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Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters
The Spine Journal 18 (2018) S142 S225 [0.05–1.73]; p=.04, and β=−0.41, 95% CI [−772.55 to −76.30]; p=.02, respectively). ROTEM analysis identified hypofibrinogenemia as a major contributor to ongoing coagulopathy. CONCLUSIONS: Compared to the conventional transfusion criteria, the use of ROTEM-guided transfusion algorithm in lumbar PSO for surgical correction of ASD was associated with greater number of cryoprecipitate units and lower FFP volume transfused. ROTEM-guided transfusion allowed early identification and treatment of hypofibrinogenemia, and aggressive management of this complication may reduce intraoperative EBL and total volume of blood products transfused. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.624
P87. Determination of clinically meaningful PROMIS severity ranges for adult spinal deformity Rafa Rahman1, Alvaro Ibaseta, MS2, Jay S. Reidler, MD, MPH3, Richard L. Skolasky, ScD4, David B. Cohen, MD, MPH4, Daniel M. Sciubba, MD1, Khaled M. Kebaish, MD2, Brian J. Neuman, MD2; 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2 Baltimore, MD, USA; 3 Johns Hopkins Hospital, Baltimore, MD, USA; 4 Johns Hopkins University, Baltimore, MD, USA BACKGROUND CONTEXT: PROMIS provides severity ranges for scores in many domains. These ranges are determined based on the general population, using a normalized mean score of 50 and standard deviation of 10. However, patients who present for Adult Spinal Deformity (ASD) surgery have worse scores on average compared to the general population, making PROMIS severity ranges clinically meaningless in the care of ASD patients. PURPOSE: To determine PROMIS severity ranges specific to ASD patients. STUDY DESIGN/SETTING: Retrospective review. PATIENT SAMPLE: A total of 146 lumbar and cervical adult spinal deformity patients with PROMIS Computerized Adaptive Tests (CATs). OUTCOME MEASURES: PROMIS Pain Interference, Physical Function, Fatigue, Anxiety, Depression, Sleep Disturbance, and Satisfaction with Participation in Social Roles CATs METHODS: Preoperative PROMIS scores in Pain Interference, Physical Function, Fatigue, Anxiety, Depression, Sleep Disturbance, and Satisfaction with Participation in Social Roles were obtained for 146 ASD surgical patients. To create a severity classification of PROMIS scores specific to ASD patients, the average and standard deviation (SD) for each PROMIS domain were calculated for the ASD cohort. Scores 1.0-2.0 SD worse than the mean were considered “moderately worse” than the average for ASD patients, scores 2.0 or more SD worse than the mean were “severely worse,” and scores 1.0 or more SD better than the mean were “moderately better.” RESULTS: 146 ASD patients were included (avg. age 59.8 years; 32.2% male; 81.8% White, 13.3% African American, 4.9% other). Average PROMIS score and severity ranges were determined as follows: Pain Interference average: 65.3, moderately better: <57.8, moderately worse: 72.980.5, severely worse: >80.5; Physical Function average: 32.8, moderately better: >40.4, moderately worse: 17.6-25.2, severely worse: <17.6; Fatigue average: 58.4, moderately better: <48.9, moderately worse: 67.977.3, severely worse: >77.3; Anxiety average: 55.6, moderately better: <45.5, moderately worse: 65.8-76.0, severely worse: >76.0; Depression average: 52.4, moderately better: <41.3, moderately worse: 63.5-74.6, severely worse: >74.6; Sleep Disturbance average: 55.8, moderately better: <45.9, moderately worse: 65.7-75.6; severely worse: >75.6; Satisfaction with Participation in Social Roles average: 38.0, moderately better: >46.8; moderately worse: 20.3-29.1; severely worse: <20.3. CONCLUSIONS: While PROMIS provides severity ranges useful for the general population, on average, patients who present for adult spinal deformity surgery have scores worse than the general population. This analysis provides clinically meaningful PROMIS severity ranges in seven domains
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for these patients. These ranges will allow surgeons to better assess severity in their patients and will aid in point-of-care decision-making. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.625
P88. Medical complications and risk factors after long level spinal fusion for adult degeneration scoliosis Xinuo Zhang, MD; Beijing Chaoyang Hospital, Beijing, China BACKGROUND CONTEXT: Adult degenerative scoliosis (ADS) treated with long level internal fixation surgery is known for its high incidence of complications. PURPOSE: The propose of this study was to determine current medical complication rates and the predictors of each individual medical complication in surgical ASD patients. STUDY DESIGN/SETTING: A retrospective review comparative database was used to evaluate long level internal fixation surgery for adult degenerative scoliosis (ADS) patients. PATIENT SAMPLE: One hundred and fifty-three ADS patients who underwent long level spinal fusion were included. The total medical complication incidence was 26.1%, which included infection (13.1%), neurological (12.4%), cardiopulmonary (10.5%), gastrointestinal (5.2%), and renal (1.3%) complications. OUTCOME MEASURES: The radiological measurements included Cobb angle, PI-LL, lumbar lordosis (LL), spondylolisthesis, C7 sagittal vertical axis (C7SVA), the proximal junctional kyphosis (PJK), and pseudarthrosis. Clinical outcomes were collected preoperatively and last follow-up after surgery. Clinical outcomes include metrics of the Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, Visual Analog Scale (VAS), and Lumbar Stiffness Disability Index (LSDI). METHODS: The patient- and surgical-related risk factors for each individual medical complication were identified by using univariate testing. Patients were separated into groups of with and without medical complication, into groups of with and without infection, into groups with and without neurological complications, and into groups with and without cardiopulmonary complications, retrospectively. Potential risk factors were identified using univariate testing. Multivariate Logistic regression was used to evaluate independent predictors of medical complications. RESULTS: Patient-related independent risk factors for development of medical complications included diabetes (OR 2.87, P=.038), smoking (OR 4.44, P=.001); for infection were diabetes (OR 4.74, P=.006) and smoking (OR 3.17, P=.033); for neurological complications were BMI (OR 1.16, P=.010) and diabetes (OR 4.12, P=.014); for cardiopulmonary complications were hypertension (OR 4.35, P=.039), smoking (OR 4.23, P=.035) and cardiac comorbidity (OR 6.14, P=.015). Fusion level (OR 2.79 P=.000), length of hospital stay (OR 1.88 P=.016) and symptom duration (OR 2.57, P=.001). Surgical-related independent risk factors for development of medical complications were fusion level (OR 3.57, P=.000), operative time (OR 0.99, P=.041), osteotomy (OR 9.33, P=.004), blood transfusion (OR 4.37, P=.043) and LOS (OR 1.68, P=.001); for infection were fusion level (OR 2.55, P=.006), blood transfusion (OR 23.06, P=.001) and LOS (OR 1.36, P=.010); for neurological complication were fusion level (OR 2.54, P=.009), osteotomy (OR 9.35, P=.012) and blood transfusion (OR 6.90, P=.033); for cardiopulmonary complication were fusion level (OR 2.17, P=.001). CONCLUSIONS: Diabetes and smoking were the most common patientrelated independent risk factors increase the development of each individual medical complication. On the other hand, factors fusion levels and blood transfusion were the most common surgical-related independent risk factors increase the development of each individual medical complication. Prevention of these risk factors can reduce the incidence of complications in Chinese patients with ADS surgery.
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.
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The Spine Journal 18 (2018) S142 S225
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.626
P89. Risk factors for proximal junction kyphosis (PJK) in Scheuermann’s kyphosis (SK) Vishal Sarwahi, MD1, Jesse M. Galina, BS2, Stephen Wendolowski3, Adam Benton, MBBS4, Sean Molloy Orth, MSc, FRCS5, Darren Lui, FRCS6, Terry D. Amaral, MD7; 1 North Shore LIJ Health System, New Hyde Park, NY, USA; 2 New Hyde Path, NY, USA; 3 Cohen Children’s Medical Center, New Hyde Park, NY, USA; 4 Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom; 5 Lyndhurst, Gerrards Cross, Bucks, United Kingdom; 6 Dublin, Ireland; 7 Bronx, NY, USA BACKGROUND CONTEXT: Proximal junction kyphosis (PJK) has been well documented with pedicle screws in AIS patients. In Scheuermann's kyphosis (SK), PJK has been reported with hybrid fixation in the presence of shorter fusions. The literature is deficient about PJK in SK with all pedicle screw constructs. PURPOSE: To determine if the incidence of PJK is higher with pedicle screw fixation than hybrid. STUDY DESIGN/SETTING: Multicenter ambispective review. PATIENT SAMPLE: Eighty-four patients. OUTCOME MEASURES: PJK, kyphosis. METHODS: Xray and chart review of all SK patients operated with all pedicle screw (PS), hybrid fixation (HF), and anterior or posterior fusions with hybrid fixation (AP) were reviewed. Number of fusion levels, percent correction, UIV, LIV, pre and postop PJK, sagittal balance, and demographic data was collected. PJK was defined as more than 10°. Fisher's exact test, Kruskal-Wallis, Wilcoxon ranked sum test were used. RESULTS: A total of 84 total patients: PS (n=29), HF (n=24), and AP (n=31). Median preop kyphosis was significantly higher in the AP compared to PS and HF (89 vs. 77 vs. 81.5, p<.001). Median postop kyphosis was significantly higher in the PS cohort (50.3 vs. HF: 45.5 vs. AP: 43, p=.048). Median percent correction was highest in the AP cohort (51.8 vs. HF: 43.8 vs. PS: 32.9, p<.001). Pre and post sagittal balance was similar across the three cohorts. Overall, at postop 47.6% of patients had PJK, and at final 70.2%. Immediate postop-PJK was significantly higher in PS 13.4 versus HF: 7.8 versus AP: 8, p=0.008). However, final PJK was similar across the three groups (PS: 19 vs. HF: 15 vs. AP:14, p=.07). T2 was the most common UIV for AP (71%) and HF (71%) compared to T3 for PS (59%), p<.001). Overall, significantly higher postop-PJK was seen with UIV below T3 (13.7 vs. 9.4, p=0.043). CONCLUSIONS: Incidence of PJK appears to be higher in SK compared to that reported in AIS. Patients with pedicle screw fixation appear to be at the highest risk. UIV at T3 or proximally has significantly lower PJK. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.627
P90. Touched vertebra (TV) on standing XR is a good predictor for LIV. TV on prone XR is better Vishal Sarwahi, MD1, Stephen Wendolowski2, Jesse M. Galina, BS3, Beverly Thornhill, MD4, Yungtai Lo, PhD4, Kathleen Maguire, MD5, Terry D. Amaral, MD6; 1 North Shore LIJ Health System, New Hyde Park, NY, USA; 2 Cohen Children’s Medical Center, New Hyde Park, NY, USA; 3 New Hyde Path, NY, USA; 4 Albert Einstein College of Medicine, Bronx, NY, USA; 5 Montefiore Medical Center, Bronx, NY, USA; 6 Bronx, NY, USA BACKGROUND CONTEXT: Minimizing the fusion levels in PSF for AIS is important. Previous studies have shown good results utilizing touched vertebra (TV) as the lowest instrumented vertebra (LIV). TV is the vertebra ‘touched; by central sacral vertical line on standing AP XRs (TVS). In our experience, we find that TV moves proximally on supine or
prone XRs. Thus utilizing TV on prone XRs (TVP) in LIV decision making may allow even shorter fusion. PURPOSE: To determine if using TVP to determine LIV saves fusion levels with good correction and coronal balance. STUDY DESIGN/SETTING: Ambispective cohort study. PATIENT SAMPLE: A total of 260: 132 nonoperative scoliosis patients, 128 who underwent pedicle screw fixation. OUTCOME MEASURES: Cobb, coronal balance, disc wedging, LIV tilt, levels saved, decompensation. METHODS: There were three groups. Group I: patients where TVP was used to determine LIV. Group II: patients where TVS was used to determine LIV. Group III: nonoperative AIS (Risser 4/5, Cobb <30) to determine ‘acceptable’ end vertebra tilt and disc wedging. Patients with only thoracic fusion were excluded. Cobb angle, coronal balance (CB), LIV tilt angle and translation, and disc wedging were collected at preop and postop.Median values and interquartile were collected for the subsets. RESULTS: The control group had 100 patients with a median Cobb angle of 20°, age of 15.3 years, coronal balance 1.2 cm (0.5–1.8), disc wedging of 4° (3–6), and LIV tilt of 9° (6–11.5). In group I (n=83), median pre-op Cobb was 53.75° (47.55°–61.9°), kyphosis was 32.2° (25.3°–38.9°), and coronal balance was 1.6 cm (1.0–3.0 cm). Post op median Cobb was 12.9° (7.0°– 19.7°), kyphosis was 37° (24.6°–39.7°) and coronal balance was 1.4 cm (0.3– 2.45 cm). Compared to controls, group I patients had similar coronal balance (0.9 vs. 1.2, p=.18), but significantly lower disc wedging (1.2° vs. 4, p>.001), and LIV tilt (4.3° vs. 9 p<.001). Group I saved an average 1.05 (0–3) levels compared to TVS.In group II (n=27), median preop Cobb was 54.4° (50°–66.6°, kyphosiswas 26.8 (17–43.6) and coronal balance was 2.3 cm (0.8–2.9 cm). Post op median cobb was 19.2° (12.5°–27.3°), kyphosis was 24.6 (21.1–30.5) and coronal balance was 1.8 cm (1.2–2.9 cm). Group II patients could have saved an average 2.24 (1–4) levels, if fused to TVP. CONCLUSIONS: In AIS, using TVP to determine LIV allows shorter fusion saving than TVS. Despite shorter fusion, coronal balance and correction is maintained, at final follow up with no adding on. LIV tilt and disc wedging is also within ‘acceptable’ levels determined on controls. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.628
P91. Lenke 1 adolescent idiopathic scoliosis: effects of TK restoration on regional and global alignment Jonathan Elysee1, Renaud Lafage, MSc1, Brice Henry, MD2, Colleen Wixted, BS1, Manon Bolzinger, MD3, Han Jo Kim, MD1, Matthew E. Cunningham, MD, PhD1, Elie Choufani, MD4, Virginie Lafage, PhD1, John S. Blanco, MD5, Roger F. Widmann, MD1, Jean-Luc Jouve, MD4, Sebastien Pesenti, MD1; 1 Hospital for Special Surgery, New York, NY, USA; 2 Hôpital Timone Enfants, Marseille, Provence-Alpes-Côte d’Azur, France; 3 Toulouse, USA; 4 Marseille, France; 5 Hospital for Special Surgery, New York, New York, USA BACKGROUND CONTEXT: While historically the main focus in AIS was the coronal Cobb, there has been a growing interest in also integrating consideration for sagittal plane alignment. The effect of surgical thoracic kyphosis (TK) correction on adjacent curvatures remains unclear. PURPOSE: This study aims to elucidate the reciprocal changes associated with TK correction in Lenke one-two AIS patients. STUDY DESIGN/SETTING: Multicenter retrospective study. PATIENT SAMPLE: A total of 155 AIS patients with Lenke one-two curves operated on with either surgical bands or pedicle screws were included. OUTCOME MEASURES: Classic spino-pelvic parameters at baseline and 2 years (2Y). METHODS: Reciprocal changes associated to TK correction were analyzed, alignment predictive formulas were defined using 75% of the cohort and 25% for validation. RESULTS: A total of 155 patients were included (15yo, 86% female), the majority of patients (92.9%) had T4-T12 completely fused. From pre to
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.
P87. Determination of clinically meaningful PROMIS severity ranges for adult spinal deformity Rafa Rahman1, Alvaro Ibaseta, MS2, Jay S. Reidler, MD, MPH3, Richard L. Skolasky, ScD4, David B. Cohen, MD, MPH4, Daniel M. Sciubba, MD1, Khaled M. Kebaish, MD2, Brian J. Neuman, MD2; 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2 Baltimore, MD, USA; 3 Johns Hopkins Hospital, Baltimore, MD, USA; 4 Johns Hopkins University, Baltimore, MD, USA BACKGROUND CONTEXT: PROMIS provides severity ranges for scores in many domains. These ranges are determined based on the general population, using a normalized mean score of 50 and standard deviation of 10. However, patients who present for Adult Spinal Deformity (ASD) surgery have worse scores on average compared to the general population, making PROMIS severity ranges clinically meaningless in the care of ASD patients. PURPOSE: To determine PROMIS severity ranges specific to ASD patients. STUDY DESIGN/SETTING: Retrospective review. PATIENT SAMPLE: A total of 146 lumbar and cervical adult spinal deformity patients with PROMIS Computerized Adaptive Tests (CATs). OUTCOME MEASURES: PROMIS Pain Interference, Physical Function, Fatigue, Anxiety, Depression, Sleep Disturbance, and Satisfaction with Participation in Social Roles CATs METHODS: Preoperative PROMIS scores in Pain Interference, Physical Function, Fatigue, Anxiety, Depression, Sleep Disturbance, and Satisfaction with Participation in Social Roles were obtained for 146 ASD surgical patients. To create a severity classification of PROMIS scores specific to ASD patients, the average and standard deviation (SD) for each PROMIS domain were calculated for the ASD cohort. Scores 1.0-2.0 SD worse than the mean were considered “moderately worse” than the average for ASD patients, scores 2.0 or more SD worse than the mean were “severely worse,” and scores 1.0 or more SD better than the mean were “moderately better.” RESULTS: 146 ASD patients were included (avg. age 59.8 years; 32.2% male; 81.8% White, 13.3% African American, 4.9% other). Average PROMIS score and severity ranges were determined as follows: Pain Interference average: 65.3, moderately better: <57.8, moderately worse: 72.980.5, severely worse: >80.5; Physical Function average: 32.8, moderately better: >40.4, moderately worse: 17.6-25.2, severely worse: <17.6; Fatigue average: 58.4, moderately better: <48.9, moderately worse: 67.977.3, severely worse: >77.3; Anxiety average: 55.6, moderately better: <45.5, moderately worse: 65.8-76.0, severely worse: >76.0; Depression average: 52.4, moderately better: <41.3, moderately worse: 63.5-74.6, severely worse: >74.6; Sleep Disturbance average: 55.8, moderately better: <45.9, moderately worse: 65.7-75.6; severely worse: >75.6; Satisfaction with Participation in Social Roles average: 38.0, moderately better: >46.8; moderately worse: 20.3-29.1; severely worse: <20.3. CONCLUSIONS: While PROMIS provides severity ranges useful for the general population, on average, patients who present for adult spinal deformity surgery have scores worse than the general population. This analysis provides clinically meaningful PROMIS severity ranges in seven domains
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for these patients. These ranges will allow surgeons to better assess severity in their patients and will aid in point-of-care decision-making. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.625
P88. Medical complications and risk factors after long level spinal fusion for adult degeneration scoliosis Xinuo Zhang, MD; Beijing Chaoyang Hospital, Beijing, China BACKGROUND CONTEXT: Adult degenerative scoliosis (ADS) treated with long level internal fixation surgery is known for its high incidence of complications. PURPOSE: The propose of this study was to determine current medical complication rates and the predictors of each individual medical complication in surgical ASD patients. STUDY DESIGN/SETTING: A retrospective review comparative database was used to evaluate long level internal fixation surgery for adult degenerative scoliosis (ADS) patients. PATIENT SAMPLE: One hundred and fifty-three ADS patients who underwent long level spinal fusion were included. The total medical complication incidence was 26.1%, which included infection (13.1%), neurological (12.4%), cardiopulmonary (10.5%), gastrointestinal (5.2%), and renal (1.3%) complications. OUTCOME MEASURES: The radiological measurements included Cobb angle, PI-LL, lumbar lordosis (LL), spondylolisthesis, C7 sagittal vertical axis (C7SVA), the proximal junctional kyphosis (PJK), and pseudarthrosis. Clinical outcomes were collected preoperatively and last follow-up after surgery. Clinical outcomes include metrics of the Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, Visual Analog Scale (VAS), and Lumbar Stiffness Disability Index (LSDI). METHODS: The patient- and surgical-related risk factors for each individual medical complication were identified by using univariate testing. Patients were separated into groups of with and without medical complication, into groups of with and without infection, into groups with and without neurological complications, and into groups with and without cardiopulmonary complications, retrospectively. Potential risk factors were identified using univariate testing. Multivariate Logistic regression was used to evaluate independent predictors of medical complications. RESULTS: Patient-related independent risk factors for development of medical complications included diabetes (OR 2.87, P=.038), smoking (OR 4.44, P=.001); for infection were diabetes (OR 4.74, P=.006) and smoking (OR 3.17, P=.033); for neurological complications were BMI (OR 1.16, P=.010) and diabetes (OR 4.12, P=.014); for cardiopulmonary complications were hypertension (OR 4.35, P=.039), smoking (OR 4.23, P=.035) and cardiac comorbidity (OR 6.14, P=.015). Fusion level (OR 2.79 P=.000), length of hospital stay (OR 1.88 P=.016) and symptom duration (OR 2.57, P=.001). Surgical-related independent risk factors for development of medical complications were fusion level (OR 3.57, P=.000), operative time (OR 0.99, P=.041), osteotomy (OR 9.33, P=.004), blood transfusion (OR 4.37, P=.043) and LOS (OR 1.68, P=.001); for infection were fusion level (OR 2.55, P=.006), blood transfusion (OR 23.06, P=.001) and LOS (OR 1.36, P=.010); for neurological complication were fusion level (OR 2.54, P=.009), osteotomy (OR 9.35, P=.012) and blood transfusion (OR 6.90, P=.033); for cardiopulmonary complication were fusion level (OR 2.17, P=.001). CONCLUSIONS: Diabetes and smoking were the most common patientrelated independent risk factors increase the development of each individual medical complication. On the other hand, factors fusion levels and blood transfusion were the most common surgical-related independent risk factors increase the development of each individual medical complication. Prevention of these risk factors can reduce the incidence of complications in Chinese patients with ADS surgery.
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.
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The Spine Journal 18 (2018) S142 S225
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.626
P89. Risk factors for proximal junction kyphosis (PJK) in Scheuermann’s kyphosis (SK) Vishal Sarwahi, MD1, Jesse M. Galina, BS2, Stephen Wendolowski3, Adam Benton, MBBS4, Sean Molloy Orth, MSc, FRCS5, Darren Lui, FRCS6, Terry D. Amaral, MD7; 1 North Shore LIJ Health System, New Hyde Park, NY, USA; 2 New Hyde Path, NY, USA; 3 Cohen Children’s Medical Center, New Hyde Park, NY, USA; 4 Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom; 5 Lyndhurst, Gerrards Cross, Bucks, United Kingdom; 6 Dublin, Ireland; 7 Bronx, NY, USA BACKGROUND CONTEXT: Proximal junction kyphosis (PJK) has been well documented with pedicle screws in AIS patients. In Scheuermann's kyphosis (SK), PJK has been reported with hybrid fixation in the presence of shorter fusions. The literature is deficient about PJK in SK with all pedicle screw constructs. PURPOSE: To determine if the incidence of PJK is higher with pedicle screw fixation than hybrid. STUDY DESIGN/SETTING: Multicenter ambispective review. PATIENT SAMPLE: Eighty-four patients. OUTCOME MEASURES: PJK, kyphosis. METHODS: Xray and chart review of all SK patients operated with all pedicle screw (PS), hybrid fixation (HF), and anterior or posterior fusions with hybrid fixation (AP) were reviewed. Number of fusion levels, percent correction, UIV, LIV, pre and postop PJK, sagittal balance, and demographic data was collected. PJK was defined as more than 10°. Fisher's exact test, Kruskal-Wallis, Wilcoxon ranked sum test were used. RESULTS: A total of 84 total patients: PS (n=29), HF (n=24), and AP (n=31). Median preop kyphosis was significantly higher in the AP compared to PS and HF (89 vs. 77 vs. 81.5, p<.001). Median postop kyphosis was significantly higher in the PS cohort (50.3 vs. HF: 45.5 vs. AP: 43, p=.048). Median percent correction was highest in the AP cohort (51.8 vs. HF: 43.8 vs. PS: 32.9, p<.001). Pre and post sagittal balance was similar across the three cohorts. Overall, at postop 47.6% of patients had PJK, and at final 70.2%. Immediate postop-PJK was significantly higher in PS 13.4 versus HF: 7.8 versus AP: 8, p=0.008). However, final PJK was similar across the three groups (PS: 19 vs. HF: 15 vs. AP:14, p=.07). T2 was the most common UIV for AP (71%) and HF (71%) compared to T3 for PS (59%), p<.001). Overall, significantly higher postop-PJK was seen with UIV below T3 (13.7 vs. 9.4, p=0.043). CONCLUSIONS: Incidence of PJK appears to be higher in SK compared to that reported in AIS. Patients with pedicle screw fixation appear to be at the highest risk. UIV at T3 or proximally has significantly lower PJK. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.627
P90. Touched vertebra (TV) on standing XR is a good predictor for LIV. TV on prone XR is better Vishal Sarwahi, MD1, Stephen Wendolowski2, Jesse M. Galina, BS3, Beverly Thornhill, MD4, Yungtai Lo, PhD4, Kathleen Maguire, MD5, Terry D. Amaral, MD6; 1 North Shore LIJ Health System, New Hyde Park, NY, USA; 2 Cohen Children’s Medical Center, New Hyde Park, NY, USA; 3 New Hyde Path, NY, USA; 4 Albert Einstein College of Medicine, Bronx, NY, USA; 5 Montefiore Medical Center, Bronx, NY, USA; 6 Bronx, NY, USA BACKGROUND CONTEXT: Minimizing the fusion levels in PSF for AIS is important. Previous studies have shown good results utilizing touched vertebra (TV) as the lowest instrumented vertebra (LIV). TV is the vertebra ‘touched; by central sacral vertical line on standing AP XRs (TVS). In our experience, we find that TV moves proximally on supine or
prone XRs. Thus utilizing TV on prone XRs (TVP) in LIV decision making may allow even shorter fusion. PURPOSE: To determine if using TVP to determine LIV saves fusion levels with good correction and coronal balance. STUDY DESIGN/SETTING: Ambispective cohort study. PATIENT SAMPLE: A total of 260: 132 nonoperative scoliosis patients, 128 who underwent pedicle screw fixation. OUTCOME MEASURES: Cobb, coronal balance, disc wedging, LIV tilt, levels saved, decompensation. METHODS: There were three groups. Group I: patients where TVP was used to determine LIV. Group II: patients where TVS was used to determine LIV. Group III: nonoperative AIS (Risser 4/5, Cobb <30) to determine ‘acceptable’ end vertebra tilt and disc wedging. Patients with only thoracic fusion were excluded. Cobb angle, coronal balance (CB), LIV tilt angle and translation, and disc wedging were collected at preop and postop.Median values and interquartile were collected for the subsets. RESULTS: The control group had 100 patients with a median Cobb angle of 20°, age of 15.3 years, coronal balance 1.2 cm (0.5–1.8), disc wedging of 4° (3–6), and LIV tilt of 9° (6–11.5). In group I (n=83), median pre-op Cobb was 53.75° (47.55°–61.9°), kyphosis was 32.2° (25.3°–38.9°), and coronal balance was 1.6 cm (1.0–3.0 cm). Post op median Cobb was 12.9° (7.0°– 19.7°), kyphosis was 37° (24.6°–39.7°) and coronal balance was 1.4 cm (0.3– 2.45 cm). Compared to controls, group I patients had similar coronal balance (0.9 vs. 1.2, p=.18), but significantly lower disc wedging (1.2° vs. 4, p>.001), and LIV tilt (4.3° vs. 9 p<.001). Group I saved an average 1.05 (0–3) levels compared to TVS.In group II (n=27), median preop Cobb was 54.4° (50°–66.6°, kyphosiswas 26.8 (17–43.6) and coronal balance was 2.3 cm (0.8–2.9 cm). Post op median cobb was 19.2° (12.5°–27.3°), kyphosis was 24.6 (21.1–30.5) and coronal balance was 1.8 cm (1.2–2.9 cm). Group II patients could have saved an average 2.24 (1–4) levels, if fused to TVP. CONCLUSIONS: In AIS, using TVP to determine LIV allows shorter fusion saving than TVS. Despite shorter fusion, coronal balance and correction is maintained, at final follow up with no adding on. LIV tilt and disc wedging is also within ‘acceptable’ levels determined on controls. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.628
P91. Lenke 1 adolescent idiopathic scoliosis: effects of TK restoration on regional and global alignment Jonathan Elysee1, Renaud Lafage, MSc1, Brice Henry, MD2, Colleen Wixted, BS1, Manon Bolzinger, MD3, Han Jo Kim, MD1, Matthew E. Cunningham, MD, PhD1, Elie Choufani, MD4, Virginie Lafage, PhD1, John S. Blanco, MD5, Roger F. Widmann, MD1, Jean-Luc Jouve, MD4, Sebastien Pesenti, MD1; 1 Hospital for Special Surgery, New York, NY, USA; 2 Hôpital Timone Enfants, Marseille, Provence-Alpes-Côte d’Azur, France; 3 Toulouse, USA; 4 Marseille, France; 5 Hospital for Special Surgery, New York, New York, USA BACKGROUND CONTEXT: While historically the main focus in AIS was the coronal Cobb, there has been a growing interest in also integrating consideration for sagittal plane alignment. The effect of surgical thoracic kyphosis (TK) correction on adjacent curvatures remains unclear. PURPOSE: This study aims to elucidate the reciprocal changes associated with TK correction in Lenke one-two AIS patients. STUDY DESIGN/SETTING: Multicenter retrospective study. PATIENT SAMPLE: A total of 155 AIS patients with Lenke one-two curves operated on with either surgical bands or pedicle screws were included. OUTCOME MEASURES: Classic spino-pelvic parameters at baseline and 2 years (2Y). METHODS: Reciprocal changes associated to TK correction were analyzed, alignment predictive formulas were defined using 75% of the cohort and 25% for validation. RESULTS: A total of 155 patients were included (15yo, 86% female), the majority of patients (92.9%) had T4-T12 completely fused. From pre to
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.