Anterior Posterior Approaches Research Articles

Surgical outcomes following hemivertebrectomy in congenital scoliosis: a systematic review and observational meta-analysis.

Hemivertebrectomy is widely used definitive correction surgery in congenital scoliosis due to hemivertebrae. It may be done either as combined anterior and posterior approach or a single-stage posterior approach only. The purpose of this meta-analysis was to compare two techniques with regards to blood loss, operative time, deformity correction and complications. The systematic review andmeta-analysis were conducted according to PRISMA guidelines among peer-reviewed journals published in English between June 2000 and June 2020. Quality appraisal of all selected articles was done and data extracted. After thorough literature search and excluding, 37 studieswere included for review.The commonest location of the hemivertebrae was thoracolumbar spine (51.3%), thoracic (26.2%), lumbar/lumbosacral (21.6%) followed by cervical (0.7%). Pooled data showed a significant difference (p < 0.05) in mean operative time with posterior only approach (227min, 95% CI 205-250) as compared to Combined Anterior Posterior Approach (CAPA) (316min95% CI 291-341). Significant difference (p < 0.05) in mean blood loss was observed in posterior only approach (522ml, 95% CI 434-611) as compared to CAPA (888ml, 95% CI 663-1113). No significant difference was noted in mean correction in either of the approaches and overall pooled mean correction rate was 66%, 95% CI 61-72. This review and meta-analysis of two surgical techniques of hemivertebrectomy, shows that operative time and blood loss is significantly lower in posterior only approach with no difference in correction rate as compared to CAPA. There was significant correlation between age at surgery and need for revision surgeries. IV.

Acetabular and Femoral Component Positioning Using Direct Anterior Approach Versus Posterior Approach in Total Hip Arthroplasty.

Direct anterior approach (DAA) has recently become popular in total hip arthroplasty (THA). However, irrespective of the surgical approach used, component malposition is an important factor affecting function and complications after THA. This study aims to compare component positioning on the femoral and acetabular side between DAA and posterior approach (PA) to the hip joint. We hypothesized that the two approaches are similar in terms of component positioning. We prospectively studied 50 patients, matched according to age, sex, and body mass index, undergoing THA, divided non-randomly into 2 groups. Group 1 comprised 25 patients (35 hips) undergoing THA using DAA and group 2 comprised 25 patients (25 hips) undergoing THA using PA. Ten patients from group 1 had simultaneous bilateral THA. Radiological parameters studied were acetabular inclination (AI), coronal femoral stem alignment (CFA), leg length difference (LLD), acetabular cup version (AV), and femoral stem version (FV). There was no significant difference in AI, CFA, LLD, AV, and FV between the two groups. Excellent to good inter and intra-observer reliability expressed in terms of intraclass correlation coefficient (ICC) was noted for all the radiographic measurements. Both DAA and PA for THA achieve comparable radiological component positioning. DAA may not provide any advantage over PA in terms of positioning of the prosthesis. Level II, non-randomized comparative study.

Comparison of direct anterior approach and posterior approach total hip arthroplasty: More than 5-year follow-up

PurposeIn this study we compare the surgical outcome of DAA and PA more than 5-year follow-up evaluation. Materials and methodsThis is a retrospective cohort single-surgeon study of consecutive primary THAs using the DAA or PA. ResultsThere was no significant difference in HHS and JHEQ score. Posterior dislocation occurred in 4 cases in PA group (9.5%, p = 0.038) while there was no dislocation in DAA group. ConclusionBoth DAA and PA yield good results at the final follow-up in terms of function, quality of life, and survivorship. However dislocation was significantly higher in PA group.

Bipolar hemiarthroplasty of hip joint: prospective randomised comparative study of direct anterior approach versus posterior approach

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The dilemma while treating cases with hemiarthroplasty is the surgical approach to be employed. The aim of present study is comparison of posterior approach and direct anterior approach with regards to various relevant outcomes and evaluate early surgical complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this randomized observational study conducted over 2 years, 20 patients each with intra-capsular neck femur fracture were enrolled as per predefined selection criteria and treated with hemiarthroplasty (bipolar) either by posterior approach or by direct anterior approach. Follow up was done for all the patients at regular intervals with standard post-operative protocol, including evaluation for surgical complications, active range of motion and assessment of Harris hip score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall infection rate was 5% (two patients in posterior approach, no patient in direct anterior approach, the difference being statistically insignificant). No incidences of dislocation were reported in either group. Two patients of posterior approach had abductor weakness. Periprosthetic fracture and deep vein thrombosis were observed in one case each in posterior approach group. In posterior surgical group, excellent Harris hip score in 25% patients, good in 57.5% patients and fair in 17.5% patients were observed; while in direct anterior surgical group, excellent score was observed in 12.5% patients, good in 55% patients and fair in 32.5% patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; No major clinically or statistically significant differences were observed between for outcomes and complications between the two approaches. Larger randomized trials with bigger samples are recommended.&lt;/p&gt;

Surgical approaches to the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: A systematic review.

Minimally invasive pancreaticoduodenectomy (MIPD) has recently been safely performed by experts, and various methods for resection have been reported. This review summarizes the literature describing surgical approaches for MIPD. A systematic literature search of PubMed (MEDLINE) was conducted for studies reporting robotic and laparoscopic pancreaticoduodenectomy; the reference lists of review articles were searched. Of 444 articles yielded, 23 manuscripts describing the surgical approach to dissect around the superior mesenteric artery (SMA), including hand-searched articles, were assessed. Various approaches to dissect around the SMA have been reported. These approaches were categorized according to the direction toward the SMA when initiating dissection around the SMA: anterior approach (two articles), posterior approach (four articles), right approach (16 articles), and left approach (three articles). Thus, many reports used the right approach. Most articles provided a technical description. Some articles showed the advantage of their method in a comparison study. However, these were single-center retrospective studies with a small sample size. Various approaches for MIPD have been reported; however, few authors have reported the advantage of their methods compared to other methods. Further discussion is needed to clarify the appropriate surgical approach to the SMA during MIPD.

Transoral release to realign postoperative loss of reduction following occipitocervical fixation for congenital basilar invagination.

Revision surgery in an irreducible atlantoaxial dislocation (IAAD) previously operated with a posterior approach is challenging. Multiple modalities using anterior, posterior, and dual approaches have been described. We report a so far unreported technique of revision surgery by posterior implant removal and decompression with anterior transoral release followed by posterior instrumentation. 14-year male with basilar invagination (BI) with IAAD, previously operated with posterior decompression and instrumented occipitocervical fusion presented three months later with post-traumatic recurrence of myelopathy with quadriparesis with Di Lorenzo grade 4 and loss of reduction. He was operated with a posterior implant and early fusion mass removal with extended foramen magnum decompression (FMD), followed by anterior transoral release with a satisfactory reduction on traction, and finally, a posterior revision instrumented occipitocervical fusion. At 2-year follow-up, the patient was symptom-free with Di Lorenzo grade 1 and cervicomedullary angle improvement from 97.4° to 141.2°; achieving bony fusion. Single-stage posterior-anterior transoral-posterior approach can be used to achieve satisfactory reduction for a revision BI with IAAD with prior posterior instrumentation.

Minimum Five-Year Outcomes of Hip Resurfacing: Propensity-Score Matched Against Total Hip Arthroplasty Control Groups

BackgroundThe aim of this study is to evaluate clinical outcomes of patients undergoing Birmingham hip resurfacing (BHR) with a minimum 5-year follow-up and compare these outcomes to 2 matched control groups of patients undergoing either direct anterior approach (DAA) or posterior approach (PA) total hip arthroplasty (THA). MethodsData between September 2008 and April 2015 were retrospectively reviewed. Male patients were included if they underwent a THA or BHR with minimum 5-year patient-reported outcomes. BHR patients were propensity-score matched in a 1:1 ratio to 2 control groups of patients: one group who underwent DAA THA and one group who underwent PA THA. ResultsFifty BHR patients were propensity-score matched to 2 control groups: 50 cases of PA THA and 50 cases of DAA THA. Both control groups were well matched with respect to demographics. The BHR 5-year patient-reported outcomes were comparable to both control groups. The BHR cohort compared favorably to the PA THA group with no significant differences in their average Forgotten Joint Score (77.9, 79.4, P = .84 respectively) and the number of patients reporting a score greater than or equal to 50 were also comparable, 41 (82%), 42 (84%), P = .79 respectively. ConclusionBHR yielded good functional status and outcomes, which compared favorably with control groups of DAA THA and PA THA. Decision-making should be based upon other factors such as potential risk factors, the surgeon’s and patient’s preferences, and the patient’s physical demand.

Reoperation and Mortality Rates Following Elective 1 to 2 Level Lumbar Fusion: A Large State Database Analysis.

Study Design:Retrospective cohort.Objective:Reoperation to lumbar spinal fusion creates significant burden on patient quality of life and healthcare costs. We assessed rates, etiologies, and risk factors for reoperation following elective 1 to 2 level lumbar fusion.Methods:Patients undergoing elective 1 to 2 level lumbar fusion were identified using the Health Care Utilization Project (HCUP) state inpatient databases from Florida and California. Patients were tracked for 5 years for any subsequent lumbar fusion. Cox proportional hazard analyses for reoperation were assessed using the following covariates: fusion approach type, age, race, Charlson comormidity index, gender, and length of stay. Distribution of etiologies for reoperation was then assessed.Results:71, 456 patients receiving elective 1 to 2 level lumbar fusion were included. A 5-year reoperation rate of 13.53% and mortality rate of 2.22% was seen. Combined anterior-posterior approaches (HR = 0.904, p < 0.05) and TLIF (HR = 0.867, p < 0.001) were associated with reduced risk of reoperation compared to stand-alone anterior approaches and non-TLIF posterior approaches. Age, gender, and number of comorbidities were not associated with risk of reoperation. From 1 to 5 years, degenerative disease rose from 43.50% to 50.31% of reoperations; mechanical failure decreased from 37.65% to 29.77%.Conclusions:TLIF and combined anterior-posterior approaches for 1 to 2 level lumbar fusion are associated with the lowest rate of reoperation. Number of comorbidities and age are not predictive of reoperation. Primary etiologies leading to reoperation were degenerative disease and mechanical failure. Mortality rate is not increased from baseline following 1 to 2 level lumbar fusion.

Risk Factors for Revision Surgery After Primary Adult Thoracolumbar Deformity Surgery.

This is a retrospective cohort study. The aim was to identify the risk factors for revision surgery within 2 years of patients undergoing primary adult spinal deformity (ASD) surgery. Previous literature reports estimate 20% of patients undergoing thoracolumbar ASD correction undergo reoperation within 2 years. There is limited published data regarding specific risk factors for reoperation in ASD surgery in the short term and long term. The authors queried the MarketScan database in order to identify patients who were diagnosed with a spinal deformity and underwent ASD surgery from 2007 to 2015. Patient-level factors and revision risk were investigated during 2 years after primary ASD surgery. Patients under the age of 18 years and those with any prior history of trauma or tumor were excluded from this study. A total 7422 patients underwent ASD surgery during 2007-2015 in the data set. Revision rates were 13.1% at 90 days, 14.5% at 6 months, 16.7% at 1 year, and 19.3% at 2 years. In multivariate multiple logistic regression analysis, obesity [adjusted odds ratio (OR): 1.58, P<0.001] and tobacco use (adjusted OR: 1.38, P=0.0011) were associated with increased odds of reoperation within 2 years. Patients with a combined anterior-posterior approach had lower odds of reoperation compared with those with posterior only approach (adjusted OR: 0.66, P=0.0117). Obesity and tobacco are associated with increased odds of revision surgery within 2 years of index ASD surgery. Male sex and combined surgical approach are associated with decreased odds of revision surgery.

Lateral corpectomy and reconstruction for thoracolumbar burst fractures with neurological injury

Spine injuries have substantial impact on quality of life, especially when neurologic injury is present, with significant associated healthcare costs. Most spine injuries occur within the thoracolumbar spine, with burst fractures representing a notable proportion. Unstable burst fractures with neurologic deficits come with difficult evaluation and management decisions. Treatment of these injuries has substantially evolved over the last 2 decades. Options for operative management include anterior, posterior, and combined anterior-posterior approaches. Posterior approaches allow for stabilization of fractures, but come with challenges of performing an adequate decompression in the setting of neurologic deficit. Anterior approaches allow for direct decompression, but traditional approaches have noteworthy complications. Growth of minimally invasive spine surgery has helped to mitigate some risks associated with traditional open approaches. Minimally invasive anterior decompression with percutaneous posterior stabilization represents a reasonable management option in unstable thoracolumbar burst fractures with neurologic deficit.

Anterior and Posterior Approach Results for Treatment of Cervical Myelopathy in the Elderly: A 10-Year Experience in a Mexican Institution

Introduction: Degeneration of the cervical spine (CDSD) prevalence is nearly 90% by the 7th decade. This is the first research that compares the outcomes between the Anterior Approach (AA) and Posterior Approach (PA) to cervical myelopathy (CM) in the elderly. Materials and Methods: A retrospective observational study of electronic health records at the Hospital Central Sur de Alta Especialidad (HCSAE), PEMEX from January 2010 to May 2020 with patients older than 60 years submitted to cervical surgery. For the analysis we elaborated two groups according to the surgical approach: AA vs PA; we analyzed the trans-operative behavior, the immediate outcome, and after 3 months, 6 months, and 1 year. Results: As a total of 145 patients, the prevalence of CM in elderly was the 63.8% with a median age of 69 (64 - 75) years. We found statistical differences in strength outcome only in the P3m (p = 0.011), for sensitivity we found major prevalence of affection in the PA group. We didn’t report a significant difference in the Neck Disability Index (NDI) at all measures, but the PA presented a major incapacity. The Nurick scale results were significant in all stages (p . Discussion: Patients show significant improvements in outcome measures with either anterior or posterior surgery. Both approaches are highly efficacious in preventing neurologic deterioration and in most cases improve neurological function with appropriate postoperative management like rehabilitation, pain management, and psychological support. Conclusion: The patients submitted to surgical medullary decompression presented a favorable outcome despite the age and the higher prevalence of comorbidities; whereby we favor the surgical treatment in all patients in a case-to-case selection to generate a positive impact on functional outcomes.

Changes in serum creatine kinase and C-reactive protein after posterior and direct anterior approaches in total hip arthroplasty.

Some studies reported that measuring serum creatine kinase (CK) level is an objective method with which to determine the relative invasiveness of surgery. The purpose of this study was to evaluate the change in postoperative serum CK levels as a measure of whether the direct anterior approach (DAA) is less invasive than the posterior approach (PA) regarding postoperative rehabilitation. We prospectively recruited 71 women who were undergoing total hip arthroplasty, 47 were treated by the PA and 24 by the DAA. Serum CK and C-reactive protein (CRP) levels were measured preoperatively and 3 hours and 1, 4, 7, 10, and 14 days after the operation. The serum CK levels were significantly higher in the DAA group than in the PA group on postoperative days 1, 4, 7, 10, and 14. On postoperative day 4 and 7, the percentage of patients whose serum CK levels were above the normal range was 46.8% and 8.5% in the PA group and 95.2% and 45.5% in the DAA group. CK levels were significantly higher in the 2 weeks after THA by a DAA than after the same procedure by a PA indicating that DAA causes prolonged muscle damage. Although the DAA is considered to be a muscle-sparing approach this may not be the case and DAA may not actually be a minimally-invasive approach.

Atypical hangman’s fracture with concomitant subaxial fracture–dislocation treated with circumferential fusion of C2–C5—a case report

Atypical hangman's fractures are coronally-oriented vertical fractures of the posterior body of C2. Though these are not uncommon injuries, there is a paucity of data investigating the management of these fractures, especially when they occur in association with subaxial fracture dislocations. A 50-year-old male suffered a cervical extension injury when he dove into a shallow swimming pool while intoxicated. Initial examination demonstrated 2/5 strength in the right deltoid and biceps and 3/5 strength in the left deltoid and biceps with no motor or sensory function distal to the C5 level. Cervical CT scan revealed a C2 atypical hangman's fracture and a C4 right-sided facet fracture with traumatic spondylolisthesis at C4/5. We performed C2-C5 anterior cervical discectomy and fusion followed by a C3-C5 posterior instrumented fusion. At the patient's two year postoperative visit, the patient has had minimal improvement in neurologic function with 4/5 strength in bilateral deltoids and biceps and 2/5 strength in right wrist extension. Radiographs show a solid arthrodesis on flexion-extension radiographs. To our knowledge, this is the first case report discussing the operative management of an atypical hangman's fracture with a concomitant subaxial fracture-dislocation. This case report adds to our current knowledge by demonstrating a novel anterior-posterior approach for treating these complicated injuries.

Utility of Intraoperative Fluoroscopic Positioning of Total Hip Arthroplasty Components Using a Posterior and Direct Anterior Approach.

Positioning of implant components for total hip arthroplasty (THA) is important for polyethylene liner wear, prosthesis joint stability, and range of motion. The introduction of fluoroscopy for the direct anterior approach has been shown to improve physician accuracy for component positioning. Few studies compare the use of intraoperative fluoroscopy for THA component positioning in posterior THA. The purpose of this project is to retrospectively evaluate the effect of intraoperative fluoroscopy on component positioning for THA using posterior and direct anterior approach (DAA). A retrospective review of postoperative weight-bearing X-ray films of THAs was performed over a 2-year period where a single fellowship-trained total joint surgeon introduced direct anterior approach into his practice while expanding the intraoperative use of fluoroscopy for all THA procedures, regardless of approach. Component position was evaluated through radiographic measurement of acetabular cup inclination (goal of 40 degrees), limb length discrepancy (goal of 0 mm), and femoral component offset difference (goal of 0 mm). Radiographic analysis was performed by two independent providers. Statistical analysis was performed using Student's t-tests. A total of 107 patients with an average age of 62 years were identified during the 2-year period surrounding the THA practice change, adding fluoroscopy to posterior and DAA THA. Three cohorts were identified: cohort A: 44 patients who underwent posterior THAs without the use of intraoperative fluoroscopy, cohort B: 35 patients who underwent direct anterior approach THAs with the use of intraoperative fluoroscopy, and cohort C: 18 patients who underwent posterior THAs with the use of intraoperative fluoroscopy. The use of intraoperative fluoroscopy for the posterior approach versus unguided posterior approach increased accuracy of both cup inclination (44 degrees vs 50 degrees, P < .05) and femoral offset (4 mm vs 7 mm, P < .05). A comparison of DAA with fluoroscopy versus posterior approach without fluoroscopy showed improvement in cup inclination (48 degrees vs 50 degrees, P < .05). Fluoroscopy with posterior approach versus fluoroscopy with DAA was found to have improved cup inclination (44 degrees vs 48 degrees, P < .05). Intraoperative use of fluoroscopy can improve component positioning for posterior THA.

Response to: Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterior-only Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review.

Response to: Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterior-only Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review.

Letter to the Editor: Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterior-only Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review.

Letter to the Editor: Does Combined Anterior-Posterior Approach Improve Outcomes Compared with Posterior-only Approach in Traumatic Thoracolumbar Burst Fractures?: A Systematic Review.

The Posterior Surgical Approach in Treatment of Neuromuscular Scoliosis Patients: A Systematic Review of Literature

Background Data: Neuromuscular scoliosis (NS) causes disorders to the spinal cord, which affects the innervation and tone of the musculoskeletal system. NS can affect the quality of life by causing spinal deformity, sitting difficulties, and back pain. Progression of NS after skeletal maturity is common, and the incidence of surgery in NS is high. Whether posterior surgical strategy in the management of NS results in higher correction and fewer complications than other approaches, either anterior alone or combined, is a controversial issue. Study Design: Systematic review of the literature. Purpose: To determine if the management of NS via the posterior approach has better results and fewer complications or not. Methods: This study was conducted using the PubMed and Cochrane databases; it includes patients treated for NS deformity and the type of surgery, degree of correction achieved, and rate of complications were reported. Results: Our systematic review yielded 104 citations with 9 studies meeting the required criteria. Six studies focused on the comparisons of posterior-only approach (POA) and anteroposterior approach (APA) and three studies on POA only regarding postoperative outcomes and complications such as correction angle of scoliosis (Cobb's angle), pelvic obliquity, lordosis, kyphosis, amount of blood loss, hospital stay and ICU stay, and operative time. Conclusion: Posterior-only approach has the same results in correction of neuromuscular scoliosis deformity as anterior-posterior approach but with fewer complications. However, the anterior-posterior approach has more advantage in correcting severe rigid neuromuscular scoliosis. (2020ESJ215)

212. Operative treatment of adult spinal deformity patients with severe scoliosis: retrospective review of a prospectively collected multicenter series with minimum 2-year follow up

BACKGROUND CONTEXT Prior studies have demonstrated potential benefits of adult spinal deformity (ASD) surgery, but less outcomes data exist for operative ASD patients with severe scoliotic curves (thoracic [TH] curve ≥75°, thoracolumbar [TL] curve ≥50°, or lumbar [LL] curve ≥50°). Also, the surgical complication profile is less clear for this subset of patients with severe scoliotic deformity and warrants focused investigation. PURPOSE The objective of the current study was to assess treatment outcomes and complication rates associated with ASD surgery in patients with severe scoliosis. STUDY DESIGN/SETTING Retrospective review of a prospectively collected multicenter consecutive case registry PATIENT SAMPLE Enrollment required: age ≥18 yrs, scoliosis ≥20°, sagittal vertical axis (SVA) ≥5cm, pelvic tilt ≥25°, and/or thoracic kyphosis ≥60°. OUTCOME MEASURES Standard coronal and sagittal spinopelvic deformity measurements and health-related quality of life (HRQL) outcomes, which included Oswestry Disability Index (ODI), Short Form-36 (SF-36) scores, and Scoliosis Research Society-22 (SRS-22) scores. METHODS Using a prospective multicenter database, we identified surgically treated ASD patients with severe scoliosis (TH Cobb ≥75° or TL/LL Cobb ≥50°) and minimum 2-yr follow-up. Demographic data, surgical characteristics, radiographic alignment measurements, HRQL outcomes and associated complications were analyzed. RESULTS Of 178 patients, 146 (82%, mean age 54 yrs, 92% women, 88 TL, 50 LL, 8 TH) had minimum 2-yr follow-up (mean=3.1 yrs). Almost 30% had prior spine fusion, 6% were active or past smokers, 16% had osteoporosis and 77% had at least 1 comorbidity. Surgical details included: posterior-only (58%) or anterior-posterior approach (42%), SPO (65%), 3CO (14%), TLIF (23%), ALIF (37%), sacropelvic fixation (76%), upper thoracic UIV (64%) and mean posterior fusion length of 13.2 levels. Postoperative coronal alignment improved significantly for all patients (global coronal alignment 3.8 to 2.8 cm, p CONCLUSIONS Surgery for severe adult scoliosis is associated with significant improvement in radiographic alignment and HRQL measures. Although associated complication rates are high, these appear to be comparable to reports of less severe scoliosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

P139. High rate of mortality after spinal trauma in patients with ankylosing spondylitis

BACKGROUND CONTEXT Spinal trauma in patients with Ankylosing Spondylitis (AS) often result in devastating injuries, as minor insult can manifest in spinal instability and spinal cord injury. Initial diagnostics include CT and MRI of the injured spinal region, which may indicate need for surgery. The significance of radiological findings and subsequent need for surgery in this challenging injury is not well described. PURPOSE The purpose of this study was to describe radiological findings in patients with AS sustaining spinal injuries and to analyze rate of neurologic injury, radiologic canal compromise and in-hospital mortality. STUDY DESIGN/SETTING Multicenter retrospective analysis. PATIENT SAMPLE Eighty-one patients with ankylosing spondylitis sustaining spinal trauma. OUTCOME MEASURES Rates of neurologic injury, radiologic canal compromise, in-hospital mortality, cause of death. METHODS Patients with AS (identified in radiology report) sustaining spinal injuries identified by CT or MRI were retrospectively reviewed from two level 1 trauma hospitals. Patients with prior spine surgery were excluded. CT and MRI studies at the time of injury were reviewed for fracture pattern (AO classification), ligamentous disruption, and evidence of canal compromise >50% (fracture displacement, epidural hematoma, disc herniation). Patient records were reviewed for injury mechanism, neurological status (radiculopathy, weakness, or paresthesias), need for surgical fixation, and in-hospital mortality. RESULTS A total of 81 patients with AS sustaining spine trauma were identified (mean age: 69 years, SD: 14.9; 80.2% male). Twenty-nine patients (35.8%) presented with neurological symptoms (ASIA D: 11 patients, C: 4 patients, B: 4 patients, A:5 patients). Seventy patients (86.4%) reported low-energy mechanism of injury (ground level falls). 65 patients (91.5%) sustained no associated injuries. Ankylosis of the entire spine was observed on CT in 77 patients (95.1%). AO Spine Type C injury was most common (52.1%). Fracture involving all three columns were identified on CT in 64 patients (79.0%). Three-column injury was identified on four additional patients on MRI, increasing overall three-column injury diagnosis to 68 patients (84.0%). Fracture displacement on CT causing canal compromise was observed in 40 patients (49.4%). Among patients without fracture displacement on CT causing canal compromise, 10 additional patients were observed to have canal compromise on MRI from hematoma or disc herniation increasing overall canal compromise to 50 patients (61.7%). Among patients who underwent MRI, 89.7% of patients were observed to have anterior longitudinal ligamentous injury and 75.4% were observed to have posteroligamentous complex injury. Fifty-eight patients (71.6%) underwent surgical fixation (51 patients posterior approach, 7 patients combined anterior posterior approach). Overall, in-hospital mortality rate was 8.6% (7 patients), with cause of death attributable to aspiration pneumonia in four cases. CONCLUSIONS In this multi-institutional series of 81 patients with AS sustaining spinal trauma, 7 in 10 patients required surgical fixation and nearly 1 in 10 patients expired in the hospital. Despite the vast majority of injuries being attributed to be low-energy falls, 79.0% of patients sustained three-column injuries, 61.7% of patients were observed to have canal compromise or evidence of cord compression, and 35.8% of patients presented with neurological compromise. Spine surgeons should be aware that severity of injury on CT as well as mortality may be under-estimated in this patient population. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

P70. A combined anterior-posterior approach in select cervical deformity corrections has potential for superior cost effectiveness driven by outcomes

BACKGROUND CONTEXT The choice of surgical approach in CD surgery is often dictated by surgeon preference and experience. This choice could significantly impact the costs and outcomes of an operation, therefore the approaches should be analyzed in order to determine the optimal approach from a cost-utility perspective. The cost utility of different surgical approaches in cervical deformity (CD) has not been investigated in the literature. PURPOSE Investigate the cost utility of differing approaches in operative CD patients. STUDY DESIGN/SETTING Retrospective review of a prospective multicenter cervical deformity database. PATIENT SAMPLE A total of 105 CD patients. OUTCOME MEASURES Costs, EuroQol-5D (EQ-5D), Quality adjusted life years (QALYs), Cost per quality adjusted life years. METHODS Included CD patients (C2-C7 Cobb>10°or CK>10°, cSVA>4cm or CBVA>25°) >18yr with follow-up (1-year) surgical and health related quality of life scores. Costs were calculated using the PearlDiver database, which reflects both private insurance and Medicare reimbursement claims. QALYs and cost per QALY were calculated using a 3% discount rate to account for residual decline to life expectancy (78.7 years). After accounting for complications, LOS, revisions, and death, cost per QALY at 1Y and life expectancy [LE] were calculated for surgical approach (anterior-only, posterior-only [excluding PSO and VCR to account for differences in instrumentation], combined). In a subanalysis, approach groups were propensity-score matched for TS-CL to account for baseline (BL) deformity. RESULTS A total of 105 CD patients met inclusion criteria (61.9 yrs, 63% female, 28.6kg/m2, CCI: 0.97). By approach, 21.9% underwent anterior only, 37.1% posterior only and 41% combined approaches. Average number of levels fused was 6.9, with a mean EBL of 948 ml and total operative time of 544.2 minutes. Mean EQ5D at BL was 0.74±0.07 and at 1Y was 0.79±0.08 (a difference of 0.05±0.08). Average difference in EQ5D from BL to 1Y was significant (p=0.002) across approach: 0.093 anterior-only, 0.021 posterior-only, 0.044 combined. 13% (3) of anterior-only patients underwent a revision, 10.3% (4) of posterior and 13.9% (6) of combined approaches. The average costs per surgery for CD patients at 1-year undergoing surgery by anterior approach was $27,640.75, $38,499.44 posterior-only, and $36,553.41 combined approach (p>0.05).The cost per QALY was higher for posterior-only patients at 1-year ($948,946.81) compared to anterior-only ($152,616.65) and combined ($424,110.14), p CONCLUSIONS After accounting for comorbidities, complications, revisions, and death, all surgical approaches showed improvement in postoperative EQ5D scores, however posterior approach demonstrated overall lower cost effectiveness. CD patients who underwent anterior-only approach had the lowest average costs for CD corrective surgery, as well as the lowest cost per QALY (best cost-effectiveness) compared to posterior and combined approaches. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.