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Spinal column and spinal cord injuries in the pediatric population
114S
Proceedings of the NASS 17th Annual Meeting / The Spine Journal 2 (2002) 47S–128S
Relationship between findings and existing knowledge: Previous studies have demonstrated a relationship between wound infection and smoking after lumbar spine surgery. However, the effects of increased smoking and smoking cessation have not been determined. Overall significance of findings: Wound complications after lumbar spine surgery are more common in smokers than in nonsmokers. Patients who smoke two or more packs per day are at nearly three times the risk of developing a wound complication. Smoking cessation 3 months or more before surgery may reduce the risk of wound complication, and patients who are smokers should be encouraged to quit before surgery. Disclosures: No disclosures. Conflict of interest: No conflicts. PII: S1529-9430(02)00247-4
Spinal column and spinal cord injuries in the pediatric population Michael Wang, MD1, Pamela Griffith, RNC, MBA2, Gordon Mccomb, MD2, Michael Levy, MD2; 1University of Southern California, Miami, FL, USA; 2Children’s Hospital of Los Angeles, Los Angeles, CA, USA Purpose of study: Spinal cord and spinal column injuries are uncommon in the pediatric population, and few large series have described the epidemiology and occurrence of these injuries. Methods of use: A retrospective review of traumatic spinal column injuries at the Children’s Hospital of Los Angeles was conducted. A total of 83 cases occurring over the past 9 years were identified. Summary of findings: Seventeen fractures (21%) occurred in the atlantoaxial region, 18 in the cervical region (22%), 21 in the thoracic region (26%), 17 in the lumbar region (21%) and 10 in the sacral region (12%). Seventy percent of sacral fractures were associated with a pelvic fracture. Neurologic injuries occurred in 26 patients. Seven of the patients with neurologic deficits underwent spinal decompression, and 10 had surgical fusions. Outcome included death in seven cases, return to preinjury capacity in 10 cases, deficits resulting in temporary disability lasting less than one year in 4 cases and permanent neurologic deficits in 5 cases. Spinal cord injury without radiographic abnormality was found in 9 cases. Relationship between finding and existing knowledge: Patterns of spinal column injury in the pediatric population are different from adults. We demonstrate a higher incidence of thoracic, lumbar and sacral fractures than previous series. An increased potential for neurologic recovery is also seen. Overall significance of findings: Because of their rarity, the epidemiology and prognosis of spinal injuries in children deserves further study. Disclosures: No disclosures. Conflict of interest: No conflicts. PII: S1529-9430(02)00246-2
A national register for lumbar spine surgery: results of a 1-year cohort Bjorn Stromqvist, MD, PhD1, Bo Jonsson, MD, PhD2, Peter Fritzell, MD3, Olle Hagg, MD4, Bengt-Erik Larsson, MD3, Bengt Lind, MD4; 1Department of Orthopedics, Lund, Sweden; 2Department of Orthopedics, Helsingborg, Sweden; 3Department of Orthopedics, Falun, Sweden; 4Department of Orthopedics, Gothenburg, Sweden Purpose of study: To register preoperative demographic data, data on surgery and data on outcome in a standardized way after surgery for degenerative lumbar spine disorders on a national basis. Methods used: Pre- and postoperative data reported by patients: demographics, pain on visual analog scale (VAS), Short Form (SF)-36, pain drawing and Euroqol. Data on surgery reported by the individual surgeon: diagnosis, type of operation, type of implant, level, antibiotic prophylaxis and complication. Post operative data: same parameters as preoperatively plus patient satisfaction with surgery and degree of leg and back pain as compared with preoperatively. Registration on standardized protocol to the FileMakerPro program. Data export to SPSS software and reporting of aggregated data for Sweden on yearly basis.
Summary of findings: an increasing use of the register has been noted, and today the register covers more than 80% of surgery for degenerative lumbar spine disorders in Sweden. Examples of information obtained: 1) Demographics: Fifty percent of the patients were operated on for disc herniation and 33% for spinal stenosis and the remainder for spondylolisthesis or disc degenerative disorders. Mean preoperative VAS pain for disc herniation was 75. Fusions for spondylolisthesis and disc degenerative pain mainly were performed at university hospitals. Mean back pain (VAS) for spondylolisthesis preoperatively was 72. 2) Outcome: Patient satisfaction was best in disc surgery and least favorable in central spinal stenosis and disc degenerative pain. The outcome was similar in different type of hospitals. The improvement noted on the VAS was substantiated by the improvement in the SF-36 scores (physical as well as mental domain). Complication rate was 5%, but less than 1% were significant. The highest complication rate was seen in decompression plus instrumented fusion. Correlation was seen between outcome on the VAS and other pain parameters. Relationship between findings and existing knowledge: Today, to our knowledge, no national spine register exists. Overall significance of findings: The register demonstrates surgical outcome when applied to broad clinical use and can also show variations in indications and type of surgery over time. When developing evidence-based lumbar spine surgery, pilot studies, prospective randomized studies and broad registers, preferably national, are required. Disclosures: No disclosures. Conflict of interest: No conflict. PII: S1529-9430(02)00245-0
Work-related outcomes after lumbar fusion William R. Klemme, MD1, Leila S. Nelson, PhD2, Edgar G. Dawson, MD3, J. Kenneth Burkus, MD4, Kevin T. Foley, MD5, Stephen M. Papadopoulos, MD6, 1Bethesda, MD, USA; 2PhDx Systems, Inc., Albuquerque, NM, USA; 3 The Spine Institute, Santa Monica, CA, USA; 4The Hughston Clinic, Columbus, GA, USA; 5Memphis, TN, USA; 6Barrow Neurosurgical Association, LTD, Phoenix, AZ, USA Purpose of study: To date, there are few published data concerning workrelated outcomes in patients undergoing lumbar fusion. The present observational study was designed to evaluate specific work-related outcomes in a population-based cohort of patients undergoing lumbar fusion. Methods used: A population-based database of 815 prospectively identified lumbar fusion patients was queried for patients with complete 2-year follow-up. From the resultant subset of 292 patients with complete prospective data, a study group of 104 patients met inclusion criteria and completed a detailed work outcome questionnaire. Baseline patient self-assessment and physician questionnaire data included standard sociodemographic information, measures of back and leg pain, smoking history, general work history, compensation/litigation status and Short Form (SF)-36. Baseline measures were compared with similar outcome measures (including SF-36) administered at 6, 12 and 24 months after surgery. Independent associations between baseline characteristics and measures of patient satisfaction and work outcome were identified. Summary of findings: Among the study group, 67% of patients were satisfied with treatment, and 54% of patients were satisfied with overall improvement, 46% experienced decrease in pain and 51% experienced improved functioning. Factors negatively associated with at least one self-assessed outcome category included male gender, overweight/obese body mass index, workers compensation coverage, greater preoperative leg pain and prior lumbar surgery. Work-related outcomes showed little correlation between first return to work and successful return to work at 2-year follow-up. Although several factors (age less than 50 years, preoperative narcotics use, workers compensation coverage, involvement with litigation, moderate/heavy job labor, time off from work before surgery and preoperative leg pain) were negatively associated with first return to work. Only workers compensation coverage and involvement with litigation were associated with a less successful work outcome at 2 years. Despite a negative association, 68% of
Proceedings of the NASS 17th Annual Meeting / The Spine Journal 2 (2002) 47S–128S
Relationship between findings and existing knowledge: Previous studies have demonstrated a relationship between wound infection and smoking after lumbar spine surgery. However, the effects of increased smoking and smoking cessation have not been determined. Overall significance of findings: Wound complications after lumbar spine surgery are more common in smokers than in nonsmokers. Patients who smoke two or more packs per day are at nearly three times the risk of developing a wound complication. Smoking cessation 3 months or more before surgery may reduce the risk of wound complication, and patients who are smokers should be encouraged to quit before surgery. Disclosures: No disclosures. Conflict of interest: No conflicts. PII: S1529-9430(02)00247-4
Spinal column and spinal cord injuries in the pediatric population Michael Wang, MD1, Pamela Griffith, RNC, MBA2, Gordon Mccomb, MD2, Michael Levy, MD2; 1University of Southern California, Miami, FL, USA; 2Children’s Hospital of Los Angeles, Los Angeles, CA, USA Purpose of study: Spinal cord and spinal column injuries are uncommon in the pediatric population, and few large series have described the epidemiology and occurrence of these injuries. Methods of use: A retrospective review of traumatic spinal column injuries at the Children’s Hospital of Los Angeles was conducted. A total of 83 cases occurring over the past 9 years were identified. Summary of findings: Seventeen fractures (21%) occurred in the atlantoaxial region, 18 in the cervical region (22%), 21 in the thoracic region (26%), 17 in the lumbar region (21%) and 10 in the sacral region (12%). Seventy percent of sacral fractures were associated with a pelvic fracture. Neurologic injuries occurred in 26 patients. Seven of the patients with neurologic deficits underwent spinal decompression, and 10 had surgical fusions. Outcome included death in seven cases, return to preinjury capacity in 10 cases, deficits resulting in temporary disability lasting less than one year in 4 cases and permanent neurologic deficits in 5 cases. Spinal cord injury without radiographic abnormality was found in 9 cases. Relationship between finding and existing knowledge: Patterns of spinal column injury in the pediatric population are different from adults. We demonstrate a higher incidence of thoracic, lumbar and sacral fractures than previous series. An increased potential for neurologic recovery is also seen. Overall significance of findings: Because of their rarity, the epidemiology and prognosis of spinal injuries in children deserves further study. Disclosures: No disclosures. Conflict of interest: No conflicts. PII: S1529-9430(02)00246-2
A national register for lumbar spine surgery: results of a 1-year cohort Bjorn Stromqvist, MD, PhD1, Bo Jonsson, MD, PhD2, Peter Fritzell, MD3, Olle Hagg, MD4, Bengt-Erik Larsson, MD3, Bengt Lind, MD4; 1Department of Orthopedics, Lund, Sweden; 2Department of Orthopedics, Helsingborg, Sweden; 3Department of Orthopedics, Falun, Sweden; 4Department of Orthopedics, Gothenburg, Sweden Purpose of study: To register preoperative demographic data, data on surgery and data on outcome in a standardized way after surgery for degenerative lumbar spine disorders on a national basis. Methods used: Pre- and postoperative data reported by patients: demographics, pain on visual analog scale (VAS), Short Form (SF)-36, pain drawing and Euroqol. Data on surgery reported by the individual surgeon: diagnosis, type of operation, type of implant, level, antibiotic prophylaxis and complication. Post operative data: same parameters as preoperatively plus patient satisfaction with surgery and degree of leg and back pain as compared with preoperatively. Registration on standardized protocol to the FileMakerPro program. Data export to SPSS software and reporting of aggregated data for Sweden on yearly basis.
Summary of findings: an increasing use of the register has been noted, and today the register covers more than 80% of surgery for degenerative lumbar spine disorders in Sweden. Examples of information obtained: 1) Demographics: Fifty percent of the patients were operated on for disc herniation and 33% for spinal stenosis and the remainder for spondylolisthesis or disc degenerative disorders. Mean preoperative VAS pain for disc herniation was 75. Fusions for spondylolisthesis and disc degenerative pain mainly were performed at university hospitals. Mean back pain (VAS) for spondylolisthesis preoperatively was 72. 2) Outcome: Patient satisfaction was best in disc surgery and least favorable in central spinal stenosis and disc degenerative pain. The outcome was similar in different type of hospitals. The improvement noted on the VAS was substantiated by the improvement in the SF-36 scores (physical as well as mental domain). Complication rate was 5%, but less than 1% were significant. The highest complication rate was seen in decompression plus instrumented fusion. Correlation was seen between outcome on the VAS and other pain parameters. Relationship between findings and existing knowledge: Today, to our knowledge, no national spine register exists. Overall significance of findings: The register demonstrates surgical outcome when applied to broad clinical use and can also show variations in indications and type of surgery over time. When developing evidence-based lumbar spine surgery, pilot studies, prospective randomized studies and broad registers, preferably national, are required. Disclosures: No disclosures. Conflict of interest: No conflict. PII: S1529-9430(02)00245-0
Work-related outcomes after lumbar fusion William R. Klemme, MD1, Leila S. Nelson, PhD2, Edgar G. Dawson, MD3, J. Kenneth Burkus, MD4, Kevin T. Foley, MD5, Stephen M. Papadopoulos, MD6, 1Bethesda, MD, USA; 2PhDx Systems, Inc., Albuquerque, NM, USA; 3 The Spine Institute, Santa Monica, CA, USA; 4The Hughston Clinic, Columbus, GA, USA; 5Memphis, TN, USA; 6Barrow Neurosurgical Association, LTD, Phoenix, AZ, USA Purpose of study: To date, there are few published data concerning workrelated outcomes in patients undergoing lumbar fusion. The present observational study was designed to evaluate specific work-related outcomes in a population-based cohort of patients undergoing lumbar fusion. Methods used: A population-based database of 815 prospectively identified lumbar fusion patients was queried for patients with complete 2-year follow-up. From the resultant subset of 292 patients with complete prospective data, a study group of 104 patients met inclusion criteria and completed a detailed work outcome questionnaire. Baseline patient self-assessment and physician questionnaire data included standard sociodemographic information, measures of back and leg pain, smoking history, general work history, compensation/litigation status and Short Form (SF)-36. Baseline measures were compared with similar outcome measures (including SF-36) administered at 6, 12 and 24 months after surgery. Independent associations between baseline characteristics and measures of patient satisfaction and work outcome were identified. Summary of findings: Among the study group, 67% of patients were satisfied with treatment, and 54% of patients were satisfied with overall improvement, 46% experienced decrease in pain and 51% experienced improved functioning. Factors negatively associated with at least one self-assessed outcome category included male gender, overweight/obese body mass index, workers compensation coverage, greater preoperative leg pain and prior lumbar surgery. Work-related outcomes showed little correlation between first return to work and successful return to work at 2-year follow-up. Although several factors (age less than 50 years, preoperative narcotics use, workers compensation coverage, involvement with litigation, moderate/heavy job labor, time off from work before surgery and preoperative leg pain) were negatively associated with first return to work. Only workers compensation coverage and involvement with litigation were associated with a less successful work outcome at 2 years. Despite a negative association, 68% of