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P64. Lumbar spine kinematics: a novel approach using digital fluoroscopic video
140S
Proceedings of the NASS 20th Annual Meeting / The Spine Journal 5 (2005) 1S–189S
METHODS: After decompression, all patients underwent fusion with rhBMP-2 and without iliac crest autograft harvesting. Local laminectomy bone was placed within the rhBMP-2 impregnated collagen sponges, which were rolled and placed over the fusion bed bilaterally. In addition, 30 cc of morselized cancellous allograft was used per level fused. 32 patients underwent instrumented fusion and 3 without instumentation. All patients were braced for 3–4 months, and 8 patients received electric stimulation. RESULTS: All patients had radiographic evidence of satisfactory posterolateral fusion at 6 months and flexion- extension radiographs did not show any motion. There was significant improvement in Oswestry Disability Index at last follow-up. Mean preoperative Score of 51 had improved to 17 at last follow-up. All but one patients stated that they would undergo the procedure again, if necessary. Complications included dural tear in two patients and one suprajacent vertebral compression fracture. CONCLUSIONS: Iliac crest autograft is considered to be the gold standard for achieving posterolateral lumbar spinal fusion. However, iliac crest harvesting adds to operative time, blood loss and morbidity. Moreover, the quality and volume of such graft in the elderly is frequently suboptimal. Use of RhBMP-2 appears to be a safe and effective method in achieving multilevel posterolateral lumbar fusion in this preliminary study involving patients over 60 years of age. Longer-term prospective studies are warranted. DISCLOSURES: FDA device/drug: Infuse. Status: Not approved for this indication. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2005.05.278
P64. Lumbar spine kinematics: a novel approach using digital fluoroscopic video Deydre Teyhen, PT, PhD, OCS1, Timothy Flynn, PT, PhD, OCS2, John Childs, PT, PhD, MBA, OCS3, Timothy Kuklo, MD, JD4, Michael Rosner, MD4, David Polly, Jr., MD5, Lawrence Abraham, PhD6; 1U.S. Army–Baylor University, Fort Sam Houston, TX, USA; 2Regis University, Denver, CO, USA; 3Wilford Hall Medical Center, Lackland AFB, TX, USA; 4Walter Reed Army Medical Center, Washington, DC, USA; 5University of Minnesota, Minneapolis, MN, USA; 6University of Texas at Austin, Austin, TX, USA BACKGROUND CONTEXT: Descriptive data on the magnitude of segmental angular and linear displacement of the lumbar spine can be readily assessed using static imaging. However, knowledge of sequencing parameters during lumbar spine movement may provide a greater understanding of the kinematic deficits in patients with lumbar segmental instability (LSI). PURPOSE: The purpose of this study was to use digital fluoroscopic videos (DFV) to characterize dynamic parameters of angular and linear displacement during flexion and extension in individuals with and without LSI. STUDY DESIGN/SETTING: A comparative group study. PATIENT SAMPLE: Data from 20 subjects with LSI were compared with data from 20 healthy subjects (mean age⫽36⫹8 years). OUTCOME MEASURES: Not applicable. METHODS: DFV (30 Hertz) were examined to describe the movement patterns at three segments (L3-4, L4-5, and L5-S1). Repeated measures analysis of variance and post-hoc analyses with a Bonferroni correction were used to detect differences in angular and linear displacement parameters. RESULTS: Greater motion occurred in the more cephalad segments, regardless of group membership. A greater proportion of angular motion occurred at L3-4 (36%) and L4-5 (36%), while L5-S1 was relatively less mobile (28%; p⬍.001). Greater segmental linear displacement as a percent of total motion was observed at L3-4 (38.15%) relative to L4-5 (32.5%, p⫽.018) and at to L5-S1 (29.25%, p⫽.003). The rate of attainment of angular motion occurred in a cephalad to caudal sequential pattern; L3-4 attained its greatest rate of angular motion during the first 25% of flexion (p⬍.015), followed by L4-5 during 55–75% of flexion (p⬍.012), while
L5-S1 had its greatest rate of attainment of angular motion during the last 25% of flexion (p⬍.004). The greatest rate of attainment of linear motion occurred at end-range flexion (p⬍.001) and at the final stage of the return to an upright posture (p⫽.008), regardless of group membership or lumbar segment. CONCLUSIONS: Overall L3-4 had greater motion than L5-S1. Further sequential attainment of angular range was observed during flexion, while the majority of linear displacement occurred at the end-range of movements. Future studies should measure the relationship between muscular activity of the lumbar paraspinal muscles and the timing of the linear displacement during the end of flexion. DFV may provide a tool to allow a more accurate understanding of lumbar spine segmental kinematics. Ultimately, the ability to measure the dynamic parameters of motion may improve the ability to identify patients with aberrant movement patterns potentially amenable to either conservative or surgical intervention. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2005.05.279
P65. Clinical and radiographic outcomes as a function of number of levels decompressed with laminotomy for patients with acquired lumbar stenosis Frank Acosta, Jr., MD, Samantha Piper, AB, Cynthia Chin, MD, Philip Weinstein, MD; University of California, San Francisco, San Francisco, CA, USA BACKGROUND CONTEXT: Laminotomy has been shown to be as effective as laminectomy in treating lumbar stenosis and results in similar or slightly lower rates of postoperative spondylolisthesis. The effect of single or multilevel laminotomy without fusion on degenerative spondylolisthesis and clinical outcome has not been studied. PURPOSE: The purpose of this study was to compare the radiographic and clinical outcomes after limited (1–2 levels) or extensive (3–4 levels) bilateral laminotomy for lumbar spinal stenosis. STUDY DESIGN/SETTING: Retrospective review of clinical and radiographic records of patients treated with decompressive laminotomy for acquired lumbar stenosis by the senior author at UCSF from 2000–2004. PATIENT SAMPLE: One-hundred patients were included in the analysis. All patients had evidence of lumbar stenosis on both plain films and magnetic resonance (MR) imaging. Group A consisted of patients treated with laminotomy at 1 or 2 levels (limited), and Group B consisted patients treated at 3 or 4 levels (multilevel). OUTCOME MEASURES: Sagittal angulation and translation were calculated. Pain was measured using the visual analogue scale (VAS). METHODS: Pre- and postoperative static and dynamic plain films were analyzed. Sagittal angulation and translation were calculated at the operative levels according to the method described by Dupuis et al. Pre- and postoperative VAS scores were obtained and compared between groups. RESULTS: Average follow-up was 23.9 months. Seventy-two patients were in group A and 28 in group B. The average maximum postoperative listhesis was 8.51⫾3.83% for patients in group A and 11.33⫾5.27% in group B (p⬍.01). The average increase in listhesis after surgery was 5.49⫾2.7% in group A and 8.30⫾2.26% in goup B (p⬍.01). Clinically, the average improvement in the VAS score was 3.93⫾2.69 in group A and 5.25⫾2.76 in group B (p⫽.223) (Fig. 1). CONCLUSIONS: Although multilevel (3-4 levels) bilateral laminotomy for lumbar stenosis may result in greater postoperative spondylolisthesis compared with more limited (1–2 levels) decompression, improvement in patient-perceived pain level was comparable. Increase in spondylolisthesis did not adversely affect outcome. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2005.05.280
Proceedings of the NASS 20th Annual Meeting / The Spine Journal 5 (2005) 1S–189S
METHODS: After decompression, all patients underwent fusion with rhBMP-2 and without iliac crest autograft harvesting. Local laminectomy bone was placed within the rhBMP-2 impregnated collagen sponges, which were rolled and placed over the fusion bed bilaterally. In addition, 30 cc of morselized cancellous allograft was used per level fused. 32 patients underwent instrumented fusion and 3 without instumentation. All patients were braced for 3–4 months, and 8 patients received electric stimulation. RESULTS: All patients had radiographic evidence of satisfactory posterolateral fusion at 6 months and flexion- extension radiographs did not show any motion. There was significant improvement in Oswestry Disability Index at last follow-up. Mean preoperative Score of 51 had improved to 17 at last follow-up. All but one patients stated that they would undergo the procedure again, if necessary. Complications included dural tear in two patients and one suprajacent vertebral compression fracture. CONCLUSIONS: Iliac crest autograft is considered to be the gold standard for achieving posterolateral lumbar spinal fusion. However, iliac crest harvesting adds to operative time, blood loss and morbidity. Moreover, the quality and volume of such graft in the elderly is frequently suboptimal. Use of RhBMP-2 appears to be a safe and effective method in achieving multilevel posterolateral lumbar fusion in this preliminary study involving patients over 60 years of age. Longer-term prospective studies are warranted. DISCLOSURES: FDA device/drug: Infuse. Status: Not approved for this indication. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2005.05.278
P64. Lumbar spine kinematics: a novel approach using digital fluoroscopic video Deydre Teyhen, PT, PhD, OCS1, Timothy Flynn, PT, PhD, OCS2, John Childs, PT, PhD, MBA, OCS3, Timothy Kuklo, MD, JD4, Michael Rosner, MD4, David Polly, Jr., MD5, Lawrence Abraham, PhD6; 1U.S. Army–Baylor University, Fort Sam Houston, TX, USA; 2Regis University, Denver, CO, USA; 3Wilford Hall Medical Center, Lackland AFB, TX, USA; 4Walter Reed Army Medical Center, Washington, DC, USA; 5University of Minnesota, Minneapolis, MN, USA; 6University of Texas at Austin, Austin, TX, USA BACKGROUND CONTEXT: Descriptive data on the magnitude of segmental angular and linear displacement of the lumbar spine can be readily assessed using static imaging. However, knowledge of sequencing parameters during lumbar spine movement may provide a greater understanding of the kinematic deficits in patients with lumbar segmental instability (LSI). PURPOSE: The purpose of this study was to use digital fluoroscopic videos (DFV) to characterize dynamic parameters of angular and linear displacement during flexion and extension in individuals with and without LSI. STUDY DESIGN/SETTING: A comparative group study. PATIENT SAMPLE: Data from 20 subjects with LSI were compared with data from 20 healthy subjects (mean age⫽36⫹8 years). OUTCOME MEASURES: Not applicable. METHODS: DFV (30 Hertz) were examined to describe the movement patterns at three segments (L3-4, L4-5, and L5-S1). Repeated measures analysis of variance and post-hoc analyses with a Bonferroni correction were used to detect differences in angular and linear displacement parameters. RESULTS: Greater motion occurred in the more cephalad segments, regardless of group membership. A greater proportion of angular motion occurred at L3-4 (36%) and L4-5 (36%), while L5-S1 was relatively less mobile (28%; p⬍.001). Greater segmental linear displacement as a percent of total motion was observed at L3-4 (38.15%) relative to L4-5 (32.5%, p⫽.018) and at to L5-S1 (29.25%, p⫽.003). The rate of attainment of angular motion occurred in a cephalad to caudal sequential pattern; L3-4 attained its greatest rate of angular motion during the first 25% of flexion (p⬍.015), followed by L4-5 during 55–75% of flexion (p⬍.012), while
L5-S1 had its greatest rate of attainment of angular motion during the last 25% of flexion (p⬍.004). The greatest rate of attainment of linear motion occurred at end-range flexion (p⬍.001) and at the final stage of the return to an upright posture (p⫽.008), regardless of group membership or lumbar segment. CONCLUSIONS: Overall L3-4 had greater motion than L5-S1. Further sequential attainment of angular range was observed during flexion, while the majority of linear displacement occurred at the end-range of movements. Future studies should measure the relationship between muscular activity of the lumbar paraspinal muscles and the timing of the linear displacement during the end of flexion. DFV may provide a tool to allow a more accurate understanding of lumbar spine segmental kinematics. Ultimately, the ability to measure the dynamic parameters of motion may improve the ability to identify patients with aberrant movement patterns potentially amenable to either conservative or surgical intervention. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2005.05.279
P65. Clinical and radiographic outcomes as a function of number of levels decompressed with laminotomy for patients with acquired lumbar stenosis Frank Acosta, Jr., MD, Samantha Piper, AB, Cynthia Chin, MD, Philip Weinstein, MD; University of California, San Francisco, San Francisco, CA, USA BACKGROUND CONTEXT: Laminotomy has been shown to be as effective as laminectomy in treating lumbar stenosis and results in similar or slightly lower rates of postoperative spondylolisthesis. The effect of single or multilevel laminotomy without fusion on degenerative spondylolisthesis and clinical outcome has not been studied. PURPOSE: The purpose of this study was to compare the radiographic and clinical outcomes after limited (1–2 levels) or extensive (3–4 levels) bilateral laminotomy for lumbar spinal stenosis. STUDY DESIGN/SETTING: Retrospective review of clinical and radiographic records of patients treated with decompressive laminotomy for acquired lumbar stenosis by the senior author at UCSF from 2000–2004. PATIENT SAMPLE: One-hundred patients were included in the analysis. All patients had evidence of lumbar stenosis on both plain films and magnetic resonance (MR) imaging. Group A consisted of patients treated with laminotomy at 1 or 2 levels (limited), and Group B consisted patients treated at 3 or 4 levels (multilevel). OUTCOME MEASURES: Sagittal angulation and translation were calculated. Pain was measured using the visual analogue scale (VAS). METHODS: Pre- and postoperative static and dynamic plain films were analyzed. Sagittal angulation and translation were calculated at the operative levels according to the method described by Dupuis et al. Pre- and postoperative VAS scores were obtained and compared between groups. RESULTS: Average follow-up was 23.9 months. Seventy-two patients were in group A and 28 in group B. The average maximum postoperative listhesis was 8.51⫾3.83% for patients in group A and 11.33⫾5.27% in group B (p⬍.01). The average increase in listhesis after surgery was 5.49⫾2.7% in group A and 8.30⫾2.26% in goup B (p⬍.01). Clinically, the average improvement in the VAS score was 3.93⫾2.69 in group A and 5.25⫾2.76 in group B (p⫽.223) (Fig. 1). CONCLUSIONS: Although multilevel (3-4 levels) bilateral laminotomy for lumbar stenosis may result in greater postoperative spondylolisthesis compared with more limited (1–2 levels) decompression, improvement in patient-perceived pain level was comparable. Increase in spondylolisthesis did not adversely affect outcome. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2005.05.280