- Email: [email protected]
P87. Trabecular Bone Micro-Architecture and Bone Mineral Density of Adolescent Idiopathic Scoliosis and Congenital Scoliosis
Proceedings of the NASS 21st Annual Meetings / The Spine Journal 6 (2006) 1S–161S with the control. FACS analysis after 14 days of co-culture showed that 0.5% of cells were double fluorescent for GFP and RFP. However, both male and female cells were independently identified by FISH (Fig. 1). CONCLUSIONS: The results of this study demonstrate that the interaction between MSC and NPC may derive from a combination of MSC differentiation towards a more chondrogenic phenotype as well as stimulatory paracrine effects exerted by MSCs upon NPCs. The presence of few twocolor positive cells by FACS, without any qualitative observation of cells with tetraploid DNA by FISH, leads us to consider cell fusion a rare phenomenon. The ongoing study of mRNA expression of other gene will further clarify the interaction between MSC and NPC. This study further clarifies the mechanism of the interaction between MSCs and NPCs, and improves the understanding of the potential of MSCs to alter the course of intervertebral disc degeneration. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2006.06.232
P87. Trabecular Bone Micro-Architecture and Bone Mineral Density of Adolescent Idiopathic Scoliosis and Congenital Scoliosis Feng Zhu1, Yong Qiu, MD1, Hiu Yan Yeung2, Kwong Man Lee3, ChunYiu Cheng4; 1Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; 2Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China; 3Lee Hysan Clinical Research Laboratories, The Chinese University of Hong Kong, Hong Kong, China; 4Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China BACKGROUND CONTEXT: Previous study has shown that there exists bone mass insufficiency in certain parts of idiopathic scoliosis and the osteopenia could be one of the prognostic factors for the progression of spinal deformity. The microstructure of trabecular bone of AIS and congenital scoliosis (CS) were still unknown to us. PURPOSE: To evaluate the bone mineral status of CS patients compared with normal control and AIS patients. To investigate the microstructure of trabecular bone in adolescent idiopathic scoliosis (AIS) and age-matched congenital scoliosis (CS). STUDY DESIGN/SETTING: Biopsy of iliac crest was collected during autograft harvesting for spinal fusion from AIS and CS patients. Bone mineral status was assessed in every patient by DEXA (Norland XR-36, U.S.). Bone specimens were scanned by micro computer tomography (mCT40, Scanco Medical, Switzerland) to evaluate the microstructure of trabecular bone. PATIENT SAMPLE: 15 AIS patients with mean age 14.9 years (range 12–19 years), Cobb angle range 48-104 with mean 59 , were recruited into this study. Another group consisted of 16 CS patients aged 13–18 years with mean 14.6 years and Cobb 40-125 (mean 60.6 ). Normal control group consisted of 35 female adolescents with mean age of 14.6 (range 13–16 years). OUTCOME MEASURES: Corrective surgery was indicated in AIS and CS patients, and iliac crest biopsy was collected during autograft harvesting. Bone mineral status was assessed at the area of lumbar and hip in every patient by DEXA (Norland XR-36). Consent was obtained from patients and their parents. Bone specimens were scanned by micro computer tomography (mCT40, Scanco Medical, Switzerland). Reconstructed 3-D images at the resolution of 20 mm were achieved for morphometric analysis. METHODS: To collect the trabecular bone of iliac crest from AIS and CS patients, bone mineral status was assessed in every patient and the normal control group by DEXA (Norland XR-36, U.S.). Bone specimens were scanned by micro computer tomography (mCT40, Scanco Medical, Switzerland) to evaluate the microstructure of trabecular bone. The BMD values were compared between AIS, CS, and normal groups. Micro-
125S
structure values were compared between AIS and CS patients to determine the difference between them. RESULTS: Significantly lower lumbar and femur neck BMD were found in AIS patients compared with normal controls. All BMD and BMC parameters were significantly lower in CS patients compared with agematched normal controls. Significant association between BV/TV and the BMD values under DEXA assessment was observed. Femur neck BMD and BMC were significantly lower in CS than that in AIS. In the 3-D model BV/TV value was significantly higher in AIS (19. 63.4%) than that in CS (13.363.0%, p!.05). Significant differences between AIS and CS were also found in the parameters of trabecular thickness (Tb.Th) and bone surface/bone volume (BS/BV) (155.5654.9 mm vs. 108.1617.4 mm and 16.463.3% vs. 22.063.4% respectively, p!.05 in both). CONCLUSIONS: Lower bone mineral status and weak trabecular bone structure observed in CS justified further investigation on the bone mineral status in scoliosis with various etiology. This study further presented the feature of bone mineral density and micro-architecture in AIS patients which could have an etiopathogenetic significance. FDA DEVICE/DRUG STATUS: DEXA: Approved for this indication; micro computer tomography: Approved for this indication. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2006.06.233
P88. Ketorolac Decreases Postoperative Pain and Morphine Requirements Following Decompressive Lumbar Laminectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial Ezequiel Cassinelli, MD1, Clayton Dean, MD1, Raymond Graber, MD1, Christopher Furey, MD1, Nicholas Ahn, MD1, Henry Bohlman, MD2; 1 Case Western Reserve University, Cleveland, OH, USA; 2Spine Institute, University Hospitals of Cleveland, Cleveland, OH, USA BACKGROUND CONTEXT: Ketorolac is a potent nonsteroidal analgesic agent used to treat postoperative pain. Its efficacy has been demonstrated after general surgery and orthopedic outpatient procedures. PURPOSE: The purpose of this study was to examine the effect of ketorolac on postoperative pain and morphine requirements after decompressive lumbar laminectomy. STUDY DESIGN/SETTING: A prospective, randomized, double-blind, placebo-controlled trial. PATIENT SAMPLE: Ninteen patients undergoing primary two and three level decompressive laminectomy for lumbar stenosis. Patients with regular preoperative narcotic use were excluded. OUTCOME MEASURES: Visual Analog Scores, Postoperative morphine requirement. METHODS: Patients were randomized to receive either postoperative ketorolac (Group 1, n510) or placebo (Group 2, n59). The study medication was administered in a double-blinded fashion immediately postoperatively, as well as 6 and 12 hours postoperatively. A standardized general anesthesia protocol was used intraoperatively for all patients, and all were given IV morphine as needed for the first 24 hours. After 24 hours, patients were given oral pain medication with IV morphine for breakthrough pain. RESULTS: There were no differences between the two groups with regard to age, number of levels decompressed, surgical time, blood loss, or ASA class. VAS scores were lower in Group 1 at 0, 4, 8, 12, 16, 24, and 36 hours, but statistically significant only at 4 hours (p5.039) and 16 hours (p5.04). 24-hour morphine use was lower in Group 1 (6.4 mg vs. 20.1 mg, p5.052). Total morphine requirements were significantly lower in Group 1 (6.4 mg vs. 22.4 mg, p5.019). No significant differences were noted in oral pain medication requirements. Drain output was slightly lower in Group 1 (191 ml vs. 247.1 ml, p5.46). One epidural hematoma occurred in Group 2 (excluded from statistical analysis), and one postoperative ileus occurred in Group 1. Hospital stay was less in group 1 (56.5 hours vs. 70.4 hours), although this was not statistically significant (p5.23).
P87. Trabecular Bone Micro-Architecture and Bone Mineral Density of Adolescent Idiopathic Scoliosis and Congenital Scoliosis Feng Zhu1, Yong Qiu, MD1, Hiu Yan Yeung2, Kwong Man Lee3, ChunYiu Cheng4; 1Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; 2Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China; 3Lee Hysan Clinical Research Laboratories, The Chinese University of Hong Kong, Hong Kong, China; 4Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China BACKGROUND CONTEXT: Previous study has shown that there exists bone mass insufficiency in certain parts of idiopathic scoliosis and the osteopenia could be one of the prognostic factors for the progression of spinal deformity. The microstructure of trabecular bone of AIS and congenital scoliosis (CS) were still unknown to us. PURPOSE: To evaluate the bone mineral status of CS patients compared with normal control and AIS patients. To investigate the microstructure of trabecular bone in adolescent idiopathic scoliosis (AIS) and age-matched congenital scoliosis (CS). STUDY DESIGN/SETTING: Biopsy of iliac crest was collected during autograft harvesting for spinal fusion from AIS and CS patients. Bone mineral status was assessed in every patient by DEXA (Norland XR-36, U.S.). Bone specimens were scanned by micro computer tomography (mCT40, Scanco Medical, Switzerland) to evaluate the microstructure of trabecular bone. PATIENT SAMPLE: 15 AIS patients with mean age 14.9 years (range 12–19 years), Cobb angle range 48-104 with mean 59 , were recruited into this study. Another group consisted of 16 CS patients aged 13–18 years with mean 14.6 years and Cobb 40-125 (mean 60.6 ). Normal control group consisted of 35 female adolescents with mean age of 14.6 (range 13–16 years). OUTCOME MEASURES: Corrective surgery was indicated in AIS and CS patients, and iliac crest biopsy was collected during autograft harvesting. Bone mineral status was assessed at the area of lumbar and hip in every patient by DEXA (Norland XR-36). Consent was obtained from patients and their parents. Bone specimens were scanned by micro computer tomography (mCT40, Scanco Medical, Switzerland). Reconstructed 3-D images at the resolution of 20 mm were achieved for morphometric analysis. METHODS: To collect the trabecular bone of iliac crest from AIS and CS patients, bone mineral status was assessed in every patient and the normal control group by DEXA (Norland XR-36, U.S.). Bone specimens were scanned by micro computer tomography (mCT40, Scanco Medical, Switzerland) to evaluate the microstructure of trabecular bone. The BMD values were compared between AIS, CS, and normal groups. Micro-
125S
structure values were compared between AIS and CS patients to determine the difference between them. RESULTS: Significantly lower lumbar and femur neck BMD were found in AIS patients compared with normal controls. All BMD and BMC parameters were significantly lower in CS patients compared with agematched normal controls. Significant association between BV/TV and the BMD values under DEXA assessment was observed. Femur neck BMD and BMC were significantly lower in CS than that in AIS. In the 3-D model BV/TV value was significantly higher in AIS (19. 63.4%) than that in CS (13.363.0%, p!.05). Significant differences between AIS and CS were also found in the parameters of trabecular thickness (Tb.Th) and bone surface/bone volume (BS/BV) (155.5654.9 mm vs. 108.1617.4 mm and 16.463.3% vs. 22.063.4% respectively, p!.05 in both). CONCLUSIONS: Lower bone mineral status and weak trabecular bone structure observed in CS justified further investigation on the bone mineral status in scoliosis with various etiology. This study further presented the feature of bone mineral density and micro-architecture in AIS patients which could have an etiopathogenetic significance. FDA DEVICE/DRUG STATUS: DEXA: Approved for this indication; micro computer tomography: Approved for this indication. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2006.06.233
P88. Ketorolac Decreases Postoperative Pain and Morphine Requirements Following Decompressive Lumbar Laminectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial Ezequiel Cassinelli, MD1, Clayton Dean, MD1, Raymond Graber, MD1, Christopher Furey, MD1, Nicholas Ahn, MD1, Henry Bohlman, MD2; 1 Case Western Reserve University, Cleveland, OH, USA; 2Spine Institute, University Hospitals of Cleveland, Cleveland, OH, USA BACKGROUND CONTEXT: Ketorolac is a potent nonsteroidal analgesic agent used to treat postoperative pain. Its efficacy has been demonstrated after general surgery and orthopedic outpatient procedures. PURPOSE: The purpose of this study was to examine the effect of ketorolac on postoperative pain and morphine requirements after decompressive lumbar laminectomy. STUDY DESIGN/SETTING: A prospective, randomized, double-blind, placebo-controlled trial. PATIENT SAMPLE: Ninteen patients undergoing primary two and three level decompressive laminectomy for lumbar stenosis. Patients with regular preoperative narcotic use were excluded. OUTCOME MEASURES: Visual Analog Scores, Postoperative morphine requirement. METHODS: Patients were randomized to receive either postoperative ketorolac (Group 1, n510) or placebo (Group 2, n59). The study medication was administered in a double-blinded fashion immediately postoperatively, as well as 6 and 12 hours postoperatively. A standardized general anesthesia protocol was used intraoperatively for all patients, and all were given IV morphine as needed for the first 24 hours. After 24 hours, patients were given oral pain medication with IV morphine for breakthrough pain. RESULTS: There were no differences between the two groups with regard to age, number of levels decompressed, surgical time, blood loss, or ASA class. VAS scores were lower in Group 1 at 0, 4, 8, 12, 16, 24, and 36 hours, but statistically significant only at 4 hours (p5.039) and 16 hours (p5.04). 24-hour morphine use was lower in Group 1 (6.4 mg vs. 20.1 mg, p5.052). Total morphine requirements were significantly lower in Group 1 (6.4 mg vs. 22.4 mg, p5.019). No significant differences were noted in oral pain medication requirements. Drain output was slightly lower in Group 1 (191 ml vs. 247.1 ml, p5.46). One epidural hematoma occurred in Group 2 (excluded from statistical analysis), and one postoperative ileus occurred in Group 1. Hospital stay was less in group 1 (56.5 hours vs. 70.4 hours), although this was not statistically significant (p5.23).