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P55. The Occurrence and Degree of Cement Leakage Following Vertebral Body Augmentation: A Comparison of the Confidence Vertebral Augmentation System and Kyphoplasty
144S
Proceedings of the NASS 24th Annual Meeting / The Spine Journal 9 (2009) 1S-205S
were used to model the probability of each source of LBP (IDD, PFJ, and SIJ) vs any other source. The predictor variables considered were age group (& 55 years, O 55 years) presence/absence of midline LBP, paramidline LBP, hip/girdle pain, leg pain, thigh pain, pain during SHF and/ or PR. Backwards selection methods were used to reduce the models to retain only the significant independent predictor variables. RESULTS: 328 cases from 310 subjects (34% male), were reviewed with a mean age of 52.7 years (SD 5 15.0) and median duration of LBP of 12 months (IQR 5 6 – 24). LBP duration 5 3 months in 11%, 3 to 6 months in 24%, and O 6 months in 65%. 189 cases were excluded from calculations due to lack of definitive diagnostic procedures. A multiple logistic regression model indicated that midline LBP (p-value ! 0.0001), pain during SHF (p-value 5 0.0008), and age group (p-value 5 0.0003) were significant independent predictors of the probability of IDD (table 1). Only midline LBP was found an independent predictor of FJA and SIJ pain (p-values ! 0.0001 for each) (table 2). CONCLUSIONS: Patients report of midline LBP which is exacerbated by SHF in the young adult is strongly predictive of lumbar IDD as the source of the patient’s symptoms. Conversely, absence of midline LBP regardless of SHF findings or age, is a strong predictor that an intervertebral disc is not the source of the patient’s LBP and strong consideration of a facet or sacroiliac joint should be exercised by the investigating clinician.
PATIENT SAMPLE: A series of 65 consecutively treated patients were identified for the review. There were a total of 105 levels, 58 Confidence and 47 kyphoplasty–treated levels, which ranged from T5 to L5. OUTCOME MEASURES: The degree of leakage was assessed at each treated level using a strict 4-point scale (none, minimal, moderate, severe). The pattern of any observed leakage was also characterized as: discal, venous (paravetebral), or epidural. METHODS: The radiographic reviewer was blinded to the treatment group. Each film was assessed for percent collapse, evidence of cement leakage, as well as degree and pattern of any noted leak. RESULTS: The average vertebral collapse was 26% in the Confidence group vs. 25% in the kyphoplasty group. There was no or minimal leakage in 91% Confidence and 85% kyphoplasty cases (minimal: 36% Confidence vs. 38% kyphoplasty). Severe leakage was only reported in 1 (2%) Confidence and 1 (2%) kyphoplasty cases. In both cases, the severe leakage was found in the disc space. No significant leakage was noticed that required any surgical intervention. CONCLUSIONS: The leakage rate with the high viscosity Confidence Vertebral Augmentation System is comparable to that of kyphoplasty. High viscosity cements and specialized delivery systems may reduce the risk of leaks for standard vertebral body augmentation. FDA DEVICE/DRUG STATUS: Confidence System: Approved for this indication. doi: 10.1016/j.spinee.2009.08.314
P56. Incidence of Symptomatic Spondylolysis Associated with Spina Bifida Occulta Nicola Vannet1, Stuart James, FRCS1, Kathleen Hammer1, Sashin Ahuja, MD2; 1 University Hospital of Wales, Cardiff, Wales, United Kingdom; 2 University of Wales Institute, Cardiff, South Wales, United Kingdom
Table 1.
Table 2.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.313
P55. The Occurrence and Degree of Cement Leakage Following Vertebral Body Augmentation: A Comparison of the Confidence Vertebral Augmentation System and Kyphoplasty Bassem Georgy, MD; University of California, San Diego, San Diego, CA, USA BACKGROUND CONTEXT: Vertebroplasty was known for relatively high cement leakage rates compared to kyphoplasty. Advances in delivery systems and new high viscosity cements provide enhanced control and uniformity of cement filling during vertebroplasty compared to the previously available technology(1). PURPOSE: This study was conducted to assess the incidence and pattern of cement leakage with Confidence compared to kyphoplasty. STUDY DESIGN/SETTING: This is single center retrospective review of post-operative radiographs of consecutive patients treated with either kyphoplasty or Confidence
BACKGROUND CONTEXT: The simultaneous occurrence of spina bifida occulta (SBO) and spondylolysis has been noted previously. The occurrence of SBO and spondylolysis are approximately 17% and 5% respectively. PURPOSE: The aim of this study was to determine the incidence of SBO when a symptomatic spondylolysis has been proven. STUDY DESIGN/SETTING: This was a retrospecitve review of radiological studies on patients with back pain using the IMPAX radiology system. This was performed in the Spinal unit of the University Hospital of Wales. PATIENT SAMPLE: Patient data was reviewed retrospectively using all lumbar spine CT scans performed in the spinal unit in the last five years. OUTCOME MEASURES: A positive association was determined by the finding of an associated spina bifida in patients with a spondylolysis found on CT. METHODS: Analysis of five years of lumbar spine CT scans was performed. Patients with spondylolysis or spondylolisthesis caused by a pars defect were identified. These patients’ CT images were then reviewed to establish the patients who also had SBO. RESULTS: 650 CT scans of lumbar spines were performed in the last five years. 100 (15%) were found to have a pars defect. The average age was 34.6. On CT 30 (30%) patients had SBO. 23 were under 18 years old and 13 (56%) of these patients had SBO associated with the spondylolysis. In the over 18 year olds 21 (27%) patients had SBO associated with spondylolysis. On review of the 550 other scans the average age was 51.9 years old. The incidence of SBO within this group is 10%. Only 6% of these patients were under 18. Out of these 33 patients 30.3% (10 patients) had SBO. Over 18 the incidence of SBO was only 8.5%. CONCLUSIONS: Our results indicate that the occurrence of SBO within the group with a spondylolysis is much higher than in the group where no spondylolysis is present. There is higher incidence of SBO in the younger patients with spondylolysis. 56% of paediatric patients with symptomatic spondylolysis will have SBO. Clinicians should be aware of this fact
Proceedings of the NASS 24th Annual Meeting / The Spine Journal 9 (2009) 1S-205S
were used to model the probability of each source of LBP (IDD, PFJ, and SIJ) vs any other source. The predictor variables considered were age group (& 55 years, O 55 years) presence/absence of midline LBP, paramidline LBP, hip/girdle pain, leg pain, thigh pain, pain during SHF and/ or PR. Backwards selection methods were used to reduce the models to retain only the significant independent predictor variables. RESULTS: 328 cases from 310 subjects (34% male), were reviewed with a mean age of 52.7 years (SD 5 15.0) and median duration of LBP of 12 months (IQR 5 6 – 24). LBP duration 5 3 months in 11%, 3 to 6 months in 24%, and O 6 months in 65%. 189 cases were excluded from calculations due to lack of definitive diagnostic procedures. A multiple logistic regression model indicated that midline LBP (p-value ! 0.0001), pain during SHF (p-value 5 0.0008), and age group (p-value 5 0.0003) were significant independent predictors of the probability of IDD (table 1). Only midline LBP was found an independent predictor of FJA and SIJ pain (p-values ! 0.0001 for each) (table 2). CONCLUSIONS: Patients report of midline LBP which is exacerbated by SHF in the young adult is strongly predictive of lumbar IDD as the source of the patient’s symptoms. Conversely, absence of midline LBP regardless of SHF findings or age, is a strong predictor that an intervertebral disc is not the source of the patient’s LBP and strong consideration of a facet or sacroiliac joint should be exercised by the investigating clinician.
PATIENT SAMPLE: A series of 65 consecutively treated patients were identified for the review. There were a total of 105 levels, 58 Confidence and 47 kyphoplasty–treated levels, which ranged from T5 to L5. OUTCOME MEASURES: The degree of leakage was assessed at each treated level using a strict 4-point scale (none, minimal, moderate, severe). The pattern of any observed leakage was also characterized as: discal, venous (paravetebral), or epidural. METHODS: The radiographic reviewer was blinded to the treatment group. Each film was assessed for percent collapse, evidence of cement leakage, as well as degree and pattern of any noted leak. RESULTS: The average vertebral collapse was 26% in the Confidence group vs. 25% in the kyphoplasty group. There was no or minimal leakage in 91% Confidence and 85% kyphoplasty cases (minimal: 36% Confidence vs. 38% kyphoplasty). Severe leakage was only reported in 1 (2%) Confidence and 1 (2%) kyphoplasty cases. In both cases, the severe leakage was found in the disc space. No significant leakage was noticed that required any surgical intervention. CONCLUSIONS: The leakage rate with the high viscosity Confidence Vertebral Augmentation System is comparable to that of kyphoplasty. High viscosity cements and specialized delivery systems may reduce the risk of leaks for standard vertebral body augmentation. FDA DEVICE/DRUG STATUS: Confidence System: Approved for this indication. doi: 10.1016/j.spinee.2009.08.314
P56. Incidence of Symptomatic Spondylolysis Associated with Spina Bifida Occulta Nicola Vannet1, Stuart James, FRCS1, Kathleen Hammer1, Sashin Ahuja, MD2; 1 University Hospital of Wales, Cardiff, Wales, United Kingdom; 2 University of Wales Institute, Cardiff, South Wales, United Kingdom
Table 1.
Table 2.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.313
P55. The Occurrence and Degree of Cement Leakage Following Vertebral Body Augmentation: A Comparison of the Confidence Vertebral Augmentation System and Kyphoplasty Bassem Georgy, MD; University of California, San Diego, San Diego, CA, USA BACKGROUND CONTEXT: Vertebroplasty was known for relatively high cement leakage rates compared to kyphoplasty. Advances in delivery systems and new high viscosity cements provide enhanced control and uniformity of cement filling during vertebroplasty compared to the previously available technology(1). PURPOSE: This study was conducted to assess the incidence and pattern of cement leakage with Confidence compared to kyphoplasty. STUDY DESIGN/SETTING: This is single center retrospective review of post-operative radiographs of consecutive patients treated with either kyphoplasty or Confidence
BACKGROUND CONTEXT: The simultaneous occurrence of spina bifida occulta (SBO) and spondylolysis has been noted previously. The occurrence of SBO and spondylolysis are approximately 17% and 5% respectively. PURPOSE: The aim of this study was to determine the incidence of SBO when a symptomatic spondylolysis has been proven. STUDY DESIGN/SETTING: This was a retrospecitve review of radiological studies on patients with back pain using the IMPAX radiology system. This was performed in the Spinal unit of the University Hospital of Wales. PATIENT SAMPLE: Patient data was reviewed retrospectively using all lumbar spine CT scans performed in the spinal unit in the last five years. OUTCOME MEASURES: A positive association was determined by the finding of an associated spina bifida in patients with a spondylolysis found on CT. METHODS: Analysis of five years of lumbar spine CT scans was performed. Patients with spondylolysis or spondylolisthesis caused by a pars defect were identified. These patients’ CT images were then reviewed to establish the patients who also had SBO. RESULTS: 650 CT scans of lumbar spines were performed in the last five years. 100 (15%) were found to have a pars defect. The average age was 34.6. On CT 30 (30%) patients had SBO. 23 were under 18 years old and 13 (56%) of these patients had SBO associated with the spondylolysis. In the over 18 year olds 21 (27%) patients had SBO associated with spondylolysis. On review of the 550 other scans the average age was 51.9 years old. The incidence of SBO within this group is 10%. Only 6% of these patients were under 18. Out of these 33 patients 30.3% (10 patients) had SBO. Over 18 the incidence of SBO was only 8.5%. CONCLUSIONS: Our results indicate that the occurrence of SBO within the group with a spondylolysis is much higher than in the group where no spondylolysis is present. There is higher incidence of SBO in the younger patients with spondylolysis. 56% of paediatric patients with symptomatic spondylolysis will have SBO. Clinicians should be aware of this fact