Lumbar Spine Pathology Research Articles

Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology

BackgroundDue to its unique arrangement, the deep and superficial fibers of the multifidus may have differential roles for maintaining spine stabilization and lumbar posture; the superficial multifidus is responsible for lumbar extension and the deep multifidus for intersegmental stability. In patients with chronic lumbar spine pathology, muscle activation patterns have been shown to be attenuated or delayed in the deep, but not superficial, multifidus. This has been interpreted as pain differentially influencing the deep region. However, it is unclear if degenerative changes affecting the composition and function of the multifidus differs between the superficial and deep regions, an alternative explanation for these electrophysiological changes. Therefore, the goal of this study was to investigate macrostructural and microstructural differences between the superficial and deep regions of the multifidus muscle in patients with lumbar spine pathology.MethodsIn 16 patients undergoing lumbar spinal surgery for degenerative conditions, multifidus biopsies were acquired at two distinct locations: 1) the most superficial portion of muscle adjacent to the spinous process and 2) approximately 1 cm lateral to the spinous process and deeper at the spinolaminar border of the affected vertebral level. Structural features related to muscle function were histologically compared between these superficial and deep regions, including tissue composition, fat fraction, fiber cross sectional area, fiber type, regeneration, degeneration, vascularity and inflammation.ResultsNo significant differences in fat signal fraction, muscle area, fiber cross sectional area, muscle regeneration, muscle degeneration, or vascularization were found between the superficial and deep regions of the multifidus. Total collagen content between the two regions was the same. However, the superficial region of the multifidus was found to have less loose and more dense collagen than the deep region.ConclusionsThe results of our study did not support that the deep region of the multifidus is more degenerated in patients with lumbar spine pathology, as gross degenerative changes in muscle microstructure and macrostructure were the same in the superficial and deep regions of the multifidus. In these patients, the multifidus is not protected in order to maintain mobility and structural stability of the spine.

Relación de los trastornos posturales del sistema estomatognático con las patologías de la columna lumbar, en pacientes adultos del servicio de fisioterapia y rehabilitación del Hospital Militar Central de las Fuerzas Armadas

El Sistema Estomatognático es uno de los sistemas más complejos del cuerpo humano, influye de manera concreta sobre otros sistemas respetando los principios de biotensegridad, ya que este sistema y su posición influye con el centro de gravedad al punto de que el Sistema Estomatognático lo relacionamos con patologías de la columna lumbar en pacientes adultos. El diseño de la investigación fue de tipo experimental, enfoque cuantitativo. El objetivo fue “analizar la relación de los trastornos posturales del Sistema estomatognático con las patologías de la columna lumbar en pacientes adultos en el año 2019”. La muestra formada 40 pacientes adultos de ambos sexos, comprendido entre 18 a 60 años, con patologías lumbares. La fuente primaria de donde se obtuvieron los datos es un software Al Posture Evaluation and Correction Sistem APECS, versión 1.84 evaluación completa en todos los planos más en flexión. Las fichas fueron codificadas por números correlativos para salvaguardar las características personales del paciente. Cada paciente le correspondió 18 fichas con diferentes características en total se analizó 720 fichas. Se observó la diferencia de promedios de cambios biomecánicos en el plano anterior con el promedio de mejoría de 0,9° en el grupo experimental vs al -0,2° en el grupo control en el plano posterior una mejoría de cambios de 1,3 en el grupo experimental vs el 0,2 del grupo control. En el plano lateral derecho y lateral izquierdo los cambios se presentaron en aumento la angulatura después del tratamiento lo que la diferencia de los promedios de antes y después arrojo datos negativos para el plano lateral derecho de -0,81° para el grupo experimental y -1,41° grupo control. El dolor mejoro en ambos grupos, sin embargo fue más significativo en el grupo experimental.

Rate of radiographic hip OA in spine patients: utility of including femoral heads on plain film A/P lumbar radiographs.

The incidence of concomitant lumbar spine and hip pathology is common in referral patients to spine clinics. Differentiating between the two pathologies is a key component to the clinical practitioner's role. At our institution, it has become routine protocol to obtain radiographs including the femoroacetabular joints on the AP and lateral views of the lumbar spine as part of the initial workup. The purpose of this study was to determine the rates of radiographic hip pathology seen on lumbar spine imaging. We report just over 25% concomitant spine and hip pathology with 25% of patients requiring further management from a hip surgeon. The studied protocol will assist in the workup of spine patients to further differentiate the intricacies of hip- and spine-related pathology.

The effect of obesity, diabetes, and epidural steroid injection on regional volumetric bone mineral density measured by quantitative computed tomography in the lumbosacral spine.

High body mass index (BMI) is positively correlated with bone mineral density (BMD) in healthy adults; however, the effect of BMI on regional segmental BMDs in the axial skeleton is unclear. In addition, obese patients often have glucose intolerance and patients with lumbar spine pathology commonly have a history of epidural steroid injections (ESIs). The purpose of this study is to evaluate the effect of these patient factors on regional differences in BMD measured by quantitative computed tomography (QCT) in a lumbar fusion patient cohort. The data were obtained from a database comprised of clinical and preoperative CT data from 296 patients who underwent primary posterior lumbar spinal fusion from 2014 to 2017. QCT-vBMDs of L1 to L5, S1 body, and sacral alae were measured. Multivariate linear regression analyses were performed with setting vBMDs as the response variables. As explanatory variables, age, sex, race, current smoking, categorized BMI, diabetes, and ESI were chosen a priori. A total of 260 patients were included in the final analysis. Multivariate analyses demonstrated that obese and morbidly obese patients had significantly higher vBMD in the sacral alae (SA). Diabetes showed independent positive associations with vBMDs in L1, L2, and the SA. Additionally, patients with an ESI history demonstrated significantly lower vBMD in the SA. Our results demonstrate that obesity, diabetes, and epidural steroids affected vBMD differently by lumbosacral spine region. The vBMD of the SA appeared to be more sensitive to various patient factors than other lumbar regions.

Dolor sacroilíaco: Epidemiología, fisiopatología, diagnóstico y tratamiento

El dolor sacroilíaco es una causa generalmente subdiagnosticada de dolor lumbar, que afecta del 15% a 30% de los pacientes con dolor lumbar bajo crónico no radicular. La articulación sacroilíaca (ASI) recibe continuo stress durante la bipedestación y marcha, siendo estabilizada por estructuras ligamentarias, capsulares y miofasciales fuertes, que reciben una abundante inervación. Destaca la dificultad en el diagnóstico del dolor sacroilíaco; debido a su naturaleza heterogénea. éste se debe sospechar en todo paciente con síndrome de dolor lumbar no radicular, unilateral y no central. El examen físico debería descartar patología de cadera y columna lumbar. La realización de maniobras de provocación del dolor sacroilíaco aporta en el diagnóstico, teniendo la combinación de 3 o más maniobras positivas una sensibilidad de 85% y especificidad de 79%. Se ha recurrido a inyecciones diagnósticas con anestésicos locales, tanto intraarticulares como de ligamentos circundantes. El tratamiento del dolor sacroilíaco es multimodal e individualizado para cada paciente. El tratamiento conservador –basado en terapia física y antiinflamatorios no esteroidales– es la terapia de primera línea. Las infiltraciones esteroidales tanto intra como extraarticulares pueden proveer alivio en un grupo de pa-cientes con inflamación activa. La denervación de los ramos dorsales laterales con radiofrecuencia ha mostrado ser un tratamiento exitoso en pacientes con dolor sacroilíaco, logrando 6 meses a 1 año de alivio del dolor. En pacientes con dolor refractario, la fusión de la articulación sacroilíaca es una opción, prefiriéndose la técnica mínimamente invasiva de fijación trans-sacroilíaca.

P126. Psychometric evaluation of PROMIS physical function computer adaptive testing in minimally invasive lumbar spine surgery: an analysis of responsiveness, coverage, discriminant validity and concurrent validity

BACKGROUND CONTEXT While ODI has historically been the most commonly used patient-reported outcome measure for patients with lumbar spinal pathology, Patient-Reported Outcome Measurement Information System (PROMIS) is increasingly being utilized. However, there are few studies assessing the psychometric properties of PROMIS in minimally invasive (MIS) spine surgery. PURPOSE To perform a psychometric evaluation of PROMIS Physical Function Computer Adaptive Testing (PROMIS-PF CAT) in MIS lumbar surgery. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE A total of 421 patients who underwent MIS lumbar surgery. OUTCOME MEASURES Patient-reported outcome measures [Oswestry disability Index – ODI, PROMIS-PF CAT, Short Form (SF)-12]. METHODS Patient-reported outcome measure (PROMs) collected pre- and post-operatively of patients undergoing MIS lumbar surgery were retrospectively analyzed to assess responsiveness, coverage, discriminant validity and concurrent validity of PROMIS-PF CAT. Responsiveness was assessed using paired t-test, effect size (ES) and standardized response mean (SRM). Coverage was measured by assessing floor and ceiling effects. Discriminant validity was assessed pre- and post-op using independent t-test to identify difference in PROMIS-PF scores in known groups. Concurrent validity was assessed by evaluating the correlation with legacy PROMs, ODI and SF12. RESULTS Responsiveness 1. Decompression cohort: SF-12 PHS and PROMIS-PF have lower responsiveness than ODI in detecting an improvement at 2 weeks; PROMIS-PF also has lower responsiveness in detecting improvement at 1 year. 2. Fusion cohort: ODI and PROMIS-PF demonstrate equivalent responsiveness at all time-points; however, the responsiveness of SF-12 is lower than that of ODI and PROMIS-PF at all time-points. Coverage No floor effect was seen for any PROMs. ODI showed a ceiling effect (% having the best possible score: 0.5% pre-operatively; gradually increasing at 16.7% at 1-year). SF-12 PHS and PROMIS-PF did not show a ceiling effect, and clustering at higher levels was CONCLUSIONS Although PROMIS-PF showed lower responsiveness than ODI, particularly in the decompression sub-group, it demonstrated discriminant validity pre- and post-operatively, convergent validity with ODI and better coverage than ODI. These findings suggest that PROMIS-PF CAT demonstrates reasonable psychometric properties and may be a good surrogate for ODI. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Large Rises in Thoracolumbar Fusions by 2040: A Cause for Concern with an Increasingly Elderly Surgical Population

With a growing aging population in the United States, the number of operative lumbar spine pathologies continues to grow. Therefore, our objective was to estimate the future demand for lumbar spine surgery volumes for the United States to the year2040. The National/Nationwide Inpatient Sample was queried for years 2003-2015 for anterior interbody and posterior lumbar fusions (ALIF, PLF) to create national estimates of procedural volumes for those years. The average age and comorbidity burden was characterized, and Poisson modeling controlling for age and sex allowed for surgical volume prediction to 2040 in 10-year increments. Age was grouped into categories (<25, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, and >85 years), and estimates of surgical volumes for each age subgroup were created. ALIF volume is expected to increase from 46,903 to 55,528, and PLF volume is expected to increase from 248,416 to 297,994 from 2020 to 2040. For ALIF, the largest increases are expected in the 45-54 years (10,316 to 12,216) and 75-84 years (2,898 to 5,340) age groups. Similarly the largest increases in PLF will be seen in the 65-74 years (71,087 to 77,786) and 75-84 years (28,253 to 52,062) age groups. The large increases in expected volumes of ALIF and PLF could necessitate training of more spinal surgeons and an examination of projected costs. Further analyses are needed to characterize the needs of this increasingly large population of surgical patients.

Advances of Naturally Derived and Synthetic Hydrogels for Intervertebral Disk Regeneration.

Intervertebral disk (IVD) degeneration is associated with most cases of cervical and lumbar spine pathologies, amongst which chronic low back pain has become the primary cause for loss of quality-adjusted life years. Biomaterials science and tissue engineering have made significant progress in the replacement, repair and regeneration of IVD tissue, wherein hydrogel has been recognized as an ideal biomaterial to promote IVD regeneration in recent years. Aspects such as ease of use, mechanical properties, regenerative capacity, and their applicability as carriers for regenerative and anti-degenerative factors determine their suitability for IVD regeneration. This current review provides an overview of naturally derived and synthetic hydrogels that are related to their clinical applications for IVD regeneration. Although each type has its own unique advantages, it rarely becomes a standard product in truly clinical practice, and a more rational design is proposed for future use of biomaterials for IVD regeneration. This review aims to provide a starting point and inspiration for future research work on development of novel biomaterials and biotechnology.

The influence of comorbidity on the results of surgical treatment of elderly and senile patients with degenerative lumbar spinal stenosis

Objective. To analyze the influence of somatic comorbidity on the results of surgical treatment of elderly and senile patients with degenerative lumbar spinal stenosis.Material and Methods. The study design corresponds to a single-center non-randomized retrospective cohort study with level 3 evidence (OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence). The influence of somatic comorbidity on quality of life after surgery for degenerative lumbar spinal stenosis was analyzed in 962 patients 60–85 years old. Analysis and evaluation of the results of the study was carried out in two groups of patients with radicular compression syndrome: Group 1 (less than 5 points according to White – Panjabi criteria) included 625 (65%) patients, and Group 2 (5 or more points according to White – Panjabi criteria) – 337 (35%) patients.Results. Body mass index of patients in Group 1 was statistically significantly lower than in Group 2. Repeated surgical interventions performed during the first year after the primary operation were statistically significantly more frequent in Group 1, and those performed after 3–4 years were more frequent in Group 2 (BMI ≥ 30) due to the development of adjacent level disease. In obese patients, the duration of surgery, blood loss and postoperative hospital stay are statistically significantly increased. One year after surgery, a statistically significant negative effect of increase in BMI on the parameters of back pain, lower limb pain, functional adaptation, and quality of life was revealed in both groups of patients. No association of obesity and complication rates was noted. In Group 2, the incidence of adjacent level disease 2–5 years after the primary operation was higher in patients with BMI ≥ 30 compared with patients with BMI &lt; 30 and with patients in Group 1. It was found that somatic comorbidity and the age of patients statistically significantly prolonged postoperative hospital stay in Group 1 and did not affect its duration in Group 2. No effect of the comorbidity index on the quality of life was noted. Osteoporosis was statistically significantly associated with an increase in the frequency of technical complications during surgery (malposition of pedicle screws, cage migration, and damage to the vertebral endplates).Conclusion. Obesity is statistically significantly associated with an increase in postoperative hospital stay, surgery duration and blood loss, and is a predictor of the development of instability of the spinal motion segment and adjacent level disease. Obese patients have higher levels of back and lower limb pain and worse quality of life parameters after surgical interventions than patients with normal body weight. When using minimally invasive technologies in the surgical treatment of degenerative lumbar spine pathology, the number of complications in obese patients is not higher than in patients with normal body weight. The effect of comorbidity on the results of minimally invasive surgery for degenerative lumbar pathology was not detected. Osteoporosis affects the frequency of technical complications during surgery.

Comparison of Minimal Invasive Versus Biportal Endoscopic Transforaminal Lumbar Interbody Fusion for Single-level Lumbar Disease.

Study Design:Retrospective study.Objective:The authors aimed to compare the clinical outcomes of biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) with those of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) using a microscope.Summary of Background Data:Lumbar spinal fusion has been widely performed for various lumbar spinal pathologies. Minimally invasive transforaminal interbody fusion using a tubular retractor under a microscope is a method of achieving fusion while reducing soft tissue injury. Recently, several studies have reported minimally invasive techniques for lumbar discectomy, decompression, and interbody fusion using biportal endoscopic spinal surgery.Materials and Methods:This retrospective study included 87 patients who underwent single-level TLIF for degenerative or isthmic spondylolisthesis between 2015 and 2018. Thirty-two and 55 patients underwent BE-TLIF (group A) and MI-TLIF (group B), respectively. Visual Analogue Scale scores of the back and leg and Oswestry Disability Index were collected perioperatively.Further, data regarding perioperative complications, including length of hospital stay, time to ambulation, and fusion rate, were collected.Results:The Visual Analogue Scale score at 2 weeks and 2 months postoperatively was significantly lower in group A (P=0.001). All other clinical scores showed improvement with no significant difference between the 2 groups (P>0.05). The difference in the fusion rates between group A (93.7%) and group B (92.7%) were not significant (P=0.43).Conclusions:Because BE-TLIF yieldeds lesser early postoperative back pain than did MI-TLIF, it may allow early ambulation and a shorter hospitalization period. BE-TLIF may be a viable alternative to MI-TLIF in patients with degenerative or isthmic spondylolisthesis with superior clinical results in the early postoperative period.

The Value of Video Rasterstereography in the Detection of Alterations in Posture as a Marker of Pain Relief after Targeted Infiltrations of the Lumbar Spine.

Targeted infiltrations to the lumbar spine are used to identify the correct scope for surgery in patients with chronic lumbar back pain (CLBP) and multi-segmental pathologies, where radiologic imaging and clinical presentation do not match. Conclusions from that method have so far been based on individual statements of pain relief. The main principle for the infiltrations is the assumption that by locally administering an analgesic agent to possible surgical target areas, the effect of surgery can be temporarily simulated. The aim was to investigate the use of rasterstereographic posture measurements to substantiate reported pain reduction after infiltrations. In this case-control study (Level II), rasterstereography was performed on 57 patients and 28 reference subjects to evaluate changes in posture during 1 week of injections under fluoroscopic guidance and correlated with changes in the Numeric Pain Rating Scale (NRS). Statistical analysis was performed with SPSS (α = .05, two-sided) and presented in the form of box, scatter, and Bland-Altman plots. The CLBP patients' trunk inclination (median 6°) and absolute lateral tilt were significantly increased (p < .01 each) compared to the reference group. No significant difference was observed for trunk length, kyphotic/lordotic angle, or lateral deviation. During infiltration, no significant difference in posture could be observed. A subgroup analysis of patients reporting the highest pain improvement indicated no significant difference. No correlation was observed with pain improvement reported by the patients during injections. Subsequent rasterstereography does not seem to be able to verify results of injections in the diagnostics of lumbar spine pathologies, as patients' reported pain relief does not correlate with a relevant alteration in posture. The short-term effect of the targeted infiltrations may not suffice to change false posture being developed over years.

SUN-355 Associations of Trabecular Bone Score and Bone Mineral Density with Cardiorespiratory Fitness and Body Composition in Men with and Without Paraplegia

Introduction: Following spinal cord injury (SCI) lower extremity bone mineral density (BMD) losses are as high as 40% due to mechanical unloading and autonomic dysfunction. While lumbar spine (LS) BMD appears to be relatively spared, evidence suggests BMD by dual-energy radiographic absorptiometry (DXA) may overlook bone pathology in this region. Trabecular Bone Score (TBS), representative of bone microarchitecture, may be a more informative measurement of LS pathology in SCI. Our objective was to determine differences in BMD and TBS within the LS in humans with and without SCI. Correlation of fitness and body composition measures with TBS and BMD were also explored to determine their role in bone health after SCI. Methods: Seven male participants with paraplegia (level T3 – T7) were recruited through The Miami Project to Cure Paralysis, and 6 males without SCI were recruited from local advertisement. DXA scans of the lumbar spine and whole body were performed using Hologic Discovery A densitometer. TBS score (unitless) was derived from L1-L4 scans using TBS iNsight software v3.0.2. A graded arm exercise test directly measured cardiorespiratory fitness (VO2peak) for all subjects. An independent samples t-test determined between-group differences in LS BMD and TBS. Pearson correlation analysis investigated within-group relations among LS BMD, TBS and VO2peak (ml/kg/min), weight (kg), total body fat (%), and visceral adipose tissue (estimated VAT mass(g)). Results: In SCI, the mean duration of injury was 8.6 years. Mean LS BMD was not different (p=.47) between non-injured (1.10 ±0.11 g/cm2) and SCI (1.10 ±0.13 g/cm2) groups. However, mean TBS score was different (p=.053) between non-injured (1.55±0.09) and SCI (1.47±0.07) groups. In non-injured, VO2peak was correlated with LS BMD (r=.356) and TBS (r=.244). In SCI, VO2peak was correlated with LS BMD (r=.111) and TBS (r=.822). In non-injured, TBS was correlated with body mass (r=.244), total body fat (%) (r=.382), and visceral adipose tissue (r=.361). In SCI, negative correlations were observed; TBS was correlated with body mass (r= -.255), total body fat (%) (r= -.474), and visceral adipose tissue (r= -.513). LS BMD was positively correlated with body mass, total body fat (%) and visceral adipose tissue in both non-injured and SCI groups. Conclusion: Men with and without SCI displayed similar BMD but differed in TBS at the LS. Correlations with measures of fitness and body composition were similar for LS BMD but discordant for TBS between non-injured and SCI groups. The data suggest changes in the relationships between cardiorespiratory fitness, metabolism and bone quality in SCI. TBS may capture alterations in bone microarchitecture at the spine after SCI that are undetected by conventional DXA.

Cell populations and muscle fiber morphology associated with acute and chronic muscle degeneration in lumbar spine pathology.

Many chronic musculoskeletal conditions are associated with loss of muscle volume and quality, resulting in functional decline. While atrophy has long been implicated as the mechanism of muscle loss in these conditions, recent evidence has emerged demonstrating a degenerative phenotype of muscle loss consisting of disrupted muscle fiber membranes, infiltration of cells into muscle fibers, and as previously describer, possible replacement of muscle fibers by adipose tissue. Here, we use human lumbar spine pathology as a model system to provide a more comprehensive analysis of the morphological features of this mode of muscle loss between early and late stages of disease, including an analysis of the cell populations found in paraspinal muscle biopsies from humans with acute vs chronic lumbar spine pathology. Using longitudinal sections, we show that degeneration of muscle fibers is localized within a fiber (ie, focal), and is characterized by discontinuous or ragged membrane disruption, cellular infiltration, and apparently vacant space containing limited numbers of nuclei and hyper‐contractile cell debris. Samples from patients with acute and chronic pathology demonstrate similar magnitudes of muscle degeneration, however, larger proportions of PDGFRβ‐positive progenitor cells and leukocytes were observed in the acute group, with no differences in myogenic cells, macrophages, or T‐cells. By better understanding the cell population behaviors over the course of disease, therapies can be optimized to address the appropriate targets and timing of administration to minimize the functional consequences of muscle degeneration in lumbar spine pathology.

Extraspinal findings on routine lumbar spinal MR imaging: Prevalence and etiologies in 4012 patients

Aim: To investigate the prevalence and reporting rates of incidental findings (IF) in the routine magnetic resonance imaging (MRI) of the lumbar spine, and to emphasize their clinical importance. Methods: A total of 4012 lumbar MRI taken between January 2014 and December 2016 were reevaluated. The low back pain and sciatalgia those suspected for lumbar spinal pathology were chosen for this study. Extra-spinal abnormalities were classified according to a modified CT Colonography Reporting and Data System (C-RADS) and analyzed. Results The mean age of patients was 49, 83 (range 17-87) years. Of the cases, 2472 were women and 1540 were men. In 3834 cases, disk pathology was observed. In 1282 cases extraspinal pathology was detected. The largest group in the study consisted of C-RADS E2 with 1048 patients (82.5%). There were 195 patients (28.3%) in the C-RADS E3 group and 23 (1.8%) patients in the C-RADS E4 group, potentially important. Conclusion: Our results show that random extra-spinal abnormalities in the lumbar spine MRI, are very common and systematic evaluation and proper reporting of MRI are crucial.

A Novel Scale for Assessing the Burden of Caregiving for Functionally Compromised Patients: Proposal and Validation.

BackgroundDisability not only burdens the patient, but also the caregiver. To quantify this caregiving burden, we propose a simple four-part questionnaire tool. Our objective is to validate this questionnaire by administering it to caregivers who oversee patients with low back pain and are functionally compromised.MethodsTwenty-five spouse caregivers who were taking care of in-patients awaiting surgery for various lumbar spine pathologies were shortlisted. The content-validated questionnaire was administered on different occasions during the care recipient’s treatment. Cronbach’s α was calculated to assess internal consistency. Interrelationships between the care recipient’s pain score, extent of functional compromise, and caregiver burden were calculated. The questionnaire’s ability to track changes in the caregivers’ attitudes over time was assessed.ResultsThe percentage of caregiver burden before the surgery of the care recipient was 52.5. This increased significantly to 61.1% (P=0.001) 3 days after surgery, but was found to decrease to 32.5% (P<0.001) a month after the surgery; demonstrating the questionnaire’s efficacy to track changes. Cronbach’s alpha of 0.948 signifies the questionnaire’s excellent internal consistency. Pearson’s correlation coefficient (r) between the care recipient’s pain score and caregiver’s burden score was 0.41 (P=0.04), and between the care recipient’s disability score and caregiver’s burden score was 0.9 (P<0.001).ConclusionThe proposed questionnaire is consistent and can track changes in a caregiver’s attitude over time. It can be adopted for clinical use to assess the burden of caregiving for functionally compromised patients.

Considerations in spinopelvic parameters and acetabular component orientation in patients with lumbar spinal fusion following total hip arthroplasty: A retrospective study

Background: Although several authors have tried to describe the ideal acetabular component position, the influence of the spine on the orientation of the pelvis is not always considered. The aim of this study was to describe the spinopelvic behavior through body postural changes and its influence on acetabular component orientation in patients with previous spinal lumbar fusion who underwent total hip arthroplasty (THA). Methods: This is a retrospective case control study of 10 patients with previous lumbar spine fusion who underwent THA (study group) compared with 17 patients without lumbar spine pathology who underwent THA (control group). Spinopelvic parameters and acetabular component orientation were measured in each group on spinopelvic radiographs in standing and sitting positions, and dislocations were recorded. Results: From standing to sitting position, the pelvic tilt (PT) increased posteriorly, and the sacral slope (SS) decreased in both groups. However, the mean degree of change of PT was higher in the control than in the study group (−23.64 degrees vs. −12.8 degrees, P=0.017). Regarding acetabular component orientation, from standing to sitting position, the mean degree of change of the ante-inclination angle (AIA) was highest in patients in the control group as compared to the study group (−23.94 degrees vs. −13.9 degrees, P=0.017). Two study group patients and no control group patients experienced hip dislocation. Conclusions: The presence of concomitant spine disease should be considered in preoperative planning of THA because procedures such as lumbar spine fusion influence adaptability of spinopelvic parameters and acetabular component orientation in functional body position changes. Level of Evidence: Level III.

Hip-Spine Syndrome: The Diagnostic Utility of Guided Intra-articular Hip Injections.

Overlapping symptoms between hip and lumbar spine pathologies complicate diagnoses and treatments. The purpose of this study was to determine the utility of guided intra-articular hip injection in identifying the pain source in hip-spine syndrome. A search of PubMed and Cochrane databases yielded 9 studies. The mean values for sensitivity, specificity, positive predictive value, and negative predictive value of guided intra-articular hip injection were 93.6%, 95.0%, 98.8%, and 86.3%, respectively. Thus, in hip-spine syndrome, when a pain source cannot be elucidated, an ultrasound- or fluoroscopic-guided intra-articular hip injection may be a powerful and reliable diagnostic tool. [Orthopedics. 2020; 43(2):e65-e71.].

Surgical Treatment of Patients With Dual Hip and Spinal Degenerative Disease: Effect of Surgical Sequence of Spinal Fusion and Total Hip Arthroplasty on Postoperative Complications.

Retrospective study. To determine how lumbar spinal fusion-total hip arthroplasty (LSF-THA) operative sequence would affect THA outcomes. Outcomes following THA in patients with a history of lumbar spinal degenerative disease and fusion are incompletely understood. The PearlDiver Research Program (http://www.pearldiverinc.com) was used to identify patients undergoing primary THA. Patients were divided into four cohorts: 1) Primary THA without spine pathology, 2) remote LSF prior to hip pathology and THA, and patients with concurrent hip and spinal pathology that had 3) THA following LSF, and 4) THA prior to LSF. Postoperative complications and opioid use were assessed with multivariable logistic regression to determine the effect of spinal degenerative disease and operative sequence. Between 2007 and 2017, 85,595 patients underwent primary THA, of whom 93.6% had THA without lumbar spine degenerative disease, 0.7% had a history of remote LSF, and those with concurrent hip and spine pathology, 1.6% had THA prior to LSF, and 2.4% had THA following LSF. Patients with hip and lumbar spine pathology who underwent THA prior to LSF had significantly higher rates of dislocation (aOR = 2.46, P < 0.0001), infection (aOR = 2.65, P < 0.0001), revision surgery (aOR = 1.91, P < 0.0001), and postoperative opioid use at 1 month (aOR: 1.63, P < 0.001), 3 months (aOR = 1.80, P < 0.001), 6 months (aOR: 2.69, P < 0.001), and 12 months (aOR = 3.28, P < 0.001) compared with those treated with THA following LSF. Patients with degenerative hip and lumbar spine pathology who undergo THA prior to LSF have a significantly increased risk of postoperative dislocation, infection, revision surgery, and prolonged opioid use compared with THA after LSF. Surgeons should consider the surgical sequence of THA and LSF on outcomes for patients with this dual pathology. Shared decision making between patients, spine surgeons, and arthroplasty surgeons is necessary to optimize outcomes in patients with concomitant hip and spine pathology. 3.

Outcomes Following Posterior Lumbar Fusion in Patients with Polycythemia Vera

Polycythemia vera (PV) is a chronic myeloproliferative neoplasm that is associated with increased risk for venous and arterial thromboembolism. The aim of this study was to evaluate outcomes following elective posterior lumbar fusion (PLF) and/or posterior interbody fusion (PLIF) among patients with PV. Using PearlDiver retrospective national database, Medicare patients <85 years old who underwent elective primary PLF (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 81.07) and/or PLIF (ICD-9-CM code 81.08) for degenerative lumbar spine pathologies during 2006-2013 were identified. Patients included in the PLF and/or PLIF cohort were separated into patients with a prior diagnosis of PV (ICD-9-CM code 238.4) and a control cohort of patients without PV. Comparisons of postoperative outcomes were made between the PV patient group and matched control group. Significance was set at 0.05. Selected study participants included 1491 patients with PV and 29,056 patients in the matched control group. Patients with PV had a significantly increased rate of 90-day acute pulmonary embolism (1.9% vs. 1.2%, odds ratio [OR] 1.65, 95% confidence interval [CI] 1.10-2.38, P= 0.010), 90-day lower extremity deep vein thrombosis (3.4% vs. 1.9%, OR 1.81, 95% CI 1.33-2.40, P < 0.001), and 1-year diagnosis of surgical site infection (5.4% vs. 4.2%, OR 1.30, 95% CI 1.02-1.63, P= 0.027) compared with patients without PV. Nonetheless, PV was not associated with other major medical complications, including stroke, myocardial infarction, and mortality, following PLF and/or PLIF. Patients with PV undergoing elective PLF and/or PLIF have a significantly increased risk for pulmonary embolism, lower extremity deep vein thrombosis, and surgical site infection.

P67. The efficacy of advanced practice physiotherapy assessment for cervical and lumbar spine pathologies

BACKGROUND CONTEXT We developed an Advanced Practice Physiotherapist (APP) spine assessment to improve access and quality of care for patients with cervical (CER) and lumbar (LUM) spine pathologies. To date, other Canadian assessment models have been limited to lumbar pathologies only. PURPOSE We present the results of our 1-year pilot examining its efficacy and exploring any differences between cervical and lumbar presentations. STUDY DESIGN/SETTING This prospective cohort was done at a rapid access phystiotherapy triage clinic at a single quaternary referral spine center. PATIENT SAMPLE A total of 1,576 patients METHODS Two APPs underwent 3 months training from spine surgeons, based on the ISAEC program. Adaptations of CORE Cervical and Lumbar Tools were utilized for assessment. All consecutive referrals to our quaternary spine program were assessed. Wait times for all referrals (WT1), for Emergency Dept referrals (WTEmerg) and for final surgical consult (WTSurgCon) were compared to the prior 12-month historical. We prospectively recorded referral patterns and agreement between APP and surgeon, for both diagnosis and urgency. Patient satisfaction was also examined. Data is presented as mean, for the first (6M1) and second (6M2) 6 months of the pilot. RESULTS A total of 1,576 patients were seen in the 12-month pilot. 34% were CER cases. WT1 decreased from 687 to 14 days. WTEmerg decreased from 55 to 7 days. WTSurgCon decreased from 687 to 62 days. Percentage of patients referred monthly to a surgeon remained unchanged for LUM (mean 36%), but decreased for CER 30% to 11% (6M1 to 6M2). Percentage agreement for diagnosis improved for LUM from 82% to 94% (6M1 to 6M2), and for CER from 77% to 98% (6M1 to 6M2). Percentage agreement for urgency improved for LUM from 81% to 93% (6M1 to 6M2), and for CER from 74% to 96% (6M1 to 6M2). Patient satisfaction was 95% for 6M1 and 97% for 6M2. CONCLUSIONS APP assessment provides timely and appropriate triage of patients with both cervical and lumbar spine pathologies. Significant reductions are achieved for all wait times. Lumbar complaints predominate while there appears to be a learning curve to improved screening of cervical pathology. APP/surgeon agreement increases with APP experience. Patient satisfaction with the process is very high. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.