeks to remove any hematopoetic and nonadherent cells. At two weeks, a final total MSC count was obtained. RESULTS: The average percentage yield of MSCs (final total cell count / initial total count 100%) for the iliac crest bone was 0.03%. The average percentage yield for the posterior elements was 0.13%. (p!0.05) CONCLUSIONS: The posterior elements yielded a significantly higher percentage of mesenchymal stem cells than the iliac crest bone. To our knowledge this is the first study comparing the yield of MSCs from the posterior elements versus the iliac crest in the mammalian model. This finding may eventually allow surgeons to use the local autologous posterior element bone harvested during their decompression and laminectomy for fusion, avoiding the morbidity associated with harvesting iliac crest bone graft.
Proceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S
113S
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
doi:10.1016/j.spinee.2008.06.265
doi:10.1016/j.spinee.2008.06.266
P24. Radiation Exposure during Orthopaedic CT Scanning Debdut Biswas, BA1, Jesse Bible, BS1, Michael Bohan, BS2, Peter Whang, MD1, Jonathan Grauer, MD1; 1Yale University School of Medicine, Department of Orthopaedics and Rehabilitation, New Haven, CT, USA; 2 Yale-New Haven Hospital, Department of Radiological Physics, New Haven, CT, USA
P25. Comparison Between Multi-level Oblique Corpectomy with or without Image-guided Navigation for Multi-segmental Cervical Spondylotic Myelopathy Ho-Yeon Lee, MD, PhD, Sang-Ho Lee, MD, PhD, Hyeong-Kweon Son, MD, June Ho Lee, MD, Oon Ki Baek, MD, PhD, Tae Joon Ahn, MD, Chan Shik Shim, MD, PhD; Wooridul Spine Hospital, Seoul, South Korea
BACKGROUND CONTEXT: Computerized Tomography (CT) scans are routinely obtained in the evaluation of complex orthopaedic injuries. As CT exposes patients to the highest doses of ionizing radiation of the medical imaging procedures, there has been increasing concern over this exposure. PURPOSE: Several investigations have reported the effective dose of commonly performed CT examinations (Head, Chest, Abdomen, and Pelvis), but no studies have evaluated the radiation related risks of orthopaedic CT scans. The purpose of this study was to report the effective radiation dose of CT scans commonly performed in the evaluation of orthopaedic injuries. STUDY DESIGN/ SETTING: CT scans of the extremities and spine were retrospectively reviewed from our institution’s digital imaging archive. The CT dose index by volume (CTDIvol) was recorded from the dose report for each examination and was used to calculate the effective dose for each scan. PATIENT SAMPLE: Our institution’s digital imaging archive was retrospectively reviewed for helical CT scans of adults of the upper and lower extremities and spine (cervical, thoracic, and lumbar). CT scans of the chest, abdomen, and pelvis were also included to compare our calculations to prior studies. The scans were performed on GE Lightspeed 16, Lightspeed Qx/I, Lightspeed VCT scanners. OUTCOME MEASURES: In the assessment of radiation related risk from CT, the effective dose (ED) is a useful value that accounts for the radiosensitivity of specific organs and provides an estimate of the overall radiation-related risk to the patient. The effective dose of radiation was reported for CT scans of the upper and lower extremities and the cervical and thoracolumbar spine. METHODS: The CT dose index by volume (CTDIvol), dose-length product (DLP), current-rotation time (mAs), and voltage (kVp) were reported for each scan. Using the CTDIvol and scan intervals, organ doses and effective dose calculations were performed according to Monte Carlo techniques and on methods specified in the United Kingdom’s National Radiological Protection Board’s (NRPB) SR250 publication. RESULTS: The effective dose estimations for chest, abdomen, and pelvis scans (5.03, 5.01, and 4.20 mSv, respectively) were similar to those reported in prior studies. In our study, the ED was particularly high in CT scans of the spine. The ED of a cervical spine CTwas 3.69 mSv, and the dose of a thoracic spine CT scan was significantly higher than a chest CT (18.15 vs. 5.03 mSv, P!0.0001) while a lumbar spine CT was significantly higher than an abdominal CT (19.60 vs. 5.01 mSv, P!0.000001). In the upper extremity, the ED of a shoulder CT (1.51mSv) was higher than than the dose of an elbow scan (0.18mSv) and significantly higher than the dose of a CT of the wrist (0.02 mSv, P50.03). In the lower extremity, the ED of a hip scan (2.91 mSv) was significantly higher than than dosages of knee (0.18 mSv, P!0.0000001) and ankle scans (0.04mSv, P!0.0000001). CONCLUSIONS: The use of CT in orthopaedics allows for the visualization of complex fractures and dislocations in the extremities and spine. The radiation related risks for CT scans of the distal extremities should not be overemphasized, particularly when the diagnostic information may affect clinical management. The orthopaedic surgeon, however, should more carefully consider the benefits of CT scans of the shoulders, spine, hips and pelvis, since these examinations may be associated with a higher radiation related risk.
BACKGROUND CONTEXT: MOC is a technique in treatment of multisegmental cervical spondylotic myelopathy including extensive ossified posterior longitudinal ligament. But oblique angle is not familiar with surgeons and no anatomic landmark is present on posterior portion of vertebral body. To overcome these difficulties, authors used intra-operative C-arm-based IGN (ION, Medtronic Sofamor Danek, Memphis, TN). PURPOSE: To evaluate the efficacy of image-guided navigation (IGN) in multilevel oblique corpectomy (MOC). STUDY DESIGN/ SETTING: A retrospective review of cases. PATIENT SAMPLE: Since the application of IGN on MOC, 22 patients have had post-operative MR images; among them, eleven patients underwent MOC with IGN. OUTCOME MEASURES: Clinical outcomes were measured preoperatively and on the 5th day after operation by the scoring system of Japanese Orthopaedic Association (JOA) with several perioperative parameters. The completeness of MOC was measured at the most compressive level; sum of bilateral remaining posterior body minus remaining approach side anterior body in millimeter. Result was considered better when the value is smaller. METHODS: In eleven IGN group, total 39 levels were operated. IGN was applied after exposure of cervical spine. Drilling and IGN probe checking were repeated during bony dissection to confirm the depth and angle. RESULTS: Mean completeness of MOC was 0.89mm in navigation group, 5.9mm in control group. Mean change of JOA score is 4.27 and 2.91 respectively. In control group, two patients underwent re-exploration due to remaining OPLL. Even extra time was spent to set up the navigation, mean operative time was shorter in the study group (248min vs. 259min). Treated levels were 3.55 and 3.36 respectively. CONCLUSIONS: With image-guided navigation, authors could achieve faster and more complete MOC. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.267
P26. Comparison of Range of Motion Following Cervical Spine Decompression Surgical Procedures and the Effect on Patient Satisfaction Kevin Bell, MS1, Charise Shively, BS2, Erik Frazier, MS2, Robert Hartman3, Joon Y. Lee, MD2, James Kang, MD2, William Donaldson, III, MD2; 1Pittsburgh, PA, USA; 2University of Pittsburgh, Pittsburgh, PA, USA; 3Pittsburgh, PA, USA BACKGROUND CONTEXT: Operative treatment options for cervical decompression include anterior and/or posterior procedures aimed at expansion of the spinal canal. Direct comparison of the postoperative success of these treatments using cervical range of motion (CROM) and the Neck Disability Index (NDI) will provide objective data adding to the clinical knowledge base. PURPOSE: The purpose of this research study is to compare CROM and NDI scores for the decompressive surgical treatments to an age-matched,
Proceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S
Adequacy of decompression, size of the construct footprint, sagittal and coronal balance, fusion success rates, clinical success rates, and instrumentation outcomes were assessed by postoperative clinical and radiographic evaluations. RESULTS: 40 consecutive patients (27M, 13F; mean age- 41 years) underwent thoracolumbar corpectomies. Mean follow-up was 38 months. 85% had neurological impairment preoperatively. Single level corpectomy was performed in 78% and multilevel in 22%. Three sizes of cage footprints were used based on the vertebral level treated. On CT scan analysis, the mean percent coverage of the adjacent vertebral bodies was 60%. There were no cage failures, instrumentation breakages, or permanent neurological deteriorations. One patient had revision surgery for pseudarthrosis with cage subsidence and another required a revision for transient neurological worsening. The average width of decompression was 20mm and the sagittal correction averaged 10 degrees. Successful fusions were demonstrated in 97.5%. CONCLUSIONS: Providing endplate coverage of 60% following thoracolumbar corpectomies led to satisfactory clinical and radiographic outcomes in a consecutive series of 40 patients at greater than 3 years mean follow-up. This footprint analysis, documenting that 60% coverage of the involved vertebra by the cage leads to long-term success, is an objective measurement not previously available following this type of surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.263
P22. Safety of the Extreme Lateral Interbody Fusion (XLIF) Procedure: Complication Rates in a Series of 300 Surgeries Wm B. Rodgers, MD, Curtis S. Cox, MD, Edward J. Gerber, PA-C; Spine Midwest Inc., Jefferson CIty, MO, USA BACKGROUND CONTEXT: The XLIF procedure is performed through two small skin incisions. Safe passage to the retroperitoneal space is assured by gentle blunt dissection. The psoas muscle is traversed and the lumbosacral plexus is protected by the use of automated dynamic electrophysiology. Exposure is achieved with an expandable three-bladed retractor, which allows for direct illuminated visualization facilitating diskectomy and complete anterior column stabilization. XLIF allows for minimally invasive placement of a large anterior graft, disk height and alignment restoration, and indirect decompression. Because it is minimally invasive, XLIF can be performed on a wide range of at-risk populations, including smokers, the elderly and obese patients. However, complication rates in a large cohort have not yet been presented. PURPOSE: The peri- and post-operative complications associated with the XLIF procedure are reported to demonstrate the feasibility, safety, and effectiveness of the approach. STUDY DESIGN/ SETTING: Prospective, nonrandomized safety assessment. PATIENT SAMPLE: Data is presented from our single-site consecutive series consisting of over 300 XLIF procedures. OUTCOME MEASURES: Peri- and post-operative complications and their relation to clinical and radiographic outcomes were evaluated. METHODS: All XLIF patients were prospectively followed to evaluate clinical and radiographic outcomes, including surgical details, hospital stay, pain scores, changes in disk height and alignment, and fusion. Surgical and postoperative complications were also documented and highlighted here, with respect to type and severity. RESULTS: The total series of cases included patients aged 27–87 years (average 61 years). Diagnoses included stenosis (41%), spondylolisthesis (17%), HNP (13%), DDD (11%), post-laminectomy instability (10%), and scoliosis (8%). 73% had one or more pre-existing comorbidities, including diabetes, CAD, COPD, smoking, and chronic steroid use. 38% had prior lumbar surgery. 150 (50%) were obese or morbidly obese. 375
levels were treated: 80% single-level; 56% at L4-5. All but 4 included supplemental instrumentation. Hospital stay averaged 1.3days. There were a total of 21 complications (6.9% complication rate): 1 wound hernia; 5 GI (4 ileus, 1 gastric volvulus); 2 renal (1 urinary retention, 1 peritoneal catheter occlusion); 4 respiratory (2 pneumonia, 1 pulmonary embolism, 1 re-intubation); 3 cardiac (2 atrial fibrillations, 1 MI at 6 wks postop); 4 neural (2 quad weakness, 2 anterior tibialis weakness); 1 endplate fracture; and 1 cage fracture on insertion. There were no infections. All complications were repaired or resolved without incident.One patient with post op quadricep weakness had incomplete recovery at latest follow up (6 weeks). No patient required revision or reoperation. Average VAS pain scores, radiographic measures, and fusion scores were not different between the group with complications and the total series. CONCLUSIONS: XLIF is a safe and effective minimally invasive treatment option for multiple thoracolumbar degenerative conditions. This large series of prospective patient data shows that XLIF surgery can be performed in a wide variety of conditions with an acceptably low complication rate. Identification of these occurrences allows for educated discussions with patients and surgeons alike. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.264
P23. Comparison of Mesenchymal Stem Cell Yield in Rabbit Lumbar Posterior Elements vs. Iliac Crest Kamal Dagly, MD1, Nicholas Renaldo, MD1, Robert Daher, MD1, Daniel Grande, Phd2, Jeff Silber, MD3; 1North Shore Long Island Jewish Medical Center, New Hyde Park, NY, USA; 2North Shore Research Laboratory, Manahsset, NY, USA; 3North Shore Long Island Jewish Medical Center, Great Neck, NY, USA BACKGROUND CONTEXT: Autologous iliac crest bone graft remains the gold standard for spinal fusion surgery. The high incidence of donor site morbidity has prompted practitioners to seek alternatives to this adjunct procedure. PURPOSE: The purpose of this study was to compare the total number of mesenchymal stem cell (MSC) yield (cells needed to obtain bony fusion) from the iliac crest versus local lumbar posterior elements (spinous process and lamina). STUDY DESIGN/ SETTING: Comparison of Mesenchymal Stem Cell Yield in Rabbit Lumbar Posterior Elements versus Iliac Crest. PATIENT SAMPLE: N.A. New Zealand White rabbits were used in this study. OUTCOME MEASURES: Mesenchymal stem cell yield. METHODS: Under sterile conditions, the posterior elements from five lumbar levels were harvested as well as both iliac crests from four adult New Zealand White rabbits. The iliac crests were clam-shelled and the cancellous bone and marrow was curetted out. The posterior elements were enzymatically digested in a spinner flask, then washed three times. An initial total cell count was obtained for each rabbit and tissue type. The cells were then evenly distributed into six well plates. Media was aspirated daily for two weeks to remove any hematopoetic and nonadherent cells. At two weeks, a final total MSC count was obtained. RESULTS: The average percentage yield of MSCs (final total cell count / initial total count 100%) for the iliac crest bone was 0.03%. The average percentage yield for the posterior elements was 0.13%. (p!0.05) CONCLUSIONS: The posterior elements yielded a significantly higher percentage of mesenchymal stem cells than the iliac crest bone. To our knowledge this is the first study comparing the yield of MSCs from the posterior elements versus the iliac crest in the mammalian model. This finding may eventually allow surgeons to use the local autologous posterior element bone harvested during their decompression and laminectomy for fusion, avoiding the morbidity associated with harvesting iliac crest bone graft.
Proceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S
113S
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
doi:10.1016/j.spinee.2008.06.265
doi:10.1016/j.spinee.2008.06.266
P24. Radiation Exposure during Orthopaedic CT Scanning Debdut Biswas, BA1, Jesse Bible, BS1, Michael Bohan, BS2, Peter Whang, MD1, Jonathan Grauer, MD1; 1Yale University School of Medicine, Department of Orthopaedics and Rehabilitation, New Haven, CT, USA; 2 Yale-New Haven Hospital, Department of Radiological Physics, New Haven, CT, USA
P25. Comparison Between Multi-level Oblique Corpectomy with or without Image-guided Navigation for Multi-segmental Cervical Spondylotic Myelopathy Ho-Yeon Lee, MD, PhD, Sang-Ho Lee, MD, PhD, Hyeong-Kweon Son, MD, June Ho Lee, MD, Oon Ki Baek, MD, PhD, Tae Joon Ahn, MD, Chan Shik Shim, MD, PhD; Wooridul Spine Hospital, Seoul, South Korea
BACKGROUND CONTEXT: Computerized Tomography (CT) scans are routinely obtained in the evaluation of complex orthopaedic injuries. As CT exposes patients to the highest doses of ionizing radiation of the medical imaging procedures, there has been increasing concern over this exposure. PURPOSE: Several investigations have reported the effective dose of commonly performed CT examinations (Head, Chest, Abdomen, and Pelvis), but no studies have evaluated the radiation related risks of orthopaedic CT scans. The purpose of this study was to report the effective radiation dose of CT scans commonly performed in the evaluation of orthopaedic injuries. STUDY DESIGN/ SETTING: CT scans of the extremities and spine were retrospectively reviewed from our institution’s digital imaging archive. The CT dose index by volume (CTDIvol) was recorded from the dose report for each examination and was used to calculate the effective dose for each scan. PATIENT SAMPLE: Our institution’s digital imaging archive was retrospectively reviewed for helical CT scans of adults of the upper and lower extremities and spine (cervical, thoracic, and lumbar). CT scans of the chest, abdomen, and pelvis were also included to compare our calculations to prior studies. The scans were performed on GE Lightspeed 16, Lightspeed Qx/I, Lightspeed VCT scanners. OUTCOME MEASURES: In the assessment of radiation related risk from CT, the effective dose (ED) is a useful value that accounts for the radiosensitivity of specific organs and provides an estimate of the overall radiation-related risk to the patient. The effective dose of radiation was reported for CT scans of the upper and lower extremities and the cervical and thoracolumbar spine. METHODS: The CT dose index by volume (CTDIvol), dose-length product (DLP), current-rotation time (mAs), and voltage (kVp) were reported for each scan. Using the CTDIvol and scan intervals, organ doses and effective dose calculations were performed according to Monte Carlo techniques and on methods specified in the United Kingdom’s National Radiological Protection Board’s (NRPB) SR250 publication. RESULTS: The effective dose estimations for chest, abdomen, and pelvis scans (5.03, 5.01, and 4.20 mSv, respectively) were similar to those reported in prior studies. In our study, the ED was particularly high in CT scans of the spine. The ED of a cervical spine CTwas 3.69 mSv, and the dose of a thoracic spine CT scan was significantly higher than a chest CT (18.15 vs. 5.03 mSv, P!0.0001) while a lumbar spine CT was significantly higher than an abdominal CT (19.60 vs. 5.01 mSv, P!0.000001). In the upper extremity, the ED of a shoulder CT (1.51mSv) was higher than than the dose of an elbow scan (0.18mSv) and significantly higher than the dose of a CT of the wrist (0.02 mSv, P50.03). In the lower extremity, the ED of a hip scan (2.91 mSv) was significantly higher than than dosages of knee (0.18 mSv, P!0.0000001) and ankle scans (0.04mSv, P!0.0000001). CONCLUSIONS: The use of CT in orthopaedics allows for the visualization of complex fractures and dislocations in the extremities and spine. The radiation related risks for CT scans of the distal extremities should not be overemphasized, particularly when the diagnostic information may affect clinical management. The orthopaedic surgeon, however, should more carefully consider the benefits of CT scans of the shoulders, spine, hips and pelvis, since these examinations may be associated with a higher radiation related risk.
BACKGROUND CONTEXT: MOC is a technique in treatment of multisegmental cervical spondylotic myelopathy including extensive ossified posterior longitudinal ligament. But oblique angle is not familiar with surgeons and no anatomic landmark is present on posterior portion of vertebral body. To overcome these difficulties, authors used intra-operative C-arm-based IGN (ION, Medtronic Sofamor Danek, Memphis, TN). PURPOSE: To evaluate the efficacy of image-guided navigation (IGN) in multilevel oblique corpectomy (MOC). STUDY DESIGN/ SETTING: A retrospective review of cases. PATIENT SAMPLE: Since the application of IGN on MOC, 22 patients have had post-operative MR images; among them, eleven patients underwent MOC with IGN. OUTCOME MEASURES: Clinical outcomes were measured preoperatively and on the 5th day after operation by the scoring system of Japanese Orthopaedic Association (JOA) with several perioperative parameters. The completeness of MOC was measured at the most compressive level; sum of bilateral remaining posterior body minus remaining approach side anterior body in millimeter. Result was considered better when the value is smaller. METHODS: In eleven IGN group, total 39 levels were operated. IGN was applied after exposure of cervical spine. Drilling and IGN probe checking were repeated during bony dissection to confirm the depth and angle. RESULTS: Mean completeness of MOC was 0.89mm in navigation group, 5.9mm in control group. Mean change of JOA score is 4.27 and 2.91 respectively. In control group, two patients underwent re-exploration due to remaining OPLL. Even extra time was spent to set up the navigation, mean operative time was shorter in the study group (248min vs. 259min). Treated levels were 3.55 and 3.36 respectively. CONCLUSIONS: With image-guided navigation, authors could achieve faster and more complete MOC. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.267
P26. Comparison of Range of Motion Following Cervical Spine Decompression Surgical Procedures and the Effect on Patient Satisfaction Kevin Bell, MS1, Charise Shively, BS2, Erik Frazier, MS2, Robert Hartman3, Joon Y. Lee, MD2, James Kang, MD2, William Donaldson, III, MD2; 1Pittsburgh, PA, USA; 2University of Pittsburgh, Pittsburgh, PA, USA; 3Pittsburgh, PA, USA BACKGROUND CONTEXT: Operative treatment options for cervical decompression include anterior and/or posterior procedures aimed at expansion of the spinal canal. Direct comparison of the postoperative success of these treatments using cervical range of motion (CROM) and the Neck Disability Index (NDI) will provide objective data adding to the clinical knowledge base. PURPOSE: The purpose of this research study is to compare CROM and NDI scores for the decompressive surgical treatments to an age-matched,