- Email: [email protected]
Pedicle Screws Allow Maintenance of Thoracic Kyphosis in AIS, but Ability to Improve Hypokyphosis is Limited
154S
Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S
CONCLUSIONS: Screening 2D echo identifies structural heart defects and pulm HT. Scoliosis surgery prevents progression and reverses pulm HT, avoiding potentially fatal compromise. This is the first study to document evidence of pulmonary hypertension (pulm HT) in AIS patients, the severity of which directly correlates with the size of the curve. Pulmonary hypertension, which can potentially be fatal, reverts to normal after corrective scoliosis surgery. These findings provide direct evidence of immediate benefit of scoliosis surgery and can change the entire scoliosis treatment paradigm. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.371
P118. Pedicle Screws Allow Maintenance of Thoracic Kyphosis in AIS, but Ability to Improve Hypokyphosis is Limited Vishal Sarwahi, MD1, Adam L. Wollowick, MD2, Preethi M. Kulkarni, MD3, Terry D. Amaral, MD2; 1New York, NY, US; 2Bronx, NY, US; 3 Montefiore Medical Centre, Bronx, NY, US BACKGROUND CONTEXT: Pedicle screw instrumentation in AIS has been shown to produce hypokyphosis. Contributing factors may include rod size, material, and correction maneuvers. This study seeks to evaluate the ability of pedicle screws to maintain normal kyphosis or restore normal kyphosis in patients with preoperative hypokyphosis. PURPOSE: The purpose of this study is evaluate the ability of pedicle screw to maintain normal kyphosis. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: 236 AIS patients who underwent PSF. OUTCOME MEASURES: Frequency and generalized linear model. METHODS: 236 AIS patients who underwent PSF utilizing pedicle screws between 2004 and 2011 were evaluated for kyphosis (T3-12), sagittal balance and proximal junction kyphosis (O 10 ). Charts as well as preop, immediate postop, one- and two-year postop X-ray images were reviewed. RESULTS: 83 patients met inclusion criteria. Sixty (72%) had normal preop kyphosis. Immediately post-op, 81% of patients had normal kyphosis. At one year, 83% had normal kyphosis and 72% at 2 years, (p50.32). Rod translation, rod derotation and DVR were not found to have a hypokyphosing. Patient and curve characteristics, length of fusion, LIV and number of screws were not found to have a significant effect on kyphosis. 85% with normal preop kyphosis maintained it at 2 years, and 15 % of these patients had hypokyphosis postop and remained unchanged at 2 years. 60.9% of patients with preop hypokyphosis were restored to normal thoracic kyphosis and maintained at 2 years. Patients did not significantly change their sagittal balance at 2 years. The use of high strength rods did not improve maintenance or restoration of thoracic kyphosis. No significant incidence of PJK, p50.92. CONCLUSIONS: Pedicle screws did not produce hypokyphosis and allow the surgeon to maintain kyphosis in patients with normal kyphosis. No specific curve characteristics or surgical maneuver was found to negatively influence kyphosis. Further attention needs to be paid to patients with preop hypokyphosis as only 60% were normalized. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.372
P119. Minimally Invasive versus Open Sacroiliac Joint Fusion: A Comparison of Outcomes in Propensity Matched Cohorts Charles Gerald T. Ledonio, MD1, David W. Polly, Jr., MD2, Marc Swiontkowski, MD3; 1Minneapolis, MN, US; 2University of
Minnesota Physicians, Minneapolis, MN, US; 3University of Minnesota Department of Orthopaedic Surgery, Minneapolis, MN, US BACKGROUND CONTEXT: The sacroiliac joint has been implicated as a source of chronic low back pain in 15% to 30% of patients. When nonsurgical approaches fail, sacroiliac joint fusion may be recommended. Advances in intraoperative image guidance have assisted minimally invasive surgical (MIS) techniques using ingrowth-coated fusion rods; however, how these techniques perform relative to open anterior fusion of the sacroiliac joint using plates and screws is not known. PURPOSE: To compare minimally invasive surgical (MIS) techniques using ingrowth-coated fusion rods against open anterior fusion of the sacroiliac joint using plates and screws on process measures (blood loss, surgical time, hospital stay) and Oswestry Disability Index (ODI). STUDY DESIGN/SETTING: Retrospective chart review at single institution. PATIENT SAMPLE: From 2006 to 2011, a total of 63 patients underwent sacroiliac joint fusions (open: 36; MIS: 27). Of those, 10 in the open group had incomplete records and were excluded. OUTCOME MEASURES: Process measures (blood loss, surgical time, hospital stay) and ODI. METHODS: We performed a retrospective study of patients who underwent sacroiliac joint fusion with minimum 1-year follow-up at a single institution to compare process measures and ODI scores between the two techniques. All patients had sacroiliac joint dysfunction confirmed by image-guided intraarticular anesthetic sacroiliac joint injection and had failed nonoperative treatment. Patients were matched via propensity score adjusting for age, gender, BMI, history of spine fusion, and preoperative ODI scores, leaving 22 in each group. Nine patients were not matched. Follow-up was at a mean of 13 months in the open group (range 11 to 33) and 15 months in the MIS group (range 12 to 26 ). RESULTS: Patients in the open group had more estimated blood loss (681 cc vs 41 cc, p ! 0.001). Surgical time and hospital stay were shorter in the MIS group than in the open group (68 mins vs 128 mins; 3.3 days vs 2 days p ! 0.001 for both). The postoperative ODI scores were no different between groups (47% vs 54%, p 5 0.272). CONCLUSIONS: Surgical process measures favored the MIS sacroiliac fusion group, and ODI scores were similar between the groups. Because the implants used for these procedures make assessment of fusion challenging with available imaging techniques, we do not know how many patients’ sacroiliac joints successfully fused, so longer follow-up and critical evaluation of outcomes scores over time are . FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.373
P120. Outcome of Navigated Minimally Invasive Sacroiliac Joint Fusion: Does Surgical History Matter? Charles Gerald T. Ledonio, MD1, David W. Polly, Jr., MD2, Ivana Ninkovic, MPH, MS3, Edward Rainier G. Santos, MD4, Jonathan N. Sembrano, MD3; 1Minneapolis, MN, US; 2University of Minnesota Physicians, Minneapolis, MN, US; 3University of Minnesota, Minneapolis, MN, US; 4Rosemount, MN, US BACKGROUND CONTEXT: The sacroiliac (SI) joint has been implicated in chronic low back pain for 13%-30% of patients seen in spine practices. When conservative management fails, SI joint arthrodesis is a viable alternative. Recent studies have implicated a history of lumbar fusion as a cause of SI joint pain, which may in turn affect treatment outcomes. PURPOSE: This study examines the effect of low back surgery history on SI joint fusion outcomes. STUDY DESIGN/SETTING: Retrospective review of consecutive case series.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S
CONCLUSIONS: Screening 2D echo identifies structural heart defects and pulm HT. Scoliosis surgery prevents progression and reverses pulm HT, avoiding potentially fatal compromise. This is the first study to document evidence of pulmonary hypertension (pulm HT) in AIS patients, the severity of which directly correlates with the size of the curve. Pulmonary hypertension, which can potentially be fatal, reverts to normal after corrective scoliosis surgery. These findings provide direct evidence of immediate benefit of scoliosis surgery and can change the entire scoliosis treatment paradigm. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.371
P118. Pedicle Screws Allow Maintenance of Thoracic Kyphosis in AIS, but Ability to Improve Hypokyphosis is Limited Vishal Sarwahi, MD1, Adam L. Wollowick, MD2, Preethi M. Kulkarni, MD3, Terry D. Amaral, MD2; 1New York, NY, US; 2Bronx, NY, US; 3 Montefiore Medical Centre, Bronx, NY, US BACKGROUND CONTEXT: Pedicle screw instrumentation in AIS has been shown to produce hypokyphosis. Contributing factors may include rod size, material, and correction maneuvers. This study seeks to evaluate the ability of pedicle screws to maintain normal kyphosis or restore normal kyphosis in patients with preoperative hypokyphosis. PURPOSE: The purpose of this study is evaluate the ability of pedicle screw to maintain normal kyphosis. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: 236 AIS patients who underwent PSF. OUTCOME MEASURES: Frequency and generalized linear model. METHODS: 236 AIS patients who underwent PSF utilizing pedicle screws between 2004 and 2011 were evaluated for kyphosis (T3-12), sagittal balance and proximal junction kyphosis (O 10 ). Charts as well as preop, immediate postop, one- and two-year postop X-ray images were reviewed. RESULTS: 83 patients met inclusion criteria. Sixty (72%) had normal preop kyphosis. Immediately post-op, 81% of patients had normal kyphosis. At one year, 83% had normal kyphosis and 72% at 2 years, (p50.32). Rod translation, rod derotation and DVR were not found to have a hypokyphosing. Patient and curve characteristics, length of fusion, LIV and number of screws were not found to have a significant effect on kyphosis. 85% with normal preop kyphosis maintained it at 2 years, and 15 % of these patients had hypokyphosis postop and remained unchanged at 2 years. 60.9% of patients with preop hypokyphosis were restored to normal thoracic kyphosis and maintained at 2 years. Patients did not significantly change their sagittal balance at 2 years. The use of high strength rods did not improve maintenance or restoration of thoracic kyphosis. No significant incidence of PJK, p50.92. CONCLUSIONS: Pedicle screws did not produce hypokyphosis and allow the surgeon to maintain kyphosis in patients with normal kyphosis. No specific curve characteristics or surgical maneuver was found to negatively influence kyphosis. Further attention needs to be paid to patients with preop hypokyphosis as only 60% were normalized. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.372
P119. Minimally Invasive versus Open Sacroiliac Joint Fusion: A Comparison of Outcomes in Propensity Matched Cohorts Charles Gerald T. Ledonio, MD1, David W. Polly, Jr., MD2, Marc Swiontkowski, MD3; 1Minneapolis, MN, US; 2University of
Minnesota Physicians, Minneapolis, MN, US; 3University of Minnesota Department of Orthopaedic Surgery, Minneapolis, MN, US BACKGROUND CONTEXT: The sacroiliac joint has been implicated as a source of chronic low back pain in 15% to 30% of patients. When nonsurgical approaches fail, sacroiliac joint fusion may be recommended. Advances in intraoperative image guidance have assisted minimally invasive surgical (MIS) techniques using ingrowth-coated fusion rods; however, how these techniques perform relative to open anterior fusion of the sacroiliac joint using plates and screws is not known. PURPOSE: To compare minimally invasive surgical (MIS) techniques using ingrowth-coated fusion rods against open anterior fusion of the sacroiliac joint using plates and screws on process measures (blood loss, surgical time, hospital stay) and Oswestry Disability Index (ODI). STUDY DESIGN/SETTING: Retrospective chart review at single institution. PATIENT SAMPLE: From 2006 to 2011, a total of 63 patients underwent sacroiliac joint fusions (open: 36; MIS: 27). Of those, 10 in the open group had incomplete records and were excluded. OUTCOME MEASURES: Process measures (blood loss, surgical time, hospital stay) and ODI. METHODS: We performed a retrospective study of patients who underwent sacroiliac joint fusion with minimum 1-year follow-up at a single institution to compare process measures and ODI scores between the two techniques. All patients had sacroiliac joint dysfunction confirmed by image-guided intraarticular anesthetic sacroiliac joint injection and had failed nonoperative treatment. Patients were matched via propensity score adjusting for age, gender, BMI, history of spine fusion, and preoperative ODI scores, leaving 22 in each group. Nine patients were not matched. Follow-up was at a mean of 13 months in the open group (range 11 to 33) and 15 months in the MIS group (range 12 to 26 ). RESULTS: Patients in the open group had more estimated blood loss (681 cc vs 41 cc, p ! 0.001). Surgical time and hospital stay were shorter in the MIS group than in the open group (68 mins vs 128 mins; 3.3 days vs 2 days p ! 0.001 for both). The postoperative ODI scores were no different between groups (47% vs 54%, p 5 0.272). CONCLUSIONS: Surgical process measures favored the MIS sacroiliac fusion group, and ODI scores were similar between the groups. Because the implants used for these procedures make assessment of fusion challenging with available imaging techniques, we do not know how many patients’ sacroiliac joints successfully fused, so longer follow-up and critical evaluation of outcomes scores over time are . FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.373
P120. Outcome of Navigated Minimally Invasive Sacroiliac Joint Fusion: Does Surgical History Matter? Charles Gerald T. Ledonio, MD1, David W. Polly, Jr., MD2, Ivana Ninkovic, MPH, MS3, Edward Rainier G. Santos, MD4, Jonathan N. Sembrano, MD3; 1Minneapolis, MN, US; 2University of Minnesota Physicians, Minneapolis, MN, US; 3University of Minnesota, Minneapolis, MN, US; 4Rosemount, MN, US BACKGROUND CONTEXT: The sacroiliac (SI) joint has been implicated in chronic low back pain for 13%-30% of patients seen in spine practices. When conservative management fails, SI joint arthrodesis is a viable alternative. Recent studies have implicated a history of lumbar fusion as a cause of SI joint pain, which may in turn affect treatment outcomes. PURPOSE: This study examines the effect of low back surgery history on SI joint fusion outcomes. STUDY DESIGN/SETTING: Retrospective review of consecutive case series.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.