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P77. Correction of Degenerative Adult Scoliosis in Patients Undergoing Selective Transforaminal Lumbar Interbody Fusion
138S
Proceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.321
P77. Correction of Degenerative Adult Scoliosis in Patients Undergoing Selective Transforaminal Lumbar Interbody Fusion Ewell Nelson, MD1, Alan Villavicencio, MD1, Sigita Burneikiene, MD1, Cassandra Roeca, BA2; 1Boulder Neurosurgical Associates, Boulder, CO, USA; 2University of Colorado at Boulder, Boulder, CO, USA
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.319
P76. Microdiscectomy for the Treatment of Recurrent Disc Herniation Marcelo Valacco, MD1, Marcelo Gruenberg, MD2, Carlos Sola´, MD3, Matı´As Petracchi, MD1; 1Buenos Aires, Argentina; 2Capital Federal, Buenos Aires, Argentina; 3Hospital Italiano Buenos Aires, Buenos Aires, Argentina BACKGROUND CONTEXT: A recurrent disc herniation is a well recognized complication after lumbar microdiscectomy. When the revision surgery is the option, some authors prefer to perform a discectomy followed by arthrodesis or dynamic stabilization, while others advocate the microdiscectomy. PURPOSE: To compare the clinical results between two groups of patients, one for primary disc herniation and the other for recurrent disc herniation, both treated with microdiscectomy. STUDY DESIGN/ SETTING: A retrospective clinical study. PATIENT SAMPLE: A total of 50 patients in two groups who had undergone microdiscectomies were surveyed to asses their clinical outcomes. All medical and surgical records were analized in both groups including pain free interval, average age, gender, weight, perioperative complications, surgical time, and postsurgery hospital stay. OUTCOME MEASURES: Clinical outcomes were assessed based on Prolo’s scale. METHODS: We retrospectively evaluated 2 groups of patients after microdiscectomies, done by the same group of surgeons in the same hospital. One group was conformed by 23 patients with recurrent disc herniation operated on between May 1996 and March 2003 (Group A). The other group was conformed by 27 patients operated on between May and October 1998 for primary disc herniation (Group B). RESULTS: According to Prolo’s functional scale used at final evaluation, the result was good in 13 patients (62%), poor in 3 (14%), and fair in 5 (24%) in group A, and 19 patients were graded as good (79%), 4 poor (17%) and 1 fair (4%) in group B. There were three complications in the group A, and there were no complications in the group B. The weight of the patients was significantly higher in the group with recurrence, perhaps may be inferred that the overweight patients are more prone to suffer a relapse, but the small number of patients and lack of other parameters (height, and corporal index), we can not be conclusive. CONCLUSIONS: In our small series there was no statistical difference in the functional evaluation between both groups. Microdiscectomy can be considered as the first surgical option for the treatment of a recurrent disc herniation. Future studies are required to understand the risk factors for recurrent disc herniation and the fair result after microdiscectomy.
BACKGROUND CONTEXT: Adult scoliosis is a multifaceted disease accompanied by spinal rigidity, stenosis and severe, progressive back pain and degeneration. Scoliotic deformities can be corrected via anterior and/ or posterior surgical approaches. Utilizing a single posterior TLIF (Transforaminal Lumbar Interbody Fusion) approach theoretically minimizes risks to the patient typically associated with an anterior procedure. PURPOSE: The purpose of this study was to analyze the safety and feasibility for TLIF surgical approach in this unique patient population. STUDY DESIGN/ SETTING: A retrospective chart review study was performed. PATIENT SAMPLE: Patients with back pain as a result of degenerative scoliosis with or without disc herniation, spondylolisthesis and/or central canal stenosis were included in this study. The levels chosen to undergo TLIF were based on clinical and/or radiographic findings. The number of levels ranged from 1 to 3. Twenty-one scoliosis patients were included in this study and followed for an average of 36 months (range 32–47). Mean patient age was 63 years (range 45–77). OUTCOME MEASURES: Cobb angle was used to measure correction of the deformity. Clinical outcome (self-reported measures, e.g., patient satisfaction, MacNab’s criteria), operative data (operative time, estimated blood loss), hospitalization time, additional surgeries, and complications were assessed. METHODS: Patients underwent a selective TLIF with a longer instrumentation and posterolateral construct. RESULTS: The mean pre-operative coronal Cobb angle was 25.2 degrees (range 9–52) compared to the mean of 10.1 degrees (range 1–35) post-operativelly, P50.0007. Clinical outcome defined as patients’ perceived overall treatment effect was excellent/good in 19 (91%) of patients. The overall patient satisfaction rate was 77%. Additional surgical procedures were performed in two patients, one for a failed fusion and one for hardware removal because of radiculopathy. The mean operative time was 388 minutes (range 275–501). The mean estimated blood loss was 1142 mL (range 250–2500) and hospitalization time was 7.3 days (range 2–16). Complications included cerebrospinal fluid leaks (4), pseudoarthrosis (2), pedicle screw malposition (1), deep venous thrombosis (1), pulmonary embolism (1), hematoma (1), and illeus (1). CONCLUSIONS: This study implies that the TLIF surgical technique is feasible, safe and an effective alternative to anterior-posterior reconstructive surgery in adult patients with degenerative scoliosis and spinal stenosis. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.322
P78. Effect of Allograft Bone Processing on Structural Cortical Grafts: A Comparison of Three Proprietary Processing Methods Michael Dunn, PhD1, Moonhae Sunwoo, PhD2, Wilton Reynoso2, Evangelia Chnari, PhD2, Jeffrey Cartmell, PhD2, Arthur Gertzman2; 1 University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA; 2Musculoskeletal Transplant Foundation, Edison, NJ, USA BACKGROUND CONTEXT: Machined cortical bone is routinely utilized for spinal fixation. The processing of cortical bone, intended to remove undesirable immunologically active elements, may also remove
Proceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.321
P77. Correction of Degenerative Adult Scoliosis in Patients Undergoing Selective Transforaminal Lumbar Interbody Fusion Ewell Nelson, MD1, Alan Villavicencio, MD1, Sigita Burneikiene, MD1, Cassandra Roeca, BA2; 1Boulder Neurosurgical Associates, Boulder, CO, USA; 2University of Colorado at Boulder, Boulder, CO, USA
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.319
P76. Microdiscectomy for the Treatment of Recurrent Disc Herniation Marcelo Valacco, MD1, Marcelo Gruenberg, MD2, Carlos Sola´, MD3, Matı´As Petracchi, MD1; 1Buenos Aires, Argentina; 2Capital Federal, Buenos Aires, Argentina; 3Hospital Italiano Buenos Aires, Buenos Aires, Argentina BACKGROUND CONTEXT: A recurrent disc herniation is a well recognized complication after lumbar microdiscectomy. When the revision surgery is the option, some authors prefer to perform a discectomy followed by arthrodesis or dynamic stabilization, while others advocate the microdiscectomy. PURPOSE: To compare the clinical results between two groups of patients, one for primary disc herniation and the other for recurrent disc herniation, both treated with microdiscectomy. STUDY DESIGN/ SETTING: A retrospective clinical study. PATIENT SAMPLE: A total of 50 patients in two groups who had undergone microdiscectomies were surveyed to asses their clinical outcomes. All medical and surgical records were analized in both groups including pain free interval, average age, gender, weight, perioperative complications, surgical time, and postsurgery hospital stay. OUTCOME MEASURES: Clinical outcomes were assessed based on Prolo’s scale. METHODS: We retrospectively evaluated 2 groups of patients after microdiscectomies, done by the same group of surgeons in the same hospital. One group was conformed by 23 patients with recurrent disc herniation operated on between May 1996 and March 2003 (Group A). The other group was conformed by 27 patients operated on between May and October 1998 for primary disc herniation (Group B). RESULTS: According to Prolo’s functional scale used at final evaluation, the result was good in 13 patients (62%), poor in 3 (14%), and fair in 5 (24%) in group A, and 19 patients were graded as good (79%), 4 poor (17%) and 1 fair (4%) in group B. There were three complications in the group A, and there were no complications in the group B. The weight of the patients was significantly higher in the group with recurrence, perhaps may be inferred that the overweight patients are more prone to suffer a relapse, but the small number of patients and lack of other parameters (height, and corporal index), we can not be conclusive. CONCLUSIONS: In our small series there was no statistical difference in the functional evaluation between both groups. Microdiscectomy can be considered as the first surgical option for the treatment of a recurrent disc herniation. Future studies are required to understand the risk factors for recurrent disc herniation and the fair result after microdiscectomy.
BACKGROUND CONTEXT: Adult scoliosis is a multifaceted disease accompanied by spinal rigidity, stenosis and severe, progressive back pain and degeneration. Scoliotic deformities can be corrected via anterior and/ or posterior surgical approaches. Utilizing a single posterior TLIF (Transforaminal Lumbar Interbody Fusion) approach theoretically minimizes risks to the patient typically associated with an anterior procedure. PURPOSE: The purpose of this study was to analyze the safety and feasibility for TLIF surgical approach in this unique patient population. STUDY DESIGN/ SETTING: A retrospective chart review study was performed. PATIENT SAMPLE: Patients with back pain as a result of degenerative scoliosis with or without disc herniation, spondylolisthesis and/or central canal stenosis were included in this study. The levels chosen to undergo TLIF were based on clinical and/or radiographic findings. The number of levels ranged from 1 to 3. Twenty-one scoliosis patients were included in this study and followed for an average of 36 months (range 32–47). Mean patient age was 63 years (range 45–77). OUTCOME MEASURES: Cobb angle was used to measure correction of the deformity. Clinical outcome (self-reported measures, e.g., patient satisfaction, MacNab’s criteria), operative data (operative time, estimated blood loss), hospitalization time, additional surgeries, and complications were assessed. METHODS: Patients underwent a selective TLIF with a longer instrumentation and posterolateral construct. RESULTS: The mean pre-operative coronal Cobb angle was 25.2 degrees (range 9–52) compared to the mean of 10.1 degrees (range 1–35) post-operativelly, P50.0007. Clinical outcome defined as patients’ perceived overall treatment effect was excellent/good in 19 (91%) of patients. The overall patient satisfaction rate was 77%. Additional surgical procedures were performed in two patients, one for a failed fusion and one for hardware removal because of radiculopathy. The mean operative time was 388 minutes (range 275–501). The mean estimated blood loss was 1142 mL (range 250–2500) and hospitalization time was 7.3 days (range 2–16). Complications included cerebrospinal fluid leaks (4), pseudoarthrosis (2), pedicle screw malposition (1), deep venous thrombosis (1), pulmonary embolism (1), hematoma (1), and illeus (1). CONCLUSIONS: This study implies that the TLIF surgical technique is feasible, safe and an effective alternative to anterior-posterior reconstructive surgery in adult patients with degenerative scoliosis and spinal stenosis. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi:10.1016/j.spinee.2008.06.322
P78. Effect of Allograft Bone Processing on Structural Cortical Grafts: A Comparison of Three Proprietary Processing Methods Michael Dunn, PhD1, Moonhae Sunwoo, PhD2, Wilton Reynoso2, Evangelia Chnari, PhD2, Jeffrey Cartmell, PhD2, Arthur Gertzman2; 1 University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA; 2Musculoskeletal Transplant Foundation, Edison, NJ, USA BACKGROUND CONTEXT: Machined cortical bone is routinely utilized for spinal fixation. The processing of cortical bone, intended to remove undesirable immunologically active elements, may also remove