Degenerative Spinal Deformity Research Articles

Using Satellite Rod Technique in Patients with Severe Kyphoscoliosis Undergoing Three-Column Osteotomy: A Minimum of 2 Years' Follow-up.

ObjectiveTo introduce the satellite rod technique utilized in severe spinal deformity after three‐column osteotomy (3CO) and to evaluate the radiographic and clinical outcomes at 2‐year follow‐up, further discussing its utilization in this particular cohort.MethodsA total of 32 (19 females and 13 males) with an average age of 32.9 ± 18.3 years from December 2012 to March 2016 were retrospectively reviewed. Radiographic measurements were performed on standing full‐spine anteroposterior and lateral radiographs preoperatively, postoperatively, and at last follow‐up. The coronal parameters including Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL‐CSVL), as well as the sagittal parameters including global kyphosis (GK) and sagittal vertical axis (SVA) were measured at three time points. The Scoliosis Research Society‐22 questionnaire (SRS‐22) was fulfilled preoperatively and at each follow‐up. Paired t test would be used to determine whether there was a significant difference between time points.ResultsA total of 32 patients were enrolled in this study with mean age of 32.9 ± 18.3 (range, 12 to 66) years old. Twenty patients underwent pedicle subluxation osteotomy (PSO) and 12 patients underwent vertebral column resection (VCR). The pathogenesis of this cohort included neuromuscular scoliosis (11 cases), congenital kyphoscoliosis (seven with hemivertebrae and five with segmentation failure), degenerative spinal deformity (five cases), and thoracolumbar tuberculosis with angular kyphosis (four cases). The post‐operative Cobb angle decreased significantly from 49.1° ± 28.0° to 19.0° ± 16.7° with a correction rate of 65.2% ± 21.8%. At final follow‐up, the average Cobb angle was 19.4° ± 16.9° and no obvious loss of correction was found. The preoperative, postoperative, and last follow‐up C7PL‐CSVL were 23.9 ± 14.5 mm, 15.7 ± 11.1 mm, and 12.1 ± 7.4 mm, respectively. Significant postoperative improvement was attained while there was no change observed at last follow‐up. Postoperative GK significantly improved from 73.8° ± 28.1° to 23.2° ± 11.7° with the correction rate of 66.0% ± 17.9%. SVA decreased significantly from 42.9 ± 33.9 mm to 24.1 ± 21.1 mm. The average GK and SVA at final follow‐up were 22.7° ± 10.1° and 23.5 ± 21.1 mm, respectively and no obvious loss of correction was observed of them during follow‐up. In addition, no change or loss of motor or somatosensory evoked potential occurred during surgery. During the follow‐up, two malposition screws and one rod breakage were found.ConclusionThe satellite rod used in patients with severe kyphoscoliosis undergoing 3CO could yield favorable radiological and clinical outcomes. With the utilization of this technique, the coronal and sagittal balance could be well‐maintained during follow‐up.

Assessment of isokinetic trunk muscle strength and its association with health-related quality of life in patients with degenerative spinal deformity

BackgroundA considerable portion of the elderly population are increasingly afflicted by degenerative spinal deformity (DSD), which seriously affects patient health-related quality of life (HRQoL). HRQoL index is used across many studies to show correlations between radio-graphical alignment, disability, and pain in patients with DSD. However, imaged structural deformity represents only one aspect for consideration, namely, the disability effect of DSD. We assessed the isokinetic strength of trunk muscle in patients with degenerative spinal deformity (DSD), and investigated its relationship with HRQoL.MethodsIn total, 38 patients with DSD (DSD group) and 32 healthy individuals (control group) were recruited. Both groups were homogeneous for age, weight, height and body mass index (BMI). Assessments were performed using the isokinetic dynamometer IsoMed-2000; trunk extensor, flexor strength and flexion/extension (F/E) ratios were explored concentrically at speeds of 30°, 60° and 120° per second. The grip strength of both hands was measured using a hand-held dynamometer. Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), a Roland-Morris disability questionnaire (RDQ), and a 36-item Short Form Health Survey (SF-36) evaluated patient HRQoL. Correlations between trunk strength and HRQoL were analyzed.ResultsWhen compared with the control group, the DSD group showed lower trunk extensor strength at three velocity movements, and higher F/E ratios at 60° and 120°/s (p < 0.05). Both groups exhibited similar trunk flexor strength and grip strength (p > 0.05). In DSD group, trunk extensor strength at 60°/s was negatively associated with ODI and RDQ (p < 0.05). A negative relationship between trunk flexor strength at 120°/s and ODI was also recorded (p < 0.05). In addition, trunk extensor strength at 60°/s and trunk flexor strength at 120°/s were positively correlated with physical functioning and role-physical scores according to the SF-36 (p < 0.05).ConclusionsWe identified isolated trunk extensor myopathy in DSD, which causes an imbalance in trunk muscle strength. Isokinetic trunk extensor strength at 60°/s and trunk flexor strength at 120°/s can predict disability, and decrease physical HRQoL in DSD patients.

Surgeon experience influences patient characteristics and outcomes in spine deformity surgery.

To characterize differences in patient demographics and outcomes by surgeon experience in a cohort of patients undergoing adult spinal deformity surgery. Patients undergoing degenerative spinal deformity were included. Patients whose surgeons graduated from fellowship ≤ 5years prior to surgery versus > 5years were compared. Multivariable linear and logistic regression, controlling for age, sex, comorbidity burden, number of segments fused, blood loss and operative time were used to evaluate differences in outcomes. Characteristics of operative invasiveness were plotted against surgeons' level of experience, and trends in these measures were assessed with univariate linear regression. Three-hundred sixty-three patients were included. 147 patients' surgeons had ≤ 5years of experience. Patient demographics were evenly matched. Patients with junior surgeons had more pre-existing medical complications, and senior surgeons were less likely to take care of patients with Medicare/Medicaid (p < 0.001). Junior surgeons were more likely to operate on non-elective patients (p < 0.001). Patients of junior surgeons received larger fusions (9.6 vs. 7.6 segments fused, p < 0.001). There were no differences in complication rates or death. Patients of junior surgeons had longer overall length of stays (p = 0.037) and higher rates of nonhome discharge (OR 2.0, p < 0.001), 30- and 90-day (p < 0.005) ED visits, and higher costs (+ $8548, 95% CI: $1596 to $15,502; p = 0.016). Junior surgeons tend to perform more extensive deformity operations on more medically complex patients compared to senior surgeons, associated with higher costs and more resource utilization than senior surgeons.

Stenosis of the vertebral canal of the lumbar spine

The overall incidence of symptomatic lumbar spinal stenosis is about 1015% among persons aged 5070 years. Due to the aging of the population, the incidence of this pathology is constantly growing. The desire of older patients to preserve their quality of life and their functional abilities, along with the improvement of surgical techniques, leads to an increase in the number of surgical interventions for lumbar stenosis. This publication describes the classification of spinal canal stenosis. The clinical picture of this disease has been studied in detail. A special attention is paid to such diagnostic methods as computed tomography (CT), radiography, CT-myelography, magnetic resonance imaging (MRI). Various methods of surgical treatment decompression and decompression-stabilization are described in detail.. The efficiency of various types of decompression operations are 7280%, the results of surgery not differing statistically between the types of decompression (hemilaminectomy, interlaminectomy). Decompression-stabilization operations are used for progressive degenerative spinal deformity, destabilization after the surgical treatment, and disruption of the vertebral-pelvic relations. Currently, the following types of stabilization are used in the lumbar stenosis surgery: ALIF, PLIF, PLF, TLIF, XLIF, OLIF, and transpedicular fixation. The rate of complications in the stabilizing interventions is 27.6%; after decompression operations 9.7%. The frequency of revision operations is also higher after stabilization 10.3%, while after decompression it is 6.5%, which makes us cautious about these types of interventions. Systems of interosseous fixation are also used in the treatment of lumbar stenosis. In the 14 years of followup after interosseous fixation and decompression in 142 patients, 30 (21.1%) patients underwent revision interventions, with chronic pain (38.5%) and disc herniation (42.3%) being the main indication for repeated surgery in 26 of them.

Is it sufficient to treat adult lumbar spinal deformity using anterior lumbar interbody fusion with percutaneous pedicle screw fixation?

Anterior lumbar interbody fusion (ALIF) has been performed for lumbar spinal restoration and stabilization without extensive paraspinal muscle damage or massive bleeding. The authors retrospectively investigated surgical results of multilevel ALIF followed by percutaneous pedicle screw fixation (PPSF) in adult lumbar spinal deformity (ALSD). This study included 28 patients with degenerative lumbar spinal deformity, who underwent selective multilevel ALIF and PPSF between January 2013 and August 2016 at our hospital. Standing X-rays were performed and coronal Cobb angle (CCA) of scoliosis, sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), and sacral slope (SS) were measured. Pain and functional assessment were performed using visual analogue scale (VAS) scores for low back pain and leg pain, and Oswestry Disability Index (ODI) scores. CCA, SVA and LL were significantly improved immediately after surgery and relatively well maintained until the last follow-up. After surgery, PT was significantly decreased and SS was increased, respectively. However, cases with SVA > 95 mm or PT > 30° showed a loss of correction in sagittal balance parameters to a greater extent at the last follow-up compared to the group of patients with minor sagittal imbalance. VAS scores for back and radicular pain, and ODI score were significantly decreased at the final follow-up (p < 0.05). Multilevel ALIF with PPSF yielded favorable clinical and radiological outcomes in coronal and sagittal balance without severe surgical mortality or morbidity in patients with ALSD. However, correction loss in sagittal balance was observed in cases with SVA > 95 mm or PT > 30˚.

The opioid crisis: 18 years of opioid prescriptions in spine patients

Abstract Background The US opioid epidemic continues to afflict patients and the healthcare system. Surgery remains a risk factor for opioid misuse, and treatment of low back pain in orthopedics and neurosurgery is one of the largest introductions of opioids into the community. The objective of the study is to understand how opioid prescribing practices for spinal surgery have evolved in two academic hospital in the last 18 years. Methods Data were obtained from the Research Patient Data Registry for Brigham and Women's and Massachusetts General Hospital from January 2000 to December 2018. Patients included had a primary diagnosis of degenerative diseases, trauma, spinal infection, spinal deformities, or spinal pain symptoms/syndromes; were aged &amp;gt; 18 years; and had an opioid prescription. Covariates included demographics, diagnoses, comorbidities, procedures, opioid type, number of prescriptions, route of administration, doses and length of prescription. Results A total of 38,250 patients with spine-related diagnoses received an opioid prescription. The median age was 63 years (18-107), 50% male and 86% white. A total of 32,304 patients (84.4%) received at least one opioid prescription during their hospitalization. The sum of opioid prescriptions filled (inpatient and outpatient) were 889,868 between 2000 and 2018 (55.2% oral, 41.7% intravenous). Oxycodone was the most prescribed. The dose of ≥ 50 morphine milligram equivalents MME/day was reduced from 65.0% in 2000 to 17.3% in 2018, and doses ≥ 90 MME/day dropped from 26.9% in 2000 to 6.4% in 2018. However, the duration of prescription has increased from 4.1% having an opioid prescription for &amp;gt;7 days in 2000, to 21.7% in 2018. Conclusions Opioid prescription rates for spinal surgery patients have increased since 2000, declined temporarily in 2016, but are rising again. Physicians are prescribing fewer MMEs per day but have increased longitudinal dosing, which still leaves patients at risk for misuse and opioid use disorder. Key messages Between 2000 and 2016 there was an increase of 140 times the number of opioid prescriptions for spine patients. More interventions and non-pharmacological solutions are needed to reduce this public health epidemic.

Individual Lordotic Cages Implantation and Radiographic Evaluation of Segmental and Lumbar Lordosis Correction for Patients with Adult Degenerative Scoliosis

Relevance. The development of minimally invasive surgery has led to the development of new methods for surgical treatment of the spine. Conventional surgical technique, such as vertebrotomy is accompanied by a several number of disadvantages (high blood loss, prolonged hospital stay, long intraoperative time, postoperative neurological deficit). An alternative to improve sagittal balance in the spine is to use custom-made hyperlordotic cages, which can also be used for indirect decompression of neural structures. The objective is to compare the degree of segmental and total lumbar lordosis using hyperlordotic cages through ALIF and TLIF with posterior instrumentation.Materials and Methods. A single-center retrospective cohort study using 96 patients treated from 2018 to 2019 about degenerative spinal deformities. Comparison of two groups: group 1 (A) consisted of 30 patients who were held anterior spinal fusion with individual lordotic cages from minimally invasive anterior approach (MISS ALIF) without posterior fixation. Group 2 (B) consisted of 33 patients whom were performed spinal fusion from the posterior approach (TLIF) with Smith-Peterson Osteotomy (SPO) and transpedicular fixation. Measuring segmental and lumbar lordosis, teleradiographs were used in a standing position. For an accurate assessment, the non-commercial available Surgimap software, © Nemaris, was used.Results. Segmental lordosis were superior to preoperative ones. In the intergroup comparison, the ALIF group showed an excellent increase in the enlarged lordosis segment (L3-L4 in 8 degrees; p = 0.0005, L4-L5 in 7 degrees; p = 0.0002, L5-S1 in 7 degrees; p = 0.0001). When conducting an intergroup comparison of total lumbar lordosis in the preoperative period, there was a statistically significant difference between them (p = 0.0043). At the same time, a greater degree of correction of lordosis is shown in ALIF compared to TLIF group (29,1 in comparison with 22,5; p = 0.00005).Conclusion. The results of this study confirm that the using of custom-made lordotic cages can significantly increase segmental and total lumbar lordosis for patients with degenerative scoliosis in adults.

Surgical correction of degenerative sagittal imbalance of the lumbar spine

Objective. To analyze the early clinical and radiological outcomes of lumbar spine fusion in patients with degenerative sagittal imbalance.Material and Methods. The data of 45 patients who were operated on sequentially using a combination of surgical methods for vertebrogenic pain syndrome and (or) neurological deficit and who had a violation of the sagittal balance of degenerative origin were analyzed. All patients underwent anterior spinal fusion at the L4–L5, L5–S1 levels to correct and restore lower lumbar lordosis. The next stage was decompression through posterior approach, if necessary supplemented by interbody fusion at clinically significant lumbar levels above the L4–L5 segment. In all patients, surgical treatment was completed with screw transpedicular fixation at the levels of interbody fusion. Demographic, clinical and surgical data, and radiological parameters were evaluated.Results. The study included data from 6 men and 39 women with an average age of 58.9 ± 7.8 years. Duration of hospital stay was 27.1 ± 7.4 days. The primary surgery was performed in 33 (73.3 %) patients, and the reoperation for pain recurrence after previous surgery at the same lumbar level – in 12 (26.7 %) patients. The duration of surgery was 529.8 ± 117.8 min, the blood loss was 1130.4 ± 560.1 ml. Back and leg pain VAS score decreased after surgery from 6.7 ± 0.9 and 4.7 ± 1.4 to 3.3 ± 0.9 and 0.5 ± 0.6, respectively (p &lt; 0.001). The ideal sagittal type according the Russoly’s classification was restored in 27 (60 %) cases, that below the ideal – in 9 (20 %), and hypercorrection was in 9 (20 %). PT decreased from 26.1° ± 5.7° to 17.4° ± 3.9° (p &lt; 0.001) and SVA – from 6.7 ± 3.5 to 2.7 ± 2.3 cm (p &lt; 0.001). LL increased from 36.3° ± 18.5° to 55.1° ± 11.8° (p &lt; 0.001) and Low LL – from 13.5° ± 9.8° to 37.9° ± 8.2° (p &lt; 0.001). According to GAP, the number of patients with severe and moderate imbalance was reduced (p &lt; 0.001). Surgical complications were observed in 26 (57.7 %) patients.Conclusion. The multi-stage surgical treatment of patients with degenerative spinal deformities using corrective fusion in the lumbar spine significantly improves parameters of the spinopelvic and global sagittal balances in the early postoperative period.

Anterolateral and Posterior versus Posterior-Only Approaches for the Correction of Degenerative Adult Spinal Deformity

Anterolateral and Posterior versus Posterior-Only Approaches for the Correction of Degenerative Adult Spinal Deformity

Anterolateral and Posterior versus Posterior-Only Approaches for the Correction of Degenerative Adult Spinal Deformity

Anterolateral and Posterior versus Posterior-Only Approaches for the Correction of Degenerative Adult Spinal Deformity

Research progress in the application status and development trend of artificial intelligence in the diagnosis and treatment of spinal disease

The cross-fusion research of artificial intelligence technology and spinal surgery represented by machine learning and neural network model is a new research direction and hot issue in the field of artificial intelligence in recent years. The anatomy and disease symptoms of the spine are complex, and the diagnosis and treatment of spinal surgery require rich clinical experience. However, the distribution of medical resources in China is seriously uneven. How to improve the ability of primary medical services so that the most extensive patient groups can benefitis still an urgent problem to be solved. Artificial intelligence is a technical science that researches and develops theories, methods, technologies, and application systems for simulating, extending and expanding human intelligence. With the advent of the era of big data medical technology, artificial intelligence technology may solve this problem by transforming experts sinking into tech sinking . At present, technologies such as confrontation learning, weakly supervised learning, intensive learning and graph neural networks have become research hotspots in the field of artificial intelligence, and have also played an important role in many fields of clinical medicine. Based on the advantages of deep learning and neural network in disease learning, many spine surgeons combine it with the diagnosis and treatment of cervical spondylosis, low back pain, lumbar degenerative diseases, spinal deformity, spinal tumors, and other spine-related diseases. The rapid location and accurate diagnosis of the disease not only makes it an effective tool for the comprehensive diagnosis of spinal diseases but also provides the basis for the most reasonable treatment options for spinal diseases. In the domestic application of artificial intelligence in the diagnosis and treatment of spinal surgery, it can also solve the problems of difficult diagnosis and complicated treatment of spinal diseases faced by primary doctors, reduce the rate of misdiagnosis and missed diagnosis, and effectively reduce the economic and social burden of spinal diseases. This paper reviews the research progress of artificial intelligence represented by deep learning in the field of diagnosis and treatment of spinal surgery at home and abroad, and the advantages and application prospects of artificial intelligence in the diagnosis and treatment of spinal surgery.

Long segment fusion for adult degenerative scoliosis: long-term outcomes and sagittal complications

Objective To investigate the long-term outcomes of posterior long segment instrumentation and fusion in adult degenerative scoliosis (ADS), and to explore the correlative factors of sagittal imbalance after long segment instrumentation and fusion, and to summarize the impacts of different lowest instrumented vertebra (LIV) on sagittal complication rates. Methods ADS patients who underwent long segment instrumentation and fusion between January 2008 and January 2014 were retrospectively reviewed and divided into two groups depended on LIV (L 5 group and S1 group). The follow-up time was at least five years. Radiographic parameters, Visual Analogue Score (VAS), Oswestry Disability Indexscore(ODI), the 12-item Short Form Health Survey-Physical Component Summary (SF-12 PCS)and sagittal complications were analyzed. And the correlation between sagittal imbalance and sagittal complications were calculated. Patients were divided into two groups(sagittal imbalance group and sagittal balance group) to explore the correlative factors of sagittal imbalance. Results All of 56 patients were included and evaluated in this study, and 35 cases stopped at L 5, 21 cases at S1. The mean follow-up time was 6.6±1.6 years. No significant difference were found in age, gender, follow-up time and surgery method (P>0.05) between two groups. No significant differences were found in Cobb angle(11.8°±7.3° vs 12.6°±6.4°), coronal balance distance(CBD) (0.7±0.6 cm vs 1.0±0.5 cm), sagittal vertebral axis(SVA)(3.0±3.1 cm vs 2.6±5.6 cm), thoracic kyphosis(TK) (21.4°±9.6° vs 22.5°±6.9°), lumbar lordosis(LL) (-32.7°±7.3° vs-34.8°±9.1°), pelvic tilt (PT) (23.4°±9.8° vs 23.3°±8.1°), VAS score(2.0±1.2 vs. 2.2±0.9), ODI score(18.5%±6.4% vs 19.3%±5.2%) and SF-12 PCSscore(45.5±5.2 vs 42.4±7.0) between two groups at final follow-up time(P>0.05). Radiographic parameters including Cobb angle, CBD, SVA and health related quality of life scores including VAS score, ODI score and SF-12 PCS scores were improved significantly at two weeks postoperatively, two-year follow-up time andfinal follow-up time in two groupscompared with those preoperatively (P 0.05). The incidence of adjacent segment degeneration in L 5 group was higher than that in S1 group (P<0.05) at final follow-up time, and the incidence of pseudojoint in S1 group was higher than that in L 5 group (P=0.002) at final follow-up time. Conclusion Posterior long segment instrumentation and fusion for adult degenerative spinal deformity can obtain satisfying long-term clinical outcomes, and postoperative sagittal imbalance was related to preoperative sagittal/coronal imbalance, postoperativeinternal fixation failure, PJK, pseudoarticulation formation and adjacent segment degeneration. Distal fusion at L 5 or S1 may lead to high risk of adjacent segment degeneration or pseudoarticulation formation respectively. Key words: Adult; Lumbar vertebrae; Intervertebral disc degeneration; Scoliosis; Postoperative complications

Long Term Outcomes and Effects of Surgery on Degenerative Spinal Deformity: A 14-Year National Cohort Study.

Degenerative spinal deformity (DSD) has become a prevalent cause of disability and pain among the aging population worldwide. Though surgery has emerged as a promising option for DSD, the natural course, outcomes, and effects of surgery on DSD have remained elusive. This cohort study used a national database to comprehensively follow up patients of DSD for all-cause mortality, respiratory problems, and hip fracture-related hospitalizations. All patients were grouped into an operation or a non-operation group for comparison. An adjustment of demographics, comorbidities, and propensity-score matching was conducted to ameliorate confounders. A Cox regression hazard ratio (HR) model and Kaplan-Meier analysis were also applied. The study comprised 21,810 DSD patients, including 12,544 of the operation group and 9266 of the non-operation group. During the 14 years (total 109,591.2 person-years) of follow-up, the operation group had lower mortality (crude hazard ratio = 0.40), lower respiratory problems (cHR = 0.45), and lower hip fractures (cHR = 0.63) than the non-operation group (all p < 0.001). After adjustment, the risks for mortality and respiratory problems remained lower (adjusted HR = 0.60 and 0.65, both p < 0.001) in the operation than the non-operation group, while hip fractures were indifferent (aHR = 1.08, p > 0.05). Therefore, surgery for DSD is invaluable since it could reduce the risks of mortality and of hospitalization for respiratory problems.

360-Degree Complex Primary Reconstruction Using Porous Tantalum Cages for Adult Degenerative Spinal Deformity.

Study Design:Retrospective cohort study.Objective:To assess both implant performance and the amount of correction that can be achieved using multilevel anterior lumbar interbody fusion (ALIF).Methods:Retrospective cohort study (n = 178) performed over a 4-year period. Surgical variables examined included blood loss, operative time, perioperative complications, and secondary/revision procedures. Follow-up radiographic assessment was performed to record implant-related problems. Radiographic parameters were examined pre- and postoperatively. Health-related quality of life (HRQOL) outcome measures were collected preoperatively and at 6 weeks, 6 months, 1 year, and 2 years postoperatively. Descriptive and comparative statistical analysis, using paired-sample t test and repeated-measures analysis of variance (rANOVA), was performed.Results:Lumbar lordosis increased from 42° ± 17° preoperatively to 55° ± 11° postoperatively (P < .001). The visual analog scale back pain mean score improved from 8.3 ± 1.5 preoperatively to 2.6 ± 2.4 at 2 years (P < .001). The mean Oswestry Disability Index improved from 69.5 ± 21.5 preoperatively to 19.9 ± 15.2 at 2 years (P < .001). The EQ-5D mean score improved from 0.2 ± 0.2 preoperatively to 0.8 ± 0.1 at 2 years (P = .02). There were no neurological, vascular, or visceral approach–related injuries reported. No rod breakages and no symptomatic nonunions occurred. There was one revision procedure performed for fracture.Conclusions:The use of porous tantalum cages as part of a 360-degree fusion to treat adult degenerative spinal deformity has been demonstrated to be a safe and effective strategy, leading to good clinical, functional, and radiographic outcomes in the short term.

Analyse radiographique 3D en position debout : relation entre paramètres radiologiques sagittaux et incapacité fonctionnelle dans la pathologie rachidienne

PurposeTo clarify the relationship between whole body sagittal radiographic parameters and health related quality of life (HRQOL) in patients with spinal disease, and further analyse such relationship based on the pelvic incidence (PI) value. Methods100 patients (mean age: 64.4 years, M/F=50/50) with lumbar degenerative disease or spinal deformity were prospectively investigated. Following Oswestry Disability Index (ODI) and Scoliosis Research Society Score 22 (SRS-22) questionnaire, whole body sagittal X-ray parameters were measured using a slot-scanning 3D X-ray imager (EOS). Correlations between such radiographic parameters and ODI/SRS-22 scores were analysed. Then, patients were divided into three groups based on the PI value (PI≤45°, 45°<PI≤60°, and 60°<PI), and correlations between the significantly correlated parameters and ODI/SRS-22 scores were analysed for each PI group. ResultsC2-7 lordosis, pelvic tilt (PT), pelvic incidence (PI), PI minus lumbar lordosis (PI-LL), sagittal vertical axis (SVA), full balance integrated index (FBI), and knee flexion angle (KneeFlex) had a significant correlation with ODI or SRS-22 scores. Among those parameters, PI and FBI showed a significant correlation with both ODI and SRS-22 scores. High PI (>60°) group showed a strong correlation (R>0.4) with both ODI and SRS-22 scores for PI-LL parameter. ConclusionsPI and FBI showed a significant correlation with both ODI and SRS-22 scores. PI-LL mismatch was strongly correlated with disability in high PI patients. Our study results may indicate that it is important to pay attention to the PI value in addition to the spinopelvic relationship. Level of evidenceII, prospective study.

A Computed Tomography Analysis of the Success of Spinal Fusion Using Ultra-Low Dose (0.7 mg per Facet) of Recombinant Human Bone Morphogenetic Protein 2 in Multilevel Adult Degenerative Spinal Deformity Surgery.

Study DesignRetrospective cohort study.PurposeTo report on spinal fusion assessment using computed tomography (CT) after adult spinal deformity (ASD) surgery using ultra-low dose recombinant human bone morphogenetic protein 2 (RhBMP-2).Overview of LiteratureThe reported dose of RhBMP-2 needed for successful spinal posterolateral fusion in ASD ranges from 10 to 20 mg per spinal level. This study reports the use of ultra-low dose of RhBMP-2 (0.07 mg per facet) to achieve spinal fusion in multilevel ASD surgery.MethodsConsecutive patients who underwent ASD surgery using ultra-low dose RhBMP-2 were recruited. Routine postoperative CT analysis for spinal fusion was performed by two spine surgeons. Inter-observer agreement was calculated for facet fusion (FF) and interbody fusion (IBF) at 6 and 12 months after the procedure.ResultsSix consecutive ASD patients with a mean age of 62 years (28–72 years) were examined. Each patient received a total dose of 12 mg with an average dose of 0.69±0.2 mg (0.42–1 mg) per single FF and 1.38±0.44 mg (0.85–2 mg) for IBF. Total 131 FF and 15 IBF were examined in the study, with 88 FFs and nine IBFs being analyzed specifically at 6 months after the surgery. FF and IBF reported by surgeons A and B at 6 months were 97.7% vs. 91.9% FF, respectively (κ=0.95) and 100% vs. 100% IBF, respectively (κ=1). Two patients underwent longitudinal follow-up CT at 12 months, and the FF rates reported by surgeons A and B were 100% vs. 95.8%, respectively (κ=0.96). Five out of nine facet (56%) non-unions were identified at the cross-links. The remaining four facet pseudarthrosis were noted at 1–2 spinal levels caudal to the cross-links. At the final clinical follow-up, there was no rod breakage, deformity progression, neurological deficit, or symptom recurrence. The Oswestry Disability Index improved by an average of 32.8±6.3, while the mental component summary of the 36-item Short-Form Health Survey improved by an average of 4.7±2.1, and physical component summary improved by an average of 10.5±2.1.Conclusions To our knowledge, this is the first study to report a CT that defined 92%–98% FF and 100% IBF using the lowest reported dose of RhBMP-2 in multilevel ASD surgery. The use of ultra-low dose RhBMP-2 reduces the RhBMP-2 related complications and healthcare costs.

Combination of degenerative lumbar spinal stenosis and spinal deformity. Literature review

The study objective is to analyze currently available publications on spinal deformity in patients with degenerative lumbar spinal stenosis.Materials and methods. We analyzed 90 manuscripts published between 1980 and 2017.Results. We describe the parameters used to assess spinal deformity and evaluate their role for predicting the course of degenerative spinal disease. We provide the results of latest studies assessing the impact of spinal deformity on the outcome of surgical treatment in patients with degenerative lumbar spinal stenosis. We identified the following risk factors for scoliosis progression: wedge-shaped intervertebral disc in the frontal projection, low middle sacral axis, lateral spondylolisthesis, small L vertebral body, vertebral rotation, Cobb angle &gt;20°, and sagittal imbalance.Conclusion. We recommend decompressive interventions with facet joint preservation in patients with spinal deformity and degenerative lumbar spinal stenosis with no risk factors for scoliosis progression and radicular symptoms only (without pronounced low back pain). In patients with no risk factors for scoliosis progression, radicular symptoms, and low back pain, it is advisable to combine decompression with short fixation. For individuals at risk of scoliosis progression, we recommend supplementing decompression with long fixation exceeding scoliosis curve.

Surgical strategy and relevant problems about degenerative spinal deformity

As the complicated and three-dimensional deformity, degenerative spinal deformity is common in middle-aged and elderly patients, which often accompanies with severe lumbar spinal stenosis and corresponding symptoms, high surgical difficulties and risks in perioperative periods. The aims of the surgery are removing decompression of spinal cord and nerve root, ending the process of deformity and rebuilding spinal balance. Recently, relevant problems of sagittal balance in degenerative spinal deformity have attracted more and more attention. Proper use of orthopedic technique and correct choice of upper and lower instrumented vertebra play a key role in deformity correction and improvement of postoperative symptoms.

Relationship between sagittal radiographic parameters and disability in patients with spinal disease using 3D standing analysis

PurposeTo clarify the relationship between whole body sagittal radiographic parameters and health related quality of life (HRQOL) in patients with spinal disease, and further analyse such relationship based on the pelvic incidence (PI) value. Methods100 patients (mean age: 64.4 years, M/F=50/50) with lumbar degenerative disease or spinal deformity were prospectively investigated. Following oswestry disability index (ODI) and scoliosis research society score 22 (SRS-22) questionnaire, whole body sagittal x-ray parameters were measured using a slot-scanning 3D x-ray imager (EOS). Correlations between such radiographic parameters and ODI/SRS-22 scores were analysed. Then, patients were divided into three groups based on the PI value (PI≤45°, 45<PI≤60°, and 60<PI), and correlations between the significantly correlated parameters and ODI/SRS-22 scores were analysed for each PI group. ResultsC2-7 lordosis, pelvic tilt (PT), pelvic incidence (PI), PI minus lumbar lordosis (PI-LL), sagittal vertical axis (SVA), full balance integrated index (FBI), and knee flexion angle (KneeFlex) had a significant correlation with ODI or SRS-22 scores. Among those parameters, PI and FBI showed a significant correlation with both ODI and SRS-22 scores. High PI (>60°) group showed a strong correlation (R>0.4) with both ODI and SRS-22 scores for PI-LL parameter. ConclusionsPI and FBI showed a significant correlation with both ODI and SRS-22 scores. PI-LL mismatch was strongly correlated with disability in high PI patients. Our study results may indicate that it is important to pay attention to the PI value in addition to the spinopelvic relationship. Level of evidenceII, prospective study.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

BACKGROUND CONTEXT Minimally invasive anterolateral interbody fusions are becoming increasingly utilized for the treatment of lumbar degenerative and adult spinal deformity conditions. There remains contention whether a prepsoas or transpsoas approach is superior. Several small studies have compared these interventions; however, the quality of evidence to date is low and is comprised of a large number of independent, uncontrolled case series dedicated to each specific approach. PURPOSE We sought to combine the results of the published studies for modern minimally invasive lateral approaches to compare the safety and complication rates for the prepsoas and transpsoas techniques. STUDY DESIGN/SETTING Systematic review and meta-analysis. PATIENT SAMPLE Eligible studies were those in which minimally invasive prepsoas or transpsoas (LLIF, ELIF, DLIF, XLIF) approaches were used to treat degenerative and/or scoliosis or deformity lumbar conditions. Studies evaluating anterior column realignment (ACR) were excluded. OUTCOME MEASURES Complication rates for each complication type were calculated per patient for each approach. METHODS A systematic review was performed to identify eligible studies reporting outcomes for each approach type. Each study was individually evaluated to determine whether it could be included in the meta-analysis. Complication reporting was variable and only studies that directly reported the specific complication were included in each analysis. RESULTS A total of 19 pre-psoas studies with 1,854 patients and 36 transpsoas studies with 3,978 patients were included. The pre-psoas approach was significantly associated with a higher rate of major vascular injury (1.2vs. 0.2 %, p CONCLUSIONS Based on the large collective sample size reported in the literature, complication rates for both procedures remain low, and largely present as transient deficits inherent to each access trajectory. Higher rates of major vascular injury for the prepsoas approach and motor neurological deficit for the transpsoas approach present as the major delineating risks.