History Of Spine Surgery Research Articles

Smartphone Use and Interest in a Spine Surgery Recovery Mobile Application Among Patients in a US Academic Neurosurgery Practice.

Mobile applications (apps) are serving an increasingly important role in healthcare for patients and providers alike. In addition to streamlining active communication of patient-reported outcomes regarding quality of life, pain, and opioid consumption, smartphones equipped with activity tracking afford the opportunity to passively and objectively measure mobility, a key metric of recovery in spine surgery. However, app development is a resource-intensive process. To survey adult neurosurgery patients regarding access to and interest in this platform. In June and July 2017, a paper-based anonymous survey was distributed to patients in the waiting room of the adult neurosurgery clinic of a large US academic medical center. Patients' smartphone use and interest in using a mobile app following spine surgery were the primary and secondary outcomes, respectively. Of 146 included responses, 102 patients (70%) regularly used a smartphone, and this number increased to 77% among patients with a history of spine surgery (n=66, 45% of respondents). Seventy-one percent of patients with previous spine surgery expressed an interest in using a postoperative monitoring and communication app, compared to 81% of patients without prior spine operations (n=80, 55%). Among neurosurgery patients, there is a high level of access to and interest in smartphone apps to aid postoperative recovery. These results are useful for other neurosurgeons considering mobile app development for this purpose.

The incidence of post-dural puncture headache in the obese parturient compared to the non-obese parturient after an accidental dural puncture: a systematic review protocol.

The purpose of this systematic review is to determine if there is a difference in the incidence of post-dural puncture headache in the obese parturient compared to the non-obese parturient after an accidental dural puncture. Placement of an epidural catheter is a common technique to ease the pain of childbirth. One potential complication is a headache that occurs if the dura mater is accidentally punctured with the epidural needle during the procedure. Certain factors impact the likelihood of a postdural puncture headache after an accidental dural puncture in parturients. One potential factor is obesity. There is evidence to suggest that obesity lowers the risk of postdural puncture headache, although not all studies agree. There are no current or active systematic reviews that address whether or not obesity in parturients is protective against postdural puncture headache. Studies with parturients aged 18 to 45 who have had a documented accidental dural puncture with an epidural needle will be included in this review. Studies with parturients with a history of spinal surgery or pre-existing headache pathology will be excluded. Studies involving non-obstetrical patients will be excluded. A systematic search of MEDLINE, CINAHL Complete, Scopus, and Wiley Online Library will be conducted to identify studies on the topic of interest. Studies will be selected for review based on the inclusion criteria and will be appraised by two reviewers using the appropriate JBI standardized appraisal tool. 136047 (PROSPERO).

190. Preoperative opioid therapy poorly controls pain in nonrevision adult spinal deformity (ASD) and increases risk for chronic postoperative opioid usage

BACKGROUND CONTEXT Iatrogenic malalignment, nonunion and adjacent segment degeneration are established etiologies for pain in adult spinal deformity (ASD). However, reasons for pain among ASD patients with no prior history of surgery (nonrevision) are incompletely understood. Opioid therapy for pain is controversial and problematic. PURPOSE Compare pain scores in nonrevision ASD patients who preoperatively receive opioids vs no opioids and evaluate pain scores and risk for chronic opioid use following surgical treatment. It is hypothesized that preop opioid therapy poorly controls pain and increases risk for chronic postop opioid use compared to opioid nonusers in nonrevision ASD patients. STUDY DESIGN/SETTING Analysis of a prospective multicenter ASD database. PATIENT SAMPLE ASD patients with no history of prior spine surgery, enrolled into a prospective multicenter database and subsequently surgically treated for ASD. OUTCOME MEASURES Scoliosis Research Society-22r questionnaire (SRS-22r), SF-36, numeric rating scale (NRS) back and leg pain. METHODS ASD patients (age >18 years, no history of spine surgery), were enrolled into a prospective multicenter ASD database and evaluated for opioid use on SRS-22r questionnaire. Patients divided into preop opioid (OPIOID) vs nonopioid (NON) users, organized into SRS deformity types (thoracic, lumbar, double, sagittal and mixed), treated surgically for ASD and evaluated minimum 2 years postop. Pre- and postop demographic, radiographic, and pain values evaluated, and postop opioid usage compared. RESULTS Two hundred twenty-seven of 426 patients, (mean follow-up 3.3 years) were eligible for study and evaluated. Distribution of SRS deformity type for OPIOID vs NON was similar. Comparison of scoliosis patients (thoracic, lumbar or double deformities) demonstrated OPIOID (n=32) had similar preop age, BMI, smoking history, maximal scoliosis, SVA, and sagittal spinopelvic parameters as NON (n=95; p>0.05). However, OPIOID had greater preop NRS back pain (7.3 vs 6.1), leg pain (4.9 vs 3.1), and worse SF-36 bodily pain (31.8 vs 39.8) than NON (p 0.05). However, OPIOID had greater preop NRS back pain (7.8 vs 7.0), leg pain (5.8 vs. 3.8), and worse SF-36 bodily pain (29.3 vs. 35.6) than NON (p CONCLUSIONS Evaluation of 227 surgically treated nonrevision ASD patients demonstrated that despite having similar demographics, spinal deformity and similar surgery OPIOID reported greater preop pain scores, greater postop pain scores and had greater risk for opioid usage than NON. The relative risk of opioid usage at 2 years postop was 5.0 for preop daily users and 2.8 for preop weekly users compared to NON. Preop opioid therapy should be avoided in non-revision ASD. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

153. Can cervical transforaminal epidural steroid injections be surgery-sparing?

BACKGROUND CONTEXT Cervical radiculopathy can have a significant effect on patient quality of life. Cervical transforaminal epidural steroid injections (TF ESIs) have come under scrutiny due to risk of the procedure and lack of literature demonstrating long-term effect. PURPOSE To determine whether cervical TF ESIs improve patient-reported quality-of-life outcomes, offer therapeutic benefit, and whether TF ESIs decrease the need for cervical spine surgery. STUDY DESIGN/SETTING Hospital-based outpatient medical spine practice. PATIENT SAMPLE A total of 99 consecutive patients who underwent unilateral cervical TF ESI. Of those, 82 patients were available for analysis who underwent cervical injection between 12/11/2013 and 11/8/2017. Average age was 51.3 (SD = 11.5 years) with 51.2% male, 48.8% female. Levels included 45.1% performed at C5-6, 31.7% at C6-7, and 23% at other cervical levels. Median duration of symptoms was seven months. OUTCOME MEASURES We evaluated data using validated outcomes measures – PHQ9, PDQ, and PROMIS-Physical. METHODS Retrospective review of single practitioner's outcomes after all patients undergoing cervical TF ESIs from 2014-2017. RESULTS Of the 99 patients, 25 went on to have cervical surgery; 90.2% patients had diagnostic benefit considered to at least 80% immediate relief 4 hours after injection. Only one patient had a complication: a less than 1 minute seizure with lidocaine test dose. History of spine surgery was the only statistically significant predictor to long-term benefit after cervical TF ESI. Patients who had prior spine surgery had a hazard of postinjection surgery that was 4.2 times larger, compared to patients who did not have prior spine surgery (P = 0.001). None of the other predictors were significantly associated with time from injection to surgery. Patients who had duration of symptoms of 1 year or more had higher postinjection PDQ scores than patients who had duration of symptoms 3 months or less, and patients who had history of spine surgery had higher postinjection PDQ scores. Overall Mean Visual Analog Score (VAS) decreased mean 7.6 to 4.09 at 3 months (n=82), (P CONCLUSIONS Cervical TF ESIs can be done safely with minimal morbidity and significant benefit at 6 months. In more than 2/3 of the patients, surgery was not needed due to diagnostic and therapeutic benefit from cervical TF ESI. FDA DEVsICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

66. Preop opioid use is associated with worse postop outcomes and chronic opioid use in nonrevision adult scoliosis patients: corroboration of two independent multicenter studies

BACKGROUND CONTEXT Sagittal malalignment and failed surgery are established etiologies for pain in adult spinal deformity (ASD). However, pain in primary adult scoliosis with good sagittal alignment is poorly understood. Opioids may be administered to control pain in adult scoliosis but are controversial and may negatively impact patient outcome. Evaluation of two independent ASD datasets may reduce bias and help understand the impact of preop opioid therapy on postop outcomes. PURPOSE Compare datasets from two independent ASD studies to evaluate the impact that the presence and frequency of opioid use has upon postop outcomes in adult scoliosis patients who have no prior history of spine surgery and no sagittal malalignment. STUDY DESIGN/SETTING Comparative analysis of datasets from two prospective multicenter ASD studies. PATIENT SAMPLE ASD patients with no history of prior spine surgery and no sagittal malalignment (as defined by the Scoliosis Research Society ASD Classification) enrolled into two independent multicenter databases and subsequently surgically treated for adult scoliosis OUTCOME MEASURES Scoliosis Research Society-22r questionnaire (SRS-22r), SF-36 and SF-12 Physical Component Score (PCS) and Mental Component Score (MCS), numeric rating scale (NRS) back and leg pain METHODS Adult scoliosis patients age >18 years, no history of spine surgery, and presence of thoracic, lumbar or double scoliosis (as per SRS deformity type) were identified from 2 independent prospective databases and assessed for preop non-opioid (NON) vs opioid use and amount of use (DAILY vs WEEKLY). Mixed and sagittal deformities were eliminated to reduce confounding pain impact of sagittal malalignment. Patients were treated surgically and pre- and postop demographic, radiographic data, patient-reported outcome measures and postop opioid usage were evaluated, minimum 2-year follow-up. RESULTS Database 1 (D1; 102/102 patients; mean follow up 2.1+0.2yr) and Database 2 (D2; 116/168 patients, mean follow-up 3.3 years) demonstrated similar preop demographic, depression history, smoking history and radiographic parameters for NON, DAILY and WEEKLY (p>0.05; Table). DAILY had greater preop NRS back and leg pain, and worse preop PCS and MCS than NON (p 0.05). At last follow-up, DAILY had worse postop NRS back pain (D1=4.1, D2=4.9), worse PCS (D1=38.8, D2=41.9), and worse MCS (D1=49.7, D2=45.4) than NON and WEEKLY (p CONCLUSIONS Comparison of datasets from two independent, multicenter prospective ASD studies demonstrated dataset agreement that preop opioid use and increased frequency of preop opioid use in adult scoliosis patients with no history of prior surgery and no sagittal malalignment is associated with worse postop pain, outcomes and continued opioid use. Attempts should be made, including program development, to aid in the discontinuation of preop and postop opioid usage for adult scoliosis to help improve postop outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

191. Operative treatment for thoracic adult Scheuermann kyphosis: preoperative disability and surgical outcomes

BACKGROUND CONTEXT While there is a substantial amount of information regarding treatment for adolescent Scheuermann kyphosis, little data exists on surgical outcomes for thoracic adult Scheuermann kyphosis (TASK). Comparison of surgical outcomes for TASK to outcomes for adult scoliosis patients may assist patient counseling and formulation of treatment strategies. PURPOSE Evaluate preoperative disability and surgical outcomes for TASK compared to adult scoliosis. STUDY DESIGN/SETTING Retrospective analysis of a prospective multicenter adult spine deformity (ASD) database. PATIENT SAMPLE TASK and adult scoliosis patients with no history of prior spine surgery, enrolled into a multicenter database and subsequently surgically treated. OUTCOME MEASURES Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form Health Survey-36 (SF-36), numeric rating scale (NRS) back and leg pain, Oswestry Disability Index (ODI), neck disability index (NDI). METHODS ASD patients age >18 years enrolled into a prospective multicenter ASD database were evaluated for (1) TASK (as defined by Sorensen's criteria) and (2) no history of spine surgery prior to database enrollment. Following database enrollment, TASK patients were treated surgically, pre- and postoperative demographic, radiographic, patientreported outcome measures, and surgical complications were evaluated and compared to surgically treated adult scoliosis (AS) patients (as defined by Scoliosis Research Society ASD classification) matched according to age, upper instrumented vertebra (UIV), lower instrumented vertebra (LIV) and total levels fused, with minimum 2-year follow-up. RESULTS Twenty of 27 TASK patients eligible for study were evaluated [mean follow-up 2.9 year (2-5 years), age 43.2 years (18.5-78.9), preoperative thoracic kyphosis 74.3° (61.2-107.5°), lumbar lordosis 71.7° (28.2-88.9°). Mean TASK postoperative thoracic kyphosis was 50.6° (41.2-61.4), postoperative lumbar lordosis 62.6 (44.1-89), levels fused 13.8 (11-18)], median UIV= T2, LIV= L3. TASK complication rate was 50% including PJK 5% (n=1), DJK 5% (n=1), and implant failure 10% (n=2). Comparing TASK to matched AS patients, TASK had similar preoperative back pain (6.9 vs 6.4), ODI (37.6 vs 32.7), SRS-22r total (2.8 vs 3.0), SRS-22r self image (2.2 vs 2.6), SF36-PCS (34.6 vs 38.1), and NDI (21.3 vs 24.5), respectively (p>0.05). Postoperative patient reported outcomes were similar for TASK and AS including back pain (4.4 vs 4.2), ODI (24.1 vs 23.8), SRS-22r total (3.6 vs 3.8), SRS-22r self image (3.8 vs 3.8), SF36-PCS (48.7 vs 50.9), and NDI (23.2 vs 23.0), respectively (p>0.05). Postoperative complications were similar for TASK and matched AS including, PJK, DJK, infection, implant failure and revision spine surgery (p CONCLUSIONS Evaluation of surgically treated TASK patients matched to adult scoliosis according to age, UIV and LIV demonstrates TASK has a negative impact on pain, disability, and self image analogous to adult scoliosis. Surgical treatment for TASK demonstrates excellent improvements in pain and self-image, with similar associated postoperative complication rates at minimum two-year follow-up as adult scoliosis. Treating physicians should be cognizant of the negative impact TASK can have on quality of life and responsiveness to surgical treatment. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Systemic effects of fluoroscopically guided epidural steroid injection with dexamethasone.

BackgroundEpidural steroid injections (ESIs) have been widely used in managing spinal pain. Dexamethasone has recently emerged as a useful drug in this setting, relative to particulate steroids, although the associated systemic effects have not been fully elucidated. This study aimed to investigate the incidences and types of systemic effects after fluoroscopically guided ESI with dexamethasone.MethodsThis retrospective study included 888 ESIs with dexamethasone (fluoroscopically guided at the cervical and lumbosacral levels) performed on 825 patients during January to June 2017. Data regarding systemic effects were collected via telephone interviews using a standardized questionnaire at 2 weeks after the procedure. Data on patient demographic, clinical, and procedural characteristics were collected and analyzed to identify factors that were associated with systemic effects. All statistical analyses were performed using the chi-squared test.ResultsAmong the 825 patients, 40 patients (4.8%) experienced systemic effects during the 2-week follow-up period. The most common systemic effect was facial flushing (12 patients, 1.5%), which was followed by urticaria (7 patients, 0.8%) and insomnia (7 patients, 0.8%). A history of spine surgery was significantly associated with the occurrence of systemic effects (P = 0.036). Systemic effects were significantly more common for injections at the cervical level than at the lumbar level (P = 0.019).ConclusionsApproximately 4.8% of the patients who underwent ESI with dexamethasone experienced minor and transient systemic effects. These effects were more common in patients who had undergone a previous spine surgery or received a cervical ESI.

History of Spinal Surgery in Japan - From the Pioneering Period to the Progressive Era (1911-2017).

History of Spinal Surgery in Japan - From the Pioneering Period to the Progressive Era (1911-2017).

Cost-effectiveness analysis of the pharmacological management of chronic low back pain with four leading drugs

BackgroundChronic low back pain is a major health problem that has a substantial effect on people's quality of life and places a significant economic burden on healthcare systems. However, there has been little cost-effectiveness analysis of the treatments for it. Therefore, the purpose of this prospective observational study was to evaluate the cost-effectiveness of the pharmacological management of chronic low back pain. MethodsA total of 474 patients received pharmacological management for chronic low back pain using four leading drugs for 6 months at 28 institutions in Japan. Outcome measures, including EQ-5D, the Japanese Orthopaedic Association (JOA) score, the JOA back pain evaluation questionnaire (BPEQ), the Roland–Morris Disability Questionnaire, the Medical Outcomes Study SF-8, and the visual analog scale, were investigated at baseline and every one month thereafter. The incremental cost–utility ratio (ICUR) was calculated as drug cost over the quality-adjusted life years. An economic estimation was performed from the perspective of a public healthcare payer in Japan. Stratified analysis based on patient characteristics was also performed to explore the characteristics that affect cost-effectiveness. ResultsThe ICUR of pharmacological management for chronic low back pain was JPY 453,756. Stratified analysis based on patient characteristics suggested that the pharmacological treatments for patients with a history of spine surgery or cancer, low frequency of exercise, long disease period, low scores in lumbar spine dysfunction and gait disturbance of the JOA BPEQ, and low JOA score at baseline were not cost-effective. ConclusionsPharmacological management for chronic low back pain is cost-effective from the reference willingness to pay. Further optimization based on patient characteristics is expected to contribute to the sustainable development of a universal insurance system in Japan.

Risk Factors for Nerve Injury After Total Hip Arthroplasty: A Case-Control Study

BackgroundPostsurgical acute nerve injury is rare but potentially devastating following total hip arthroplasty (THA). Previous literature suggests a wide range of incidence from 0.1% to 7.6%. Confirmed risk factors for these injuries remain unclear. MethodsTHA patients at our institution who developed nerve injury during their admission for THA between January 1, 1998, and December 31, 2013, were systematically identified and matched with 2 control subjects by surgical date. Relevant patient and surgical data were obtained through review of patient charts and electronic health records. We identified potential risk factors and calculated odds ratios (OR) using a conditional logistic regression model with a parsimonious stepwise approach. ResultsWe identified 93 nerve injuries in 43,761 THAs (0.21%). The mean age of cases was 63 years. Adjusting for other factors in the model, patients <45 years were found to be at increased risk of developing nerve injury (OR, 7.17; P = .033). Similarly, patients with a history of tobacco use (OR, 1.90; P = .030) and a history of spinal surgery or disease (OR, 10.06; P < .001) were also associated with increased risk of nerve injury. For every 30-minute increase in surgery time after 1 hour, risk of nerve injury risk increased (OR, 1.48; P = .034). Assignment as first operative case of the morning was associated with a decreased risk of nerve injury (OR, 0.37, P = .043). ConclusionThis study demonstrates that nerve injury is a rare complication following THA at our institution. We found risk factors that are possibly modifiable factors such as lumbar spine disease, smoking, and time of surgical scheduling.

Utility of the claw sign in spine magnetic nuclear resonance with diffusion to differentiate Modic type I changes for degenerative disease versus infection.

In 1988, Modic and his colleagues described changes in the subchondral bone marrow of the vertebral plates in patients with degenerative disease or other pathologies, which were observed in the nuclear magnetic resonance (NMR) of the spine and were subdivided into three patterns of signal changes, called Modic type I, Modic type II and Modic type III. The main differential diagnosis of the Modic I changes of the vertebral plates due to degenerative disease in spine NMR, is infection in its early stages. In their study in 2014, Patel and collaborators, using a protocol and the concept of diffusion in spine MRI, were able to demonstrate that by means of the "claw sing", a degenerative disease with Modic type I changes, can be differentiated from an infection in early stages. In this series of cases, the algorithm used by Patel et al. was implemented. The clinical records of patients who consulted the emergency department for lumbar pain without clear etiology, between January 1, 2017 and December 31, 2017, were analyzed. Due to axial lumbar pain, subjects were hospitalized and studies were ordered, including contrasted MRI of the lumbosacral spine. Then, with laboratory tests and MRI findings of Modic type I changes, it was not possible to differentiate between degenerative disease vs. spondylodiscitis. Therefore, the algorithm used in the study by Patel and collaborators was applied. There were 13 patients identified with lumbar or dorsal pain over 3 months of evolution, with nonspecific symptoms; 5 patients (38.46%) reported arterial hypertension, 4 patients (30.77%) diabetes mellitus, and 4 patients (30.77%) chronic kidney disease stage V in management with hemodialysis, 3 patients (23.08%) presented immunosuppressive conditions and 3 patients (23.08%) had a history of spinal surgery with instrumentation. All the patients were hospitalized and a lumbosacral and thoracic spine simple MRI was performed with Modic type I changes to perform contrast-enhanced MRI with diffusion and ADC. From the 13 cases studied for low back pain, there were 7 patients (53.85%) with confirmed findings of Modic type I changes due to degenerative disease for presenting claw sign in spinal MRI diffusion and 6 patients (46.15%) Modic type changes I due to infection in the absence of a claw sign in the column MRI diffusion. Spinal column MRI with diffusion is useful to differentiate patients with type I changes due to degenerative disease with positive claw sign; of patients with type I changes due to infection with absent claw sign. In addition, in patients with compromised renal function, column MRI with diffusion without contrast could be a diagnostic alternative, since it does not require contrast media to confirm infection.

Development of the Japanese Core Outcome Measures Index (COMI): cross-cultural adaptation and psychometric validation

BackgroundThe patient-rated Core Outcome Measures Index (COMI) assesses the multidimensional impact of back problems on the sufferer. The brevity and comprehensibility of the tool make it practical for use in clinical and research settings. Although the COMI has been cross-culturally adapted in various languages worldwide, there is currently no Japanese version. The aim of this study was to develop a Japanese version of the COMI by: (1) performing a cross-cultural adaptation of the English version and (2) evaluating the psychometric properties of the Japanese version of the COMI in Japanese volunteers with chronic back problems.MethodsThe English version of the COMI was cross-culturally adapted for the Japanese language using established guidelines. The pre-final version was pilot-tested in five Japanese-speaking patients with low back pain (LBP) and a history of spine surgery. The psychometric properties of the Japanese COMI were tested in a group of 1052 individuals with chronic LBP (LBP ≥3 months), aged 20–69 years, who were recruited through a web-based survey. The psychometric properties that were evaluated included convergent and known-group validity, using the following reference questionnaires: EuroQol 5 Dimension, Roland Morris Disability Questionnaire, Short Form 8™ Health Survey, and the Keele STarT Back Screening Tool.ResultsThe pre-final version of the cross-culturally adapted Japanese COMI was completed without any major problems of understanding or acceptability. For the evaluation of its psychometric properties, tests for convergent validity showed moderate correlations between COMI items and the respective reference questionnaires for symptom-specific well-being [− 0.33–−0.48] and disability domains [0.48] and strong correlations (> 0.5) for the other domains and the COMI summary score. The analysis of known-group validity showed a linear trend for the COMI score in relation to prognostic risk (P < 0.001).ConclusionsThe Japanese COMI retained conceptual equivalence to the original using comprehensible and acceptable Japanese expressions. We developed a Japanese version of the COMI that displayed qualities that support its convergent and known-group validity. The availability of a Japanese version of the COMI should allow for improved documentation of the care provided to patients with back problems.

Atividade física comunitária: efeitos sobre a funcionalidade na lombalgia crônica

Objective: To evaluate the pain intensity, lumbar strength and functionality of individuals presenting chronic non-specific low back pain and taking part in a public physical exercise program. Methods: Exploratory, cross-sectional and quantitative survey conducted in 2017 with 130 women from 30 to 60 years of age and without history of spinal surgery. The Oswestry Low Back Pain Disability Questionnaire (ODQ) was applied for assessment of the disability related to the lumbar spine. The pain was quantified through the visual analog scale (VAS) and the lumbar muscle strength through lumbar dynamometry (Takei®). Results: Of the 130 participants, 97.7% (n=127) presented minimal functional disability related to the lumbar spine (ODQ). In respect to strength, 16.9% (n=10) presented normal values and 83.1% (n=120) were below the reference values, presenting muscle weakness. As for the pain intensity, 47.7% (n=67) of the participants showed mild intensity, 45.5% (n=59) presented moderate intensity and 6.9% (n=9), severe. Conclusion: The program has characteristics that contribute to maintaining under control the pain intensity, which has been slight, as well as the significant functional disability of the individuals. The muscle weakness in the lumbar region, presented by the participants without association with functionality, and the pain as well, might be factors that perpetuate the chronic low back pain. The findings suggest the need to revise the therapeutic prescription of the exercises of the implemented program.

Factors influencing spinal sagittal balance, bone mineral density, and Oswestry Disability Index outcome measures in patients with rheumatoid arthritis.

To identify the factors influencing spinal sagittal alignment, bone mineral density (BMD), and Oswestry Disability Index (ODI) outcome measures in patients with rheumatoid arthritis (RA). We enrolled 272 RA patients to identify the factors influencing sagittal vertical axis (SVA). Out of this, 220 had evaluation of bone mineral density (BMD) and vertebral deformity (VD) on the sagittal plane; 183 completed the ODI questionnaire. We collected data regarding RA-associated clinical parameters and standing lateral X-ray images via an ODI questionnaire from April to December 2012 at a single center. Patients with a history of spinal surgery or any missing clinical data were excluded. Clinical parameters included age, sex, body mass index, RA disease duration, disease activity score 28 erythrocyte sedimentation rate (DAS28-ESR), serum anti-cyclic citrullinated peptide antibody, serum rheumatoid factor, serum matrix metalloproteinase-3, BMD and treatment type at survey, such as methotrexate (MTX), biological disease-modifying anti-rheumatic drugs, and glucocorticoids. We measured radiological parameters including pelvic incidence (PI), lumbar lordosis (LL), and SVA. We statistically identified the factors influencing SVA, BMD, VD, and ODI using multivariate regression analysis. Multivariate regression analysis showed that larger SVA correlated with older age, higher DAS28-ESR, MTX nonuse, and glucocorticoid use. Lower BMD was associated with female, older age, higher DAS28-ESR, and MTX nonuse. VD was associated with older age, longer disease duration, lower BMD, and glucocorticoid use. Worse ODI correlated with older age, larger PI-LL mismatch or larger SVA, higher DAS28-ESR, and glucocorticoid use. In managing low back pain and spinal sagittal alignment in RA patients, RA-related clinical factors and the treatment type should be taken into consideration.

218 - Concave Coronal Malalignment Is Associated with Worse Health-Related Quality of Life: An Analysis of Painful Scoliosis in Adult Patients with No History of Spine Surgery

218 - Concave Coronal Malalignment Is Associated with Worse Health-Related Quality of Life: An Analysis of Painful Scoliosis in Adult Patients with No History of Spine Surgery

Descriptive Cadaveric Study Comparing the Accuracy of Ultrasound Versus Fluoroscopic Guidance for First Sacral Transforaminal Injections: A Comparison Study

BackgroundUltrasound is rarely used for guiding lumbosacral epidural steroid injections due to its technical limitations. For example, sonographic imaging lacks the ability to confirm epidural spread and identify vascular uptake. The perceived risk that these limitations pose to human subjects has precluded any large scale clinical trials to date. ObjectiveTo compare the accuracy of ultrasound versus fluoroscopic guidance for first sacral transforaminal epidural injections. DesignCadaveric comparative study using dichotomous outcomes. SettingA fluoroscopy suite and anatomic laboratory at an academic medical center. SubjectsFour unembalmed adult human cadavers with no history of spinal surgery. MethodsEight sites were injected twice by one interventionalist, using fluoroscopic and ultrasound guidance. In the fluoroscopy arm, contrast spread was assessed using computed tomography. In the ultrasound arm, latex spread was assessed using gross anatomic dissection. Any visible evidence of epidural spread constituted a positive result. Main Outcome MeasurementsComparison of the success of obtaining epidural contrast flow was the primary outcome measure. Secondary outcome measures included average duration, rate of intravascular uptake, and quantity of intravascular uptake. ResultsAll injections performed in both the ultrasound arm and the fluoroscopy arm had positive epidural spread. The average duration was 3.03 minutes with fluoroscopy and 4.76 minutes with ultrasound. The rate of intravascular uptake was 37.5% with fluoroscopy and 50% with ultrasound. Within the ultrasound arm, greater intravascular spread and duration variability were recorded. ConclusionAlthough ultrasonography can provide reliable image guidance for cannulating the first sacral foramen in cadavers, it would have limited clinical utility due to its inability to visualize relevant neurovascular structures deep to the osseus roof and exclude intravascular uptake. Level of EvidenceIV

High Kinesiophobia and Pain Catastrophizing in People with Articular Cartilage Defects in the Knee

Objectives:Psychosocial factors, including kinesiophobia and pain catastrophizing, are increasingly recognized for the role they play in knee function and quality of life for people with anterior cruciate ligament reconstruction (ACLR), knee osteoarthritis (OA), and total knee arthroplasties (TKA). People with articular cartilage defects in the knee have impaired function and poor quality of life, however the extent to which they present with kinesiophobia and pain catastrophizing is not known. The purpose of this study is to compare kinesiophobia, i.e. fear of movement-related pain/reinjury, and pain catastrophizing of people with articular cartilage defects (ACD) in the knee to healthy controls.Methods:Thirty-five individuals (19M:16F, Age mean ± 95%CI 29.8 ± 2.8 years old, BMI 28.1 ± 1.44) seeking surgical consultation for an ACD in the knee confirmed with 3.0T MRI and 18 controls (9M:9F, Age 29.8 ± 3.0 years old, BMI 24.9 ± 1.3) without history of knee injury participated in the study. Exclusion criteria included; age >55 years, BMI >35kg/m2, recent surgery, current low back pain or unrelated lower extremity pain, and history of spine surgery or neurological injury and pathology. Kinesiophobia for all 53 subjects was measured with the Tampa Scale of Kinesiophobia (TSK). The TSK was scored using the original 17-item (TSK-17, Min 17 - Max 68) and modified 11-item (TSK-11, Min 11 - Max 44) scoring systems as both have been commonly used in the literature. Pain catastrophizing was measured with the Pain Catastrophizing Scale (PCS, Min 0 - Max 52). Higher scores on these measures indicate greater kinesiophobia and pain catastrophizing. Independent t-tests were used to compare the ACD group to the healthy controls (α=0.05). Mean TSK and PCS scores (± 95% CI) were plotted alongside values published in samples with other knee pathologies for reference.Results:Participants with ACDs reported higher kinesiophobia (TSK-17 mean score ± 95%CI [range]: ACD 40.9 ± 1.7 [29-53], Healthy Control 29.9 ± 1.3 [26-35], p<0.001; TSK-11 score: ACD 27.0 ± 1.2[16-34], Healthy Control 15.8 ± 1.2 [11-20], p<0.001) and higher pain catastrophizing (PCS score: ACD 12.7 ± 3.5 [0-42], Healthy Control 4.0 ± 2.6 [0-14], p<0.001) than age-matched healthy controls. Greater kinesiophobia and pain catastrophizing were also observed in people with ACDs compared to values published in people after ACLR, people with knee OA, and similar to people with severe OA preparing for TKA (Figure 1).Conclusion:This is the first study to our knowledge to evaluate psychosocial factors in people with ACDs of the knee. Kinesiophobia and pain catastrophizing in people with knee ACDs were similar to people with severe knee OA preparing for TKA, and higher than healthy controls and people before and after ACLR. While higher kinesiophobia and pain catastrophizing are consistently associated with worse function and quality of life in these populations, understanding the relationship to outcomes and prognosis in people with knee ACDs remains unknown and is a target of our ongoing work.

INTRAOPERATIVE TRACTION IN SURGERY FOR ADOLESCENT IDIOPATHIC SCOLIOSIS

Objective. To analyze the effectiveness of intraoperative traction in the treatment of adolescent idiopathic scoliosis, including in relation to the initial magnitude of scoliotic curve. Material and Methods . Data on patients meeting the following criteria were selected from the electronic database and analyzed: idiopathic scoliosis (Lenke types I, III, V); age 10 to 20 years; surgery performed through posterior approach; hook or hybrid (using of pedicle screws only in the lumbar spine, at 2-4 levels) fixation; no previous history of spine surgery; and follow-up period at least two years. Results . Flattening of thoracic kyphosis and alignment of lumbar lordosis during surgical correction were significantly more pronounced in the traction group. Postoperative changes in the sagittal contour of the thoracic and lumbar spine did not differ significantly between the traction and no-traction groups. Intraoperative traction was associated with significantly reduced blood loss, though operation time decreased statistically insignificantly. Normalization of the frontal imbalance in the immediate and long-term postoperative periods was different in the two groups, but these differences were insignificant. Intraoperative traction was most effective in the group with deformities of 50° to 75°, although it also increased the achieved correction in patients with scoliosis of a smaller and greater magnitude. Conclusion . The operation performed with intraoperative traction allows achieving greater correction during an intervention and smaller loss of correction during a long follow-up period than that without a distraction influence. This applies equally to both primary and secondary curvatures.

10 kHz High-Frequency Spinal Cord Stimulation for Chronic Axial Low Back Pain in Patients With No History of Spinal Surgery: A Preliminary, Prospective, Open Label and Proof-of-Concept Study

To explore the effectiveness of 10 kHz high frequency spinal cord stimulation (HF10 therapy) treatment of chronic low back pain in patients who have not had spinal surgery. Patients with chronic low back pain without prior spinal surgery were evaluated by a team of spine surgeons to rule out any spinal pathology amenable to surgical interventions and by a multidisciplinary pain team to confirm eligibility for the study. After a successful (>50% back pain reduction) trial of HF10 therapy, enrolled subjects underwent permanent system implantation and were followed-up one year post-implant. About 95% of the enrolled subjects (20/21) received the permanent system. At 12 months post-implant, both back pain VAS score and ODI were significantly reduced compared with baseline values (by 73% and 48%, respectively); an estimated quality-adjusted life year gain of 0.47 and a reduction in opioid use by 64% was observed. Four more patients among those unable to work at baseline due to back pain were employed at 12 months post-implant. There were no serious adverse events. HF10 therapy may provide significant back pain relief, reduction in disability, improvement quality of life, and reduction in opioid use in chronic low back pain not resulting from spinal surgery.

Comparison of Ropivacaine with Fentanyl vs Bupivacaine with Fentanyl for Postoperative Epidural Analgesia in Total Knee Arthroplasty: A Prospective, Randomized, Single-blinded Controlled Study

ABSTRACT Aim The primary aim of the study was to compare epidural ropivacaine with fentanyl and epidural bupivacaine with fentanyl for postoperative epidural analgesia after total knee arthroplasty (TKA). The secondary objective was to assess the outcomes of passive and active mobilizations postoperatively, requirement of rescue analgesia, and adverse effects, such as nausea vomiting, sedation, numbness, motor weakness, hypotension, and respiratory depression. Materials and methods After obtaining hospital ethics committee approval and written informed consent, 100 patients were randomly allocated to two groups of 50 each. Group B received 0.125% bupivacaine with fentanyl (2 μg/mL) epidurally for postoperative pain relief. Group R received 0.2% ropivacaine with fentanyl (2 μg/mL) epidurally for postoperative pain relief. Patients of American Society of Anesthesiologists (ASA) grades I to II of both sexes undergoing elective TKA and giving written consent were included in the study. Patients with coagulation disorders, history of spine surgery, vertebral deformities, and having contraindications for spinal analgesia were excluded from the study. All patients were preoperatively assessed and clinically evaluated thoroughly. They received conventional combined spinal epidural anesthesia followed by epidural infusion in the postoperative period of ropivacaine fentanyl or bupivacaine fentanyl as per the allocation. The postoperative epidural analgesia was supplemented with intravenous (IV) paracetamol 1 gm TDS, and rescue analgesia, if needed, was given with IV tramadol 50 mg. All patients were monitored for postoperative pain by the visual analog scale (VAS), requirement of rescue analgesia, hemodynamic parameters, sedation scores, and adverse effects. How to cite this article Potdar MP, Tomar A, Kamat L. Comparison of Ropivacaine with Fentanyl vs Bupivacaine with Fentanyl for Postoperative Epidural Analgesia in Total Knee Arthroplasty: A Prospective, Randomized, Single-blinded Controlled Study. Res Inno in Anesth 2017;2(2):51-57.