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Sensory and Motor Deficit Following Lateral Lumbar Interbody Fusion
84S
Proceedings of the NASS 26th Annual Meeting / The Spine Journal 11 (2011) 1S–173S
158. Early Development and Progression of Heterotopic Ossification in Cervical Total Disc Replacement Soo Eon Lee, MD; Seoul, South Korea BACKGROUND CONTEXT: The purpose ofcervical TDR is to decrease the incidence of adjacent segment disease through motion preservation. HO is a well-known complication after hip and knee arthroplasties. There have been very few reports regarding HO in patients undergoing cervical TDR. However, the occurrence and clinical outcomes on cervical motion have rarely been studied. In addition, temporal progression of HO has not been fully addressed. PURPOSE: The first goal of the study was to determine the incidence of heterotopic ossification (HO) identified with plain radiographs following cervical total disc replacement (TDR), and to demonstrate the progression of HO during the follow-up period. The second goal was to show whether segmental motion can be preserved, and to identify the relationship between HO and clinical outcomes. STUDY DESIGN/SETTING: A retrospective clinical and radiologic study of 28 patients who underwent cervical total disc replacement (TDR). PATIENT SAMPLE: Twenty-eight consecutive patients underwent cervical TDR with a Mobi-CÒ(LDR Medical, Troyes, France) between September 2006 and October 2008. OUTCOME MEASURES: The radiologic outcomes were evaluated with lateral dynamic radiographs preoperatively and on 1, 3, 6, 12, and 24 months postoperatively. METHODS: The occurrence of HO was interpreted on lateral radiographs according to the McAfee classification. We also measured the cervical range of motion (ROM), visual analog scale (VAS), and neck disability index (NDI) for the evaluation of cervical motion and clinical outcome. RESULTS: The mean follow-up period was 21.667.0 months and the mean occurrence of HO was observed 8.066.6 months postoperatively. At the last follow-up, 18 of 28 patients (64.3%) developed HO. (grade I, 6 patients; grade II, 8 patients; grade III, 3 patients; grade IV, 1 patient) The progression of HO was proportional to the duration of follow-up, as follows; 3/28 (10.7 %) at 1 month; 7/28 (25.0%) at 3 months; 11/26 (42.3%) at 6 months; 15/24 (62.5%) at 12 months; and 17/22 (77.3%) at 24 months. The cervical ROM was preserved in grade I and II HO, but restricted in grade III and IV HO. Clinical improvement in terms of VAS and NDI was not significantly correlated with the occurrence of HO. CONCLUSIONS: The overall incidence of HO after cervical TDR was relatively high. Moreover, HO began to appear unexpectedly early after surgery and the progression was proportional to the time which had elapsed postoperatively. Grade III or IV HO can restrict the cervical ROM and may lead to spontaneous fusion. However, the occurrence of HO did not affect the clinical outcome. Therefore, before performing cervical TDR, a high incidence of HO with the possibility of spontaneous fusion must be expected during long-term follow-up. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.210
159. Sensory and Motor Deficit Following Lateral Lumbar Interbody Fusion Matthias Pumberger, MD1, Suhel Kotwal, MD2, Darren Lebl, MD2, Alexander Hughes, MD3, Andrew Sama, MD1, Federico Girardi, MD1; 1 Hospital for Special Surgery, New York, NY, USA; 2New York, NY, USA; 3 East River Professional Building, New York, NY, USA BACKGROUND CONTEXT: Lateral lumbar interbody fusion (LLIF) as a minimally-invasive technique has gained growing interest in recent years. However, one of the procedure’s limitations remains the unknown incidence of sensory and/or motor deficit following a trans-psoatic approach. Several anatomical studies have been published, but no clinical study evaluated the incidence and risk factors of sensory and motor deficit.
PURPOSE: We seek to identify the incidence and nature of neurological events following LLIF. STUDY DESIGN/SETTING: We performed a retrospective chart review. PATIENT SAMPLE: We reviewed two-hundred thirty-seven patients undergoing LLIF between 2006 and 2009. OUTCOME MEASURES: We identified the new onset of anterior thigh pain, sensory and motor deficit. Each sensory deficit was reported to the according dermatome. Motor deficits were divided into the muscle subgroups and their severity (mild 4/5, moderate 3/5, severe !2/5). METHODS: Patient charts were reviewed for demographics, medical comorbidities, subjective neurological complaints, and physical exam findings at the following time points: preoperatively, preoperatively, and postoperatively at six weeks, twelve weeks, six months, and at twelve months followup. The specific deficits were correlated to the side and level of approach, numbers of levels fused, duration of surgery, and bone graft material employed. A multivariate logistic regression models were created to evaluate the independent associations of each potential explanatory variable to predict the likelihood of the dependent variable, presence of a neurological deficit (motor and any deficit) at the first follow-up time point. RESULTS: A total of 237 patients (139 Female, 98 Male) underwent LLIF surgery at our institution with a total of 463 levels fused. Average age was 61.5 years (range 31–88) and average BMI was 28.3 (range 17.4–60.3). At six weeks, 41.4%, 16.0% at twelve weeks, 3.7% at six months and 0.8% at twelve months experienced thigh pain postoperatively. We found a significant correlation between the involvement of L 4-5 and the occurrence of motor deficits at six weeks (p5.009), twelve weeks (p5.009) and twelve months (p5.027). However, no correlation between a sensory deficit and the involvement of L1-2, L2-3, L3-4 was found (six weeks (p5.347), twelve weeks (p5.999) and six months (p5.999) twelve months (p5.817). There is an association between the numbers of levels fused and persistent nerve injury (twelve months follow up p!.001). Bone graft material (allograft, bone morphogenetic protein and autograft) does not have an influence on sensory or motor deficit at any time point. The multivariate logistic regression model showed an independent association of the following risk factor for a motor deficit at six weeks: gender (female), duration of surgery, BMI (O30) and involvement of L 4-5. Neither age nor number of levels fused was correlated with neurological injury. CONCLUSIONS: LLIF remains a valuable tool for achieving fusion through a minimally invasive approach with little risk to neurovascular structures. Approach related iliopsoas weakness remains a common postoperative deficiency. On surgeon has to be aware of the increased risk of persistent injury if the factors above were taken into account. FDA DEVICE/DRUG STATUS: Jaguar Lumbar I/F Cage System from Depuy: Approved for this indication; XLIF from NuVasive: Approved for this indication. doi: 10.1016/j.spinee.2011.08.211
160. The Correlation between Frequency of Surgical Site Infections and Surgery Case Order Jordan Gruskay1, Jeremy Smith, MD1, Christopher Kepler, MD, MBA2, Mitchell Maltenfort, PhD3, Kris Radcliff, MD4, Alexander Vaccaro, MD, PhD1; 1 Rothman Institute, Philadelphia, PA, USA; 2New York, NY, USA; 3 Philadelphia, PA, USA; 4Ben Franklin House, Egg Harbor Township, NJ, USA BACKGROUND CONTEXT: Postoperative wound infection is the most common complication following spinal surgery. The incidence reported in the literature varies from 0.5% to 20%. The addition of instrumentation, USAe of preoperative prophylactic antibiotics, length of procedure and intraoperative blood loss have all been found to influence infection rate. No previous study, however, has attempted to correlate the case order with infection risk after surgery. PURPOSE: To determine whether surgical site infections (SSIs) are associated with case order in spinal surgery. STUDY DESIGN/SETTING: Retrospective database review.
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
Proceedings of the NASS 26th Annual Meeting / The Spine Journal 11 (2011) 1S–173S
158. Early Development and Progression of Heterotopic Ossification in Cervical Total Disc Replacement Soo Eon Lee, MD; Seoul, South Korea BACKGROUND CONTEXT: The purpose ofcervical TDR is to decrease the incidence of adjacent segment disease through motion preservation. HO is a well-known complication after hip and knee arthroplasties. There have been very few reports regarding HO in patients undergoing cervical TDR. However, the occurrence and clinical outcomes on cervical motion have rarely been studied. In addition, temporal progression of HO has not been fully addressed. PURPOSE: The first goal of the study was to determine the incidence of heterotopic ossification (HO) identified with plain radiographs following cervical total disc replacement (TDR), and to demonstrate the progression of HO during the follow-up period. The second goal was to show whether segmental motion can be preserved, and to identify the relationship between HO and clinical outcomes. STUDY DESIGN/SETTING: A retrospective clinical and radiologic study of 28 patients who underwent cervical total disc replacement (TDR). PATIENT SAMPLE: Twenty-eight consecutive patients underwent cervical TDR with a Mobi-CÒ(LDR Medical, Troyes, France) between September 2006 and October 2008. OUTCOME MEASURES: The radiologic outcomes were evaluated with lateral dynamic radiographs preoperatively and on 1, 3, 6, 12, and 24 months postoperatively. METHODS: The occurrence of HO was interpreted on lateral radiographs according to the McAfee classification. We also measured the cervical range of motion (ROM), visual analog scale (VAS), and neck disability index (NDI) for the evaluation of cervical motion and clinical outcome. RESULTS: The mean follow-up period was 21.667.0 months and the mean occurrence of HO was observed 8.066.6 months postoperatively. At the last follow-up, 18 of 28 patients (64.3%) developed HO. (grade I, 6 patients; grade II, 8 patients; grade III, 3 patients; grade IV, 1 patient) The progression of HO was proportional to the duration of follow-up, as follows; 3/28 (10.7 %) at 1 month; 7/28 (25.0%) at 3 months; 11/26 (42.3%) at 6 months; 15/24 (62.5%) at 12 months; and 17/22 (77.3%) at 24 months. The cervical ROM was preserved in grade I and II HO, but restricted in grade III and IV HO. Clinical improvement in terms of VAS and NDI was not significantly correlated with the occurrence of HO. CONCLUSIONS: The overall incidence of HO after cervical TDR was relatively high. Moreover, HO began to appear unexpectedly early after surgery and the progression was proportional to the time which had elapsed postoperatively. Grade III or IV HO can restrict the cervical ROM and may lead to spontaneous fusion. However, the occurrence of HO did not affect the clinical outcome. Therefore, before performing cervical TDR, a high incidence of HO with the possibility of spontaneous fusion must be expected during long-term follow-up. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.210
159. Sensory and Motor Deficit Following Lateral Lumbar Interbody Fusion Matthias Pumberger, MD1, Suhel Kotwal, MD2, Darren Lebl, MD2, Alexander Hughes, MD3, Andrew Sama, MD1, Federico Girardi, MD1; 1 Hospital for Special Surgery, New York, NY, USA; 2New York, NY, USA; 3 East River Professional Building, New York, NY, USA BACKGROUND CONTEXT: Lateral lumbar interbody fusion (LLIF) as a minimally-invasive technique has gained growing interest in recent years. However, one of the procedure’s limitations remains the unknown incidence of sensory and/or motor deficit following a trans-psoatic approach. Several anatomical studies have been published, but no clinical study evaluated the incidence and risk factors of sensory and motor deficit.
PURPOSE: We seek to identify the incidence and nature of neurological events following LLIF. STUDY DESIGN/SETTING: We performed a retrospective chart review. PATIENT SAMPLE: We reviewed two-hundred thirty-seven patients undergoing LLIF between 2006 and 2009. OUTCOME MEASURES: We identified the new onset of anterior thigh pain, sensory and motor deficit. Each sensory deficit was reported to the according dermatome. Motor deficits were divided into the muscle subgroups and their severity (mild 4/5, moderate 3/5, severe !2/5). METHODS: Patient charts were reviewed for demographics, medical comorbidities, subjective neurological complaints, and physical exam findings at the following time points: preoperatively, preoperatively, and postoperatively at six weeks, twelve weeks, six months, and at twelve months followup. The specific deficits were correlated to the side and level of approach, numbers of levels fused, duration of surgery, and bone graft material employed. A multivariate logistic regression models were created to evaluate the independent associations of each potential explanatory variable to predict the likelihood of the dependent variable, presence of a neurological deficit (motor and any deficit) at the first follow-up time point. RESULTS: A total of 237 patients (139 Female, 98 Male) underwent LLIF surgery at our institution with a total of 463 levels fused. Average age was 61.5 years (range 31–88) and average BMI was 28.3 (range 17.4–60.3). At six weeks, 41.4%, 16.0% at twelve weeks, 3.7% at six months and 0.8% at twelve months experienced thigh pain postoperatively. We found a significant correlation between the involvement of L 4-5 and the occurrence of motor deficits at six weeks (p5.009), twelve weeks (p5.009) and twelve months (p5.027). However, no correlation between a sensory deficit and the involvement of L1-2, L2-3, L3-4 was found (six weeks (p5.347), twelve weeks (p5.999) and six months (p5.999) twelve months (p5.817). There is an association between the numbers of levels fused and persistent nerve injury (twelve months follow up p!.001). Bone graft material (allograft, bone morphogenetic protein and autograft) does not have an influence on sensory or motor deficit at any time point. The multivariate logistic regression model showed an independent association of the following risk factor for a motor deficit at six weeks: gender (female), duration of surgery, BMI (O30) and involvement of L 4-5. Neither age nor number of levels fused was correlated with neurological injury. CONCLUSIONS: LLIF remains a valuable tool for achieving fusion through a minimally invasive approach with little risk to neurovascular structures. Approach related iliopsoas weakness remains a common postoperative deficiency. On surgeon has to be aware of the increased risk of persistent injury if the factors above were taken into account. FDA DEVICE/DRUG STATUS: Jaguar Lumbar I/F Cage System from Depuy: Approved for this indication; XLIF from NuVasive: Approved for this indication. doi: 10.1016/j.spinee.2011.08.211
160. The Correlation between Frequency of Surgical Site Infections and Surgery Case Order Jordan Gruskay1, Jeremy Smith, MD1, Christopher Kepler, MD, MBA2, Mitchell Maltenfort, PhD3, Kris Radcliff, MD4, Alexander Vaccaro, MD, PhD1; 1 Rothman Institute, Philadelphia, PA, USA; 2New York, NY, USA; 3 Philadelphia, PA, USA; 4Ben Franklin House, Egg Harbor Township, NJ, USA BACKGROUND CONTEXT: Postoperative wound infection is the most common complication following spinal surgery. The incidence reported in the literature varies from 0.5% to 20%. The addition of instrumentation, USAe of preoperative prophylactic antibiotics, length of procedure and intraoperative blood loss have all been found to influence infection rate. No previous study, however, has attempted to correlate the case order with infection risk after surgery. PURPOSE: To determine whether surgical site infections (SSIs) are associated with case order in spinal surgery. STUDY DESIGN/SETTING: Retrospective database review.
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.