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Risk Factors of Elevated Postoperative Blood Glucose and Preoperative Hemoglobin A1C are Associated with Increased Wound Complications following Surgical Treatment of Adult Degenerative Lumbar Scoliosis
104S
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S
OUTCOME MEASURES: ‘‘Contaminant’’ positive infection rate in paraspinal muscle tissue. METHODS: Institutional ethics approval was obtained (HREC 13/218). Eligible patients were consented. In each case, paraspinal tissue was obtained, and prolonged aerobic and anaerobic cultures performed (14 days including aerobic and anaerobic cultures). Growth of organism in test versus sham arms were compared. RESULTS: To date, 400 patients have been enrolled, including 366 test and 34 sham patients. There was no difference in baseline proportion of males (46% vs 55%, P50.33), diabetes (4.3% vs 11%, P50.196), smokers (16% vs 11%, P50.56), immunocomprised (0.8% vs 0%, P50.71), or single-level procedures performed (75% vs 60%, P50.11). Positive paraspinal tissue culture was comparable between test and sham groups (36% vs 39%, P50.71). For both groups, the majority of organism growth was due to P acnes (70% vs 90% of organisms detected, P50.12). CONCLUSIONS: This is the largest spine contaminant infection detection study as per our knowledge. The paraspinal tissue growth rate in degenerative disc population is similar to that of the sham group. The paraspinal tissue infection rate ranged from 36%-39%, which is similar to rates reported previously for disc infections in the literature in patients with degenerative disc related pain. The organisms commonly seen are P acnes, strep species and staph aureus. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.056
40. Risk Factors of Surgical Site Infection in Adult Degenerative Lumbar Scoliosis: Detection and Management Based on Serial Procalcitonin Measurements: An Open-Label Randomized Trial Xie En, MD1, Dingjun Hao, MD2, Dageng Huang, MD3, Biao Wang, MD1, Hua Guo, MD4; 1Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi0 an, Shan Xi, China; 2Xi’an Honghui Hospital, Xi’an, Shan Xi, China; 3Honghui Hospital, Department of Spinal Surgery, Xi’an, Shan Xi, China; 4Xi’an, China BACKGROUND CONTEXT: Little is known about the risk factors for surgical site infection in adult degernative lumbar scoliosis (ADL. Proealeitonin (PCT) is a well-known sensitive laboratory parameter that shows an increase within six hours after the onset of bacterial infection. PURPOSE: In relation to surgery, a normal PCT response is a rapid increase attended by a gradual reduction, eventually returning to the normal range. The goal of this study was to determine the diagnostic significance of the PCT as a detector for early onset of surgical site infection in ADLS and to discuss effective medical treatment through clinical interpretation and application of the measured PCT values. STUDY DESIGN/SETTING: An open-label randomized study of clinical results of risk factors of surgical site infection in ADLS. PATIENT SAMPLE: 4,787 surgically treated ADLS patients. METHODS: An open-label randomized study was performed in 4,787 consecutive cases involving patients who underwent surgical treatment for ADLS between January and September 2014. Blood samples were obtained preoperatively and on postoperative days 1, 3, 5, 7 and 14 in patients undergoing single-level decompression surgery. An additional blood specimen was obtained at postoperative day 7 in patients requiring more extensive surgeries. Recorded laboratory results were compared with the patients’ clinical course to determine the diagnostic significance of the PCT. All of the patients received intravenous prophylactic antibiotic therapy. Once an abnormal response of PCT was observed (indicated by a tendency toward continuous elevation on day 5 or day 7), the prophylactic antibiotics were replaced with another regimen and administration was resumed along with careful observation for signs of surgical site infection.
RESULTS: Monitoring of PCT revealed a characteristic increase and decrease pattern in 4,571 of 4,787 patients (95.49%) showing a normal clinical course with regard to early infectious complications. The mean measured PCT (reference range ! 0.05 ng/ml) averaged 0.157 0.217 ng/ml on day 1, 0.171 0.277 ng/ml on day 3, and 0.78 0.171 ng/ml on day 5. In contrast, there were 216 cases (4.51%) of abnormal PCT responses resulting in the resumption of intravenous antibiotic treatment, which included a second rise (in 162 cases) and a steady rise (in 54) in the PCT value. Five (1.4%) of 216 patients experienced infectious complications related to ADLS. 43 patients (0.9%) received long-term antibiotic therapy for 4–6 weeks; however, all patients recovered with medical treatment alone and did not experience gross wound disruption or subsequent disciples. As a predictor for primary wound infection, the sensitivity, specificity, positive predictive value, and negative predictive value for abnormal PCT responses were calculated as 100%, 96.7%, 39.1% and 100%, respectively. CONCLUSIONS: The above results demonstrate that PCT screening is a simple and reliable test for the detection of early infectious complications after ADLS. Close observation and appropriate therapeutic management should be performed in a timely fashion when abnormal PCT responses are observed at 5 or 7 days after surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.057 41. Risk Factors of Elevated Postoperative Blood Glucose and Preoperative Hemoglobin A1C are Associated with Increased Wound Complications following Surgical Treatment of Adult Degenerative Lumbar Scoliosis Xie En, MD1, Dingjun Hao, MD2, Dageng Huang, MD3, Biao Wang, MD1, Hua Guo, MD4; 1Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shan Xi, China; 2Xi’an Honghui Hospital, Xi’an, Shan Xi, China; 3Honghui Hospital, Department of Spinal Surgery, Xi’an, Shan Xi, China; 4Xi’an, China BACKGROUND CONTEXT: Diabetes is an established risk factor for complications following surgical treatment for adult degenerative lumbar scoliosis (ADLS). However, the correlation between postoperative blood glucose and preoperative hemoglobin A1C levels with complications following ADLS is not well described. PURPOSE: To determine the correlation between postoperative blood glucose and preoperative hemoglobin A1C levels with complications following surgical treatment for ADLS. STUDY DESIGN/SETTING: Retrospective analysis. PATIENT SAMPLE: 1,702. OUTCOME MEASURES: Elevated postoperative blood glucose and preoperative hemoglobin A1C. METHODS: All patients undergoing elective primary total ADLS at our institution from 2007 through 2014 with both postoperative blood glucose and preoperative hemoglobin A1C levels were identified in a retrospective review. From among 1,702 patients, those with wound complications within thirty days after the spine surgery were detected. A control group matched for exact age, sex, procedure and surgical approach was also created. 71 patients met the study group inclusion criteria. The mean patient age was 68.7 years (range 53 to 83 years). RESULTS: The odds ratio for developing a wound complication was 3.75 (95% confidence interval, 1.37 to 7.17; p 5 0.03) in patients with a mean postoperative glucose of O200 mg/dL, 3.0 (95% confidence interval, 0.97to 9.30; p 5 0.08) in patients with a maximum postoperative blood glucose ofO260 mg/dL, and 9.0 (95% confidence interval, 1.17 to 77.10; p 5 0.04) in patients with a preoperative hemoglobin A1C value of O6.7%. CONCLUSIONS: Patients with a mean postoperative blood glucose of O200 mg/dL or a preoperative hemoglobin A1C level of O6.7% are at increased risk for wound complications following elective primary total
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 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S ADLS spine surgery. These results show that poor preoperative and postoperative glucose control are independently associated with wound complications. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
105S
43. Berry’s Ligament and the Inferior Thyroid Artery as Reliable Anatomical Landmarks for the Recurrent Laryngeal Nerve (RLN): A Fresh Cadaveric Study Relevant to the Cervical Spine Ali Rajabian, FRCSEd1, Nasir A. Quraishi, MD2; 1The Centre for Spinal Studies and Surgery, Nottingham, UK; 2Queens Medical Centre, Nottingham, UK
http://dx.doi.org/10.1016/j.spinee.2015.07.058
Wednesday, October 14, 2015 2:05 – 3:05 pm Cervical Spine Treatments 42. Adjacent Segment Pathology Correlated with HRQOL following Cervical Laminoplasty versus Posterior Cervical Decompression and Fusion Virginie Lafage, PhD1, Themistocles S. Protopsaltis, MD1, Amir Amitai2, Anthony J. Boniello, BS1, Matthew Spiegel, BS, MD3, Renaud Lafage1, Vincent Challier, MD4, Yuriy Trimba, BA1, Emmanuelle Ferrero, MD5, Michael Smith, MD5, Peter G. Passias, MD1,6, Yong H. Kim, MD7, Afshin E. Razi, MD1, Ronald Moskovich, MD1; 1New York University Hospital for Joint Diseases, New York, NY, US; 2Moshav Rinnatia, Israel; 3Woodmere, NY, US; 4Spine Research Institute, New York, NY, US; 5New York, NY, US; 6 New York University School of Medicine, New York, NY, US; 7Madison Avenue Orthopedic Associates, New York, NY, US BACKGROUND CONTEXT: Adjacent segment degeneration (ASD) has been described after anterior cervical fusion surgeries though ASD is not always clinically relevant. Hilibrand et al described a grading system for ASD after anterior cervical fusion. We expand the ASD definition with an analysis of radiographic adjacent segment pathology (RASP) by also assessing the progression of kyphotic alignment, and spondylolisthesis at adjacent segments in patients following cervical laminoplasty (LP) and posterior cervical decompression and fusion (CDF). PURPOSE: To assess radiographic adjacent segment pathology by analyzing adjacent segment degeneration, and the progression of kyphotic alignment and spondylolisthesis at segments adjacent to operated levels for LP and CDF surgery. STUDY DESIGN/SETTING: Retrospective analysis of cervical radiographs in patients undergoing prior LP and CDF surgery. PATIENT SAMPLE: 64 patients undergoing prior LP and CDF surgery. OUTCOME MEASURES: NDI and mJOA. METHODS: Preoperative and postoperative radiographs were analyzed for ASD, progression of adjacent level kyphosis and spondylolisthesis at proximal, distal or any other segments. The RASP was determined by combining proximal and distal ASD, and the adjacent level kyphosis and spondylolisthesis into one spectrum of disease. The presence and rate of development of adjacent segment pathology was compared for LP and CDF. HRQOLs included NDI and mJOA. RESULTS: 64 patients were included (24 LP and 40 CDF) with mean age 59.9 years (46.9% female) and 30.2 months mean follow-up. Spondylolisthesis at the adjacent segment was more prevalent in CDF (29.2% vs 4.5%). Both LP and CDF demonstrated a similar rate of RASP (LP 40.9%, CDF 44%). NDI correlated with proximal adjacent level degeneration (r 5 0.34, p 5 0.024) and kyphosis (r 5 0.36 p 5 0.017). CONCLUSIONS: Both cervical laminoplasty and posterior cervical decompression and fusion are associated with adjacent level degeneration. However, there is a higher rate of adjacent segment spondylolisthesis after CDF. Motion preservation procedures may have less of a role in preventing adjacent level degeneration than previously thought. Adjacent segment degeneration correlated with NDI disability in these patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.060
BACKGROUND CONTEXT: Whilst most cadaveric studies of the recurrent laryngeal nerve (RLN) have focused on course variations as a suitable guide for right versus left RLN, they have mostly been done on preserved (fixed) cadavers which renders the RLN immobile. PURPOSE: Our aim was to perform anterior cervical exposures from C2 to T2-3 with particular attention to the course of the RLN on right- and left-sided exposures in fresh cadaveric specimens. In addition, we aimed to expose the entire course of the RLN. Finally, we wanted to show the position of the RLN in relation to the trachea-oesophageal groove, inferior thyroid artery and Berry’s ligament. STUDY DESIGN/SETTING: Eight fresh cadavers had extensive layer by layer dissections performed by two surgeons (one of whom has extensive experience as an anatomy demonstrator and dissector). The RLNs were exposed in their entire length and relationship to different landmarks recorded. Photographs were taken at each stage of the exposure. METHODS: Fresh cadaveric dissection relevant to cervical spine ACDF. RESULTS: In all specimens, we were able to demonstrate the entire course of both RLNs from origin to insertion. The RLNs were consistently associated with the inferior thyroid artery and Berry’s ligament bilaterally with the RLNs passing at almost perpendicular to these structures. CONCLUSIONS: The near horizontal direction of the Berry’s ligament in the cervical tissue planes exposed during anterior cervical exposures enables the surgeon to reliably identify the expected position of RLN at its medial end and hence avoid it prior to visual observation of the nerve on either side. We found that the most reliable anatomical landmark bilaterally for the RLN was the inferior thyroid artery and Berry’s ligament both of which would be encountered in anterior surgical exposure prior to the nerve itself. We believe that this will help spinal surgeons refine their surgical technique to identify this nerve where necessary and thus reduce the incidence of iatrogenic injury. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.061
44. Does Age Affect Surgical Outcomes in Patients with Degenerative Cervical Myelopathy? Results from the Prospective, Multicenter AOSpine International Study on 479 Patients Michael G. Fehlings, MD, PhD, FRCSC1, Hiroaki Nakashima, MD2, Lindsay Tetreault3, Branko Kopjar, MD, PhD4, Narihito Nagoshi, MD5, Aria Nouri, BA, MD5, Paul M. Arnold, MD6; 1Toronto Western Hospital, Toronto, ON, Canada; 2Nagoya University Graduate School of Medicine, Department of Orthopedic Surgery, Nagoya, Japan; 3 University of Toronto, Oakville, ON, Canada; 4University of Washington, Seattle, WA, US; 5University of Toronto, Toronto, ON, Canada; 6University of Kansas Medical Center Department of Neurosurgery, Kansas City, KS, US BACKGROUND CONTEXT: Studies have identified age as a significant predictor of surgical outcome in patients with cervical spondylotic myelopathy (CSM). In general, older patients have lower recovery potential following surgery due to comorbidities, reduced physiological reserves and age-related changes to the spinal cord. The elderly may also require a more complex surgery due to more substantial degenerative pathology.
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 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S
OUTCOME MEASURES: ‘‘Contaminant’’ positive infection rate in paraspinal muscle tissue. METHODS: Institutional ethics approval was obtained (HREC 13/218). Eligible patients were consented. In each case, paraspinal tissue was obtained, and prolonged aerobic and anaerobic cultures performed (14 days including aerobic and anaerobic cultures). Growth of organism in test versus sham arms were compared. RESULTS: To date, 400 patients have been enrolled, including 366 test and 34 sham patients. There was no difference in baseline proportion of males (46% vs 55%, P50.33), diabetes (4.3% vs 11%, P50.196), smokers (16% vs 11%, P50.56), immunocomprised (0.8% vs 0%, P50.71), or single-level procedures performed (75% vs 60%, P50.11). Positive paraspinal tissue culture was comparable between test and sham groups (36% vs 39%, P50.71). For both groups, the majority of organism growth was due to P acnes (70% vs 90% of organisms detected, P50.12). CONCLUSIONS: This is the largest spine contaminant infection detection study as per our knowledge. The paraspinal tissue growth rate in degenerative disc population is similar to that of the sham group. The paraspinal tissue infection rate ranged from 36%-39%, which is similar to rates reported previously for disc infections in the literature in patients with degenerative disc related pain. The organisms commonly seen are P acnes, strep species and staph aureus. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.056
40. Risk Factors of Surgical Site Infection in Adult Degenerative Lumbar Scoliosis: Detection and Management Based on Serial Procalcitonin Measurements: An Open-Label Randomized Trial Xie En, MD1, Dingjun Hao, MD2, Dageng Huang, MD3, Biao Wang, MD1, Hua Guo, MD4; 1Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi0 an, Shan Xi, China; 2Xi’an Honghui Hospital, Xi’an, Shan Xi, China; 3Honghui Hospital, Department of Spinal Surgery, Xi’an, Shan Xi, China; 4Xi’an, China BACKGROUND CONTEXT: Little is known about the risk factors for surgical site infection in adult degernative lumbar scoliosis (ADL. Proealeitonin (PCT) is a well-known sensitive laboratory parameter that shows an increase within six hours after the onset of bacterial infection. PURPOSE: In relation to surgery, a normal PCT response is a rapid increase attended by a gradual reduction, eventually returning to the normal range. The goal of this study was to determine the diagnostic significance of the PCT as a detector for early onset of surgical site infection in ADLS and to discuss effective medical treatment through clinical interpretation and application of the measured PCT values. STUDY DESIGN/SETTING: An open-label randomized study of clinical results of risk factors of surgical site infection in ADLS. PATIENT SAMPLE: 4,787 surgically treated ADLS patients. METHODS: An open-label randomized study was performed in 4,787 consecutive cases involving patients who underwent surgical treatment for ADLS between January and September 2014. Blood samples were obtained preoperatively and on postoperative days 1, 3, 5, 7 and 14 in patients undergoing single-level decompression surgery. An additional blood specimen was obtained at postoperative day 7 in patients requiring more extensive surgeries. Recorded laboratory results were compared with the patients’ clinical course to determine the diagnostic significance of the PCT. All of the patients received intravenous prophylactic antibiotic therapy. Once an abnormal response of PCT was observed (indicated by a tendency toward continuous elevation on day 5 or day 7), the prophylactic antibiotics were replaced with another regimen and administration was resumed along with careful observation for signs of surgical site infection.
RESULTS: Monitoring of PCT revealed a characteristic increase and decrease pattern in 4,571 of 4,787 patients (95.49%) showing a normal clinical course with regard to early infectious complications. The mean measured PCT (reference range ! 0.05 ng/ml) averaged 0.157 0.217 ng/ml on day 1, 0.171 0.277 ng/ml on day 3, and 0.78 0.171 ng/ml on day 5. In contrast, there were 216 cases (4.51%) of abnormal PCT responses resulting in the resumption of intravenous antibiotic treatment, which included a second rise (in 162 cases) and a steady rise (in 54) in the PCT value. Five (1.4%) of 216 patients experienced infectious complications related to ADLS. 43 patients (0.9%) received long-term antibiotic therapy for 4–6 weeks; however, all patients recovered with medical treatment alone and did not experience gross wound disruption or subsequent disciples. As a predictor for primary wound infection, the sensitivity, specificity, positive predictive value, and negative predictive value for abnormal PCT responses were calculated as 100%, 96.7%, 39.1% and 100%, respectively. CONCLUSIONS: The above results demonstrate that PCT screening is a simple and reliable test for the detection of early infectious complications after ADLS. Close observation and appropriate therapeutic management should be performed in a timely fashion when abnormal PCT responses are observed at 5 or 7 days after surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.057 41. Risk Factors of Elevated Postoperative Blood Glucose and Preoperative Hemoglobin A1C are Associated with Increased Wound Complications following Surgical Treatment of Adult Degenerative Lumbar Scoliosis Xie En, MD1, Dingjun Hao, MD2, Dageng Huang, MD3, Biao Wang, MD1, Hua Guo, MD4; 1Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, Shan Xi, China; 2Xi’an Honghui Hospital, Xi’an, Shan Xi, China; 3Honghui Hospital, Department of Spinal Surgery, Xi’an, Shan Xi, China; 4Xi’an, China BACKGROUND CONTEXT: Diabetes is an established risk factor for complications following surgical treatment for adult degenerative lumbar scoliosis (ADLS). However, the correlation between postoperative blood glucose and preoperative hemoglobin A1C levels with complications following ADLS is not well described. PURPOSE: To determine the correlation between postoperative blood glucose and preoperative hemoglobin A1C levels with complications following surgical treatment for ADLS. STUDY DESIGN/SETTING: Retrospective analysis. PATIENT SAMPLE: 1,702. OUTCOME MEASURES: Elevated postoperative blood glucose and preoperative hemoglobin A1C. METHODS: All patients undergoing elective primary total ADLS at our institution from 2007 through 2014 with both postoperative blood glucose and preoperative hemoglobin A1C levels were identified in a retrospective review. From among 1,702 patients, those with wound complications within thirty days after the spine surgery were detected. A control group matched for exact age, sex, procedure and surgical approach was also created. 71 patients met the study group inclusion criteria. The mean patient age was 68.7 years (range 53 to 83 years). RESULTS: The odds ratio for developing a wound complication was 3.75 (95% confidence interval, 1.37 to 7.17; p 5 0.03) in patients with a mean postoperative glucose of O200 mg/dL, 3.0 (95% confidence interval, 0.97to 9.30; p 5 0.08) in patients with a maximum postoperative blood glucose ofO260 mg/dL, and 9.0 (95% confidence interval, 1.17 to 77.10; p 5 0.04) in patients with a preoperative hemoglobin A1C value of O6.7%. CONCLUSIONS: Patients with a mean postoperative blood glucose of O200 mg/dL or a preoperative hemoglobin A1C level of O6.7% are at increased risk for wound complications following elective primary total
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 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S ADLS spine surgery. These results show that poor preoperative and postoperative glucose control are independently associated with wound complications. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
105S
43. Berry’s Ligament and the Inferior Thyroid Artery as Reliable Anatomical Landmarks for the Recurrent Laryngeal Nerve (RLN): A Fresh Cadaveric Study Relevant to the Cervical Spine Ali Rajabian, FRCSEd1, Nasir A. Quraishi, MD2; 1The Centre for Spinal Studies and Surgery, Nottingham, UK; 2Queens Medical Centre, Nottingham, UK
http://dx.doi.org/10.1016/j.spinee.2015.07.058
Wednesday, October 14, 2015 2:05 – 3:05 pm Cervical Spine Treatments 42. Adjacent Segment Pathology Correlated with HRQOL following Cervical Laminoplasty versus Posterior Cervical Decompression and Fusion Virginie Lafage, PhD1, Themistocles S. Protopsaltis, MD1, Amir Amitai2, Anthony J. Boniello, BS1, Matthew Spiegel, BS, MD3, Renaud Lafage1, Vincent Challier, MD4, Yuriy Trimba, BA1, Emmanuelle Ferrero, MD5, Michael Smith, MD5, Peter G. Passias, MD1,6, Yong H. Kim, MD7, Afshin E. Razi, MD1, Ronald Moskovich, MD1; 1New York University Hospital for Joint Diseases, New York, NY, US; 2Moshav Rinnatia, Israel; 3Woodmere, NY, US; 4Spine Research Institute, New York, NY, US; 5New York, NY, US; 6 New York University School of Medicine, New York, NY, US; 7Madison Avenue Orthopedic Associates, New York, NY, US BACKGROUND CONTEXT: Adjacent segment degeneration (ASD) has been described after anterior cervical fusion surgeries though ASD is not always clinically relevant. Hilibrand et al described a grading system for ASD after anterior cervical fusion. We expand the ASD definition with an analysis of radiographic adjacent segment pathology (RASP) by also assessing the progression of kyphotic alignment, and spondylolisthesis at adjacent segments in patients following cervical laminoplasty (LP) and posterior cervical decompression and fusion (CDF). PURPOSE: To assess radiographic adjacent segment pathology by analyzing adjacent segment degeneration, and the progression of kyphotic alignment and spondylolisthesis at segments adjacent to operated levels for LP and CDF surgery. STUDY DESIGN/SETTING: Retrospective analysis of cervical radiographs in patients undergoing prior LP and CDF surgery. PATIENT SAMPLE: 64 patients undergoing prior LP and CDF surgery. OUTCOME MEASURES: NDI and mJOA. METHODS: Preoperative and postoperative radiographs were analyzed for ASD, progression of adjacent level kyphosis and spondylolisthesis at proximal, distal or any other segments. The RASP was determined by combining proximal and distal ASD, and the adjacent level kyphosis and spondylolisthesis into one spectrum of disease. The presence and rate of development of adjacent segment pathology was compared for LP and CDF. HRQOLs included NDI and mJOA. RESULTS: 64 patients were included (24 LP and 40 CDF) with mean age 59.9 years (46.9% female) and 30.2 months mean follow-up. Spondylolisthesis at the adjacent segment was more prevalent in CDF (29.2% vs 4.5%). Both LP and CDF demonstrated a similar rate of RASP (LP 40.9%, CDF 44%). NDI correlated with proximal adjacent level degeneration (r 5 0.34, p 5 0.024) and kyphosis (r 5 0.36 p 5 0.017). CONCLUSIONS: Both cervical laminoplasty and posterior cervical decompression and fusion are associated with adjacent level degeneration. However, there is a higher rate of adjacent segment spondylolisthesis after CDF. Motion preservation procedures may have less of a role in preventing adjacent level degeneration than previously thought. Adjacent segment degeneration correlated with NDI disability in these patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.060
BACKGROUND CONTEXT: Whilst most cadaveric studies of the recurrent laryngeal nerve (RLN) have focused on course variations as a suitable guide for right versus left RLN, they have mostly been done on preserved (fixed) cadavers which renders the RLN immobile. PURPOSE: Our aim was to perform anterior cervical exposures from C2 to T2-3 with particular attention to the course of the RLN on right- and left-sided exposures in fresh cadaveric specimens. In addition, we aimed to expose the entire course of the RLN. Finally, we wanted to show the position of the RLN in relation to the trachea-oesophageal groove, inferior thyroid artery and Berry’s ligament. STUDY DESIGN/SETTING: Eight fresh cadavers had extensive layer by layer dissections performed by two surgeons (one of whom has extensive experience as an anatomy demonstrator and dissector). The RLNs were exposed in their entire length and relationship to different landmarks recorded. Photographs were taken at each stage of the exposure. METHODS: Fresh cadaveric dissection relevant to cervical spine ACDF. RESULTS: In all specimens, we were able to demonstrate the entire course of both RLNs from origin to insertion. The RLNs were consistently associated with the inferior thyroid artery and Berry’s ligament bilaterally with the RLNs passing at almost perpendicular to these structures. CONCLUSIONS: The near horizontal direction of the Berry’s ligament in the cervical tissue planes exposed during anterior cervical exposures enables the surgeon to reliably identify the expected position of RLN at its medial end and hence avoid it prior to visual observation of the nerve on either side. We found that the most reliable anatomical landmark bilaterally for the RLN was the inferior thyroid artery and Berry’s ligament both of which would be encountered in anterior surgical exposure prior to the nerve itself. We believe that this will help spinal surgeons refine their surgical technique to identify this nerve where necessary and thus reduce the incidence of iatrogenic injury. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.061
44. Does Age Affect Surgical Outcomes in Patients with Degenerative Cervical Myelopathy? Results from the Prospective, Multicenter AOSpine International Study on 479 Patients Michael G. Fehlings, MD, PhD, FRCSC1, Hiroaki Nakashima, MD2, Lindsay Tetreault3, Branko Kopjar, MD, PhD4, Narihito Nagoshi, MD5, Aria Nouri, BA, MD5, Paul M. Arnold, MD6; 1Toronto Western Hospital, Toronto, ON, Canada; 2Nagoya University Graduate School of Medicine, Department of Orthopedic Surgery, Nagoya, Japan; 3 University of Toronto, Oakville, ON, Canada; 4University of Washington, Seattle, WA, US; 5University of Toronto, Toronto, ON, Canada; 6University of Kansas Medical Center Department of Neurosurgery, Kansas City, KS, US BACKGROUND CONTEXT: Studies have identified age as a significant predictor of surgical outcome in patients with cervical spondylotic myelopathy (CSM). In general, older patients have lower recovery potential following surgery due to comorbidities, reduced physiological reserves and age-related changes to the spinal cord. The elderly may also require a more complex surgery due to more substantial degenerative pathology.
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.