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Predictors of Clinical Outcomes following Stabilization of Thoracolumbar Spine Injuries
Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S
15S
PURPOSE: To evaluate multiple clinical and radiographic variables and their relationship with the neurologic improvement following surgical management of cervical spondylotic myelopathy. STUDY DESIGN/SETTING: Consecutive Clinical Series. PATIENT SAMPLE: One hundred twenty patients (77 males and 43 females) with multilevel cervical spondylotic myelopathy who underwent surgery over a 7 year period (1999–2005). OUTCOME MEASURES: Nurick scores were obtained pre- and postoperatively. Neurologic improvement was defined as a drop in Nurick score. METHODS: Variables were evaluated with chi-square, student’s t-test, ANOVA, and Logistic Regression Analysis. RESULTS: The Nurick score improved from a pre-operative mean of 3.6 to a post-operative mean of 2.8. 91 patients (76%) improved at least one Nurick grade, 19 patients (16%) were unchanged, and 10 (8%) worsened one grade. Factors significantly different in those patients with neurologic improvement included: age !65 years at the time of surgery, Nurick grade 3 or less pre-operatively, duration of symptoms less than 12 months, no history of diabetes, absence of cardiac disease which had required surgical intervention, and no history of smoking. Radiographic features significantly different in those patients with neurologic improvement included the absence of signal change on T2 weighted images on pre-operative MRI. Factors not significantly different in those with or without neurologic improvement included: the type of surgical procedure (multilevel corpectomy and fusion, laminoplasty, or laminectomy and fusion), the occurrence of a perioperative complication, or the need for additional surgery. CONCLUSIONS: The severity and duration of mylopathy can be predictive of the extent of neurologic improvement following surgery for cervical spondylotic myelopathy. While surgery should be offered to most, if not all patients, those with more advanced myelopathy at the time of presentation (Nurick Grade 4 or 5) and those with symptoms present for greater than a year may be less likely to improve neurologically. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
RESULTS: From 1054 patients who met the inclusion criteria, 28 patients (2.6%) were identified with a worsening of ODI at two-years post-operative. The mean change in ODI was -8.4 (range -2 to -30).The cohort included 13 males and 15 females with a mean age of 43.3 years (range, 26–72). Half of the patients were smokers. Diagnoses included degenerative disc disease (32%), spinal stenosis (21%), post discectomy instability (18%), spondylolithesis (21%) and nonunion (4%). Mean duration of symptoms was 40 months (range, 1–180). Common medical comorbidities included obesity (26%) and hypertension (43%) with a mean Charlson Co-morbidity Index of 2.2 (range, 0–8). Mean BMI was 26.3 kg/m2 (range 19.2–48.5). Thirty-nine percent of patients were working at the time of surgery. Half of the patients were on worker’s compensation. Thirty-two percent of patients reported psychosocial stressors. Fifty-four percent of patients had prior spine surgery. Peri and post-operative complications were found in 57% of patients. Pseudoarthrosis was the most common complication (28%). Other complications included wound infection (7%), dural tear (7%) and nerve root injury (4%). Seventy-five percent of patients required an intervention between surgery and their most recent follow up, which included epidural injections (39%), refusion (42%) and cervical spine fusion (28%). CONCLUSIONS: Net deterioration of ODI score after lumbar fusion surgery occurred in only 28 of 1054 patients (2.6%). The etiology seems to be multi-factorial. Previously identified pre-operative risk factors such as smoking, depression and worker’s compensation were common. Pseudoarthrosis requiring revision surgery was also common. A less commonly discussed issue was a relatively high frequency of subsequent cervical spine fusions. In conclusion, it is rare that a patient is worse after surgery and this may be related to smoking, depression, worker’s compensation, nonunion and the presence of other disease processes in the spine. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
doi: 10.1016/j.spinee.2010.07.043
33. Predictors of Clinical Outcomes following Stabilization of Thoracolumbar Spine Injuries John R. Dimar, II, MD1, Charles G. Fisher, MD2, Alexander R. Vaccaro, MD3, David O. Okonkwo, MD, PhD4, Marcel F.S. Dvorak, MD2, Michael G. Fehlings, MD, PhD5, Y. Raja Rampersaud, MD6, Leah Y. Carreon, MD, MSc1; 1Norton Leatherman Spine Center, Louisville, KY, USA; 2University of British Columbia Department of Orthopedics, Vancouver, BC, Canada; 3Thomas Jefferson University Department of Orthopedics, Philadelphia, PA, USA; 4 Department of Neurologic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; 5University of Toronto Department of Surgery, Division of Neurosurgery, Toronto, ON, Canada; 6UHN Orthopaedics and Toronto General & Western Hospital Foundation, Division of Orthopedic Surgery, Toronto, ON, Canada
32. Identifying Predictors of Worsening ODI Scores after Lumbar Spine Fusion Jeffrey D. Stimac, MD1, Leah Y. Carreon, MD, MSc2, Steven D. Glassman, MD2; 1University of Louisville School of Medicine Department of Orthopedic Surgery, Louisville, KY, USA; 2Norton Leatherman Spine Center, Louisville, KY, USA BACKGROUND CONTEXT: In reviewing risks and benefits, physicians are often asked ‘‘What are the chances that a patient could be worse after surgery?’’ Although deterioration after surgery is not defined by a single parameter, an absolute decrease in ODI score might be one reasonable definition. To our knowledge, nothing in the literature has looked at patients who have had a worsening in ODI score following spinal fusion to determine if there are characteristics that may lead to this poor outcome. PURPOSE: To identify patients who have a worsening (negative net change) in ODI score following lumbar spine fusion and evaluate characteristics that may lead to patient worsening following lumbar spine fusion. STUDY DESIGN/SETTING: Longitudinal Cohort. PATIENT SAMPLE: 1054 patients who underwent a lumbar fusion for degenerative spine conditions from a single spine specialty clinic who had prospectively collected outcome scores with a minimum two year follow-up. OUTCOME MEASURES: Oswestry Disability Index scores. METHODS: Patients who had a worsening of their ODI scores from preoperative to two years post-operative were identified. ODI worsening was defined as a negative net change in score. Data evaluated included age, sex, diagnosis, duration of symptoms, comorbidities, BMI, surgical history, work status, smoking history and psychosocial stressors. Surgical data included surgical approach, number of levels fused, blood loss and perioperative complications.
doi: 10.1016/j.spinee.2010.07.044
BACKGROUND CONTEXT: Several studies have evaluated factors that affect neurologic recovery and the incidence of complications in patients with thoracolumbar spine injuries. However, factors that affect functional clinical outcomes in thoracolumbar trauma have not been extensively studied. As opposed to elective surgeries, where patient characteristics can be modified preoperatively, in the trauma patient the only factors that can be controlled by surgeons are the timing of surgery, the type of surgery and the postoperative care. PURPOSE: The purpose of this study is to identify factors, including timing of decompression and stabilization, which may impact general health related quality of life, specifically the SF-36 PCS scores. STUDY DESIGN/SETTING: Longitudinal Cohort. PATIENT SAMPLE: 280 patients enrolled in a multicenter database for spine trauma. OUTCOME MEASURES: Short Form-36 Physical Composite Summary Score. METHODS: A retrospective review of prospectively collected data from a multicenter database for spine trauma was performed. Standard
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
16S
Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S
demographic data, Glasgow Coma Scores (GCS), Injury Severity Score (ISS), ASIA score, Charlson CoMorbiditiy Index (CCI), mechanism of injury, administration of methylprednisolone (NASCIS II, III), time from injury to surgery, and surgical approach were evaluated. Multivariate regression analysis was done to identify factors predictive of the one-year SF-36 Physical Composite Summary Score (SF-36 PCS). RESULTS: There were 280 patients (78 females, 202 males) who met inclusion criteria and had adequate follow-up, 31% were smokers. The mean age at injury was 41.4617.4 years and the mean body mass index was 25.364.6 kg/m2. The most common injury mechanism was MVA (38%) followed by a fall (37%) and sports injury (15%). Half of the patients had an ASIA E injury (49%), followed by ASIA A (28%), ASIA D (9%), ASIA B (8%) and ASIA C (6%). The mean admission ISS was 10.9610.8, mean CCI was 0.961.5, mean GCS was 14.362.2. Methylprednisolone was administered in 32% of patients. The majority of patients were stabilized posteriorly (76%) with 9% treated anteriorly and combined anterior-posterior in 16%. The mean time from injury to surgery was 60.0655.4 hours. Factors predictive of the SF-36 PCS at one year were the ASIA Grade and the CCI. CONCLUSIONS: One-Year SF-36 PCS scores are dependent on ASIA score and the presence of comorbid conditions. This study does not support the contention that timing of surgical decompression and stabilization alter long term clinical outcomes. The findings of this study may be different if neurological outcome or complication rates were the clinical outcomes of interest. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.045
34. Quantifying MRI in Spinal Cord Injury to Predict Neurological Recovery Rajeshwar N. Srivastava, MD; King Georges Medical College, CSM Medical University, Lucknow, India BACKGROUND CONTEXT: Diagnostic imaging, particularly Magnetic Resonance Imaging (MRI), plays a crucial role in evaluating and detecting spinal trauma. Subtle bone marrow, soft-tissue, and spinal cord abnormalities, which may not be apparent on other imaging modalities, can be readily detected on MRI. Early detection often leads to prompt accurate diagnosis and expeditious management, in many cases avoiding unnecessary procedures. PURPOSE: MRI as a prognostic indicator in spinal trauma. STUDY DESIGN/SETTING: Prospective. PATIENT SAMPLE: Sixty two patients of spinal trauma needing admission formed the study group. OUTCOME MEASURES: Abnormal spinal cord patterns in terms of cord edema/non hemorrhagic contusion, hemorrhagic contusion, cord compression and epidural hematoma. The findings were quantified by measuring the length and girth of segment involved. METHODS: We performed this prospective study from august 2006 to July 2007, on sixty two patients of acute spinal trauma. All patients underwent MRI examination. Prior to MRI, detailed neurological and functional status of the patient were recorded. We evaluated the various traumatic findings by quantifying MRI. MRI findings were correlated with clinical findings at admission & discharge according to ASIA sensory and motor scores & ASIA impairment scale. RESULTS: 1. Sizable focus of haemorrhage involving O1 cm of the cord was present in 32% of cases with 95% confidence limit of 20.94–45.34%. 2. Severe cord compressionO75% was present in 34% of patients with 95% CL of 22.33–47.01%. 3. Epidural hematoma was present in 5% of cases. 4. Cord oedema/non haemorrhagic contusions involving!3 cm of cord was present in 24.56% of patient with 95% confidence limit of 14.13–37.76% 5. Cord oedema/contusions involvingO3 cm of cord was present in 49.12% of patients with 95% confidence limit of 35.63–62.71%. On bivariate analysis a) There was a definitive correlation of cord edema involving!3 cm of cord &
O3 cm of cord with sensory outcome. Chances of non improvement were more in patients with cord edema involving O3 cm of cord (p!.05). In patients with cord edema involving O3 cm of cord, chances of sensory improvement was 5.75 times lesser than in patients with cord edema involving !3 cm of cord (odds ratio55.75 (95% CI: 0.95, 36), Fisher’s exact p50.0427 (p!.05). b) Presence of sizable focus of haemorrhage in cord (O1 cm) was most strongly associated with the poor outcome (odds ratio 6.97 and p5.0047). The risk of retaining a complete cord injury at the time of follow up for patients who initially had evidence of significant haemorrhage in cord was more than 6 folds with patients without initial haemorrhage(Odds ratio - \6.97 and p50.0047). c) It was noted that the patients in which epidural hematoma was present, no improvement was seen, however, by statistical analysis it was proved that epidural hematomas was not a risk factor and it is not related with the outcome (odds ratio - 0.5 and p50.22). d) Presence of severe cord compression O75% was a risk factor for poor outcome (odds ratio - 4.90 and p50.0143). On multiple logistic regression/multivariate analysis, a. Sizable focus of hemorrhage O1 cm was most consistently associated with poor outcome (odds ratio -6.73 and p50.32) b. In the patients with severe cord compression O75% the risk of poor outcome was more (odds ratio 4.3 and p50.149) however was not statistically significant. c. Presence of cord oedema/ non haemorrhagic contusion was not associated with poor outcome (odds ratio 0.25 and p50.178). CONCLUSIONS: In our study we found out that T2 fr FSE sagittal images are best images for the evaluation of spinal trauma. For evaluation of cord hemorrhage best images were gradient recalled echo (GRE). Presence of sizable focus of haemorrhage in cord (O1 cm) was most strongly associated with the poor outcome. Chances of non improvement were more in patients with cord edema involving O3 cm of cord. Cord compression of O75% was a risk factor with poor outcome. Epidural hematoma was not a risk factor and did not influence outcome. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.046
35. Correlation of Preoperative Depression and Somatic Perception Scales with Postoperative Disability and Quality of Life after Lumbar Discectomy Scott L. Parker, MD1, Kaisorn L. Chaichana, MD1, Debraj Mukherjee, MD, MPH1, Owoicho Adogwa, MPH2, Joseph Cheng, MD2, Matthew McGirt, MD2; 1The Johns Hopkins University, Baltimore, MD, USA; 2Vanderbilt University, Nashville, TN, USA BACKGROUND CONTEXT: Not all patients will benefit from lumbar discectomy. Patients with certain psychological predispositions may be especially vulnerable to poor outcomes. PURPOSE: Determine the role that pre-op depression and somatic anxiety have on long-term back/leg pain, disability, quality of life for patients undergoing single-level lumbar discectomy. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: Patients undergoing discectomy for single-level herniated lumbar disc. OUTCOME MEASURES: BPVAS, LPVAS, SF-36, ODI, Zung selfrating depression scale, modified somatic perception questionnaire. METHODS: 67 adults undergoing discectomy for single-level herniated lumbar disc underwent quantitative measurement of leg/back pain(VAS),quality of life(SF-36),and disease-specific disability (ODI) pre-operatively, at 6 weeks,3,6,and 12 months after surgery. Degree of pre-op depression and somatization assessed using Zung Self-Rating Depression Scale and modified somatic perception questionnaire (MSPQ). Multivariate regression analyses assessed associations between Zung and MSPQ scores with achievement of minimum clinical important difference (MCID) in each outcome measure by 12 months post-op.
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
15S
PURPOSE: To evaluate multiple clinical and radiographic variables and their relationship with the neurologic improvement following surgical management of cervical spondylotic myelopathy. STUDY DESIGN/SETTING: Consecutive Clinical Series. PATIENT SAMPLE: One hundred twenty patients (77 males and 43 females) with multilevel cervical spondylotic myelopathy who underwent surgery over a 7 year period (1999–2005). OUTCOME MEASURES: Nurick scores were obtained pre- and postoperatively. Neurologic improvement was defined as a drop in Nurick score. METHODS: Variables were evaluated with chi-square, student’s t-test, ANOVA, and Logistic Regression Analysis. RESULTS: The Nurick score improved from a pre-operative mean of 3.6 to a post-operative mean of 2.8. 91 patients (76%) improved at least one Nurick grade, 19 patients (16%) were unchanged, and 10 (8%) worsened one grade. Factors significantly different in those patients with neurologic improvement included: age !65 years at the time of surgery, Nurick grade 3 or less pre-operatively, duration of symptoms less than 12 months, no history of diabetes, absence of cardiac disease which had required surgical intervention, and no history of smoking. Radiographic features significantly different in those patients with neurologic improvement included the absence of signal change on T2 weighted images on pre-operative MRI. Factors not significantly different in those with or without neurologic improvement included: the type of surgical procedure (multilevel corpectomy and fusion, laminoplasty, or laminectomy and fusion), the occurrence of a perioperative complication, or the need for additional surgery. CONCLUSIONS: The severity and duration of mylopathy can be predictive of the extent of neurologic improvement following surgery for cervical spondylotic myelopathy. While surgery should be offered to most, if not all patients, those with more advanced myelopathy at the time of presentation (Nurick Grade 4 or 5) and those with symptoms present for greater than a year may be less likely to improve neurologically. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
RESULTS: From 1054 patients who met the inclusion criteria, 28 patients (2.6%) were identified with a worsening of ODI at two-years post-operative. The mean change in ODI was -8.4 (range -2 to -30).The cohort included 13 males and 15 females with a mean age of 43.3 years (range, 26–72). Half of the patients were smokers. Diagnoses included degenerative disc disease (32%), spinal stenosis (21%), post discectomy instability (18%), spondylolithesis (21%) and nonunion (4%). Mean duration of symptoms was 40 months (range, 1–180). Common medical comorbidities included obesity (26%) and hypertension (43%) with a mean Charlson Co-morbidity Index of 2.2 (range, 0–8). Mean BMI was 26.3 kg/m2 (range 19.2–48.5). Thirty-nine percent of patients were working at the time of surgery. Half of the patients were on worker’s compensation. Thirty-two percent of patients reported psychosocial stressors. Fifty-four percent of patients had prior spine surgery. Peri and post-operative complications were found in 57% of patients. Pseudoarthrosis was the most common complication (28%). Other complications included wound infection (7%), dural tear (7%) and nerve root injury (4%). Seventy-five percent of patients required an intervention between surgery and their most recent follow up, which included epidural injections (39%), refusion (42%) and cervical spine fusion (28%). CONCLUSIONS: Net deterioration of ODI score after lumbar fusion surgery occurred in only 28 of 1054 patients (2.6%). The etiology seems to be multi-factorial. Previously identified pre-operative risk factors such as smoking, depression and worker’s compensation were common. Pseudoarthrosis requiring revision surgery was also common. A less commonly discussed issue was a relatively high frequency of subsequent cervical spine fusions. In conclusion, it is rare that a patient is worse after surgery and this may be related to smoking, depression, worker’s compensation, nonunion and the presence of other disease processes in the spine. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
doi: 10.1016/j.spinee.2010.07.043
33. Predictors of Clinical Outcomes following Stabilization of Thoracolumbar Spine Injuries John R. Dimar, II, MD1, Charles G. Fisher, MD2, Alexander R. Vaccaro, MD3, David O. Okonkwo, MD, PhD4, Marcel F.S. Dvorak, MD2, Michael G. Fehlings, MD, PhD5, Y. Raja Rampersaud, MD6, Leah Y. Carreon, MD, MSc1; 1Norton Leatherman Spine Center, Louisville, KY, USA; 2University of British Columbia Department of Orthopedics, Vancouver, BC, Canada; 3Thomas Jefferson University Department of Orthopedics, Philadelphia, PA, USA; 4 Department of Neurologic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; 5University of Toronto Department of Surgery, Division of Neurosurgery, Toronto, ON, Canada; 6UHN Orthopaedics and Toronto General & Western Hospital Foundation, Division of Orthopedic Surgery, Toronto, ON, Canada
32. Identifying Predictors of Worsening ODI Scores after Lumbar Spine Fusion Jeffrey D. Stimac, MD1, Leah Y. Carreon, MD, MSc2, Steven D. Glassman, MD2; 1University of Louisville School of Medicine Department of Orthopedic Surgery, Louisville, KY, USA; 2Norton Leatherman Spine Center, Louisville, KY, USA BACKGROUND CONTEXT: In reviewing risks and benefits, physicians are often asked ‘‘What are the chances that a patient could be worse after surgery?’’ Although deterioration after surgery is not defined by a single parameter, an absolute decrease in ODI score might be one reasonable definition. To our knowledge, nothing in the literature has looked at patients who have had a worsening in ODI score following spinal fusion to determine if there are characteristics that may lead to this poor outcome. PURPOSE: To identify patients who have a worsening (negative net change) in ODI score following lumbar spine fusion and evaluate characteristics that may lead to patient worsening following lumbar spine fusion. STUDY DESIGN/SETTING: Longitudinal Cohort. PATIENT SAMPLE: 1054 patients who underwent a lumbar fusion for degenerative spine conditions from a single spine specialty clinic who had prospectively collected outcome scores with a minimum two year follow-up. OUTCOME MEASURES: Oswestry Disability Index scores. METHODS: Patients who had a worsening of their ODI scores from preoperative to two years post-operative were identified. ODI worsening was defined as a negative net change in score. Data evaluated included age, sex, diagnosis, duration of symptoms, comorbidities, BMI, surgical history, work status, smoking history and psychosocial stressors. Surgical data included surgical approach, number of levels fused, blood loss and perioperative complications.
doi: 10.1016/j.spinee.2010.07.044
BACKGROUND CONTEXT: Several studies have evaluated factors that affect neurologic recovery and the incidence of complications in patients with thoracolumbar spine injuries. However, factors that affect functional clinical outcomes in thoracolumbar trauma have not been extensively studied. As opposed to elective surgeries, where patient characteristics can be modified preoperatively, in the trauma patient the only factors that can be controlled by surgeons are the timing of surgery, the type of surgery and the postoperative care. PURPOSE: The purpose of this study is to identify factors, including timing of decompression and stabilization, which may impact general health related quality of life, specifically the SF-36 PCS scores. STUDY DESIGN/SETTING: Longitudinal Cohort. PATIENT SAMPLE: 280 patients enrolled in a multicenter database for spine trauma. OUTCOME MEASURES: Short Form-36 Physical Composite Summary Score. METHODS: A retrospective review of prospectively collected data from a multicenter database for spine trauma was performed. Standard
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
16S
Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S
demographic data, Glasgow Coma Scores (GCS), Injury Severity Score (ISS), ASIA score, Charlson CoMorbiditiy Index (CCI), mechanism of injury, administration of methylprednisolone (NASCIS II, III), time from injury to surgery, and surgical approach were evaluated. Multivariate regression analysis was done to identify factors predictive of the one-year SF-36 Physical Composite Summary Score (SF-36 PCS). RESULTS: There were 280 patients (78 females, 202 males) who met inclusion criteria and had adequate follow-up, 31% were smokers. The mean age at injury was 41.4617.4 years and the mean body mass index was 25.364.6 kg/m2. The most common injury mechanism was MVA (38%) followed by a fall (37%) and sports injury (15%). Half of the patients had an ASIA E injury (49%), followed by ASIA A (28%), ASIA D (9%), ASIA B (8%) and ASIA C (6%). The mean admission ISS was 10.9610.8, mean CCI was 0.961.5, mean GCS was 14.362.2. Methylprednisolone was administered in 32% of patients. The majority of patients were stabilized posteriorly (76%) with 9% treated anteriorly and combined anterior-posterior in 16%. The mean time from injury to surgery was 60.0655.4 hours. Factors predictive of the SF-36 PCS at one year were the ASIA Grade and the CCI. CONCLUSIONS: One-Year SF-36 PCS scores are dependent on ASIA score and the presence of comorbid conditions. This study does not support the contention that timing of surgical decompression and stabilization alter long term clinical outcomes. The findings of this study may be different if neurological outcome or complication rates were the clinical outcomes of interest. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.045
34. Quantifying MRI in Spinal Cord Injury to Predict Neurological Recovery Rajeshwar N. Srivastava, MD; King Georges Medical College, CSM Medical University, Lucknow, India BACKGROUND CONTEXT: Diagnostic imaging, particularly Magnetic Resonance Imaging (MRI), plays a crucial role in evaluating and detecting spinal trauma. Subtle bone marrow, soft-tissue, and spinal cord abnormalities, which may not be apparent on other imaging modalities, can be readily detected on MRI. Early detection often leads to prompt accurate diagnosis and expeditious management, in many cases avoiding unnecessary procedures. PURPOSE: MRI as a prognostic indicator in spinal trauma. STUDY DESIGN/SETTING: Prospective. PATIENT SAMPLE: Sixty two patients of spinal trauma needing admission formed the study group. OUTCOME MEASURES: Abnormal spinal cord patterns in terms of cord edema/non hemorrhagic contusion, hemorrhagic contusion, cord compression and epidural hematoma. The findings were quantified by measuring the length and girth of segment involved. METHODS: We performed this prospective study from august 2006 to July 2007, on sixty two patients of acute spinal trauma. All patients underwent MRI examination. Prior to MRI, detailed neurological and functional status of the patient were recorded. We evaluated the various traumatic findings by quantifying MRI. MRI findings were correlated with clinical findings at admission & discharge according to ASIA sensory and motor scores & ASIA impairment scale. RESULTS: 1. Sizable focus of haemorrhage involving O1 cm of the cord was present in 32% of cases with 95% confidence limit of 20.94–45.34%. 2. Severe cord compressionO75% was present in 34% of patients with 95% CL of 22.33–47.01%. 3. Epidural hematoma was present in 5% of cases. 4. Cord oedema/non haemorrhagic contusions involving!3 cm of cord was present in 24.56% of patient with 95% confidence limit of 14.13–37.76% 5. Cord oedema/contusions involvingO3 cm of cord was present in 49.12% of patients with 95% confidence limit of 35.63–62.71%. On bivariate analysis a) There was a definitive correlation of cord edema involving!3 cm of cord &
O3 cm of cord with sensory outcome. Chances of non improvement were more in patients with cord edema involving O3 cm of cord (p!.05). In patients with cord edema involving O3 cm of cord, chances of sensory improvement was 5.75 times lesser than in patients with cord edema involving !3 cm of cord (odds ratio55.75 (95% CI: 0.95, 36), Fisher’s exact p50.0427 (p!.05). b) Presence of sizable focus of haemorrhage in cord (O1 cm) was most strongly associated with the poor outcome (odds ratio 6.97 and p5.0047). The risk of retaining a complete cord injury at the time of follow up for patients who initially had evidence of significant haemorrhage in cord was more than 6 folds with patients without initial haemorrhage(Odds ratio - \6.97 and p50.0047). c) It was noted that the patients in which epidural hematoma was present, no improvement was seen, however, by statistical analysis it was proved that epidural hematomas was not a risk factor and it is not related with the outcome (odds ratio - 0.5 and p50.22). d) Presence of severe cord compression O75% was a risk factor for poor outcome (odds ratio - 4.90 and p50.0143). On multiple logistic regression/multivariate analysis, a. Sizable focus of hemorrhage O1 cm was most consistently associated with poor outcome (odds ratio -6.73 and p50.32) b. In the patients with severe cord compression O75% the risk of poor outcome was more (odds ratio 4.3 and p50.149) however was not statistically significant. c. Presence of cord oedema/ non haemorrhagic contusion was not associated with poor outcome (odds ratio 0.25 and p50.178). CONCLUSIONS: In our study we found out that T2 fr FSE sagittal images are best images for the evaluation of spinal trauma. For evaluation of cord hemorrhage best images were gradient recalled echo (GRE). Presence of sizable focus of haemorrhage in cord (O1 cm) was most strongly associated with the poor outcome. Chances of non improvement were more in patients with cord edema involving O3 cm of cord. Cord compression of O75% was a risk factor with poor outcome. Epidural hematoma was not a risk factor and did not influence outcome. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.046
35. Correlation of Preoperative Depression and Somatic Perception Scales with Postoperative Disability and Quality of Life after Lumbar Discectomy Scott L. Parker, MD1, Kaisorn L. Chaichana, MD1, Debraj Mukherjee, MD, MPH1, Owoicho Adogwa, MPH2, Joseph Cheng, MD2, Matthew McGirt, MD2; 1The Johns Hopkins University, Baltimore, MD, USA; 2Vanderbilt University, Nashville, TN, USA BACKGROUND CONTEXT: Not all patients will benefit from lumbar discectomy. Patients with certain psychological predispositions may be especially vulnerable to poor outcomes. PURPOSE: Determine the role that pre-op depression and somatic anxiety have on long-term back/leg pain, disability, quality of life for patients undergoing single-level lumbar discectomy. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: Patients undergoing discectomy for single-level herniated lumbar disc. OUTCOME MEASURES: BPVAS, LPVAS, SF-36, ODI, Zung selfrating depression scale, modified somatic perception questionnaire. METHODS: 67 adults undergoing discectomy for single-level herniated lumbar disc underwent quantitative measurement of leg/back pain(VAS),quality of life(SF-36),and disease-specific disability (ODI) pre-operatively, at 6 weeks,3,6,and 12 months after surgery. Degree of pre-op depression and somatization assessed using Zung Self-Rating Depression Scale and modified somatic perception questionnaire (MSPQ). Multivariate regression analyses assessed associations between Zung and MSPQ scores with achievement of minimum clinical important difference (MCID) in each outcome measure by 12 months post-op.
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.