P38. Functional Spinal Range of Motion During Twelve Activities of Daily Living

120S

Proceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S

capability of differentiating into osteoblasts. However, it is well known that the number of BMSCs with osteogenic potential decreases in patients with old age, osteoporosis, and metabolic diseases. In such conditions, xenogenic BMSCs may provide an alterative to autologous BMSCs. PURPOSE: In the current study, we investigated the potential of transplanted xenogenic BMSCs to survive and induce new bone formation in the posterolateral lumbar spine of non-immunosuppressed rabbits. STUDY DESIGN/ SETTING: Animal In Vivo Study. PATIENT SAMPLE: 32 non-immonusuppressed rabbits (16 experimental and 16 control). OUTCOME MEASURES: Plain radiographs, Histology, PCR, Immunohistochemistry. METHODS: BMSCs were obtained from bilateral femurs of four male rats, cultured and expanded in medium with osteoinduction supplement and BrdU. BMSCs (5  106 cells) of male rats loaded onto 5cc compression resistant matrix (CRM; Medtronic Sofamor Danek, USA) were implanted bilaterally onto the L4-5 intertransverse processes of 16 female rabbits (xenogenic BMSCsþCRM group). 16 female rabbits that received 5cc CRM alone were used as controls (CRM alone group). To exclude the possibility of migration of BMSCs from the transverse processes of the recipient rabbits, we did not decorticate the transverse processes. No rabbits received any immunosuppressive medications during the experiment. Four rabbits each in both of the experimental and control groups were sacrificed at 1, 2, 4, and 6 months post-implantation, and the lumbar spine underwent radiological and histological analyses for evaluation of new bone formation. The PCR (polymerase chain reaction) for Sry gene (Y-chromosome-specific marker) and anti-BrdU stain were used to evaluate the survival of transplanted xenogenic BMSCs. RESULTS: The expression of Sry gene was in the lumbar spines of xenogenic BMSCsþCRM group at 1 to 6 months post-implantation. In addition, strong immunoreactivity of BrdU was identified on osteoblasts and osteocytes of the newly formed bones. Serial plain radiographs showed gradual resorption of CRM and presence of callus material at 4 and 6 months postimplantation; however, it was difficult to clearly identify the new bone formation due to the radiopacity of the remaining CRM. Histologically, mature lamellar and woven bone with osteoblasts and osteocytes were identified in xenogenic BMSCsþCRM group at 4 and 6 months post-implantation, but not at 1 and 2 months post-implantation. None of CRM alone group showed new bone formation at 1 to 6 months post-implantation. Mild infiltration of inflammatory cells was identified around the CRM carriers in both groups. No postoperative wound infection was found in either group. CONCLUSIONS: Our results indicate that xenogenic BMSCs loaded onto CRM survive and induce new bone formation when placed into the posterolateral lumbar spine of rabbits without immunosuppression. To determine if a solid fusion can be achieved with such techniques, further studies are needed to investigate the appropriate dose of xenogenic BMSCs, amounts of CRM, and the requisite incubation time. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.280

P38. Functional Spinal Range of Motion During Twelve Activities of Daily Living Jesse Bible, BS, Debdut Biswas, BA, Christopher Miller, MD, Peter Whang, MD, Jonathan Grauer, MD; Yale University, New Haven, CT, USA BACKGROUND CONTEXT: Previous studies looking at activities of daily living (ADL) have only focused on a single portion of the spine, utilized measuring devices that inhibit active range of motion (ROM), and investigated a few ADLs. PURPOSE: The purpose of this study was to determine the extremes of cervical and lumbar ROM and compare these results to those used to perform 12 different ADLs in an asymptomatic group of subjects. STUDY DESIGN/ SETTING: Observational Study

PATIENT SAMPLE: To perform reliability analyses on the non-invasive electrogoniometer measuring system, 30 symptomatic patients that were seen in spine clinic for cervical or lumbar spine issues requiring dynamic flexion/extension radiographs to be obtained as the standard of care for their work-up. In addition, 60 subjects from an asymptomatic population, in order to determine the average ROM for both the cervical and lumbar spine during ADLs. OUTCOME MEASURES: The inter- and intra-measurement variabilities for the electrogoniometer measuring system and the ROM used during specific ADLs. METHODS: The accuracy and reliability of the electrogoniometers for measuring cervical and lumbar ROM was assessed in 30 patients by comparing the ROM measured on dynamic flexion/extension radiographs versus measurements made by the device worn while the radiographs were obtained. The full active ROM in the cervical and lumbar spine (flexion, extension, and lateral bending) was measured in 60 asymptomatic subjects, along with the functional ROM during 12 ADLs in a clinical laboratory setting. RESULTS: Regression analysis found little inter-instrument measurement variability with a good Pearson’s r correlation coefficient between dynamic radiographs and the electrogoniometer. Additionally, the intraclass correlation coefficient for repeated measurements made by two different investigators using the electrogoniometers were acceptable. Personal grooming and hygiene ADLs, such as putting on socks and shaving, required the largest percentage of each subjects full spinal ROM. Locomotive ADLs, such as walking and climbing stairs, required significantly less ROM. CONCLUSIONS: This study found the non-invasive electrogoniometer system to be a valid and reliable method in measuring ROM in both cervical and lumbar spine. This study also supplies values for the amount of motion required to perform several ADLs. This information provides the clinician baseline data to which impairment and post-surgical scenarios can be compared. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.281

P39. Epidural Spinal Cord Compression with Neurologic Deficit Associated with Intrapedicular Application of FloSeal during Pedicle Screw Insertion Jacob Buchowski, MD, Christopher Good, MD, Lawrence Lenke, MD, Keith Bridwell, MD; Washington University in St. Louis, St. Louis, MO, USA BACKGROUND CONTEXT: Variety of hemostatic agents can control bleeding during pedicle screw insertion. We have often used FloSeal (Baxter, Inc., Deerfield, IL) to decrease bleeding from cannulated pedicles by injecting the material into the pedicle after manually palpating the pedicle. PURPOSE: The purpose of this report is to demonstrate the dangers of using FloSeal to decrease bleeding from cannulated pedicles by presenting two patients who–as a result of inadvertent extravasation of the matrix into the spinal canal–developed epidural spinal cord compression (ESCC) requiring emergent decompression. STUDY DESIGN/ SETTING: Case study. PATIENT SAMPLE: Two consecutive patients with AIS who underwent surgical treatment of their deformity and developed ESCC with neurologic deficit requiring emergent decompression due to extravasation of FloSeal. OUTCOME MEASURES: Clinical outcome measures and radiographic findings. METHODS: Medical records and radiographic studies of the two patients were reviewed and summarized. RESULTS: A 15 y.o. male underwent T4-L2 posterior spinal fusion (PSF). During pedicle screw insertion, a change in NMEPs and SSEPs was noted. A wake-up test confirmed bilateral LE paraplegia. Screws were removed and no perforations were noted on manual palpation. MRI showed T5-