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Preoperative Narcotic Use and its Relation to Anxiety, Depression and Payer Status in Patients Undergoing Spine Surgery
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Proceedings of the NASS 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S
retrospectively reviewed outcomes, including visual analogue pain scale (VAS), the Oswestry Disability Index (ODI), compression ratio and kyphotic angle. RESULTS: There were eleven complications, including pneumonia in 4 patients, screw loosening in 5 patients, mild hematoma at the subcutaneous tissue and pseudarthrosis in each 1 case. The mean VAS score was exhibiting V-shaped upward trend after postoperative 6 months that ended with the almost similar score obtained with preoperative status. The mean ODI score was also shown with similar trend. In functional score, there was a statistical significant improvement until only 6 months after surgery. In radiologic evaluation, the mean kyphotic angle and compression ratio was significantly corrected after surgery (P!0.05). However, these improved radiologic parameters were maximal at the immediate postoperative time with gradual loss over time. CONCLUSIONS: Taken together, our results suggest that in cases of ONV, transpedicular intracorporeal bone graft with short-segmental posterior instrumentation may not effectively provide stability, prolonged relief of back pain, or maintain stabilization over a five year period. In addition, we observed recurrent kyphotic change of the vertebral body during the follow-up period. Therefore, we do not recommend short-segmental posterior instrumentation concurrently with transpedicular intracorporeal bone graft for treating ONV. FDA DEVICE/DRUG STATUS: Allograft bone (Approved for this indication).
preoperatively, p!0.001), as were EQ5D scores (0.7560.22 at 3 months, 0.7360.22 at 12 months, compared to 0.5460.21 preoperatively, p! 0.001). ODI/NDI scores were also significantly improved at both followup visits (28.7619.6 at 3 months, 28.4620.9 at 12 months, compared to 49.2618.0 preoperatively, p!0.001). Separate longitudinal multivariable analyses controlling for age, gender, diabetes, smoking, anatomic location, preoperative Modified Somatic Perception Questionnaire (MSPQ) score, preoperative depression, primary vs revision surgery, and baseline score of the outcome variable found that preoperative narcotic use was a significant predictor of decreased postoperative SF-12 and EQ5D scores and increased ODI/NDI scores. Specifically, every 1mg MEA taken preoperatively was associated with a 0.02 decrease in the SF-12 physical health score, a 0.001 decrease in the EQ5D score, and a 0.05 increase in the ODI/NDI score (p!0.001) postoperatively. All models were examined for the random effect of performing surgeon and found not to be significant, even when directly controlling for this variable. CONCLUSIONS: Our work suggests that increased preoperative narcotic consumption prior to undergoing spine surgery for a structural lesion predicts worse patient reported outcomes. Future work should focus on the association of preoperative narcotic use and other outcome measures. Such information may help facilitate discussion between surgeon and patient regarding expectations prior to proceeding with surgery. FDA DEVICE/DRUG STATUS: Narcotics/opioids (Approved for this indication).
http://dx.doi.org/10.1016/j.spinee.2013.07.354
http://dx.doi.org/10.1016/j.spinee.2013.07.355
P81. Preoperative Narcotic Use Predicts Worse Postoperative Self-Reported Outcomes in Patients undergoing Spine Surgery Dennis S. Lee, MD1, Sheyan J. Armaghani, MD2, Jesse E. Bible, MD2, David N. Shau, BS1, Harrison F. Kay2, Chi Zhang2, Kristin Archer, PhD, DPT1, Matthew J. McGirt, MD1, Clinton J. Devin, MD2; 1Vanderbilt University Medical Center, Nashville, TN, US; 2Nashville, TN, US
P82. Preoperative Narcotic Use and its Relation to Anxiety, Depression and Payer Status in Patients Undergoing Spine Surgery Dennis S. Lee, MD1, Sheyan J. Armaghani, MD2, Jesse E. Bible, MD2, David N. Shau, BS1, Harrison F. Kay2, Chi Zhang2, Matthew J. McGirt, MD1, Clinton J. Devin, MD2; 1Vanderbilt University Medical Center, Nashville, TN, US; 2Nashville, TN, US
BACKGROUND CONTEXT: Narcotics remain a common agent class used for the management of pain in patients being evaluated for spine surgery. Recent national attention has highlighted the negative effects of narcotics in this and other non-malignant pain settings. Previous work suggests that increased preoperative narcotic use has a negative impact on spine surgery outcomes. PURPOSE: We aim to assess whether preoperative narcotic use predicts worse self-reported outcomes in patients undergoing spine surgery. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: 583 patients evaluated and treated for lumbar, thoracolumbar, or cervical lesions from October 2010 to June 2012 at a single institution. OUTCOME MEASURES: Patient reported outcome measures were assessed via 12-Item Short-Form Health Survey (SF-12) scores for general overall physical health, EuroQol-5D (EQ5D) scores for health-related quality of life, as well as Oswestry/Neck Disability Index (ODI/NDI) scores for disability. METHODS: 583 patients undergoing lumbar (60%), thoracolumbar (11%), or cervical spine (29%) surgery for a structural lesion were included. Self-reported preoperative narcotic consumption was obtained at the initial preoperative visit and converted to the corresponding daily morphine equivalent amount (MEA). Preoperative baseline, 3-month postoperative, and 12-month postoperative SF-12, ODI/NDI, and EQ5D scores were assessed for all patients. ODI and NDI scores were combined into a single outcome variable to include both cervical and lumbar patients in simultaneous analyses. Separate multivariable linear regression analyses were then used to determine whether preoperative narcotic use predicted postoperative SF-12, EQ5D, and ODI/NDI scores. RESULTS: Univariate analyses revealed that SF-12 physical health scores were significantly improved at both 3 and 12-month follow-up (39.6611.4 at 3 months, 39.0613.2 at 12 months, compared to 29.269.6
BACKGROUND CONTEXT: Narcotics remain a common agent class used for the management of pain in patients being evaluated for spine surgery. Recent national attention has highlighted the negative effects of narcotics in this and other non-malignant pain settings. Previous work suggests narcotic use and psychiatric comorbidities are intimately related. Among other psychosocial considerations, anxiety level, depression, and payer status may be associated with the amount of preoperative narcotic use in patients undergoing spine surgery. PURPOSE: We aim to assess whether the amount of preoperative narcotic use is associated with preoperative anxiety level, depression, and payer status in patients undergoing spine surgery for a structural lesion. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: 583 patients evaluated and treated for lumbar, thoracolumbar, or cervical structural lesions from October 2010 to June 2012 at a single institution. OUTCOME MEASURES: Daily morphine equivalent amount (MEA) consumption as assessed at the initial preoperative visit for patients undergoing spine surgery. METHODS: 583 patients undergoing lumbar (60%), thoracolumbar (11%), or cervical spine (29%) surgery for a structural lesion were included. Self-reported preoperative narcotic consumption was obtained at the initial preoperative visit and converted to the corresponding daily morphine equivalent amount (MEA). Preoperative Zung Depression Scale (ZDS) and Modified Somatic Perception Questionnaire (MSPQ) scores were also obtained at the initial preoperative visit and recorded as measures of depression and anxiety, respectively. Payer status was recorded as either federal Medicare/Medicaid, private, state Medicaid, uninsured/indigent, or Veterans Affairs/government. Linear regression analysis was performed including other clinically and psychosocially important covariates. These included age, gender, type of surgery, smoking status, and preoperative employment status.
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 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S RESULTS: Linear regression analysis controlling for age, gender, type of surgery, smoking status, and preoperative employment status demonstrated that payer status was not significantly associated with preoperative narcotic use. Preoperative MSPQ and ZDS scores were significantly associated with the amount of preoperative narcotic use (correlation coefficient 1.26, p! 0.05 & 0.78, p!0.01, respectively). CONCLUSIONS: Payer status does not appear to be associated with the amount of preoperative narcotic use in patients undergoing spine surgery for a structural lesion. Anxiety and depression as assessed by MSPQ and ZDS scores were significantly associated with increased preoperative narcotic use, underscoring the importance of thorough psychosocial and substance use assessment in patients being evaluated for spine surgery. FDA DEVICE/DRUG STATUS: Narcotics/opioids (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2013.07.356
P83. The Relationship Between Lumbar Spine Facet Joint Arthritis and Dynamic and Static Low Back Pain. Which Level of Lumbar Spine Facet Joint Arthritis is Most Influenced on the Static or Dynamic Low Back Pain? Sang-Bong Ko, MD; Cherry Hill, NJ, US BACKGROUND CONTEXT: The association between lumbar spine facet joint arthritis (LSFJA) and static and dynamic low back pain (LBP) remains unclear and which level of LSFJA is most influenced on the dynamic LBP and static LBP is not known. PURPOSE: To evaluate the association of lumbar spine facet joint arthritis (LSFJA) identified by multi-detector computed tomography (MDCT) with age, dynamic and static low back pain (LBP) in an unselected adult community-based population in Korea. And to know which level of LSFJA is most influenced on the dynamic low back pain and static low back pain. STUDY DESIGN/SETTING: Cross-sectional Study. PATIENT SAMPLE: A sample of four hundred seventy-two participants (age: 20 to 84 years) from our medical center and who underwent multidetector CT imaging to assess abdominal and urological lesions were included in this study. OUTCOME MEASURES: The occurrence of LBP which is occurring immediately on sitting down and relieved on standing up and needed medication in the preceding 12 months (dynamic LBP:dLBP) and the occurrence of LBP needed medication in the preceding 12 months (static LBP:sLBP) were evaluated using a self-report questionnaire (a modified Nordic Low Back Pain Questionnaire). The presence of facet joint arthritis was characterized by the CT imaging using 4-grade scale. METHODS: The association between LSFJA and dLBP and LSFJA and sLBP were examined used multiple logistic regression models and the level of LSFJA which is most influenced on the dLBP and sLBP were identified. RESULTS: Eighty-three study subjects (17.58%) demonstrated LSFJA (over grade 2). Prevalence of LSFJA increase with age: 134 study subjects (28.39%) had sLBP and 116 study subjects (24.58%) had dLBP. LSFJA group is 33 subjects (24.63%) among sLBP study subject and 26 subjects (22.41%) among dLBP study subject. LSFJA is not significant to both sLBP and dLBP. In an unselected adult community-based population in Korea, LSFJA at any spinal level showed no association with both sLBP and dLBP. CONCLUSIONS: The prevalence of sLBP is 28.39% and that of dLBP 24.58% among an unselected community-based Korean population. LSFJA based on the CT imaging is 17.51% among the same population. Prevalence of LSFJA increased with age with the highest prevalence at the L4-5 spinal level. LSFJA is not associated with both dynamic and static LBP at any spinal level. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.357
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P84. Electronic Health Records Have Negligible Impact on Outpatient Volume and Coded Level of Service: A Report from Two Departments in an Academic Medical Group Matthew L. Webb1, Daniel D. Bohl, MPH1, Jordan A. Gruskay2, Jonathan N. Grauer, MD1; 1Yale University School of Medicine, New Haven, CT, US; 2Rothman Institute, Philadelphia, PA, US BACKGROUND CONTEXT: Recent media coverage (New York Times) reports that the implementation of electronic health records (EHR) may be associated with substantial increases in Medicare payments, in part due to an increase in the coded level of service facilitated by HER (Current Procedural Terminology (CPT)). There additionally exists concern within many medical groups that the transition to EHR could be associated with a decrease in total patient volume. PURPOSE: To investigate whether outpatient volumes and coded level of service changed after the transition to EHR. STUDY DESIGN/SETTING: Two departments in our academic medical group (Internal Medicine, Orthopaedics) began transitioning to EHR in 2011. PATIENT SAMPLE: We identified all outpatient encounters that occurred on a monthly basis before and after the transition to EHR in two departments. OUTCOME MEASURES: Mean monthly patient volume and coded level of service. METHODS: We compared mean monthly volumes and CPT coding levels before the transition to EHR to those after the transition. RESULTS: We found that mean monthly volume of outpatient encounters in the internal medicine practice during the 12 months before EHR was not different from that during the 12 months after (613 v 587, p50.439). Similarly, in the department of orthopedics, the mean monthly volume of outpatient encounters during the 17 months before EHR was not different from that during the 7 months after (2157 v 2317, p50.156).The greatest change in coding level in the medicine practice was a 1.2% increase in level 4 coding, offset mostly by a complementary decrease in level 3 coding. Similarly, the greatest change in coding in the department of orthopedics was a 3.1% increase in level 4 coding, offset mostly by a complementary decrease in level 3 coding. In both departments, the minor changes across all 5 coding levels accounted for small but statistically significant upward shifts in coding (p!0.001). CONCLUSIONS: There was no perceptible change in patient volume with the transition to EHR. The changes in coding level associated with the transition are minor relative those reported by the media. The massive shifts in coding supposedly facilitated by the transition to EHR did not occur at our center. Indeed, we found it remarkable how little an impact the transition had on both patient volume and coding level. We hope these issues will be investigated further, on a larger scale, and with longer follow up as the implementation of EHR continues in centers across the country. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.358
P85. Cortical Screw as Rescue for Failed Lumbar Pedicle Screw Construct: A Biomechanical Analysis Graham Calvert, MD1, Brandon D. Lawrence, MD2, Kent N. Bacchus, PhD3, Darrel S. Broke, MD4; 1University of Utah Hospital, Salt Lake City, UT, US; 2University of Utah Orthopaedics, Salt Lake City, UT, US; 3 University of Utah Orthopedic Center Orthopedic Research Laboratory, Salt Lake City, UT, US; 4University Orthopedic Center, Salt Lake City, UT, US BACKGROUND CONTEXT: Cortical trajectory screws have been developed as an alternative to traditional pedicle screw fixation for the lumbar spine. The path of these screws takes advantage of a mostly cortical track and travels away from the midline neural elements. While studies
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 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S
retrospectively reviewed outcomes, including visual analogue pain scale (VAS), the Oswestry Disability Index (ODI), compression ratio and kyphotic angle. RESULTS: There were eleven complications, including pneumonia in 4 patients, screw loosening in 5 patients, mild hematoma at the subcutaneous tissue and pseudarthrosis in each 1 case. The mean VAS score was exhibiting V-shaped upward trend after postoperative 6 months that ended with the almost similar score obtained with preoperative status. The mean ODI score was also shown with similar trend. In functional score, there was a statistical significant improvement until only 6 months after surgery. In radiologic evaluation, the mean kyphotic angle and compression ratio was significantly corrected after surgery (P!0.05). However, these improved radiologic parameters were maximal at the immediate postoperative time with gradual loss over time. CONCLUSIONS: Taken together, our results suggest that in cases of ONV, transpedicular intracorporeal bone graft with short-segmental posterior instrumentation may not effectively provide stability, prolonged relief of back pain, or maintain stabilization over a five year period. In addition, we observed recurrent kyphotic change of the vertebral body during the follow-up period. Therefore, we do not recommend short-segmental posterior instrumentation concurrently with transpedicular intracorporeal bone graft for treating ONV. FDA DEVICE/DRUG STATUS: Allograft bone (Approved for this indication).
preoperatively, p!0.001), as were EQ5D scores (0.7560.22 at 3 months, 0.7360.22 at 12 months, compared to 0.5460.21 preoperatively, p! 0.001). ODI/NDI scores were also significantly improved at both followup visits (28.7619.6 at 3 months, 28.4620.9 at 12 months, compared to 49.2618.0 preoperatively, p!0.001). Separate longitudinal multivariable analyses controlling for age, gender, diabetes, smoking, anatomic location, preoperative Modified Somatic Perception Questionnaire (MSPQ) score, preoperative depression, primary vs revision surgery, and baseline score of the outcome variable found that preoperative narcotic use was a significant predictor of decreased postoperative SF-12 and EQ5D scores and increased ODI/NDI scores. Specifically, every 1mg MEA taken preoperatively was associated with a 0.02 decrease in the SF-12 physical health score, a 0.001 decrease in the EQ5D score, and a 0.05 increase in the ODI/NDI score (p!0.001) postoperatively. All models were examined for the random effect of performing surgeon and found not to be significant, even when directly controlling for this variable. CONCLUSIONS: Our work suggests that increased preoperative narcotic consumption prior to undergoing spine surgery for a structural lesion predicts worse patient reported outcomes. Future work should focus on the association of preoperative narcotic use and other outcome measures. Such information may help facilitate discussion between surgeon and patient regarding expectations prior to proceeding with surgery. FDA DEVICE/DRUG STATUS: Narcotics/opioids (Approved for this indication).
http://dx.doi.org/10.1016/j.spinee.2013.07.354
http://dx.doi.org/10.1016/j.spinee.2013.07.355
P81. Preoperative Narcotic Use Predicts Worse Postoperative Self-Reported Outcomes in Patients undergoing Spine Surgery Dennis S. Lee, MD1, Sheyan J. Armaghani, MD2, Jesse E. Bible, MD2, David N. Shau, BS1, Harrison F. Kay2, Chi Zhang2, Kristin Archer, PhD, DPT1, Matthew J. McGirt, MD1, Clinton J. Devin, MD2; 1Vanderbilt University Medical Center, Nashville, TN, US; 2Nashville, TN, US
P82. Preoperative Narcotic Use and its Relation to Anxiety, Depression and Payer Status in Patients Undergoing Spine Surgery Dennis S. Lee, MD1, Sheyan J. Armaghani, MD2, Jesse E. Bible, MD2, David N. Shau, BS1, Harrison F. Kay2, Chi Zhang2, Matthew J. McGirt, MD1, Clinton J. Devin, MD2; 1Vanderbilt University Medical Center, Nashville, TN, US; 2Nashville, TN, US
BACKGROUND CONTEXT: Narcotics remain a common agent class used for the management of pain in patients being evaluated for spine surgery. Recent national attention has highlighted the negative effects of narcotics in this and other non-malignant pain settings. Previous work suggests that increased preoperative narcotic use has a negative impact on spine surgery outcomes. PURPOSE: We aim to assess whether preoperative narcotic use predicts worse self-reported outcomes in patients undergoing spine surgery. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: 583 patients evaluated and treated for lumbar, thoracolumbar, or cervical lesions from October 2010 to June 2012 at a single institution. OUTCOME MEASURES: Patient reported outcome measures were assessed via 12-Item Short-Form Health Survey (SF-12) scores for general overall physical health, EuroQol-5D (EQ5D) scores for health-related quality of life, as well as Oswestry/Neck Disability Index (ODI/NDI) scores for disability. METHODS: 583 patients undergoing lumbar (60%), thoracolumbar (11%), or cervical spine (29%) surgery for a structural lesion were included. Self-reported preoperative narcotic consumption was obtained at the initial preoperative visit and converted to the corresponding daily morphine equivalent amount (MEA). Preoperative baseline, 3-month postoperative, and 12-month postoperative SF-12, ODI/NDI, and EQ5D scores were assessed for all patients. ODI and NDI scores were combined into a single outcome variable to include both cervical and lumbar patients in simultaneous analyses. Separate multivariable linear regression analyses were then used to determine whether preoperative narcotic use predicted postoperative SF-12, EQ5D, and ODI/NDI scores. RESULTS: Univariate analyses revealed that SF-12 physical health scores were significantly improved at both 3 and 12-month follow-up (39.6611.4 at 3 months, 39.0613.2 at 12 months, compared to 29.269.6
BACKGROUND CONTEXT: Narcotics remain a common agent class used for the management of pain in patients being evaluated for spine surgery. Recent national attention has highlighted the negative effects of narcotics in this and other non-malignant pain settings. Previous work suggests narcotic use and psychiatric comorbidities are intimately related. Among other psychosocial considerations, anxiety level, depression, and payer status may be associated with the amount of preoperative narcotic use in patients undergoing spine surgery. PURPOSE: We aim to assess whether the amount of preoperative narcotic use is associated with preoperative anxiety level, depression, and payer status in patients undergoing spine surgery for a structural lesion. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: 583 patients evaluated and treated for lumbar, thoracolumbar, or cervical structural lesions from October 2010 to June 2012 at a single institution. OUTCOME MEASURES: Daily morphine equivalent amount (MEA) consumption as assessed at the initial preoperative visit for patients undergoing spine surgery. METHODS: 583 patients undergoing lumbar (60%), thoracolumbar (11%), or cervical spine (29%) surgery for a structural lesion were included. Self-reported preoperative narcotic consumption was obtained at the initial preoperative visit and converted to the corresponding daily morphine equivalent amount (MEA). Preoperative Zung Depression Scale (ZDS) and Modified Somatic Perception Questionnaire (MSPQ) scores were also obtained at the initial preoperative visit and recorded as measures of depression and anxiety, respectively. Payer status was recorded as either federal Medicare/Medicaid, private, state Medicaid, uninsured/indigent, or Veterans Affairs/government. Linear regression analysis was performed including other clinically and psychosocially important covariates. These included age, gender, type of surgery, smoking status, and preoperative employment status.
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 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S RESULTS: Linear regression analysis controlling for age, gender, type of surgery, smoking status, and preoperative employment status demonstrated that payer status was not significantly associated with preoperative narcotic use. Preoperative MSPQ and ZDS scores were significantly associated with the amount of preoperative narcotic use (correlation coefficient 1.26, p! 0.05 & 0.78, p!0.01, respectively). CONCLUSIONS: Payer status does not appear to be associated with the amount of preoperative narcotic use in patients undergoing spine surgery for a structural lesion. Anxiety and depression as assessed by MSPQ and ZDS scores were significantly associated with increased preoperative narcotic use, underscoring the importance of thorough psychosocial and substance use assessment in patients being evaluated for spine surgery. FDA DEVICE/DRUG STATUS: Narcotics/opioids (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2013.07.356
P83. The Relationship Between Lumbar Spine Facet Joint Arthritis and Dynamic and Static Low Back Pain. Which Level of Lumbar Spine Facet Joint Arthritis is Most Influenced on the Static or Dynamic Low Back Pain? Sang-Bong Ko, MD; Cherry Hill, NJ, US BACKGROUND CONTEXT: The association between lumbar spine facet joint arthritis (LSFJA) and static and dynamic low back pain (LBP) remains unclear and which level of LSFJA is most influenced on the dynamic LBP and static LBP is not known. PURPOSE: To evaluate the association of lumbar spine facet joint arthritis (LSFJA) identified by multi-detector computed tomography (MDCT) with age, dynamic and static low back pain (LBP) in an unselected adult community-based population in Korea. And to know which level of LSFJA is most influenced on the dynamic low back pain and static low back pain. STUDY DESIGN/SETTING: Cross-sectional Study. PATIENT SAMPLE: A sample of four hundred seventy-two participants (age: 20 to 84 years) from our medical center and who underwent multidetector CT imaging to assess abdominal and urological lesions were included in this study. OUTCOME MEASURES: The occurrence of LBP which is occurring immediately on sitting down and relieved on standing up and needed medication in the preceding 12 months (dynamic LBP:dLBP) and the occurrence of LBP needed medication in the preceding 12 months (static LBP:sLBP) were evaluated using a self-report questionnaire (a modified Nordic Low Back Pain Questionnaire). The presence of facet joint arthritis was characterized by the CT imaging using 4-grade scale. METHODS: The association between LSFJA and dLBP and LSFJA and sLBP were examined used multiple logistic regression models and the level of LSFJA which is most influenced on the dLBP and sLBP were identified. RESULTS: Eighty-three study subjects (17.58%) demonstrated LSFJA (over grade 2). Prevalence of LSFJA increase with age: 134 study subjects (28.39%) had sLBP and 116 study subjects (24.58%) had dLBP. LSFJA group is 33 subjects (24.63%) among sLBP study subject and 26 subjects (22.41%) among dLBP study subject. LSFJA is not significant to both sLBP and dLBP. In an unselected adult community-based population in Korea, LSFJA at any spinal level showed no association with both sLBP and dLBP. CONCLUSIONS: The prevalence of sLBP is 28.39% and that of dLBP 24.58% among an unselected community-based Korean population. LSFJA based on the CT imaging is 17.51% among the same population. Prevalence of LSFJA increased with age with the highest prevalence at the L4-5 spinal level. LSFJA is not associated with both dynamic and static LBP at any spinal level. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.357
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P84. Electronic Health Records Have Negligible Impact on Outpatient Volume and Coded Level of Service: A Report from Two Departments in an Academic Medical Group Matthew L. Webb1, Daniel D. Bohl, MPH1, Jordan A. Gruskay2, Jonathan N. Grauer, MD1; 1Yale University School of Medicine, New Haven, CT, US; 2Rothman Institute, Philadelphia, PA, US BACKGROUND CONTEXT: Recent media coverage (New York Times) reports that the implementation of electronic health records (EHR) may be associated with substantial increases in Medicare payments, in part due to an increase in the coded level of service facilitated by HER (Current Procedural Terminology (CPT)). There additionally exists concern within many medical groups that the transition to EHR could be associated with a decrease in total patient volume. PURPOSE: To investigate whether outpatient volumes and coded level of service changed after the transition to EHR. STUDY DESIGN/SETTING: Two departments in our academic medical group (Internal Medicine, Orthopaedics) began transitioning to EHR in 2011. PATIENT SAMPLE: We identified all outpatient encounters that occurred on a monthly basis before and after the transition to EHR in two departments. OUTCOME MEASURES: Mean monthly patient volume and coded level of service. METHODS: We compared mean monthly volumes and CPT coding levels before the transition to EHR to those after the transition. RESULTS: We found that mean monthly volume of outpatient encounters in the internal medicine practice during the 12 months before EHR was not different from that during the 12 months after (613 v 587, p50.439). Similarly, in the department of orthopedics, the mean monthly volume of outpatient encounters during the 17 months before EHR was not different from that during the 7 months after (2157 v 2317, p50.156).The greatest change in coding level in the medicine practice was a 1.2% increase in level 4 coding, offset mostly by a complementary decrease in level 3 coding. Similarly, the greatest change in coding in the department of orthopedics was a 3.1% increase in level 4 coding, offset mostly by a complementary decrease in level 3 coding. In both departments, the minor changes across all 5 coding levels accounted for small but statistically significant upward shifts in coding (p!0.001). CONCLUSIONS: There was no perceptible change in patient volume with the transition to EHR. The changes in coding level associated with the transition are minor relative those reported by the media. The massive shifts in coding supposedly facilitated by the transition to EHR did not occur at our center. Indeed, we found it remarkable how little an impact the transition had on both patient volume and coding level. We hope these issues will be investigated further, on a larger scale, and with longer follow up as the implementation of EHR continues in centers across the country. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.358
P85. Cortical Screw as Rescue for Failed Lumbar Pedicle Screw Construct: A Biomechanical Analysis Graham Calvert, MD1, Brandon D. Lawrence, MD2, Kent N. Bacchus, PhD3, Darrel S. Broke, MD4; 1University of Utah Hospital, Salt Lake City, UT, US; 2University of Utah Orthopaedics, Salt Lake City, UT, US; 3 University of Utah Orthopedic Center Orthopedic Research Laboratory, Salt Lake City, UT, US; 4University Orthopedic Center, Salt Lake City, UT, US BACKGROUND CONTEXT: Cortical trajectory screws have been developed as an alternative to traditional pedicle screw fixation for the lumbar spine. The path of these screws takes advantage of a mostly cortical track and travels away from the midline neural elements. While studies
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.