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P55. Obese patients achieve similar mental health benefit as nonobese patients after adult spinal deformity surgery
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S158−S194 BACKGROUND CONTEXT: Lumbar total disc replacements (TDR) come in a variety of designs. The two primary device endplate designs for anchoring the device in the disc space use multiple spikes or have a keel. To date, the possible impact device design and endplate anchoring type on device motion have not been investigated. PURPOSE: The purpose of the study was to determine if different endplate designs for lumbar TDR devices impact long term radiographic outcomes in patients, and whether the outcomes are the same for L4-5 and L5-S1 level procedures. STUDY DESIGN/SETTING: The study was based on post-hoc analyses of prospectively collected data. PATIENT SAMPLE: The study included 282 patients who received single-level TDR at L4-5 or L5-S1 to treat degenerative disc disease unresponsive to at least 6 month of nonoperative care. All patients fulfilled the same selection criteria as described in the FDA IDE trial protocol. OUTCOME MEASURES: Measures included segmental range of motion (ROM) of the operated level measured on flexion/extension radiographs, adjacent segment degeneration (ASD), and heterotopic ossification (HO). All radiographic measurements were conducted by a centralized lab specializing in image assessments. METHODS: Patients were grouped based on device and endplate design: mobile core device (MCD) with either spike (n=115) or keel endplate (n=102), and constrained core device (CCD) with keel endplate (n=65). Assessments were conducted prior to surgery and at predefined points after surgery. This study was based on the 2- and 5-year follow-up points. RESULTS: ROM was maintained or improved from baseline values for both spike and keel MCD at 2 years (7.8o (p<0.05) and 6.3o, respectively) and 5 years (6.7o and 5.6o), whereas ROM was significantly lower with keel CCD at both time points (4.5o (p<0.025) and 2.8o (p<0.05)). Overall, motion was greater at L4-5 than L5-S1 for all device and endplate designs. However, at L5-S1 motion was best preserved with keel MCD (DROM: 1.8o and 0.6o) and deteriorated most with keel CCD (DROM: 0.8o and -0.4o) at 2 and 5 years. In addition, at 5 years ROM success (DROM>0o) was significantly greater with keel MCD compared to keel CCD at L5-S1 (77% vs. 48%, p<0.05), but similar between groups at L4-5. The percentage of patients presenting with new or worsening ASD at 5 years was lowest for patients with spike MCD (2.9%) and highest with keel CCD (15.4%, p<0.05). ASD developed/worsened superior to L5-S1 for patients with keel CCD, but developed similarly for both treatment levels in patients with keel MCD. With respect to HO, a greater percentage of patients with keel CCD developed Class I and II HO at L4-L5 (p<0.05) and Class III and IV HO at L5-S1. Overall, device subsidence and migration rates were greater for patients with keel CCD (4.6% and 1.5%) compared with spike MCD (1.7% and 0.9%) or keel MCD (1.0% and 2.0%). CONCLUSIONS: This study found that radiographic outcomes are impacted by the device and endplate design of lumbar TDRs. Radiographic outcomes were generally better at L4-5 than L5-S1 for all device and device endplate designs. However, at L5-S1 motion was preserved in a greater proportion of patients with keel MCD. Furthermore, ASD had a greater propensity to develop or worsen with keel CCD at L5-S1 where motion was significantly lower at follow-up compared with baseline. FDA DEVICE/DRUG STATUS: activL (Approved for this indication), ProDisc-L (Approved for this indication)
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PURPOSE: The purpose of this study was to compare the clinical outcomes and complications between the two methods for CSM with ISI on T2WI. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: A total of 64 patients. OUTCOME MEASURES: The modified-Japanese Orthopedic Association (m-JOA) score, the Visual Analogue Scale (VAS) score, the Neck Disability Index(NDI) and the physical and mental component scores (PCS and MCS) of the Short-Form 36 (SF36) of the two groups were recorded. The cervical curvature, the hight of adjacent intervertebral disc, extension and flexion range of motion (ROM) of the two groups were recorded. The indicators and complications of the two groups were compared. METHODS: We analyzed 32 patients with CSM with ISI on T2WI who underwent CDA from January 2015 to January 2017 (CDA Group). The modified-Japanese Orthopedic Association (m-JOA) score, the Visual Analogue Scale (VAS) score, the Neck Disability Index (NDI) and the physical and mental component scores (PCS and MCS) of the Short-Form 36 (SF36) of the two groups were recorded. The cervical curvature, the hight of adjacent intervertebral disc, extension and flexion range of motion (ROM) of the two groups were recorded. Propensity score matching identified 32 patients (ACDF Group) as controls, who underwent ACDF, from January 2010 to January 2015 using 6 independent variables (pre-operation): age, sex, m-JOA, SF36 PCS, SF36 MCS and tobacco use. RESULTS: There were no statistical difference in the baseline of the two groups. At the last follow-up, the m-JOA, VAS, NDI and SF-36 (PCS and MCS) scores of the two groups were all significantly improved. But NDI and SF-36 PCS and SF-36 MCS were better in CDA Group at the final follow-up. The the height of adjacent intervertebral disc, extension and flexion ROM were lost in ACDF group. The complication rate was higher in the ACDF group. CONCLUSIONS: Our results showed that both ACDF and CDA could achieve satisfactory neurological recovery for CSM with ISI on T2WI. But CDA had better clinical outcomes and lower complication rate at the final follow up. However, these results require further validation and investigation in high evidence researches. FDA DEVICE/DRUG STATUS: Unavailable from authors at time of publication. https://doi.org/10.1016/j.spinee.2019.05.478
ePosters: Psychosocial/Behavioral
P54. Cervical disc arthroplasty versus anterior cervical discectomy with fusion for cervical spondylotic myelopathy with increased signal intensity on magnetic resonance imaging Jia Nan Zhang, MD; Xi’an, Shaan’Xi, China
P55. Obese patients achieve similar mental health benefit as nonobese patients after adult spinal deformity surgery David O. Okonkwo, MD1, Richard G. Fessler, MD, PhD2, Khoi D. Than, MD3, Stacie Tran, MPH4, Dean Chou, MD5, Kai-Ming G. Fu, MD, PhD6, Paul Park, MD7, Michael Y. Wang, MD8, Adam S. Kanter, MD9, Pierce D. Nunley, MD10, Juan S. Uribe, MD11, Robert K. Eastlack, MD12, Gregory M. Mundis Jr., MD13, International Spine Study Group14; 1 Pittsburgh, PA, US; 2 Rush University Medical Center, Department of Neuro Surgery, Chicago, IL, US; 3 Oregon Health & Science University, Portland, OR, US; 4 San Diego Spine Foundation, San Diego, CA, US; 5 University of California San Francisco, San Francisco, CA, US; 6 Weill Cornell Medicine/NewYork Presbyterian, New York, NY, US; 7 University of Michigan Department of Neurosurgery, Ann Arbor, MI, US; 8 University of Miami, Dept of Neurosurgery, Miami, FL, US; 9 UPMC-Presbyterian/Dept of Neurological Surgery, Pittsburgh, PA, US; 10 Spine Institute of Louisiana, Shreveport, LA, US; 11 Barrow Neurological Institute, Phoenix, AZ, US; 12 Scripps Clinic, San Diego, CA, US; 13 Scripps Clinic Medical Group, Department of Orthopedics, La Jolla, CA, US; 14 Brighton, CO, US
BACKGROUND CONTEXT: The clinical outcomes of cervical disc arthroplasty (CDA) versus anterior cervical discectomy with fusion (ACDF) for cervical spondylotic myelopathy (CSM) with with increased signal intensity (ISI) on T2-weighted images (T2WI) is still not clear.
BACKGROUND CONTEXT: Previous research on the impact of obesity on outcomes after adult spinal deformity surgery has reported radiographic and clinical outcomes, but no analysis has compared the mental health status and outcomes in these patients.
https://doi.org/10.1016/j.spinee.2019.05.477
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.
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S158−S194
PURPOSE: This study examines the pre- and postoperative SF 36 mental health status in obese and non-obese patients undergoing correction of adult degenerative scoliosis. STUDY DESIGN/SETTING: Multicenter prospective analysis of adult spinal deformity database. PATIENT SAMPLE: A prospective, multicenter database of ASD patients was reviewed. Patients who had at least 2 years follow-up were analyzed. OUTCOME MEASURES: Demographic and pre- and post-operative SF36 mental health scores were assessed. A BMI threshold of 35 was selected to more accurately reflect real-world perception of obesity. METHODS: A prospective database was analyzed using paired t-test and Mann-Whitney U analysis for continuous variables and Chi-Square analysis for categorical variables. RESULTS: A total of 120 patients were included; 60 had a BMI <35, and 60 had a BMI >35. Patients were propensity matched on pre-operative SVA, PI-LL, and Cobb angle. There were no differences between groups in age, number of levels instrumented, pre-operative back pain, ODI, SRS22, Sacral slope, Cobb angle or PI-LL. When comparing patients with a BMI threshold of 35, there was no difference in pre-operative mental health (42 vs 44.2; p <0.291). Post-operatively, there also was no significant difference in the overall SF-36 mental health scores (49.2 vs 48.8, p <0.827). However, although not statistically significant the absolute “change” in SF-36 scores was greater in the non-obese patients than in the obese patients (7.1 vs 4,7, p<0.223). It is possible, therefore, that obesity may negatively impact post-operative mental health and satisfaction independent of pre-operative mental health. This would be consistent with previous data demonstrating poorer outcomes in some outcome measures in obese patients following correction of ASD. CONCLUSIONS: In this prospective evaluation of a large database of patients undergoing correction of ASD, patients with BMI >35 were not significantly different from non-obese patients pre-operatively or postoperatively. Furthermore, they experience similar improvement in mental health scores post-operatively compared to non-obese patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.479
P56. Preoperative patient activation is not associated with inpatient pain or narcotic utilization after minimally invasive lumbar discectomy Joon S. Yoo, BA1, Dil V. Patel, BS2, Benjamin Khechen, BA3, Brittany E. Haws, MD2, Ankur S. Narain, BA4, Arash Sayari, BS, MD2, Eric H. Lamoutte, BS3, Sailee S. Karmarkar, BS3, Kern Singh, MD2; 1 Chicago, IL, US; 2 Rush University Medical Center, Chicago, IL, US; 3 Midwest Orthopaedics at Rush, Chicago, IL, US; 4 Rush University Medical CenterDepartment of Orthopaedic Surgery, Chicago, IL, US BACKGROUND CONTEXT: Minimally invasive lumbar microdiscectomy (MIS LD) is a commonly utilized treatment for symptomatic lumbar disc herniations. Recent investigations have focused on the role of patient engagement and involvement in their postoperative outcomes, referred to as patient activation. Increased patient activation has been associated with superior pain relief and functional recovery after spine procedures. However, no previous study has investigated the association of patient activation with immediate postoperative pain and narcotic consumption following MIS spinal procedures. PURPOSE: To determine if an association exists between preoperative Patient Activation Measure (PAM) score and inpatient postoperative pain scores and narcotic utilization after MIS LD. STUDY DESIGN/SETTING: Retrospective analysis. PATIENT SAMPLE: Forty-seven patients with complete PAM scores and postoperative pain records who underwent primary, single-level MIS LD from 2015-2017.
OUTCOME MEASURES: Inpatient Visual Analogue Scale (VAS) pain score and inpatient narcotic consumption, quantified as oral morphine equivalents (OMEs). METHODS: A prospectively maintained surgical database of patients who underwent primary, single-level MIS LD from 2015-2017 for degenerative pathology was retrospectively reviewed. Patients were grouped by top and bottom halves of preoperative PAM score (≤62, >62). VAS pain scores were used to characterize postoperative pain perception in patients. Inpatient narcotic consumption through discharge were quantified as OMEs. PAM score group was tested for an association with preoperative demographic and perioperative characteristics using student’s t-test and chi-square analysis for continuous and categorical variables, respectively. Multivariate linear regression was used to test for an association between PAM score group and inpatient pain scores, and narcotic consumption on postoperative day (POD) 0. RESULTS: Of the 47 patients were included in this analysis, 46.8% (22) had a PAM score of ≤62, while 53.2% (25) had a PAM score of >62. There were no significant differences in age, gender, body mass index, smoking status, preoperative comorbidity burden, or preoperative VAS pain score between cohorts (p>0.05 for each). Additionally, there were no significant differences between PAM score groups in regards to perioperative variables including operative time, estimated blood loss, and length of inpatient stay (p>0.05 for each). Finally, there were no significant differences in VAS pain scores or total and hourly narcotic consumption between PAM score groups and on POD 0 after MIS LD (p>0.05 for each). CONCLUSIONS: Patient engagement and involvement, as measured by PAM score, was not associated with demographic or perioperative differences among those undergoing MIS LD. Additionally, patient activation was not a predictive factor for perceived pain and narcotics use in the immediate postoperative period after MIS LD. The reduced surgical trauma of MIS LD compared to other spine procedures limits the degree of postoperative pain that patients experience, thus reducing overall narcotic requirement. This may minimize the effect of patient motivation and therefore patient activation on postoperative narcotic use in this cohort. More investigation is required, specifically analyzing the role of patient activation in long-term, post-discharge narcotics usage and dependence after MIS procedures. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.480
P57. Are preoperative PHQ-9 scores predictive of postoperative outcomes improvement following anterior cervical discectomy and fusion? Joon S. Yoo, BA1, Dil V. Patel, BS2, Brittany E. Haws, MD2, Benjamin Khechen, BA3, Sailee S. Karmarkar, BS3, Eric H. Lamoutte, BS3, Kern Singh, MD2; 1 Chicago, IL, US; 2 Rush University Medical Center, Chicago, IL, US; 3 Midwest Orthopaedics at Rush, Chicago, IL, US BACKGROUND CONTEXT: Few studies have quantified depression symptoms in the preoperative period using a validated metric such as Patient Health Questionnaire-9 (PHQ-9) and have tracked patient-reported outcomes (PROs) following common spinal procedures, such as an anterior cervical discectomy and fusion (ACDF). PURPOSE: This study aims to determine if there is an association between preoperative depression, as quantified by PHQ-9, and postoperative improvement in pain and disability after an ACDF. STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: A total of 119 patients undergoing a primary, oneto three-level ACDF. OUTCOME MEASURES: NDI, VAS Neck and Arm Pain, SF-12 PCS. METHODS: Patients undergoing a primary, 1- to 3-level ACDF were retrospectively reviewed and stratified by their preoperative PHQ-9 score: minimal to no depression (<5) or mild to severe depression (≥5). PROs,
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.
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PURPOSE: The purpose of this study was to compare the clinical outcomes and complications between the two methods for CSM with ISI on T2WI. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: A total of 64 patients. OUTCOME MEASURES: The modified-Japanese Orthopedic Association (m-JOA) score, the Visual Analogue Scale (VAS) score, the Neck Disability Index(NDI) and the physical and mental component scores (PCS and MCS) of the Short-Form 36 (SF36) of the two groups were recorded. The cervical curvature, the hight of adjacent intervertebral disc, extension and flexion range of motion (ROM) of the two groups were recorded. The indicators and complications of the two groups were compared. METHODS: We analyzed 32 patients with CSM with ISI on T2WI who underwent CDA from January 2015 to January 2017 (CDA Group). The modified-Japanese Orthopedic Association (m-JOA) score, the Visual Analogue Scale (VAS) score, the Neck Disability Index (NDI) and the physical and mental component scores (PCS and MCS) of the Short-Form 36 (SF36) of the two groups were recorded. The cervical curvature, the hight of adjacent intervertebral disc, extension and flexion range of motion (ROM) of the two groups were recorded. Propensity score matching identified 32 patients (ACDF Group) as controls, who underwent ACDF, from January 2010 to January 2015 using 6 independent variables (pre-operation): age, sex, m-JOA, SF36 PCS, SF36 MCS and tobacco use. RESULTS: There were no statistical difference in the baseline of the two groups. At the last follow-up, the m-JOA, VAS, NDI and SF-36 (PCS and MCS) scores of the two groups were all significantly improved. But NDI and SF-36 PCS and SF-36 MCS were better in CDA Group at the final follow-up. The the height of adjacent intervertebral disc, extension and flexion ROM were lost in ACDF group. The complication rate was higher in the ACDF group. CONCLUSIONS: Our results showed that both ACDF and CDA could achieve satisfactory neurological recovery for CSM with ISI on T2WI. But CDA had better clinical outcomes and lower complication rate at the final follow up. However, these results require further validation and investigation in high evidence researches. FDA DEVICE/DRUG STATUS: Unavailable from authors at time of publication. https://doi.org/10.1016/j.spinee.2019.05.478
ePosters: Psychosocial/Behavioral
P54. Cervical disc arthroplasty versus anterior cervical discectomy with fusion for cervical spondylotic myelopathy with increased signal intensity on magnetic resonance imaging Jia Nan Zhang, MD; Xi’an, Shaan’Xi, China
P55. Obese patients achieve similar mental health benefit as nonobese patients after adult spinal deformity surgery David O. Okonkwo, MD1, Richard G. Fessler, MD, PhD2, Khoi D. Than, MD3, Stacie Tran, MPH4, Dean Chou, MD5, Kai-Ming G. Fu, MD, PhD6, Paul Park, MD7, Michael Y. Wang, MD8, Adam S. Kanter, MD9, Pierce D. Nunley, MD10, Juan S. Uribe, MD11, Robert K. Eastlack, MD12, Gregory M. Mundis Jr., MD13, International Spine Study Group14; 1 Pittsburgh, PA, US; 2 Rush University Medical Center, Department of Neuro Surgery, Chicago, IL, US; 3 Oregon Health & Science University, Portland, OR, US; 4 San Diego Spine Foundation, San Diego, CA, US; 5 University of California San Francisco, San Francisco, CA, US; 6 Weill Cornell Medicine/NewYork Presbyterian, New York, NY, US; 7 University of Michigan Department of Neurosurgery, Ann Arbor, MI, US; 8 University of Miami, Dept of Neurosurgery, Miami, FL, US; 9 UPMC-Presbyterian/Dept of Neurological Surgery, Pittsburgh, PA, US; 10 Spine Institute of Louisiana, Shreveport, LA, US; 11 Barrow Neurological Institute, Phoenix, AZ, US; 12 Scripps Clinic, San Diego, CA, US; 13 Scripps Clinic Medical Group, Department of Orthopedics, La Jolla, CA, US; 14 Brighton, CO, US
BACKGROUND CONTEXT: The clinical outcomes of cervical disc arthroplasty (CDA) versus anterior cervical discectomy with fusion (ACDF) for cervical spondylotic myelopathy (CSM) with with increased signal intensity (ISI) on T2-weighted images (T2WI) is still not clear.
BACKGROUND CONTEXT: Previous research on the impact of obesity on outcomes after adult spinal deformity surgery has reported radiographic and clinical outcomes, but no analysis has compared the mental health status and outcomes in these patients.
https://doi.org/10.1016/j.spinee.2019.05.477
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.
S184
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S158−S194
PURPOSE: This study examines the pre- and postoperative SF 36 mental health status in obese and non-obese patients undergoing correction of adult degenerative scoliosis. STUDY DESIGN/SETTING: Multicenter prospective analysis of adult spinal deformity database. PATIENT SAMPLE: A prospective, multicenter database of ASD patients was reviewed. Patients who had at least 2 years follow-up were analyzed. OUTCOME MEASURES: Demographic and pre- and post-operative SF36 mental health scores were assessed. A BMI threshold of 35 was selected to more accurately reflect real-world perception of obesity. METHODS: A prospective database was analyzed using paired t-test and Mann-Whitney U analysis for continuous variables and Chi-Square analysis for categorical variables. RESULTS: A total of 120 patients were included; 60 had a BMI <35, and 60 had a BMI >35. Patients were propensity matched on pre-operative SVA, PI-LL, and Cobb angle. There were no differences between groups in age, number of levels instrumented, pre-operative back pain, ODI, SRS22, Sacral slope, Cobb angle or PI-LL. When comparing patients with a BMI threshold of 35, there was no difference in pre-operative mental health (42 vs 44.2; p <0.291). Post-operatively, there also was no significant difference in the overall SF-36 mental health scores (49.2 vs 48.8, p <0.827). However, although not statistically significant the absolute “change” in SF-36 scores was greater in the non-obese patients than in the obese patients (7.1 vs 4,7, p<0.223). It is possible, therefore, that obesity may negatively impact post-operative mental health and satisfaction independent of pre-operative mental health. This would be consistent with previous data demonstrating poorer outcomes in some outcome measures in obese patients following correction of ASD. CONCLUSIONS: In this prospective evaluation of a large database of patients undergoing correction of ASD, patients with BMI >35 were not significantly different from non-obese patients pre-operatively or postoperatively. Furthermore, they experience similar improvement in mental health scores post-operatively compared to non-obese patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.479
P56. Preoperative patient activation is not associated with inpatient pain or narcotic utilization after minimally invasive lumbar discectomy Joon S. Yoo, BA1, Dil V. Patel, BS2, Benjamin Khechen, BA3, Brittany E. Haws, MD2, Ankur S. Narain, BA4, Arash Sayari, BS, MD2, Eric H. Lamoutte, BS3, Sailee S. Karmarkar, BS3, Kern Singh, MD2; 1 Chicago, IL, US; 2 Rush University Medical Center, Chicago, IL, US; 3 Midwest Orthopaedics at Rush, Chicago, IL, US; 4 Rush University Medical CenterDepartment of Orthopaedic Surgery, Chicago, IL, US BACKGROUND CONTEXT: Minimally invasive lumbar microdiscectomy (MIS LD) is a commonly utilized treatment for symptomatic lumbar disc herniations. Recent investigations have focused on the role of patient engagement and involvement in their postoperative outcomes, referred to as patient activation. Increased patient activation has been associated with superior pain relief and functional recovery after spine procedures. However, no previous study has investigated the association of patient activation with immediate postoperative pain and narcotic consumption following MIS spinal procedures. PURPOSE: To determine if an association exists between preoperative Patient Activation Measure (PAM) score and inpatient postoperative pain scores and narcotic utilization after MIS LD. STUDY DESIGN/SETTING: Retrospective analysis. PATIENT SAMPLE: Forty-seven patients with complete PAM scores and postoperative pain records who underwent primary, single-level MIS LD from 2015-2017.
OUTCOME MEASURES: Inpatient Visual Analogue Scale (VAS) pain score and inpatient narcotic consumption, quantified as oral morphine equivalents (OMEs). METHODS: A prospectively maintained surgical database of patients who underwent primary, single-level MIS LD from 2015-2017 for degenerative pathology was retrospectively reviewed. Patients were grouped by top and bottom halves of preoperative PAM score (≤62, >62). VAS pain scores were used to characterize postoperative pain perception in patients. Inpatient narcotic consumption through discharge were quantified as OMEs. PAM score group was tested for an association with preoperative demographic and perioperative characteristics using student’s t-test and chi-square analysis for continuous and categorical variables, respectively. Multivariate linear regression was used to test for an association between PAM score group and inpatient pain scores, and narcotic consumption on postoperative day (POD) 0. RESULTS: Of the 47 patients were included in this analysis, 46.8% (22) had a PAM score of ≤62, while 53.2% (25) had a PAM score of >62. There were no significant differences in age, gender, body mass index, smoking status, preoperative comorbidity burden, or preoperative VAS pain score between cohorts (p>0.05 for each). Additionally, there were no significant differences between PAM score groups in regards to perioperative variables including operative time, estimated blood loss, and length of inpatient stay (p>0.05 for each). Finally, there were no significant differences in VAS pain scores or total and hourly narcotic consumption between PAM score groups and on POD 0 after MIS LD (p>0.05 for each). CONCLUSIONS: Patient engagement and involvement, as measured by PAM score, was not associated with demographic or perioperative differences among those undergoing MIS LD. Additionally, patient activation was not a predictive factor for perceived pain and narcotics use in the immediate postoperative period after MIS LD. The reduced surgical trauma of MIS LD compared to other spine procedures limits the degree of postoperative pain that patients experience, thus reducing overall narcotic requirement. This may minimize the effect of patient motivation and therefore patient activation on postoperative narcotic use in this cohort. More investigation is required, specifically analyzing the role of patient activation in long-term, post-discharge narcotics usage and dependence after MIS procedures. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.480
P57. Are preoperative PHQ-9 scores predictive of postoperative outcomes improvement following anterior cervical discectomy and fusion? Joon S. Yoo, BA1, Dil V. Patel, BS2, Brittany E. Haws, MD2, Benjamin Khechen, BA3, Sailee S. Karmarkar, BS3, Eric H. Lamoutte, BS3, Kern Singh, MD2; 1 Chicago, IL, US; 2 Rush University Medical Center, Chicago, IL, US; 3 Midwest Orthopaedics at Rush, Chicago, IL, US BACKGROUND CONTEXT: Few studies have quantified depression symptoms in the preoperative period using a validated metric such as Patient Health Questionnaire-9 (PHQ-9) and have tracked patient-reported outcomes (PROs) following common spinal procedures, such as an anterior cervical discectomy and fusion (ACDF). PURPOSE: This study aims to determine if there is an association between preoperative depression, as quantified by PHQ-9, and postoperative improvement in pain and disability after an ACDF. STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: A total of 119 patients undergoing a primary, oneto three-level ACDF. OUTCOME MEASURES: NDI, VAS Neck and Arm Pain, SF-12 PCS. METHODS: Patients undergoing a primary, 1- to 3-level ACDF were retrospectively reviewed and stratified by their preoperative PHQ-9 score: minimal to no depression (<5) or mild to severe depression (≥5). PROs,
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.