- Email: [email protected]
Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters
The Spine Journal 18 (2018) S142 S225 PURPOSE: The objective of our study was to assess postural stability of patients with adult spinal deformity (ASD) using cCDP and (1) compare with published normative controls, (2) determine the relationship between fall status and postural stability, and (3) determine the relationship between quality of life and postural stability in ASD STUDY DESIGN/SETTING: Prospective analysis of postural stability using CDP. PATIENT SAMPLE: Eleven consecutive patients with severe adult spinal deformity who were seen and evaluated in an outpatient clinic. OUTCOME MEASURES: Equilibrium scores (ES) during Sensory Organization Testing (SOT) across 6 conditions with varying sensorimotor deprivation, motor latency during Motor Control Testing (MCT), and a history of falls in community setting. METHODS: Eleven patients with ASD were prospectively enrolled. Inclusion criteria: coronal cobb (CC)≥20°, Pelvic incidence-lumbar lorodsis (PI-LL) >10°, sagittal vertical axis (SVA) ≥5 cm, pelvic tilt (PT)≥25°, and thoracic kyphosis (TK)≥60°. Exclusion criteria: inability to stand, presence of confounding neurological conditions. PS was determined using two randomly assigned tests with CDP: (1) SOT to evaluate the voluntary use of sensory information; and (2) motor control test (MCT) to assess involuntary postural reactions in response to external perturbations. Patient performance was compared to age-gender matched controls. QOL metrics included SRS-22 and SF-36 RESULTS: Mean age was 65±4.6, and 6/13 (46%) were female. Mean PILL was 31.2±12.7, PT 32.8±8.0, SVA 11.8±6.3 cm, TK 27.3±16.6, and CC 14.5±16.7. Four patients reported falling in the previous 6 months (36%). Those patients who self reported falling in past 6 months demonstrated significantly lower SOT (Conditions 2–6, p<.04) and SRS scores (p=.003). ASD patients demonstrated significantly lower SOT scores (Conditions 2– 6, p<.03), and greater latency of limb reaction time during backward translation (p=.0379) compared to age-matched controls-consistent with a higher global instability and elevated risk of falls. Mediolateral sway (predictor of falls) was correlated with TK in the eyes open and eyes closed conditions (p<.04). CONCLUSIONS: ASD patients demonstrate impaired postural stability and dynamic balance compared to normal controls. Further, postural stability and QOL metrics correlated with self-reported falls. These findings suggest that ASD patients have drastically altered balance, which predisposes these patients to elevated risk of falls and injury as well as decreased ambulatory confidence and quality of life. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
S185
PURPOSE: To determine if the side of approach in anterior cervical discectomy and fusion is associated with increased risk of recurrent laryngeal nerve injury. STUDY DESIGN/SETTING: A fellowship trained spine surgeon prospectively performed ACDFs between the years of 2003-2012. Side of approach was chosen based on contralateral to side of symptoms (ie right sided radicular symptoms, patient received a left-sided approach). Patients were monitored postoperatively for development of recurrent laryngeal nerve palsy symptoms. Patients found to have signs of recurrent laryngeal nerve injury were sent to ENT for confirmation and monitored for recovery. PATIENT SAMPLE: A total of 411 patients undergoing anterior cervical decompression procedures over 10 years in central Pennsylvania. OUTCOME MEASURES: Symptoms of recurrent laryngeal nerve injury (dysphonia, dysphagia). METHODS: Retrospecive analysis of prospectively collected data over 10 years. RESULTS: A total of 411 ACDFs were performed during the 10-year period. 190 right sided and 221 left sided procedures were done. The incidence of recurrent laryngeal nerve injury was 14 (13 primary procedures and 1 revision). Seven nerve injuries were in a right sided approach and 7 were in a left sided approach. The risk of injury was 3.18% in a left sided approach and 3.70% in a right sided approach with a p-value of 0.7723 indicating that there is no significant difference between the sides of the approach. CONCLUSIONS: Our study's analysis showed that there was a 3.18% chance of RLN with a left-sided approach compared to a 3.70% chance of RLN injury with a right-sided approach (p-value: .7723), indicating that there is no significant difference in RLN injury between the sides of approach. Although there is usually spontaneous resolution of hoarseness, it is important to remember that patients with a vocal cord paresis may be asymptomatic, and patients with symptomatic dysphonia may have no vocal cord paresis. Our data represents the first randomized prospective single surgeon study of risk of symptomatic RLN injury from side of approach. There was no significant difference noted between the side of approach and the risk of recurrent laryngeal nerve palsy, and it is recommended that the surgeon choose an approach based on his or or her comfort and clinical judgement. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.635
https://doi.org/10.1016/j.spinee.2018.06.634
P97. The risk of recurrent laryngeal nerve injury with laterality of approach in anterior cervical discectomy and fusion procedures: a randomized, prospective study over 10 years William Beutler, MD, FACS1, Shalin Shah, DO2, Manminder S. Bhatia, DO2; 1 Pennsylvania Spine Institute, Harrisburg, PA, USA; 2 Pinnacle Health, Harrisburg, PA, USA BACKGROUND CONTEXT: Recurrent laryngeal nerve (RLN) injury is a well known, but potentially devastating injury after anterior cervical discectomy and fusion (ACDF) procedures. Although RLN injury is most often transient in nature, there are the associated clinical consequences of dysphonia, impaired phonation or cough reflex, airway obstruction, hoarseness, vocal fatigue, and in some cases, tracheotomy. The incidence of RLN injury in the literature ranges from 0.07% to 5.1%. There has been debate regarding the risk of RLN injury in relation to laterality of approach, with proponents of each left and right sided approaches. There are numerous papers reviewing the complication, but there is no large-scale, randomized prospective single surgeon, single study investigating the correlation of laterality of approach to the risk of recurrent laryngeal nerve injury.
P98. Does additional bone grafting of atlantoaxial joint increase the bone fusion rate of iliac crest autograft in posterior occipitocervical fusion? A retrospective, controlled study with a two-year follow-up Jun-Song Yang, MD, Ding-Jun Hao, MD; Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China BACKGROUND CONTEXT: Occipitocervical fusion can be utilized to correct joint instability caused by trauma, rheumatological conditions, infection, neoplasm, or congenital conditions. Bone-graft-related complication was relatively frequent during occipitocervical fusion surgery. In previous studies, the reported fusion rates were ranged from 83.6% to 100%; and the rate of instrumentation failure after nonunion was as high as 7% during occipitocervical fusion. PURPOSE: To explore whether additional bone grafting of atlantoaxial joint increase the bone fusion rate of iliac crest autograft in posterior occipitocervical fusion surgery. STUDY DESIGN/SETTING: A retrospective, controlled study with a 2year follow-up. PATIENT SAMPLE: Between January 2014 and January 2016, a total of 48 consecutive patients underwent posterior occipitocervical fusion with a screw-rod fixation system in a tertiary spine center.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
S185
PURPOSE: To determine if the side of approach in anterior cervical discectomy and fusion is associated with increased risk of recurrent laryngeal nerve injury. STUDY DESIGN/SETTING: A fellowship trained spine surgeon prospectively performed ACDFs between the years of 2003-2012. Side of approach was chosen based on contralateral to side of symptoms (ie right sided radicular symptoms, patient received a left-sided approach). Patients were monitored postoperatively for development of recurrent laryngeal nerve palsy symptoms. Patients found to have signs of recurrent laryngeal nerve injury were sent to ENT for confirmation and monitored for recovery. PATIENT SAMPLE: A total of 411 patients undergoing anterior cervical decompression procedures over 10 years in central Pennsylvania. OUTCOME MEASURES: Symptoms of recurrent laryngeal nerve injury (dysphonia, dysphagia). METHODS: Retrospecive analysis of prospectively collected data over 10 years. RESULTS: A total of 411 ACDFs were performed during the 10-year period. 190 right sided and 221 left sided procedures were done. The incidence of recurrent laryngeal nerve injury was 14 (13 primary procedures and 1 revision). Seven nerve injuries were in a right sided approach and 7 were in a left sided approach. The risk of injury was 3.18% in a left sided approach and 3.70% in a right sided approach with a p-value of 0.7723 indicating that there is no significant difference between the sides of the approach. CONCLUSIONS: Our study's analysis showed that there was a 3.18% chance of RLN with a left-sided approach compared to a 3.70% chance of RLN injury with a right-sided approach (p-value: .7723), indicating that there is no significant difference in RLN injury between the sides of approach. Although there is usually spontaneous resolution of hoarseness, it is important to remember that patients with a vocal cord paresis may be asymptomatic, and patients with symptomatic dysphonia may have no vocal cord paresis. Our data represents the first randomized prospective single surgeon study of risk of symptomatic RLN injury from side of approach. There was no significant difference noted between the side of approach and the risk of recurrent laryngeal nerve palsy, and it is recommended that the surgeon choose an approach based on his or or her comfort and clinical judgement. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.635
https://doi.org/10.1016/j.spinee.2018.06.634
P97. The risk of recurrent laryngeal nerve injury with laterality of approach in anterior cervical discectomy and fusion procedures: a randomized, prospective study over 10 years William Beutler, MD, FACS1, Shalin Shah, DO2, Manminder S. Bhatia, DO2; 1 Pennsylvania Spine Institute, Harrisburg, PA, USA; 2 Pinnacle Health, Harrisburg, PA, USA BACKGROUND CONTEXT: Recurrent laryngeal nerve (RLN) injury is a well known, but potentially devastating injury after anterior cervical discectomy and fusion (ACDF) procedures. Although RLN injury is most often transient in nature, there are the associated clinical consequences of dysphonia, impaired phonation or cough reflex, airway obstruction, hoarseness, vocal fatigue, and in some cases, tracheotomy. The incidence of RLN injury in the literature ranges from 0.07% to 5.1%. There has been debate regarding the risk of RLN injury in relation to laterality of approach, with proponents of each left and right sided approaches. There are numerous papers reviewing the complication, but there is no large-scale, randomized prospective single surgeon, single study investigating the correlation of laterality of approach to the risk of recurrent laryngeal nerve injury.
P98. Does additional bone grafting of atlantoaxial joint increase the bone fusion rate of iliac crest autograft in posterior occipitocervical fusion? A retrospective, controlled study with a two-year follow-up Jun-Song Yang, MD, Ding-Jun Hao, MD; Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China BACKGROUND CONTEXT: Occipitocervical fusion can be utilized to correct joint instability caused by trauma, rheumatological conditions, infection, neoplasm, or congenital conditions. Bone-graft-related complication was relatively frequent during occipitocervical fusion surgery. In previous studies, the reported fusion rates were ranged from 83.6% to 100%; and the rate of instrumentation failure after nonunion was as high as 7% during occipitocervical fusion. PURPOSE: To explore whether additional bone grafting of atlantoaxial joint increase the bone fusion rate of iliac crest autograft in posterior occipitocervical fusion surgery. STUDY DESIGN/SETTING: A retrospective, controlled study with a 2year follow-up. PATIENT SAMPLE: Between January 2014 and January 2016, a total of 48 consecutive patients underwent posterior occipitocervical fusion with a screw-rod fixation system in a tertiary spine center.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.