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Which Factors Influence Spontaneous Lumbar Curve Correction After Selective Thoracic Fusion In Lenke Type IB And C Curves?
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Proceedings of the NASS 26th Annual Meeting / The Spine Journal 11 (2011) 1S–173S
FDA DEVICE/DRUG STATUS: Charite Lumbar Total Disc: Approved for this indication. doi: 10.1016/j.spinee.2011.08.160
123. Does Iliac Crest Harvesting Affect Outcomes Following Posterior Fusions for Adolescent Idiopathic Scoliosis? Leah Carreon, MD, MS1, Charles Crawford, MD2, Lawrence Lenke, MD3, Daniel Sucato, MD4, B. Stephens Richards, MD4; 1Spine Institute, Louisville, KY, USA; 2Louisville, KY, USA; 3Washington University Medical Center Department of Orthopedic Surgery, St. Louis, MO, USA; 4 Texas Scottish Rite Hospital for Children, Dallas, TX, USA BACKGROUND CONTEXT: There is continued controversy regarding the morbidity associated with iliac crest bone graft (ICBG) harvesting. More importantly, its effect on clinical outcomes is poorly understood. PURPOSE: The purpose of this study is to determine if harvesting of ICBG has any effect on clinical outcomes after a posterior instrumented fusion in patients with Adolescent Idiopathic Scoliosis (AIS). We hypothesized that patients who undergo ICBG harvesting will report worse scores on the SRS pain and appearance domains. STUDY DESIGN/SETTING: Longitudinal Cohort. PATIENT SAMPLE: Patients from a prospective multicenter database of patients with AIS treated surgically. OUTCOME MEASURES: Scoliosis Research Society Instrument 22R (SRS22R). METHODS: Patients were identified from a prospective multicenter database of patients with AIS treated surgically. Inclusion criteria were posterior instrumented fusion with complete pre-operative and two year post-operative SRS-22R data. Patients who had a previous fusion surgery, thoracoplasty, or any anterior surgery were excluded. Patients were classified into two groups: those who had ICBG harvest (ICBG group) and those who did not (non-ICBG group). A subgroup analysis comparing patients with lowest instrumented vertebra (LIV) above L2 and patients with LIV below L2 was also done. Statistical comparisons were performed with Student’s t-test and Fisher’s exact test. RESULTS: Three hundred and forty-two patients were included in the ICBG group versus 563 in the non-ICBG group. In the non-ICBG group, 159 received local bone graft only, 348 received allograft, 73 had DBM, 114 had ceramics, 23 had BMP and 26 had BMA. There were no significant differences in pre-op age (14.95 vs. 14.76, p5.178), Main Thoracic Cobb angle (51.29 vs. 51.79, p5.782), Lumbar Cobb angle (34.79 vs. 35.09, p5.846), SRS Pain (4.11 vs. 4.11, p5.912), SRS Appearance (3.29 vs. 3.33, p5.384), SRS Activity (4.15 vs. 4.14, p5.847), SRS Mental (3.95 vs. 4.00, p5.313), or SRS Total Score (3.86 vs. 3.87, p5.603). Number of levels fused was similar between groups (10.6 vs 10.3, p5.137). Operative time was slightly longer in the ICBG group (293.55 vs. 276.21 min, p5.002). There were no significant differences in any of the post-op SRS domains: Pain (4.30 vs. 4.34, p5.373), Appearance (4.23 vs. 4.19, p5.310), Activity (4.31 vs. 4.33, p5.509), Mental (4.20 vs. 4.23, p5.532), Satisfaction (4.42 vs. 4.43, p5.870), Total Score (4.27 vs. 4.29, p5.674). Similarly, the subgroup analysis showed no differences in outcome between groups. There was one pseudoarthosis reported in the ICBG group and none in the non-ICBG group. CONCLUSIONS: The results of this study suggest that ICBG harvesting leads to longer operative times but does not influence two year outcomes following posterior instrumented fusion surgery for AIS. On average, patients who underwent ICBG harvesting did not report worse pain or appearance scores than patients who did not have ICBG harvesting. Further studies are warranted to determine if harvesting of ICBG to achieve fusion and clinical success after surgical correction of AIS is warranted. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.161
124. Which Factors Influence Spontaneous Lumbar Curve Correction After Selective Thoracic Fusion In Lenke Type IB And C Curves? Cagatay Ozturk, MD1, Azmi Hamzaoglu, MD2, Ahmet Alanay, MD1; 1 Istanbul Spine Center, Florence Nightingale Hospital, Istanbul, Turkey; 2 Turkey PURPOSE: The aim of this retrospective study was to analyse Lenke type 1B and C curves treated by selective fusion by using PS and to determine the critical factors which may have influenced spontaneous correction in lumbar spine. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: Between 1999 and 2009, 111 (100 female and 11 male) consecutive patients with Lenke type 1 B and C curves (44 B and 67 C modifier) who underwent selective thoracic fusion by using PS constructs were included. OUTCOME MEASURES: Preop, postop and follow-up x-ray images were evaluated in terms of curve magnitudes and flexibility, sacral tilt (more than 2 ), lower instrumented vertebra (LIV), apical vertebra translation of lumbar curve and maturity. METHODS: All surgeries were done by a single surgeon. The rule for a safe amount of correction in main thoracic curve was not to correct more than the lumbar curve magnitude in the preoperative side bending x-ray. All patients had intraoperative under-table 35 inch x-ray to apply the rule. RESULTS: Average age at the time of surgery was 15 years (range; 11 to 19) and follow-up was 64 (range; 24 to 148) months. The fusion stopped at stable vertebra in 71 patients, at neutral vertebra in 29 patients and stable and neutral vertebra which were the same in 11 patients. Average correction rates at final follow-up for thoracic curve was 81% while it was 68% for lumbar curve. Spontaenous lumbar curve correction ratio was 75% versus 54% for lumbar curves with more or less than 60% flexibility; 76% versus 66% whether LIV being both stable and neutral or not; 72% versus 66% for curves with or without sacral tilt; 71% versus 66% for patients younger or older than 14 years of age; 70% versus 66% for risser grade less or more than 2, 68% versus 53% for lumber curves lesser or greater than 45 degrees and 71% versus 63% for apical vertebra translation of lumbar curve less or more than 2 cm. There was no coronal plane decompensation and imbalance in any of the patients and no reoperation. CONCLUSIONS: Patients younger than age 14, with LIV being both stable and neutral, with lumbar curve flexibility more than 60%, with no sacral tilt, risser sign #2, preoperative lumbar curve magnitude of less than 45 degrees and apical vertebra translation of lumbar curve less than 2 cm. had more spontaneous lumbar curve correction rates after selective thoracic fusion (p!.05). FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.162
125. A Comparison Of b-TCPDBMA Versus RhBMP-2 in Anterior Lumbar Interbody Fusion: A Prospective, Randomized Trial with Two-Year Clinical and Radiographic Outcomes Jeffrey McConnell, MD; Orthopedic Associates of Allentown, Allentown, PA, USA BACKGROUND CONTEXT: Anterior lumbar interbody fusion (ALIF) is frequently used for the surgical management of degenerative spine conditions. Avoiding morbidity associated with harvesting autograft requires a reliable, cost-effective bone graft substitute. Alternatives include ultraporous b-tricalcium phosphate (b-TCP) soaked with bone marrow aspirate (BMA), and recombinant human bone morphogenetic protein-2 (RhBMP-2). PURPOSE: This study seeks to compare RhBMP-2 to b-TCP as alternatives to autograft in terms of the clinical and radiographic outcomes in ALIF.
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
Proceedings of the NASS 26th Annual Meeting / The Spine Journal 11 (2011) 1S–173S
FDA DEVICE/DRUG STATUS: Charite Lumbar Total Disc: Approved for this indication. doi: 10.1016/j.spinee.2011.08.160
123. Does Iliac Crest Harvesting Affect Outcomes Following Posterior Fusions for Adolescent Idiopathic Scoliosis? Leah Carreon, MD, MS1, Charles Crawford, MD2, Lawrence Lenke, MD3, Daniel Sucato, MD4, B. Stephens Richards, MD4; 1Spine Institute, Louisville, KY, USA; 2Louisville, KY, USA; 3Washington University Medical Center Department of Orthopedic Surgery, St. Louis, MO, USA; 4 Texas Scottish Rite Hospital for Children, Dallas, TX, USA BACKGROUND CONTEXT: There is continued controversy regarding the morbidity associated with iliac crest bone graft (ICBG) harvesting. More importantly, its effect on clinical outcomes is poorly understood. PURPOSE: The purpose of this study is to determine if harvesting of ICBG has any effect on clinical outcomes after a posterior instrumented fusion in patients with Adolescent Idiopathic Scoliosis (AIS). We hypothesized that patients who undergo ICBG harvesting will report worse scores on the SRS pain and appearance domains. STUDY DESIGN/SETTING: Longitudinal Cohort. PATIENT SAMPLE: Patients from a prospective multicenter database of patients with AIS treated surgically. OUTCOME MEASURES: Scoliosis Research Society Instrument 22R (SRS22R). METHODS: Patients were identified from a prospective multicenter database of patients with AIS treated surgically. Inclusion criteria were posterior instrumented fusion with complete pre-operative and two year post-operative SRS-22R data. Patients who had a previous fusion surgery, thoracoplasty, or any anterior surgery were excluded. Patients were classified into two groups: those who had ICBG harvest (ICBG group) and those who did not (non-ICBG group). A subgroup analysis comparing patients with lowest instrumented vertebra (LIV) above L2 and patients with LIV below L2 was also done. Statistical comparisons were performed with Student’s t-test and Fisher’s exact test. RESULTS: Three hundred and forty-two patients were included in the ICBG group versus 563 in the non-ICBG group. In the non-ICBG group, 159 received local bone graft only, 348 received allograft, 73 had DBM, 114 had ceramics, 23 had BMP and 26 had BMA. There were no significant differences in pre-op age (14.95 vs. 14.76, p5.178), Main Thoracic Cobb angle (51.29 vs. 51.79, p5.782), Lumbar Cobb angle (34.79 vs. 35.09, p5.846), SRS Pain (4.11 vs. 4.11, p5.912), SRS Appearance (3.29 vs. 3.33, p5.384), SRS Activity (4.15 vs. 4.14, p5.847), SRS Mental (3.95 vs. 4.00, p5.313), or SRS Total Score (3.86 vs. 3.87, p5.603). Number of levels fused was similar between groups (10.6 vs 10.3, p5.137). Operative time was slightly longer in the ICBG group (293.55 vs. 276.21 min, p5.002). There were no significant differences in any of the post-op SRS domains: Pain (4.30 vs. 4.34, p5.373), Appearance (4.23 vs. 4.19, p5.310), Activity (4.31 vs. 4.33, p5.509), Mental (4.20 vs. 4.23, p5.532), Satisfaction (4.42 vs. 4.43, p5.870), Total Score (4.27 vs. 4.29, p5.674). Similarly, the subgroup analysis showed no differences in outcome between groups. There was one pseudoarthosis reported in the ICBG group and none in the non-ICBG group. CONCLUSIONS: The results of this study suggest that ICBG harvesting leads to longer operative times but does not influence two year outcomes following posterior instrumented fusion surgery for AIS. On average, patients who underwent ICBG harvesting did not report worse pain or appearance scores than patients who did not have ICBG harvesting. Further studies are warranted to determine if harvesting of ICBG to achieve fusion and clinical success after surgical correction of AIS is warranted. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.161
124. Which Factors Influence Spontaneous Lumbar Curve Correction After Selective Thoracic Fusion In Lenke Type IB And C Curves? Cagatay Ozturk, MD1, Azmi Hamzaoglu, MD2, Ahmet Alanay, MD1; 1 Istanbul Spine Center, Florence Nightingale Hospital, Istanbul, Turkey; 2 Turkey PURPOSE: The aim of this retrospective study was to analyse Lenke type 1B and C curves treated by selective fusion by using PS and to determine the critical factors which may have influenced spontaneous correction in lumbar spine. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: Between 1999 and 2009, 111 (100 female and 11 male) consecutive patients with Lenke type 1 B and C curves (44 B and 67 C modifier) who underwent selective thoracic fusion by using PS constructs were included. OUTCOME MEASURES: Preop, postop and follow-up x-ray images were evaluated in terms of curve magnitudes and flexibility, sacral tilt (more than 2 ), lower instrumented vertebra (LIV), apical vertebra translation of lumbar curve and maturity. METHODS: All surgeries were done by a single surgeon. The rule for a safe amount of correction in main thoracic curve was not to correct more than the lumbar curve magnitude in the preoperative side bending x-ray. All patients had intraoperative under-table 35 inch x-ray to apply the rule. RESULTS: Average age at the time of surgery was 15 years (range; 11 to 19) and follow-up was 64 (range; 24 to 148) months. The fusion stopped at stable vertebra in 71 patients, at neutral vertebra in 29 patients and stable and neutral vertebra which were the same in 11 patients. Average correction rates at final follow-up for thoracic curve was 81% while it was 68% for lumbar curve. Spontaenous lumbar curve correction ratio was 75% versus 54% for lumbar curves with more or less than 60% flexibility; 76% versus 66% whether LIV being both stable and neutral or not; 72% versus 66% for curves with or without sacral tilt; 71% versus 66% for patients younger or older than 14 years of age; 70% versus 66% for risser grade less or more than 2, 68% versus 53% for lumber curves lesser or greater than 45 degrees and 71% versus 63% for apical vertebra translation of lumbar curve less or more than 2 cm. There was no coronal plane decompensation and imbalance in any of the patients and no reoperation. CONCLUSIONS: Patients younger than age 14, with LIV being both stable and neutral, with lumbar curve flexibility more than 60%, with no sacral tilt, risser sign #2, preoperative lumbar curve magnitude of less than 45 degrees and apical vertebra translation of lumbar curve less than 2 cm. had more spontaneous lumbar curve correction rates after selective thoracic fusion (p!.05). FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.162
125. A Comparison Of b-TCPDBMA Versus RhBMP-2 in Anterior Lumbar Interbody Fusion: A Prospective, Randomized Trial with Two-Year Clinical and Radiographic Outcomes Jeffrey McConnell, MD; Orthopedic Associates of Allentown, Allentown, PA, USA BACKGROUND CONTEXT: Anterior lumbar interbody fusion (ALIF) is frequently used for the surgical management of degenerative spine conditions. Avoiding morbidity associated with harvesting autograft requires a reliable, cost-effective bone graft substitute. Alternatives include ultraporous b-tricalcium phosphate (b-TCP) soaked with bone marrow aspirate (BMA), and recombinant human bone morphogenetic protein-2 (RhBMP-2). PURPOSE: This study seeks to compare RhBMP-2 to b-TCP as alternatives to autograft in terms of the clinical and radiographic outcomes in ALIF.
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.