- Email: [email protected]
Utility of Postoperative Radiographs in Adult Spine Deformity Surgery
202S
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S
neuroforaman, however, has an oblique orientation that is poorly visualized using conventional CT protocol. PURPOSE: To compare the dimensions of cervical foramina as seen on standard sagittal scans versus oblique CT reconstructions. The secondary goal was to correlate foraminal narrowing with radicular symptoms. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Seventy-two consecutive patients with symptoms of distinct unilateral radiculopathy that poorly correlated with magnetic resonance imaging (MRI) were reviewed. Patients with prior surgery, only axial neck pain and incomplete imaging were excluded. OUTCOME MEASURES: Cervical foraminal height and foraminal width (in mm). METHODS: Seventy-two patients (852 foramina) underwent standard CT scans with oblique sagittal reconstructions. Foraminal height (FH) and foraminal width (FW) from C2-3 to C7-T1 were measured and compared on standard and oblique sagittal reconstruction. Symptomatic levels of each patient were determined using medical records. The two methods were then compared to determine which method more accurately predicted symptoms. The differences were analyzed using ANOVA and Pearson’s correlation. Significance level was set at p!0.05. Validity of each CT method was compared using -2 log likelihood (-2LL) from regression of the physicians’ evaluations. RESULTS: Foraminal height was visualized on 98.9% [n5843] of standard sagittal and 99.9% [n5851] of oblique sagittal CT scans (p50.01). FW was visualized on 74.4% [n5634] of standard sagittal and 100% of oblique sagittal CT scans (p!0.001). FW at the upper cervical levels was less likely to be fully visualized on the standard sagittal CT scan. FW in standard sagittal CT scans was significantly larger at C5-6 (p!0.01). Oblique sagittal FW (-2LL5416.3) and oblique sagittal FH (-2LL5462.2) more accurately reflected physician evaluations than the standard sagittal FW (-2LL5434.0) and standard sagittal FH (-2LL5464.5). CONCLUSIONS: When evaluating cervical foraminal stenosis using a CT scan, reconstructed oblique sagittal views offer two advantages over the standard orientation. First, the true dimensions of the cross-sectional area of the foramen can be appreciated. Second, foraminal stenosis as observed on the oblique sagittal views could correlate more accurately with the clinical symptoms of radiculopathy. This modality can be used as an adjunct diagnostic tool in situations where patient presentation does not correlate to standard MR imaging. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.275
P41. Utility of Postoperative Radiographs in Adult Spine Deformity Surgery Kirkham B. Wood, MD1, Brian Grottkau, MD1, Mark Jacobson, MD2, Polina Osler, MS1, Dana A. Leonard, BA3; 1Massachusetts General Hospital, Boston, MA, US; 2Shoreline Orthopaedics, Holland, MI, US; 3 Brigham and Women’s Hospital, Boston, MA, US BACKGROUND CONTEXT: Typically, postoperative care of patients treated surgically for adult spinal deformity includes follow-up visits with radiographs. Because of little evidence to support routine postoperative imaging, the utility of routine radiographs following orthopedic procedures has come under scrutiny lately regarding concerns for radiation exposure, financial burden and unnecessary testing. PURPOSE: We sought to study the utility of surveillance radiographs following adult spinal deformity surgery. Our hypothesis is that routine radiographs following adult deformity surgery have low utility for directing postoperative care. STUDY DESIGN/SETTING: Retrospective case review. PATIENT SAMPLE: 69 consecutive patients undergoing thoracolumbar fusion were reviewed to determine if postoperative radiographs contributed to deviations from routine care. Logs were reviewed to identify patients
with thoracolumbar arthrodesis of seven or more motion segments treated for spine deformity from 2007 to 2011. 484 clinic visits with 481 standing radiographs were reviewed. 77% were females at an average age of 55 (1984) and 29-month follow-up. OUTCOME MEASURES: The primary outcome measure was deviation from routine postoperative care secondary to radiographic findings, physical examination or both. Hardware position, radiographic abnormalities and deviations from routine postoperative care were noted. A deviation from routine care included referral for advanced imaging, change to follow-up interval, change in bracing duration and revision surgery or its recommendation METHODS: Operative reports, clinic notes, and radiographs for all patients were thoroughly reviewed for the entire duration of follow-up or until a deviation in the follow-up care was noted. Patient diagnosis, surgical indication, date of procedure, levels of arthrodesis, approach utilized, osteotomy type (if performed) and history of prior spine procedures were all collected from the operative report. All postoperative clinic notes were reviewed for the date of follow-up, hardware position and radiographic abnormalities as noted by the provider, and deviations from the routine postoperative care. Routine postoperative care was defined as scheduled follow-up at regular intervals (typically 2 weeks, 8 weeks, 3 months, 6 months postoperatively, with subsequent annual visits), plain radiographic surveillance prior to each visit, oral narcotic or non-narcotic pain medications, physical therapy and bracing lasting no more than three months when initiated immediately postoperatively. Events representing a deviation from routine care included referral for advanced imaging, change to follow-up interval, change in bracing duration and revision surgery or the recommendation for it. Statistical Methods. All medical records were divided between two independent reviewers, and a subset (15 records) was reviewed by both. The observers were asked to indicate for each case whether a change in standard treatment occurred (Yes or No), and if that change was accompanied by a corresponding change in the plain radiographs (Yes or No). In addition, each reviewer was asked whether plain radiographs contributed to the decision-making, as documented in clinic notes, that ultimately resulted in the change in clinical management (Yes or No). The interobserver reliability was determined based on the subset of cases reviewed by both observers. A standard, unweighted Cohen’s kappa statistic was used as a measure of interobserver agreement. The strength of this agreement was rated according to the following scale: less than 0 (poor), 0 to 0.20 (slight), 0.21 to 0.40 (fair), 0.41 to 0.60 (moderate), 0.61 to 0.80 (substantial) and 0.81 to 1.0 (near perfect). The proportion of agreement was calculated as the number of cases in which the observers agreed about the management course, divided by the total number of cases reviewed. The sensitivity, specificity, positive predictive value, and negative predictive value of radiographic surveillance as a method for detecting a change in treatment were calculated using a standard 2x2 table. True positives were considered to be instances in which a positive change on the radiographs corresponding to change in management. False positives were considered those instances in which a positive change in plain radiographs did not result in change in management. True negatives were instances where there was no change in management, and no change observed on routine plain radiographs. False negatives were those instances when there was a change in management, but no changes were detected on plain radiographs. Kaplan-Meier log-rank analysis was used to compare the postoperative course between patients with versus without osteotomy, patients who had a posterior only versus a combined approach, and patients who had long fusions (more than 10 levels) versus shorter fusions (7 to 10 levels). Alpha values of 0.05 were used as a cutoff value for statistical significance. RESULTS: 484 clinic visits with 481 standing radiographs were reviewed. 77% were females at an average age of 55 (19-84) and 29-month followup. A change was noted in 54% (37) including hardware failure, rod/screw pullout, progressive deformity or kyphosis, screw halo or prominent hardware. A deviation from postoperative care occurred in 59% (41), including change in follow-up, prolonged immobilization, referral for advanced imaging, antibiotic therapy and revision surgery or its recommendation. Radiographs contributed to decision-making in 25 (56%). The sensitivity and specificity were 66% and 64% respectively.
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 CONCLUSIONS: Radiographic surveillance following adult spinal deformity surgery is both poorly sensitive and specific, and alone, is an inadequate detection method to identify patients who may deviate from routine care. Attention to both history and physical findings continues to remain paramount. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.276
203S
P43. A Comprehensive MRI Classification System for Cervical Foraminal Stenosis Sang-Hun Lee, MD, PhD1, So Young Park, MD, PhD1, Jeffrey C. Wang, MD2, Kyung-Chung Kang, MD3, Sang-Phil Hwang, MD1, Soojin Jang, MD4; 1Seoul, South Korea; 2University of Southern California Spine Center, Los Angeles, CA, US; 3KyungHee University Medical Center, Seoul, South Korea; 4Spine Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
BACKGROUND CONTEXT: Children with severe spinal curving from scoliosis were more likely to have worsening risk indicators for pulmonary hypertension, researchers reported here. PURPOSE: To test for associations between degree of scoliosis curvature and cardiac function and to measure the incidence of pulmonary hypertension with adolescent idiopathic scoliosis, the study conducted a chart review of 1000 patients (ages 11 to 21) who underwent spinal fusion therapy from 2010 to 2014. STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: 1000. OUTCOME MEASURES: Participants were compared with 300 age matched healthy control patients who visited the center for 2D-echocardiogram for innocent flow murmurs. In addition to echocardiogram outcomes, participants received scoliosis Cobb angle, aortic coordinations and tricuspid regurgitation jet velocity, and were reviewed for patient demographics. Right ventricular systolic pressure was a marker for pulmonary hypertension in cases where pressure was at or exceeded 25 mm/Hg. METHODS: Participants were compared with 300 age-matched healthy control patients who visited the center for 2D-echocardiogram for innocent flow murmurs. In addition to echocardiogram outcomes, participants received measurement of scoliosis Cobb angle, aortic coordinations and tricuspid regurgitation jet velocity, and were reviewed for patient demographics. Right ventricular systolic pressure was a marker for pulmonary hypertension in cases where pressure was at or exceeded 25 mm/Hg. Spearman correlation was done to assess associations between spine curvature and systolic pressure, while logistic regressions were used to measure tricuspid regurgitation jet velocity between idiopathic scoliosis and control groups. RESULTS: Patients had an average age of 13.7, and an average Cobb angle of 57.7 . Also, 1000 patients with idiopathic curvature had preoperative echoes. In those with idiopathic scoliosis, 57.3% adverbial mitral regurgitation, 21.7% had mild tricuspid regurgitation, 2.77% had mild mitral regurgitation, 2.73% had mitral valve prolapse, 1.67% had atrial septal defect, and 1.77% had ventricular septal defect. There was one control with an abnormal tricuspid regurgitate jet velocity. Right ventricular systolic pressure was significantly lower in control participants compared with the patients (20.7mm/Hg versus 27.7 mm/Hg. P!0.05). CONCLUSIONS: Children with severe spinal curving from scoliosis were more likely to have worsening risk indicators for pulmonary hypertension, researchers reported here. Follow-up studies would include postoperative echocardiograms of patients with elevated systolic pressure. The study recommended patients with scoliosis receive screening via echocardiogram to identify structural heart defects and pulmonary hypertension, and that those with elevated right ventricular systolic pressure ‘‘be considered for early surgery to prevent progression of pulmonary hypertension and even possible mortality. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
BACKGROUND CONTEXT: Although cervical radiculopathy originating from foraminal stenosis (FS) is very common clinical entity, still there is no clear guideline to describe shape and degree of FS. Recently, the benefits of oblique sagittal (OS) images of the cervical spine were presented to evaluate cervical FS. To date, a comprehensive classification system considering both morphological features and degree of the nerve root compression have not been presented. PURPOSE: To propose a novel, comprehensive MRI classification system for cervical FS with its reliability. STUDY DESIGN/SETTING: A cross sectional study using cervical spine MRI. PATIENT SAMPLE: We retrospectively analyzed 50 consecutive patients with cervical radiculopathy with FS and underwent MRI of the cervical spine including T2 axial and T2 OS images. OUTCOME MEASURES: The authors’ classification system for cervical FS was used. Inter- and intraobserver reliability was evaluated using kappa statistics. Kappa value interpretations were poor (k!0.1), slight (0.1-0.2), fair (0.2-0.4), moderate (0.4-0.6), substantial (0.6-0.8) and almost perfect (0.8-1.0). METHODS: A total of 400 cervical foramina (from C3-4 to C6-7) in 50 MRI of the cervical spine were analyzed. Two independent reviewers (a spine surgeon and a musculoskeletal radiologist with more than 10 years of clinical experience) blindly classified the cervical FS by the authors’ classification system. (1) Morphological characteristics on the T2 axial images were divided into: A: no stenosis, B: focal type (compression area !50% of foramen length), or C: diffuse type (O50% of foramen length). (2) Degree of nerve root compression was graded both on T2 axial image and OS images. On axial images, the grade was 0 (no neural compression), 1 (maximal compression of the nerve root!50% compared with the extraforaminal root diameter) or 2 (O50% compression). On OS images, the grade was 0, 1 (maximal compression of nerve root does not pass the midline of interpedicular space) or 2 (compression passes over the midline or severe nerve root deformation). The classification was performed by two settings on the same foramen: setting 1 – T2 axial images only (both morphology and degree of compression) and setting 2 – using both T2 axial (morphology) and T2 OS images (degree of compression) separately. Inter- and intraobserver reliability of morphology (A, B or C), degree of nerve root compression (0, 1 or 2) and classified types (A0~C2) were analyzed using kappa statistics. RESULTS: Morphological grade on T2 axial images: the intraobserver reliability is perfect (k50.81 – 0.92) and interobserver reliability is substantial (k5 0.67 – 0.88). The degree of the nerve root compression showed almost perfect intraobserver reliability on T2 axial images (k5 0.79 - 0.91) and perfect on OS images (k5 0.89 – 0.94). Interobserver reliability of the degree of nerve root compression was higher in T2 OS images (k5 0.69-86) than axial images (k5 0.55- 0.80). Based on the authors’ classification system, a total of five types of cervical FS were classified (A0, B1, B2, C1, C2). Intraobserver reliability between the classification using setting 1 and 2 was almost perfect (k50.92-0.94). But interobserver reliability was higher in the classification using setting 2 than setting 1 (k50.83:0.63). CONCLUSIONS: The authors’ novel classification system could be a simple and reliable system to evaluate both shape and degree of cervical FS using T2 axial images with/without OS images. Use of T2 OS images in combination with T2 axial images was better to grade the degree of nerve root compression than axial images only. The relevance of this system with clinical findings and treatment strategy should be further studied. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
http://dx.doi.org/10.1016/j.spinee.2015.07.277
http://dx.doi.org/10.1016/j.spinee.2015.07.278
P42. Risk Factors of Severe Adolescent Scoliosis Tied to HTN Xie En, MD1, Dingjun Hao, MD2, Dageng Huang, MD3, Biao Wang1, 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
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
neuroforaman, however, has an oblique orientation that is poorly visualized using conventional CT protocol. PURPOSE: To compare the dimensions of cervical foramina as seen on standard sagittal scans versus oblique CT reconstructions. The secondary goal was to correlate foraminal narrowing with radicular symptoms. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Seventy-two consecutive patients with symptoms of distinct unilateral radiculopathy that poorly correlated with magnetic resonance imaging (MRI) were reviewed. Patients with prior surgery, only axial neck pain and incomplete imaging were excluded. OUTCOME MEASURES: Cervical foraminal height and foraminal width (in mm). METHODS: Seventy-two patients (852 foramina) underwent standard CT scans with oblique sagittal reconstructions. Foraminal height (FH) and foraminal width (FW) from C2-3 to C7-T1 were measured and compared on standard and oblique sagittal reconstruction. Symptomatic levels of each patient were determined using medical records. The two methods were then compared to determine which method more accurately predicted symptoms. The differences were analyzed using ANOVA and Pearson’s correlation. Significance level was set at p!0.05. Validity of each CT method was compared using -2 log likelihood (-2LL) from regression of the physicians’ evaluations. RESULTS: Foraminal height was visualized on 98.9% [n5843] of standard sagittal and 99.9% [n5851] of oblique sagittal CT scans (p50.01). FW was visualized on 74.4% [n5634] of standard sagittal and 100% of oblique sagittal CT scans (p!0.001). FW at the upper cervical levels was less likely to be fully visualized on the standard sagittal CT scan. FW in standard sagittal CT scans was significantly larger at C5-6 (p!0.01). Oblique sagittal FW (-2LL5416.3) and oblique sagittal FH (-2LL5462.2) more accurately reflected physician evaluations than the standard sagittal FW (-2LL5434.0) and standard sagittal FH (-2LL5464.5). CONCLUSIONS: When evaluating cervical foraminal stenosis using a CT scan, reconstructed oblique sagittal views offer two advantages over the standard orientation. First, the true dimensions of the cross-sectional area of the foramen can be appreciated. Second, foraminal stenosis as observed on the oblique sagittal views could correlate more accurately with the clinical symptoms of radiculopathy. This modality can be used as an adjunct diagnostic tool in situations where patient presentation does not correlate to standard MR imaging. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.275
P41. Utility of Postoperative Radiographs in Adult Spine Deformity Surgery Kirkham B. Wood, MD1, Brian Grottkau, MD1, Mark Jacobson, MD2, Polina Osler, MS1, Dana A. Leonard, BA3; 1Massachusetts General Hospital, Boston, MA, US; 2Shoreline Orthopaedics, Holland, MI, US; 3 Brigham and Women’s Hospital, Boston, MA, US BACKGROUND CONTEXT: Typically, postoperative care of patients treated surgically for adult spinal deformity includes follow-up visits with radiographs. Because of little evidence to support routine postoperative imaging, the utility of routine radiographs following orthopedic procedures has come under scrutiny lately regarding concerns for radiation exposure, financial burden and unnecessary testing. PURPOSE: We sought to study the utility of surveillance radiographs following adult spinal deformity surgery. Our hypothesis is that routine radiographs following adult deformity surgery have low utility for directing postoperative care. STUDY DESIGN/SETTING: Retrospective case review. PATIENT SAMPLE: 69 consecutive patients undergoing thoracolumbar fusion were reviewed to determine if postoperative radiographs contributed to deviations from routine care. Logs were reviewed to identify patients
with thoracolumbar arthrodesis of seven or more motion segments treated for spine deformity from 2007 to 2011. 484 clinic visits with 481 standing radiographs were reviewed. 77% were females at an average age of 55 (1984) and 29-month follow-up. OUTCOME MEASURES: The primary outcome measure was deviation from routine postoperative care secondary to radiographic findings, physical examination or both. Hardware position, radiographic abnormalities and deviations from routine postoperative care were noted. A deviation from routine care included referral for advanced imaging, change to follow-up interval, change in bracing duration and revision surgery or its recommendation METHODS: Operative reports, clinic notes, and radiographs for all patients were thoroughly reviewed for the entire duration of follow-up or until a deviation in the follow-up care was noted. Patient diagnosis, surgical indication, date of procedure, levels of arthrodesis, approach utilized, osteotomy type (if performed) and history of prior spine procedures were all collected from the operative report. All postoperative clinic notes were reviewed for the date of follow-up, hardware position and radiographic abnormalities as noted by the provider, and deviations from the routine postoperative care. Routine postoperative care was defined as scheduled follow-up at regular intervals (typically 2 weeks, 8 weeks, 3 months, 6 months postoperatively, with subsequent annual visits), plain radiographic surveillance prior to each visit, oral narcotic or non-narcotic pain medications, physical therapy and bracing lasting no more than three months when initiated immediately postoperatively. Events representing a deviation from routine care included referral for advanced imaging, change to follow-up interval, change in bracing duration and revision surgery or the recommendation for it. Statistical Methods. All medical records were divided between two independent reviewers, and a subset (15 records) was reviewed by both. The observers were asked to indicate for each case whether a change in standard treatment occurred (Yes or No), and if that change was accompanied by a corresponding change in the plain radiographs (Yes or No). In addition, each reviewer was asked whether plain radiographs contributed to the decision-making, as documented in clinic notes, that ultimately resulted in the change in clinical management (Yes or No). The interobserver reliability was determined based on the subset of cases reviewed by both observers. A standard, unweighted Cohen’s kappa statistic was used as a measure of interobserver agreement. The strength of this agreement was rated according to the following scale: less than 0 (poor), 0 to 0.20 (slight), 0.21 to 0.40 (fair), 0.41 to 0.60 (moderate), 0.61 to 0.80 (substantial) and 0.81 to 1.0 (near perfect). The proportion of agreement was calculated as the number of cases in which the observers agreed about the management course, divided by the total number of cases reviewed. The sensitivity, specificity, positive predictive value, and negative predictive value of radiographic surveillance as a method for detecting a change in treatment were calculated using a standard 2x2 table. True positives were considered to be instances in which a positive change on the radiographs corresponding to change in management. False positives were considered those instances in which a positive change in plain radiographs did not result in change in management. True negatives were instances where there was no change in management, and no change observed on routine plain radiographs. False negatives were those instances when there was a change in management, but no changes were detected on plain radiographs. Kaplan-Meier log-rank analysis was used to compare the postoperative course between patients with versus without osteotomy, patients who had a posterior only versus a combined approach, and patients who had long fusions (more than 10 levels) versus shorter fusions (7 to 10 levels). Alpha values of 0.05 were used as a cutoff value for statistical significance. RESULTS: 484 clinic visits with 481 standing radiographs were reviewed. 77% were females at an average age of 55 (19-84) and 29-month followup. A change was noted in 54% (37) including hardware failure, rod/screw pullout, progressive deformity or kyphosis, screw halo or prominent hardware. A deviation from postoperative care occurred in 59% (41), including change in follow-up, prolonged immobilization, referral for advanced imaging, antibiotic therapy and revision surgery or its recommendation. Radiographs contributed to decision-making in 25 (56%). The sensitivity and specificity were 66% and 64% respectively.
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 CONCLUSIONS: Radiographic surveillance following adult spinal deformity surgery is both poorly sensitive and specific, and alone, is an inadequate detection method to identify patients who may deviate from routine care. Attention to both history and physical findings continues to remain paramount. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.276
203S
P43. A Comprehensive MRI Classification System for Cervical Foraminal Stenosis Sang-Hun Lee, MD, PhD1, So Young Park, MD, PhD1, Jeffrey C. Wang, MD2, Kyung-Chung Kang, MD3, Sang-Phil Hwang, MD1, Soojin Jang, MD4; 1Seoul, South Korea; 2University of Southern California Spine Center, Los Angeles, CA, US; 3KyungHee University Medical Center, Seoul, South Korea; 4Spine Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
BACKGROUND CONTEXT: Children with severe spinal curving from scoliosis were more likely to have worsening risk indicators for pulmonary hypertension, researchers reported here. PURPOSE: To test for associations between degree of scoliosis curvature and cardiac function and to measure the incidence of pulmonary hypertension with adolescent idiopathic scoliosis, the study conducted a chart review of 1000 patients (ages 11 to 21) who underwent spinal fusion therapy from 2010 to 2014. STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: 1000. OUTCOME MEASURES: Participants were compared with 300 age matched healthy control patients who visited the center for 2D-echocardiogram for innocent flow murmurs. In addition to echocardiogram outcomes, participants received scoliosis Cobb angle, aortic coordinations and tricuspid regurgitation jet velocity, and were reviewed for patient demographics. Right ventricular systolic pressure was a marker for pulmonary hypertension in cases where pressure was at or exceeded 25 mm/Hg. METHODS: Participants were compared with 300 age-matched healthy control patients who visited the center for 2D-echocardiogram for innocent flow murmurs. In addition to echocardiogram outcomes, participants received measurement of scoliosis Cobb angle, aortic coordinations and tricuspid regurgitation jet velocity, and were reviewed for patient demographics. Right ventricular systolic pressure was a marker for pulmonary hypertension in cases where pressure was at or exceeded 25 mm/Hg. Spearman correlation was done to assess associations between spine curvature and systolic pressure, while logistic regressions were used to measure tricuspid regurgitation jet velocity between idiopathic scoliosis and control groups. RESULTS: Patients had an average age of 13.7, and an average Cobb angle of 57.7 . Also, 1000 patients with idiopathic curvature had preoperative echoes. In those with idiopathic scoliosis, 57.3% adverbial mitral regurgitation, 21.7% had mild tricuspid regurgitation, 2.77% had mild mitral regurgitation, 2.73% had mitral valve prolapse, 1.67% had atrial septal defect, and 1.77% had ventricular septal defect. There was one control with an abnormal tricuspid regurgitate jet velocity. Right ventricular systolic pressure was significantly lower in control participants compared with the patients (20.7mm/Hg versus 27.7 mm/Hg. P!0.05). CONCLUSIONS: Children with severe spinal curving from scoliosis were more likely to have worsening risk indicators for pulmonary hypertension, researchers reported here. Follow-up studies would include postoperative echocardiograms of patients with elevated systolic pressure. The study recommended patients with scoliosis receive screening via echocardiogram to identify structural heart defects and pulmonary hypertension, and that those with elevated right ventricular systolic pressure ‘‘be considered for early surgery to prevent progression of pulmonary hypertension and even possible mortality. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
BACKGROUND CONTEXT: Although cervical radiculopathy originating from foraminal stenosis (FS) is very common clinical entity, still there is no clear guideline to describe shape and degree of FS. Recently, the benefits of oblique sagittal (OS) images of the cervical spine were presented to evaluate cervical FS. To date, a comprehensive classification system considering both morphological features and degree of the nerve root compression have not been presented. PURPOSE: To propose a novel, comprehensive MRI classification system for cervical FS with its reliability. STUDY DESIGN/SETTING: A cross sectional study using cervical spine MRI. PATIENT SAMPLE: We retrospectively analyzed 50 consecutive patients with cervical radiculopathy with FS and underwent MRI of the cervical spine including T2 axial and T2 OS images. OUTCOME MEASURES: The authors’ classification system for cervical FS was used. Inter- and intraobserver reliability was evaluated using kappa statistics. Kappa value interpretations were poor (k!0.1), slight (0.1-0.2), fair (0.2-0.4), moderate (0.4-0.6), substantial (0.6-0.8) and almost perfect (0.8-1.0). METHODS: A total of 400 cervical foramina (from C3-4 to C6-7) in 50 MRI of the cervical spine were analyzed. Two independent reviewers (a spine surgeon and a musculoskeletal radiologist with more than 10 years of clinical experience) blindly classified the cervical FS by the authors’ classification system. (1) Morphological characteristics on the T2 axial images were divided into: A: no stenosis, B: focal type (compression area !50% of foramen length), or C: diffuse type (O50% of foramen length). (2) Degree of nerve root compression was graded both on T2 axial image and OS images. On axial images, the grade was 0 (no neural compression), 1 (maximal compression of the nerve root!50% compared with the extraforaminal root diameter) or 2 (O50% compression). On OS images, the grade was 0, 1 (maximal compression of nerve root does not pass the midline of interpedicular space) or 2 (compression passes over the midline or severe nerve root deformation). The classification was performed by two settings on the same foramen: setting 1 – T2 axial images only (both morphology and degree of compression) and setting 2 – using both T2 axial (morphology) and T2 OS images (degree of compression) separately. Inter- and intraobserver reliability of morphology (A, B or C), degree of nerve root compression (0, 1 or 2) and classified types (A0~C2) were analyzed using kappa statistics. RESULTS: Morphological grade on T2 axial images: the intraobserver reliability is perfect (k50.81 – 0.92) and interobserver reliability is substantial (k5 0.67 – 0.88). The degree of the nerve root compression showed almost perfect intraobserver reliability on T2 axial images (k5 0.79 - 0.91) and perfect on OS images (k5 0.89 – 0.94). Interobserver reliability of the degree of nerve root compression was higher in T2 OS images (k5 0.69-86) than axial images (k5 0.55- 0.80). Based on the authors’ classification system, a total of five types of cervical FS were classified (A0, B1, B2, C1, C2). Intraobserver reliability between the classification using setting 1 and 2 was almost perfect (k50.92-0.94). But interobserver reliability was higher in the classification using setting 2 than setting 1 (k50.83:0.63). CONCLUSIONS: The authors’ novel classification system could be a simple and reliable system to evaluate both shape and degree of cervical FS using T2 axial images with/without OS images. Use of T2 OS images in combination with T2 axial images was better to grade the degree of nerve root compression than axial images only. The relevance of this system with clinical findings and treatment strategy should be further studied. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
http://dx.doi.org/10.1016/j.spinee.2015.07.277
http://dx.doi.org/10.1016/j.spinee.2015.07.278
P42. Risk Factors of Severe Adolescent Scoliosis Tied to HTN Xie En, MD1, Dingjun Hao, MD2, Dageng Huang, MD3, Biao Wang1, 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
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.