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Predictive Model for Return to Work after Elective Surgery for Lumbar Degenerative Disease: An Analysis From National Neurosurgery Quality Outcomes Database Registry
NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S251–S337 RESULTS: 21 pts (67 yo, 61.9%F, BMI 27.3) were included. The UIVs was T9 (n=2), T10 (n=9), T11 (n=6) and T12 (n=4). Mean radiographic parameters in preop, supine and postop radiographs were: LL (33.3 vs. 42.7 vs. 51.6°), PI-LL (14.2 vs. 4.4 vs. −4.4), TK (29.2 vs. 22.6 vs. 44.4), Tkunfused (23.9 vs. 20 vs. 33.2), Tkfused (5.5 vs. 2.7 vs. 11.3), SVA (51.8, NA, 7.5 mm), respectively. Analysis found that postop TKunfused was significantly correlated with (all results supine vs. standing): LL (−0.58 vs. −0.56), TK (0.74 vs. 0.59) and pre-TKunfused (0.839 vs. 0.735). Stepwise multilinear regression analysis revealed that the TKunfused measured on the supine radiograph predicted postop TKunfused (r2=0.704, mean error of −0.004±6.5) with a higher accuracy than the TKunfused measured on the standing radiograph (r2=0.54). Using this prediction model and its standard deviation (SD), 17 pts were within predicted value ±1 SD, while 4 pts fell outside. CONCLUSIONS: Thoracolumbar surgery for ASD can reliably control alignment within the fused segments. It remains difficult to predict the alignment change that may occur in the unfused segments. The supine radiograph better predicts the postop TKunfused than does the standing radiograph. When considering a short thoracolumbar fusion for sagittal malalignment, the supine radiograph is critical for preoperative planning. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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and ODI scores were experienced for both groups from baseline. No significant differences in VAS and ODI scores were experienced between the two restriction groups at any time point in the study. CONCLUSIONS: Continuing postoperative restrictions through six weeks after lumbar discectomy does not significantly decrease the rate of reherniation. The results of this study suggest that two weeks of postoperative restrictions allow early return to activity without significant changes in postoperative pain scores or functional outcomes. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.504
P179. Predictive Model for Return to Work after Elective Surgery for Lumbar Degenerative Disease: An Analysis From National Neurosurgery Quality Outcomes Database Registry Kristin Archer, PhD, DPT1, Clinton J. Devin, MD1, Silky Chotai, MD1, Mohamad Bydon, MD2, Matthew J. McGirt, MD3, Hui Nian4, Frank E. Harrell Jr., PhD1, Anthony L. Asher, MD3; 1Vanderbilt University Medical Center, Nashville, TN, USA; 2Mayo Clinic, Rochester, MN, USA; 3Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA; 4Vanderbilt University, Nashville, TN, USA
http://dx.doi.org/10.1016/j.spinee.2016.07.503
P178. Short (2 Weeks) versus Long (6 Weeks) Postoperative Restrictions following Lumbar Discectomy: A Prospective Randomized Control Study Christopher M. Bono, MD1, Andrew J. Schoenfeld, MD1, Dana A. Leonard, BA1, Kirkham B. Wood, MD2, Mitchel Harris, MD, FACS1; 1Brigham and Women’s Hospital, Boston, MA, USA; 2Stanford University School of Medicine, Redwood City, CA, USA BACKGROUND CONTEXT: Acute reherniation may occur in as many as 10% of lumbar discectomy patients. Previous data has suggested that absence of postoperative restrictions after index discectomy does not result in an increased risk of reherniation. However, these data were based on noncomparative case series of patients uniformly encouraged to return to full activity as soon as possible. To the authors’ knowledge, a prospective, randomized control trial comparing short vs. long postoperative restrictions following lumbar discectomy has not been performed. PURPOSE: To evaluate short (2 week) vs. long (6 week) postoperative restrictions following lumbar discectomy impacted postsurgical outcomes and reherniation rates for a period up to one year following surgery. STUDY DESIGN/SETTING: Randomized prospective controlled trial. PATIENT SAMPLE: One hundred eight patients undergoing index lumbar discectomy. OUTCOME MEASURES: Back and leg visual analog pain scales (VAS), Oswestry Disability Index (ODI) and reherniation rates at 2 weeks, 6 weeks, 3 months and one year following surgery. METHODS: Patients were randomized immediately following surgery. In the long restriction group (considered the control), patients were instructed not to bend, lift, or twist for 6 weeks after surgery. In the short restriction group, these restrictions were limited to 2 weeks. Differences in reherniation rates were analyzed using Fisher’s exact test. VAS and ODI scores were evaluated using Student’s t-test. RESULTS: There were 108 patients initially randomized with 81 available at 3-month follow-up and 68 at one year. Fifty-five patients (51%) were randomized to the long restriction group and 53 (49%) to short restriction. The average age was 43.3 (SD 11.1) and 92% of patients were white. No significant differences in baseline variables were documented between the two groups. Within 90 days, three patients in the short restriction group (6%) and one in the long restriction group (2%) experienced a reherniation (p=.36), while six (11%) in the short and four (7%) in the long restriction group had reherniations by the end of the study (p=.52). Significant reductions in VAS
BACKGROUND CONTEXT: Current costs associated with spine care are unsustainable. The productivity loss and time away from work in gainfully employed patients contributes greatly to the financial burden. Therefore, it is vital to identify the factors associated with returning to work after lumbar spine surgery. PURPOSE: We present a predictive model of ability to return to work (RTW) after lumbar spine surgery for degenerative spine disease. STUDY DESIGN/SETTING: Analysis of prospective multicenter registry data. PATIENT SAMPLE: Patients undergoing elective spine surgery for degenerative lumbar disease that were entered into prospective multicenter registry (N2QOD) over a 2-year period, were included in this study. OUTCOME MEASURES: Patients that were employed preoperatively were asked at three months whether “they were able to RTW after surgery?” If yes, then patients were asked to specify “the date of returning to work” at the 3-month follow-up interview. For patients responding yes, the time to return to work was defined as the period between operation time and date of returning to work. Patients responding “No” were considered rightcensored on the day of interview. METHODS: A total of 3,467 patients were included in this study. The patients that were employed preoperatively and completed 3-month followup were included in the analysis. The time to return to work defined as the period between operation time and date of returning to work. A multivariable Cox proportional hazards regression model, including an array of preoperative factors, was fitted for RTW. RESULTS: Eighty-two percent of patients (n=3,855) returned to work within 3-months postoperatively. The risk-adjusted predictors of lower likelihood of RTW were preoperatively employed but not working at the time of presentation, those occupied with manual labor, on workman’s compensation, on liability insurance for disability, preoperative ODI scores, preoperative NRS-BP scores, and demographic factors including female gender, AfricanAmerican race, history of diabetes, and higher ASA grades. The likelihood of RTW within 3 months was higher in patients with higher education level compared to those with less than high school level education. The c-index of our model performance was 0.71. CONCLUSIONS: We present a novel predictive model for probability of RTW after lumbar spine surgery. Spine care providers can use this model to educate patients and encourage them in shared decisionmaking regarding the RTW outcome. This will result in better communication between patients and clinicians and improve recovery expectations, which will ultimately increase the likelihood of a positive RTW trajectory.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
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NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S251–S337
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.505
P180. Minimally Invasive Lateral Lumbar Interbody Fusion (LLIF) versus Transforaminal Lumbar Interbody Fusion (TLIF): Patient Centered Results David C. Briski, MD1, Brandon W. Cook, MD2, Joseph M. Zavatsky, MD3; 1 Ochsner Medical Center, Jefferson, LA, USA; 2Ochsner Foundation Clinic, Jefferson, LA, USA; 3Spine & Scoliosis Specialists, Tampa, FL, USA BACKGROUND CONTEXT: The documented benefits of minimally invasive surgery (MIS) continue to be elucidated. These include decreased soft tissue disruption, blood loss, and shorter length of stay (LOS). The various MIS techniques each have inherent benefits. The direct patient benefit of the one procedure over the other (LLIF vs. TLIF) has yet to be clinically established. We analyzed the operative time and blood loss, postoperative VAS scores, and LOS associated with each procedure. PURPOSE: To evaluate if lateral lumbar interbody fusion (LLIF) will have lower VAS scores, EBL, and shorter LOS compared to transforaminal lumbar interbody fusion (TLIF). STUDY DESIGN/SETTING: Multi-center retrospective review. PATIENT SAMPLE: One hundred seventy-three patients with 2-year followup. LLIF—74 patients, TLIF—99 patients. OUTCOME MEASURES: Operative time and blood loss, postoperative VAS scores, and length of stay. METHODS: All patients with 1- and 2-level MIS LLIF and TLIF procedures with 2-year follow-up were included. Total operative time, blood loss, immediate postop and day of discharge VAS pain scores, along with LOS were recorded. Patients were divided into 2 groups. Group 1—LLIF; Group 2—TLIF. RESULTS: One hundred seventy-three patients met inclusion criteria. Group 1—74 patients, Group 2—99 patients. There was no difference in BMI, levels fused, perioperative complications, immediate postop or discharge VAS scores between the 2 groups. A significant benefit was observed in the LLIF compared to the TLIF Group regarding the number of patients discharged on Postop Day (POD) 1, (48% vs. 0%, p<.001), overall length of stay (2.1 vs. 3.5 days, p<.001), mean operative time (154 vs. 265 min, p<.001), and total operative blood loss (102 vs. 206 cc, p<.001), respectively. Subgroup analysis of only 1-level procedures (LLIF: 59 patients; TLIF: 80 patients) only strengthened the statistical analysis. CONCLUSIONS: There was no difference in perioperative complications, immediate postop or discharge VAS scores between the 2 Groups. The overall LOS was significantly lower in the LLIF Group and the number of patients discharged on POD 1 was significantly higher. Total operative time and blood loss was also significantly lower in the LLIF Group. Further prospective analysis is required to better delineate the financial implications and the comprehensive benefits of one procedure over the other. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.506
P181. Fluoroscopy and Surgery Times in Freehand Open, Freehand Minimally Invasive and Robotic Minimally Invasive, Short and Long Fusions Thomas M. Sweeney II, MD, PhD1, Tan D. Ly, DO2; 1Southeastern Spine Center & Research Institute, Sarasota, FL, USA; 2Southeastern Spine Center, Sarasota, FL, USA BACKGROUND CONTEXT: The current literature on minimally invasive (MIS) thoraco-lumbar fusions favors this technique over the standard
open approach for surgical and medical outcomes. However, while MIS is becoming more common, it is still routinely performed by a minority of surgeons and is typically limited to short fusions, where its clinical impact is smaller. MIS of 4 or more levels is rare due to the challenges in surgical technique (eg, rod insertion) which lengthen overall procedure time and dramatically increase the use of fluoroscopy. PURPOSE: To assess the impact of robotic-guidance on surgery time and intraoperative exposure to radiation in both short and long fusions. STUDY DESIGN/SETTING: Single community hospital, 2 surgeons, retrospective cohorts, comparative analysis. PATIENT SAMPLE: Adults with thoracolumbar degenerative conditions requiring fusion surgery. OUTCOME MEASURES: Total procedure time (“skin-to-skin”) per screw (minutes) and total fluoroscopy per screw (seconds). METHODS: A review of medical records of consecutive patients operated with robotic guidance (Renaissance, Mazor Robotics Ltd., Caesarea, Israel), and matched controls operated by the same surgeons, prior to adoption of robotic-guidance. Patients were operated either in a robotic-guided MIS approach (RG MIS), image-guided minimally invasive (FH MIS) or an open freehand approach (FH Open). RESULTS: Of 268 patients, 167 were in the RG MIS group, 46 in FH MIS and 53 in the FH Open. WIth a mean age of 68, RG MIS was significantly older than FH MIS (mean 61, p=.001). The mean age of FH Open was 65 (p=.093). There was no difference in sex and BMI between the 3 groups. RG MIS averaged 8.2 screws per case, while in FH MIS it was 5.6 (p<.001) and 8.7 in FH Open (p>.05). Total procedure time by number of levels operated was significantly faster in RG MIS compared to both freehand groups. RO MIS 2-level cases had a mean of 134 minutes compared to 170 minutes for FH MIS and 206 minutes for FH Open, which are similar to the 185 minutes average time for RO MIS in the group of 4 or more levels. Mean fluoroscopy time grouped by number of levels operated was significantly and consistently reduced in RG MIS compared to both freehand groups by 55–72%. CONCLUSIONS: Utilization of robotic-guidance in thoraco-lumbar fusions enables performance of multi-level fusions MIS, while significantly reducing the amount of fluoroscopy and overall surgery time, when normalized per level, compared to freehand MIS and open techniques. FDA DEVICE/DRUG STATUS: Mazor Robotics Renaissance (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2016.07.507
P182. Efficacy of Liposomal Bupivacaine for Postoperative Pain after Spine Surgery Jonathan Hughes, MD1, Christopher D. Chaput, MD2, Yolanda Munoz Maldonado, PhD1, Mark D. Rahm, MD3; 1Baylor Scott and White, Temple, TX, USA; 2Scott & White Hospital, Temple, TX, USA; 3 Baylor Scott and White Health, Temple, TX, USA BACKGROUND CONTEXT: Pain control following spine surgery can be challenging. Uncontrolled pain postoperatively can delay discharge, influence patient recovery, outcomes, and return to normal activities. Recently, there has been increasing interest in the use of multimodal pain regimens, including local perioperative analgesia, over postoperative narcotic and opioid use. Although the use of liposomal bupivacaine (LB) in general surgery and total joint arthroplasty has been studied, a PubMed search revealed no prior clinical data in the setting of spine surgery. PURPOSE: Assess the utility of using LB in spine surgery to decrease length of stay and improve perioperative pain control. STUDY DESIGN/SETTING: This study is a retrospective matched casecontrol study (Level III evidence). PATIENT SAMPLE: Forty-eight patients who underwent elective spine surgery utilizing an incision less than 8 cm at a single center. OUTCOME MEASURES: Length of hospital stay and cost analysis, postoperative morphine equivalent use, VAS, presence of medication related side effects, and the rate of wound complications.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
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and ODI scores were experienced for both groups from baseline. No significant differences in VAS and ODI scores were experienced between the two restriction groups at any time point in the study. CONCLUSIONS: Continuing postoperative restrictions through six weeks after lumbar discectomy does not significantly decrease the rate of reherniation. The results of this study suggest that two weeks of postoperative restrictions allow early return to activity without significant changes in postoperative pain scores or functional outcomes. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.504
P179. Predictive Model for Return to Work after Elective Surgery for Lumbar Degenerative Disease: An Analysis From National Neurosurgery Quality Outcomes Database Registry Kristin Archer, PhD, DPT1, Clinton J. Devin, MD1, Silky Chotai, MD1, Mohamad Bydon, MD2, Matthew J. McGirt, MD3, Hui Nian4, Frank E. Harrell Jr., PhD1, Anthony L. Asher, MD3; 1Vanderbilt University Medical Center, Nashville, TN, USA; 2Mayo Clinic, Rochester, MN, USA; 3Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA; 4Vanderbilt University, Nashville, TN, USA
http://dx.doi.org/10.1016/j.spinee.2016.07.503
P178. Short (2 Weeks) versus Long (6 Weeks) Postoperative Restrictions following Lumbar Discectomy: A Prospective Randomized Control Study Christopher M. Bono, MD1, Andrew J. Schoenfeld, MD1, Dana A. Leonard, BA1, Kirkham B. Wood, MD2, Mitchel Harris, MD, FACS1; 1Brigham and Women’s Hospital, Boston, MA, USA; 2Stanford University School of Medicine, Redwood City, CA, USA BACKGROUND CONTEXT: Acute reherniation may occur in as many as 10% of lumbar discectomy patients. Previous data has suggested that absence of postoperative restrictions after index discectomy does not result in an increased risk of reherniation. However, these data were based on noncomparative case series of patients uniformly encouraged to return to full activity as soon as possible. To the authors’ knowledge, a prospective, randomized control trial comparing short vs. long postoperative restrictions following lumbar discectomy has not been performed. PURPOSE: To evaluate short (2 week) vs. long (6 week) postoperative restrictions following lumbar discectomy impacted postsurgical outcomes and reherniation rates for a period up to one year following surgery. STUDY DESIGN/SETTING: Randomized prospective controlled trial. PATIENT SAMPLE: One hundred eight patients undergoing index lumbar discectomy. OUTCOME MEASURES: Back and leg visual analog pain scales (VAS), Oswestry Disability Index (ODI) and reherniation rates at 2 weeks, 6 weeks, 3 months and one year following surgery. METHODS: Patients were randomized immediately following surgery. In the long restriction group (considered the control), patients were instructed not to bend, lift, or twist for 6 weeks after surgery. In the short restriction group, these restrictions were limited to 2 weeks. Differences in reherniation rates were analyzed using Fisher’s exact test. VAS and ODI scores were evaluated using Student’s t-test. RESULTS: There were 108 patients initially randomized with 81 available at 3-month follow-up and 68 at one year. Fifty-five patients (51%) were randomized to the long restriction group and 53 (49%) to short restriction. The average age was 43.3 (SD 11.1) and 92% of patients were white. No significant differences in baseline variables were documented between the two groups. Within 90 days, three patients in the short restriction group (6%) and one in the long restriction group (2%) experienced a reherniation (p=.36), while six (11%) in the short and four (7%) in the long restriction group had reherniations by the end of the study (p=.52). Significant reductions in VAS
BACKGROUND CONTEXT: Current costs associated with spine care are unsustainable. The productivity loss and time away from work in gainfully employed patients contributes greatly to the financial burden. Therefore, it is vital to identify the factors associated with returning to work after lumbar spine surgery. PURPOSE: We present a predictive model of ability to return to work (RTW) after lumbar spine surgery for degenerative spine disease. STUDY DESIGN/SETTING: Analysis of prospective multicenter registry data. PATIENT SAMPLE: Patients undergoing elective spine surgery for degenerative lumbar disease that were entered into prospective multicenter registry (N2QOD) over a 2-year period, were included in this study. OUTCOME MEASURES: Patients that were employed preoperatively were asked at three months whether “they were able to RTW after surgery?” If yes, then patients were asked to specify “the date of returning to work” at the 3-month follow-up interview. For patients responding yes, the time to return to work was defined as the period between operation time and date of returning to work. Patients responding “No” were considered rightcensored on the day of interview. METHODS: A total of 3,467 patients were included in this study. The patients that were employed preoperatively and completed 3-month followup were included in the analysis. The time to return to work defined as the period between operation time and date of returning to work. A multivariable Cox proportional hazards regression model, including an array of preoperative factors, was fitted for RTW. RESULTS: Eighty-two percent of patients (n=3,855) returned to work within 3-months postoperatively. The risk-adjusted predictors of lower likelihood of RTW were preoperatively employed but not working at the time of presentation, those occupied with manual labor, on workman’s compensation, on liability insurance for disability, preoperative ODI scores, preoperative NRS-BP scores, and demographic factors including female gender, AfricanAmerican race, history of diabetes, and higher ASA grades. The likelihood of RTW within 3 months was higher in patients with higher education level compared to those with less than high school level education. The c-index of our model performance was 0.71. CONCLUSIONS: We present a novel predictive model for probability of RTW after lumbar spine surgery. Spine care providers can use this model to educate patients and encourage them in shared decisionmaking regarding the RTW outcome. This will result in better communication between patients and clinicians and improve recovery expectations, which will ultimately increase the likelihood of a positive RTW trajectory.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
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NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S251–S337
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.505
P180. Minimally Invasive Lateral Lumbar Interbody Fusion (LLIF) versus Transforaminal Lumbar Interbody Fusion (TLIF): Patient Centered Results David C. Briski, MD1, Brandon W. Cook, MD2, Joseph M. Zavatsky, MD3; 1 Ochsner Medical Center, Jefferson, LA, USA; 2Ochsner Foundation Clinic, Jefferson, LA, USA; 3Spine & Scoliosis Specialists, Tampa, FL, USA BACKGROUND CONTEXT: The documented benefits of minimally invasive surgery (MIS) continue to be elucidated. These include decreased soft tissue disruption, blood loss, and shorter length of stay (LOS). The various MIS techniques each have inherent benefits. The direct patient benefit of the one procedure over the other (LLIF vs. TLIF) has yet to be clinically established. We analyzed the operative time and blood loss, postoperative VAS scores, and LOS associated with each procedure. PURPOSE: To evaluate if lateral lumbar interbody fusion (LLIF) will have lower VAS scores, EBL, and shorter LOS compared to transforaminal lumbar interbody fusion (TLIF). STUDY DESIGN/SETTING: Multi-center retrospective review. PATIENT SAMPLE: One hundred seventy-three patients with 2-year followup. LLIF—74 patients, TLIF—99 patients. OUTCOME MEASURES: Operative time and blood loss, postoperative VAS scores, and length of stay. METHODS: All patients with 1- and 2-level MIS LLIF and TLIF procedures with 2-year follow-up were included. Total operative time, blood loss, immediate postop and day of discharge VAS pain scores, along with LOS were recorded. Patients were divided into 2 groups. Group 1—LLIF; Group 2—TLIF. RESULTS: One hundred seventy-three patients met inclusion criteria. Group 1—74 patients, Group 2—99 patients. There was no difference in BMI, levels fused, perioperative complications, immediate postop or discharge VAS scores between the 2 groups. A significant benefit was observed in the LLIF compared to the TLIF Group regarding the number of patients discharged on Postop Day (POD) 1, (48% vs. 0%, p<.001), overall length of stay (2.1 vs. 3.5 days, p<.001), mean operative time (154 vs. 265 min, p<.001), and total operative blood loss (102 vs. 206 cc, p<.001), respectively. Subgroup analysis of only 1-level procedures (LLIF: 59 patients; TLIF: 80 patients) only strengthened the statistical analysis. CONCLUSIONS: There was no difference in perioperative complications, immediate postop or discharge VAS scores between the 2 Groups. The overall LOS was significantly lower in the LLIF Group and the number of patients discharged on POD 1 was significantly higher. Total operative time and blood loss was also significantly lower in the LLIF Group. Further prospective analysis is required to better delineate the financial implications and the comprehensive benefits of one procedure over the other. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.506
P181. Fluoroscopy and Surgery Times in Freehand Open, Freehand Minimally Invasive and Robotic Minimally Invasive, Short and Long Fusions Thomas M. Sweeney II, MD, PhD1, Tan D. Ly, DO2; 1Southeastern Spine Center & Research Institute, Sarasota, FL, USA; 2Southeastern Spine Center, Sarasota, FL, USA BACKGROUND CONTEXT: The current literature on minimally invasive (MIS) thoraco-lumbar fusions favors this technique over the standard
open approach for surgical and medical outcomes. However, while MIS is becoming more common, it is still routinely performed by a minority of surgeons and is typically limited to short fusions, where its clinical impact is smaller. MIS of 4 or more levels is rare due to the challenges in surgical technique (eg, rod insertion) which lengthen overall procedure time and dramatically increase the use of fluoroscopy. PURPOSE: To assess the impact of robotic-guidance on surgery time and intraoperative exposure to radiation in both short and long fusions. STUDY DESIGN/SETTING: Single community hospital, 2 surgeons, retrospective cohorts, comparative analysis. PATIENT SAMPLE: Adults with thoracolumbar degenerative conditions requiring fusion surgery. OUTCOME MEASURES: Total procedure time (“skin-to-skin”) per screw (minutes) and total fluoroscopy per screw (seconds). METHODS: A review of medical records of consecutive patients operated with robotic guidance (Renaissance, Mazor Robotics Ltd., Caesarea, Israel), and matched controls operated by the same surgeons, prior to adoption of robotic-guidance. Patients were operated either in a robotic-guided MIS approach (RG MIS), image-guided minimally invasive (FH MIS) or an open freehand approach (FH Open). RESULTS: Of 268 patients, 167 were in the RG MIS group, 46 in FH MIS and 53 in the FH Open. WIth a mean age of 68, RG MIS was significantly older than FH MIS (mean 61, p=.001). The mean age of FH Open was 65 (p=.093). There was no difference in sex and BMI between the 3 groups. RG MIS averaged 8.2 screws per case, while in FH MIS it was 5.6 (p<.001) and 8.7 in FH Open (p>.05). Total procedure time by number of levels operated was significantly faster in RG MIS compared to both freehand groups. RO MIS 2-level cases had a mean of 134 minutes compared to 170 minutes for FH MIS and 206 minutes for FH Open, which are similar to the 185 minutes average time for RO MIS in the group of 4 or more levels. Mean fluoroscopy time grouped by number of levels operated was significantly and consistently reduced in RG MIS compared to both freehand groups by 55–72%. CONCLUSIONS: Utilization of robotic-guidance in thoraco-lumbar fusions enables performance of multi-level fusions MIS, while significantly reducing the amount of fluoroscopy and overall surgery time, when normalized per level, compared to freehand MIS and open techniques. FDA DEVICE/DRUG STATUS: Mazor Robotics Renaissance (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2016.07.507
P182. Efficacy of Liposomal Bupivacaine for Postoperative Pain after Spine Surgery Jonathan Hughes, MD1, Christopher D. Chaput, MD2, Yolanda Munoz Maldonado, PhD1, Mark D. Rahm, MD3; 1Baylor Scott and White, Temple, TX, USA; 2Scott & White Hospital, Temple, TX, USA; 3 Baylor Scott and White Health, Temple, TX, USA BACKGROUND CONTEXT: Pain control following spine surgery can be challenging. Uncontrolled pain postoperatively can delay discharge, influence patient recovery, outcomes, and return to normal activities. Recently, there has been increasing interest in the use of multimodal pain regimens, including local perioperative analgesia, over postoperative narcotic and opioid use. Although the use of liposomal bupivacaine (LB) in general surgery and total joint arthroplasty has been studied, a PubMed search revealed no prior clinical data in the setting of spine surgery. PURPOSE: Assess the utility of using LB in spine surgery to decrease length of stay and improve perioperative pain control. STUDY DESIGN/SETTING: This study is a retrospective matched casecontrol study (Level III evidence). PATIENT SAMPLE: Forty-eight patients who underwent elective spine surgery utilizing an incision less than 8 cm at a single center. OUTCOME MEASURES: Length of hospital stay and cost analysis, postoperative morphine equivalent use, VAS, presence of medication related side effects, and the rate of wound complications.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.