Previous Lumbar Spine Surgery Research Articles

Impact of previous lumbar spine surgery on total hip arthroplasty and vice versa: How long should we be concerned about mechanical failure?

This registry study aims to assess the prevalence and demographic characteristics of patients with lumbar spine (LS) surgical procedures who undergo total hip arthroplasty (THA), to compare the long-term survival and causes of failure of THA in patients who previously underwent LS fusion and non-fusion surgical procedures, and to evaluate the risk of undergoing a revision LS surgery after THA. Patients who underwent LS surgery followed by THA were identified by cross-referencing data from the Orthopedic Prosthetic Implants Registry and the Regional Hospital Discharge Database. Three groups of THA patients were identified: patients who underwent previous lumbar surgery with fusion (LS fusion-THA), without fusion (LS non-fusion-THA), and a control group with only THA (No LS surgery-THA). Demographic data, THA survival, number and causes of failure, and data on revision procedures on THA and LS were collected. Of the total of 79,984 THA, 2.2% of patients had a history of LS procedures. THA only patients showed better results, while patients in the LS fusion-THA group had worse implant survival at 5-year follow-up. In the LS fusion-THA and LS non-fusion-THA, mechanical THA failures were more frequent in the first two years after implantation. There were no differences between groups regarding the risk of undergoing LS revision surgery. LS surgery negatively affects THA survivorship. In patients who previously underwent LS fusion and non-fusion surgical procedures, most THA failure occurs in the first two years after implant. The study contributes to the understanding of the relationship between the hip and the LS and provides useful guidance for clinical practice.

Anesthesia practice among joint arthroplasty patients with a previous lumbar spine surgery

Study objectiveTo analyze the use of neuraxial techniques in total hip or knee arthroplasty patients who previously underwent lumbar spine surgeries. DesignRetrospective analysis of a national database. SettingU.S. hospitals. PatientsPatients undergoing a total hip or knee arthroplasty, stratified by those with a previous lumbar fusion or decompression procedure. MeasurementsOur primary outcome was the use of neuraxial anesthesia; secondary outcomes included combined complications, cardio-pulmonary complications, and prolonged length of stay. Patients with and without a history of a lumbar procedure were compared using mixed-effects regression. Main resultsAmong 758,857 THAs 8961 had a history of lumbar fusion and 8599 of decompression. Among 1,387,335 TKAs 15,827 had a history of lumbar fusion and 13,652 of decompression. History of a lumbar fusion was associated with lower odds of neuraxial anesthesia use in THA (OR: 0.74 CI: 0.70–0.79, p ≤0.0001) and TKA (OR: 0.80 CI: 0.77–0.84, p ≤0.0001). ConclusionsPrevious lumbar fusion -but not decompression- surgery is associated with lower neuraxial anesthesia in THA/TKA patients, despite its use being universally associated with decreased length of stay. More research is needed to address the importance of neuraxial techniques in patients with prior spine surgery.

Previous Lumbar Spine Surgery Decreases the Therapeutic Efficacy of Dorsal Root Ganglion Pulsed Radiofrequency in Patients with Chronic Lumbosacral Radicular Pain.

Chronic lumbosacral radicular pain (CLRP) as a possible adverse consequence of lumbar spine surgery represents a serious medical challenge. Pulsed radiofrequency of dorsal root ganglion (PRF-DRG) treatment is known to be effective in alleviating CLRP. This retrospective study compares the efficacy of a single CT-guided PRF-DRG procedure in the treatment of unilateral CLRP between patients without (non-PSS) and with (PSS) previous lumbar spine surgery. Non-PSS and PSS groups included 30 and 20 patients, respectively. Outcomes (pain intensity and disability) were evaluated by means of the visual analog scale (VAS) and Oswestry disability index (ODI) immediately after the procedure (VAS), as well as three and six months after the procedure, respectively. Non-PSS group showed a significant (p ˂ 0.001) decrease of VAS (median) at all follow-up intervals (from 6 to 4; 4; 4.5 points, respectively). The PSS group showed a significant yet transient VAS (median) decrease (from 6 to 5 points) immediately after the procedure only (p < 0.001). The decrease of VAS was more pronounced in the non-PSS group after three and six months (p = 0.0054 and 0.011, respectively) in intergroup comparison. A relative decrease of VAS ≥ 50% during follow-up was achieved in 40%; 43.3%; 26.7% (non-PSS), and 25%; 5%; 0% (PSS) of patients. ODI (median) significantly decreased in the non-PSS group (from 21.5 to 18 points) at three and six months (p = 0.014 and 0.021, respectively). In conclusion, previous lumbar spine surgery decreases the therapeutic efficacy of PRF-DRG procedure in CLRP patients.

Impact of previous lumbar spine surgery on the outcome of lumbar total disc replacement: analysis of prospective 5-year follow-up study data.

It is sometimes anticipated that patients with prior spine surgery will have a compromised outcome from future procedures. The purpose of this study was to compare TDR outcomes in patients with prior lumbar spine surgery to those with no previous surgery. Post hoc analysis was performed on 5-year follow-up data collected prospectively in the multi-centre FDA-regulated trial for the activL® Artificial Disc which involved 376 patients treated for single-level symptomatic disc degeneration. Clinical outcome measures included the Oswestry Disability Index (ODI), visual analog scales (VAS) assessing back and leg pain, SF-36, adverse events, and re-operations. Radiographic outcomes included flexion/extension range of motion (ROM) and translation of the operated segment. Patients were divided into two groups: Prior Lumbar Surgery (PLS, n = 92) and No Prior Lumbar Surgery (NPLS, n = 284). Baseline demographics were similar in the two groups. ODI, VAS, and SF-36 Physical Component Scale scores improved significantly (p < 0.05) from baseline in both groups with improvements maintained through 5-year post-TDR with no significant differences between groups. There were no statistically significant differences in rates of serious device-related events, procedure-related events, or re-operations. While ROM was significantly less prior to TDR surgery in the PLS group, there was no significant difference in ROM at post-operative points. Prior lumbar spine surgery was not associated with compromised outcomes following TDR. These results are in line with reports from earlier studies with shorter follow-up, finding that non-destabilizing prior surgery is not a contra-indication for TDR provided that selection criteria are met. Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

MRI changes of adjacent segments after transforaminal lumbar interbody fusion (TLIF) and foraminal endoscopy: A case-control study.

Background:Intervertebral foramen endoscopy has developed rapidly, but compared with transforaminal lumbar interbody fusion (TLIF), the progress of degeneration is unknown. We aim to compare the changes of intervertebral disc and intervertebral foramen in adjacent segments after TLIF and endoscopic discectomy for patients with lumbar disc herniation (LDH).Methods:From 2014 to 2017, 87 patients who were diagnosed with single-level LDH and received surgery of TLIF (group T, n = 43) or endoscopic discectomy (group F, n = 44) were retrospectively analyzed. X-ray, MRI, CT and clinical symptoms were recorded before operation and at the last follow-up (FU). The neurological function was originally evaluated by the Japanese Orthopaedic Association (JOA) scores. Radiological evaluation included the height of intervertebral space (HIS), intervertebral foramen height (FH), intervertebral foramen area (FA), lumbar lordosis (CA) and intervertebral disc degeneration Pfirrmann scores.Results:There was no significant difference in baseline characteristics, JOA improvement rate, reoperation rate and complications between the two groups. The age, average blood loss, average hospital stays and average operation time in group F were lower than those in group T. During the last FU, HIS, CA and FA decreased in both groups, and the changes in group T were more significant than those in group F (P < .05). There was no significant difference in FH changes between the two groups (P > .05).Conclusion:Both TLIF and endoscopic surgery can achieve good results in the treatment of LDH, but the risk of lumbar disc height loss and intervertebral foramina reduction in the adjacent segment after endoscopic surgery is lower.

PO144 / #813 EFFICACY & SAFETY OF THE LINQ PROCEDURE: A MULTI-CENTER RETROSPECTIVE ANALYSIS: E-POSTER VIEWING

Sacroiliac joint pain (SIJ) is a common cause of low back pain, a problem experienced by 2/3 of the United States population over time. While the SIJ can account for 60% of low back pain, that number can be higher in patients who have undergone previous lumbar spinal surgery. Traditionally, the management of persistent SIJ related pathology has involved conservative therapies (physical therapy, topical medications, oral anti-inflammatory medication), interventional therapy (SIJ injection) and surgeries (open and lateral approach).

Is radiographic lumbar spinal stenosis associated with the quality of life?: The Wakayama Spine Study.

This prospective study aimed to determine the association between radiographic lumbar spinal stenosis (LSS) and the quality of life (QOL) in the general Japanese population. The severity of radiographic LSS was qualitatively graded on axial magnetic resonance images as follows: no stenosis, mild stenosis with ≤1/3 narrowing, moderate stenosis with a narrowing between 1/3 and 2/3, and severe stenosis with > 2/3 narrowing. Patients less than 40 years of age and those who had undergone previous lumbar spine surgery were excluded from the study. The Oswestry Disability Index (ODI), which includes 10 sections, was used to assess the QOL. One-way analysis of variance was performed to determine the statistical relationship between radiographic LSS and ODI. Further, logistic regression analysis adjusted for gender, age, and body mass index was performed to detect the relationship. Complete data were available for 907 patients (300 men and 607 women; mean age, 67.3±12.4 years). The prevalence of severe, moderate, and non-mild/non-radiographic were 30%, 48%, and 22%, respectively. In addition, the mean values of ODI in each group were 12.9%, 13.1%, and 11.7%, respectively, and there was no statistically significant difference between the three groups in logistic analysis (P = 0.55). In addition, no significant differences in any section of the ODI were observed among the groups. However, severe radiographic LSS was associated with low back pain in the "severe" group as determined by logistic analysis adjusted for gender, age, and body mass index (odds ratio: 1.53, confidence interval: 1.13-2.07) compared with the non-severe group. In this general population study, severe radiographic LSS was associated with low back pain (LBP), but did not affect ODI.

Efficacy of Minimally Invasive Trans-Sacral Canal Plasty between Patients with and without Failed Back Surgery Syndrome.

Background and Objectives: Clinicians are required to manage a growing number of elderly patients with several medical comorbidities, and invasive surgical treatments are sometimes not advisable for these patients. The aim of this study was to evaluate the efficacy of minimally invasive intraspinal canal treatment, trans-sacral canal plasty (TSCP), for patients with and without failed back surgery syndrome (FBSS). Materials and Methods: A multicenter analysis was conducted. TSCP was performed in patients with chronic low back pain and leg pain due to lumbar spinal disorders. An adhesiolysis by TSCP was carried out, then a mixture of steroid and local anesthesia was injected. Visual Analog Scales (VAS) for low back pain and leg pain, and complications were evaluated. Results: A total of 271 patients with a minimum 6-month follow-up were enrolled. There were 80 patients who had a history of previous lumbar spinal surgery (F group), and 191 patients without previous lumbar spinal surgery (N group). There were no significant differences in sex and age between the two groups. VAS scores for low back pain (N group/F group) preoperatively, immediately postoperatively, and 1 month, 3 months and 6 months postoperatively, were 51/52 mm, 24/26 mm, 33/34 mm, 30/36 mm, and 30/36 mm, respectively. VAS scores for leg pain were 69/67 mm, 28/27 mm, 39/41 mm, 36/43 mm, and 32/40 mm, respectively. Both VAS scores for low back pain and leg pain were significantly decreased from baseline to final follow-up in both groups (p < 0.01). However, VAS scores for leg pain at 3 months and 6 months postoperatively were significantly higher in F group (p < 0.05). There were three catheter breakages (2/3 in F group), and one dural tear in F group. Conclusions: TSCP significantly reduced both VAS scores for low back and leg pain in patients with and without FBSS. However, co-existence of intractable epidural adhesion might be associated with less improvement in FBSS.

Development and internal validation of machine learning algorithms to predict patient satisfaction after total hip arthroplasty

BackgroundPatient satisfaction is a unique and important measure of success after total hip arthroplasty (THA). Our study aimed to evaluate the use of machine learning (ML) algorithms to predict patient satisfaction after THA.MethodsProspectively collected data of 1508 primary THAs performed between 2006 and 2018 were extracted from our joint replacement registry and split into training (80%) and test (20%) sets. Supervised ML algorithms (Random Forest, Extreme Gradient Boosting, Support Vector Machines, Logistic LASSO) were developed with the training set, using patient demographics, comorbidities and preoperative patient reported outcome measures (PROMs) (Short Form-36 [SF-36], physical component summary [PCS] and mental component summary [MCS], Western Ontario and McMaster’s Universities Osteoarthritis Index [WOMAC] and Oxford Hip Score [OHS]) to predict patient satisfaction at 2 years postoperatively. Predictive performance was evaluated using the independent test set.ResultsPreoperative models demonstrated fair discriminative ability in predicting patient satisfaction, with the LASSO model achieving a maximum AUC of 0.76. Permutation importance revealed that the most important predictors of dissatisfaction were (1) patient’s age, (2) preoperative WOMAC, (3) number of comorbidities, (4) preoperative MCS, (5) previous lumbar spine surgery, and (6) low BMI (< 18.5).ConclusionMachine learning algorithms demonstrated fair discriminative ability in predicting patient satisfaction after THA. We have identified modifiable and non-modifiable predictors of postoperative satisfaction which could enhance preoperative counselling and improve health optimization prior to THA.

Use of Higher-strength Opioids has a Dose-Dependent Association With Reoperations After Lumbar Decompression and Interbody Fusion Surgery.

A retrospective cohort study. The aim of this study was to identify an association between preoperative opioid use and reoperations rates. Chronic opioid use is a public health crisis in the United States and has been linked to worse outcomes after lumbar spine surgery. However, no studies have identified an association between preoperative opioid use and reoperations rates. A retrospective cohort study was conducted using patients from one private insurance database who underwent primary lumbar decompression/discectomy (LDD) or posterior/transforaminal lumbar interbody fusion (PLIF/TLIF). Preoperative use of five specific opioid medications (tramadol, hydromorphone, oxycodone, hydromorphone, and extended-release oxycodone) was categorized as acute (within 3 months), subacute (acute use and use between 3 and 6 months), or chronic (subacute use and use before 6 months). Multivariate regression, controlling for multilevel surgery, age, sex, and Charlson Comorbidity Index, was used to determine the association of each medication on reoperations within 5 years. A total of 11,551 patients undergoing LDD and 3291 patients undergoing PLIF/TLIF without previous lumbar spine surgery were identified. In the LDD group, opioid-naïve patients had a 5-year reoperation rate of 2.8%, compared with 25.0% and 8.0 with chronic preoperative use of hydromorphone and oxycodone, respectively. In multivariate analysis, any preoperative use of oxycodone was associated with increased reoperations (odds ratios [OR] = 1.4, 2.0, and 2.3, for acute, subacute, and chronic use; P < 0.01). Chronic use of hydromorphone was also associated with increased reoperations (OR = 7.5, P < 0.01).In the PLIF/TLIF group, opioid-naïve patients had a 5-year reoperation rate of 11.3%, compared with 66.7% and 16.8% with chronic preoperative use of hydromorphone and oxycodone, respectively. In multivariate analysis, any preoperative use of hydromorphone was associated with increased reoperations (OR = 2.9, 4.0, and 14.0, for acute, subacute, and chronic use; P < 0.05). Preoperative use of the higher-potency opioid medications is associated with increased reoperations after LDD and PLIF/TLIF in a dose-dependent manner. Surgeons should use this data for preoperative opioid cessation counseling and individualized risk stratification.Level of Evidence: 3.

Functional outcomes and 8-year survival after hip arthroscopy in patients with degenerative hip disease

Background and purposeThe purpose of this study is to identify which variables may have a significant impact in mid-term survivorship following hip arthroscopy. MethodsThis a single-centre single-surgeon retrospective study including 102 patients who underwent a hip arthroscopy procedure between August 2007 and October 2011.Each subject completed three questionnaires at final follow- up: “Hip "Outcome Score-Activities of Daily Living" (HOS-ADL), "Hip Outcome Score-Sport" (HOS-S) and " Modified Harris Hip Score “(m-HHS). ResultsThirty-nine patients (40 hips) were finally included in our study. Mean age was 43.1 ± 9.9 years with a three-year minimum follow-up (75.43 ± 25.2 months).Younger patients and those with a shorter duration of symptoms obtained significantly higher HOS-S and m-HSS scores. Patients who had undergone previous lumbar spinal surgery obtained significantly worse HOS-ADL scores.Patient acceptable symptom state (PASS) was achieved in 23 patients (57.5%) for m-HHS, 22 patients (55%) for HOS-ADL and 25 patients for HOS-S scores.No major complication was observed. Only four patients had minor complications.Mean survival time was 97.1 months (95% CI, 85.1–109.1 months), with a survival at 8 years of 69% (95% CI, 53%–85%). ConclusionsOur findings suggest that hip arthroscopy is a safe procedure with acceptable functional outcomes after a long follow-up. Care should be taken when treating patients with prior lumbar surgery. Level of evidenceLevel IV. Case series.

Resultados funcionales y supervivencia a ocho años de la artroscopia de cadera en pacientes con patología degenerativa de cadera

Background and purposeThe purpose of this study is to identify which variables may have a significant impact in mid-term survivorship following hip arthroscopy. MethodsThis a single-centre single-surgeon retrospective study including 102 patients who underwent a hip arthroscopy procedure between August 2007 and October 2011.Each subject completed three questionnaires at final follow- up: Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport (HOS-S) and Modified Harris Hip Score (m-HHS). ResultsThirty-nine patients (40 hips) were finally included in our study. Mean age was 43.1 ± 9.9 years with a three-year minimum follow-up (75.43 ± 25.2 months).Younger patients and those with a shorter duration of symptoms obtained significantly higher HOS-S and m-HSS scores. Patients who had undergone previous lumbar spinal surgery obtained significantly worse HOS-ADL scores.Patient acceptable symptom state (PASS) was achieved in 23 patients (57.5%) for m-HHS, 22 patients (55%) for HOS-ADL and 25 patients for HOS-S scores.No major complication was observed. Only four patients had minor complications.Mean survival time was 97.1 months (95% CI, 85.1 to 109.1 months), with a survival at 8 years of 69% (95% CI, 53% to 85%). ConclusionsOur findings suggest that hip arthroscopy is a safe procedure with acceptable functional outcomes after a long follow-up. Care should be taken when treating patients with prior lumbar surgery. Level of evidenceLevel IV. Case series.

Clinicopathologic Features of Thoracolumbar Interdural Disc Herniations: A Retrospective Case Series with a Systematic Literature Review

Transdural disc herniations represent about 0.3% of all herniated discs. Preoperative imaging rarely demonstrates this condition. Therefore, diagnosis of transdural disc herniation is usually made intraoperatively. We describe the clinicopathologic features of extremely rare cases of thoracic and lumbar interdural disc herniations mimicking spinal intradural en plaque tumors. This is a retrospective case series with a systematic literature review. Clinical presentation, imaging, differential diagnosis, intraoperative microsurgical findings, and possible pathogenesis were reviewed according to published guidelines. All patients underwent a posterior approach for microsurgical excision of disc herniation, but no epidural lesion was found. At intradural exploration, a tumor-like en plaque lesion was discovered. The surface of the lesion was incised, and multiple friable, cartilaginous white-yellow fragments were removed to achieve complete intralesional excision. The postoperative course was characterized by progressive neurologic improvement in all cases. In peculiar anatomic (adhesions between the anulus fibrosus, posterior longitudinal ligament, and ventral surface of dura mater) and pathologic (calcified giant disc herniation, spinal canal stenosis, previous lumbar spine surgery) conditions, penetration of disc fragment in the thickness of spinal dura mater can occur. Interdural disc herniations constitute a rare pathologic condition characterized by the migration of the herniated disc in neither the epidural nor the subdural spinal space, but rather in the thickness of the spinal dura mater. Further advances are necessary in neuroradiologic investigations to achieve a correct preoperative diagnosis, which is essential, as spine surgeons must be aware of these rare pathologies.

217. Impact of previous lumbar spine surgery on outcome of lumbar total disc replacement: analysis of prospective five-year follow up study data

BACKGROUND CONTEXT FDA-regulated prospective trials evaluating lumbar total disc replacement (LTDR) have included patients with previous lumbar surgeries. Unitedhealth care, one of the largest insurers in the United States recently issued a positive coverage policy for LTDR that disqualifies patients with previous lumbar surgeries of any kind from treatment with LTDR. However, such patients were included in FDA IDE trials that led to approval of these devices. PURPOSE The purpose of this study was to compare LTDR outcomes in patients with prior lumbar spine surgery to outcomes in those without prior surgery. STUDY DESIGN/SETTING The study was a post hoc analysis of data collected prospectively as part of an FDA-regulated trial with 5-year follow-up. PATIENT SAMPLE The study was based on 376 patients from the activL® IDE study population. All patients were treated for single-level symptomatic degenerative disc disease at L4-L5 or L5-S1 unresponsive to at least 6 months of nonoperative care. OUTCOME MEASURES Clinical outcome measures used in the study included Oswestry Disability Index (ODI), Visual analog scales (VAS) assessing back and leg pain, SF-36, adverse events and reoperations. Radiographic outcome evaluations were based on flexion/extension range of motion (ROM) and translation of the operated segment. METHODS Patients were divided into two groups: prior lumbar surgery (PLS, n=92) and no prior lumbar surgery (NPLS, n=284). PLS patients had undergone one or more of the following procedures: intradiscal electrothermal annuloplasty (IDET) (n=5), percutaneous nucleoplasty (n=4), microdiscectomy (n=81), hemilaminectomy (n=17), laminotomy (n=36) or other (n=1) prior to receiving a LTDR. Patients with prior lumbar fusion were excluded from the IDE study. Baseline characteristics, functional and pain outcomes, serious adverse events and reoperations were statistically compared between the groups preoperatively and postoperatively at 6 weeks, 3 and 6 months and 1, 2, 3, 4 and 5 years. RESULTS Patient baseline demographics were very similar between the two groups. When comparing pre- to postoperative scores, ODI, VAS back pain and leg pain and the SF-36 Physical Component Score improved significantly (p CONCLUSIONS Prior lumbar spine surgery was not related to compromised outcomes among patients undergoing LTDR. There were no statistically significant differences in ODI, SF-36, pain scores or safety rates between PLS and NPLS patients. These results are in line with findings from earlier studies that prior surgery is not a contraindication for LTDR provided that other selection criteria are met. These results do not support the denial by an insurer to give patients and providers the option of receiving LTDR for DDD unresponsive to nonoperative care as described in the FDA approved device usage labeling. FDA DEVICE/DRUG STATUS activL (Approved for this indication), ProDisc-L (Approved for this indication), Charite (Approved for this indication)

A history of spine surgery predicts a poor outcome after hip arthroscopy.

This study compared patient reported outcomes scores (PROMs) between patients undergoing hip arthroscopy who have and have not had previous lumbar spine surgery. We aimed to determine if prior spine surgery impacts the outcome of hip arthroscopy. Data were prospectively collected and retrospectively reviewed in patients who underwent hip arthroscopy between 2010 and 2017. Twenty cases were identified for analysis and matched to a control group. Four PROMs were collected pre-operatively and between 6 months and 2 years post-operatively (mean 16.2 months): Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports (HOS-Sports) and the 33-item International Hip Outcome Tool (iHOT-33). Patients with previous spine surgery reported significantly worse (P-value <0.001) post-operative scores on all PROMs and smaller net changes on all PROMs with the difference on the mHHS (P-value 0.007), HOS-Sport (P-value 0.009) and iHOT-33 (P-value 0.007) being significant. Subsequent analyses revealed that the type of spine surgery matters. Patients with a spine fusion reported worse post-operative scores on all PROMs compared with patients with a spine decompression surgery with the difference on the mHHS (P-value 0.001), HOS-ADL (P-value 0.011) and HOS-Sport (P-value 0.035) being significant. Overall, patients with prior decompression surgery experienced considerable improvements from hip arthroscopy whereas patients with a prior spine fusion reported poor post-operative outcomes. Given these results, it is vital that hip preservation surgeons understand the impact of the lumbar spine on the outcome of hip arthroscopy.

Outcomes of Hip Arthroscopy in Patients With Previous Lumbar Spine Surgery: A Matched-Pair Controlled Comparative Study With Minimum Two-Year Follow-Up

The purpose of this study was to conduct a matched-pair analysis to determine the effect of prior lumbar spine surgery (LSS) on clinical outcomes of hip arthroscopy. Data were prospectively collected on all patients undergoing hip arthroscopy during the study period from April 2008 to December 2012. Patients were excluded if they had previous hip conditions or had undergone prior hip surgery. Patients in the LSS group (history of LSS) were matched in a 1:1 ratio to a control group (no history of LSS) according to age ±5years, gender, body mass index categories, Tönnis grade, and labral treatment. The following outcomes were recorded in each group: modified Harris Hip Score, Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale, Hip Outcome Score-Activities of Daily Living, and visual analogue scale (VAS) score for pain, patient satisfaction, and rates for revision hip arthroscopies and conversion to total hip arthroplasty (THA). During the study period, 1,405 hip arthroscopies were performed with 1,017 eligible for matching. A total of 873 (85.8%) patients had a minimum 2-year follow-up. Fifty-seven patients were matched in each group. Both groups demonstrated significant improvement in patient-reported outcome (PRO) and VAS scores. The LSS group had a lower mean for all preoperative PRO scores. There was no significant difference for the postoperative mean PRO score and change in the PRO score compared with the control group except for NAHS. The mean change in the NAHS demonstrated a greater magnitude of improvement in the LSS group. There was no significant difference between mean VAS scores, patient satisfaction, and rates for revision arthroscopy and conversion to THA between the groups. Prior LSS does not adversely affect outcomes of hip arthroscopy at a minimum 2-year follow-up. These patients have lower preoperative scores but similar magnitude of improvement and revision/THA rates compared with a matched comparative group of patients without prior LSS. Level II, retrospective analysis of prospectively collected data.

Clinical experiences with a PEEK-based dynamic instrumentation device in lumbar spinal surgery: 2\xa0years and no more

BackgroundDynamic spine implants were developed to prevent adjacent segment degeneration (ASD) and adjacent segment disease (ASDi). Purpose of this study was to investigate the clinical and radiological outcomes of “topping off” devices following lumbar spinal fusion procedure using a PEEK-based dynamic rod system. Moreover, this study focused on the hypothesis that “topping off” devices can prevent ASD.MethodsThis prospective nonrandomized study included patients with indication for single-level lumbar fusion and radiological signs of ASD without instability. The exclusion criteria were previous lumbar spine surgery and no sign of disc degeneration in the adjacent segment according to magnetic resonance imaging. All patients were treated with single-level lumbar interbody fusion and dynamic stabilization of the cranial adjacent segment. Patients underwent a clinical examination and radiographs preoperatively and at 1 and 2 years after surgery. Analyses were performed on clinical data collected with the German Spine Registry using the core outcome measure index (COMI) and visual analogue scale (VAS) scores for back and leg pain.ResultsA total of 22 patients (6 male and 16 female) with an average age of 57.6 years were included in the study; 20 patients completed the follow-up (FU). The average COMI score was 9.0 preoperatively, 4.2 at the 1-year FU, and 4.7 at the 2-year FU. The average preoperative VAS scores for back and leg pain were 7.7 and 7.1, respectively. At the 1-year FU, the scores were 4.25 for back pain and 2.2 for leg pain, and at the 2-year FU, the scores were 4.7 for back pain and 2.3 for leg pain. At FU, failure of the dynamic topping off implant material was verified in four cases, and ASD of the segment cranial to the topping off was confirmed in three cases.ConclusionsThese results demonstrate significant improvements in clinical outcomes and pain reduction after lumbar spinal fusion with topping off at 2 years after surgery. However, the implant failed due to the high rate of implant failure and the development of ASD in the segment cranial to the dynamic stabilized segment.

Wednesday, September 26, 2018 10:35 AM – 12:00 PM Understanding Lumbar Stenosis/Spondylolisthesis: 9. The relationship between spinopelvic parameters and baseline pain, function or health related quality of life in degenerative lumbar spondylolisthesis

BACKGROUND CONTEXT The importance of sagittal balance and spinopelvic parameters are recognized in the management and outcomes of adult spinal deformity and isthmic spondylolisthesis, but less is known regarding their role in degenerative lumbar spondylolisthesis (DLS). The purpose of this study is to determine the influence of baseline sagittal balance and spinopelvic parameters on pain, function, and health-related quality of life (HRQOL) of patients presenting with DLS. PURPOSE The purpose of this study is to determine the influence of baseline sagittal balance and spinopelvic parameters on pain, function, and health-related quality of life (HRQOL) of patients presenting with DLS. STUDY DESIGN/SETTING Prospective, multi-center study from the Canadian Spine Outcome and Research Network (CSORN). PATIENT SAMPLE Patients with DLS were enrolled in a prospective, multi-center study between 2015 and 2017. Inclusion into this study required DLS at 1 or 2 levels and symptoms of neurogenic claudication or radicular pain with our without back pain. Patients were excluded if they had previous lumbar spine surgery or the presence of another condition which significantly affected function OUTCOME MEASURES Patient-rated outcome measures included the Numeric Pain Rating Scale (NPRS) for back pain and leg pain, Oswestry Disability Index (ODI), SF-12 Physical Component Summary score (PCS) and Mental Component Summary score (MCS), EQ-5D. Pelvic parameter measurements included: sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), sagittal vertical axis (SVA), lumbar lurdosis (LL), thoracic kyphosis (TK), T1 spino-pelvic inclination (T1 SPI), and T9 spino-pelvic inclination (T9 SPI). METHODS Baseline patient demographics, radiographic spinopelvic parameters, and sagittal alignment were analyzed for possible correlation to HRQOL using Pearson correlations. RESULTS A total of 154 patients were analyzed (mean age: 65.8, BMI: 29.1) with grade I (72%) or II (28%) DLS, of which 95 were females. Primary symptoms were related to neurogenic claudication (80%), radiculopathy (15.3%) or back pain (4.7%). On average, symptom duration was greater than 2 years in 71% of patients. Patients had moderate to severe symptoms and disability (mean NRS back: 7.2, NRS leg: 7.3, ODI: 45.6, PCS-12: 33.2, MCS-12: 49.6, EQ-5D: 0.54). Baseline measurements of radiographic alignment included sacral slope (SS=34.9±16.7°), pelvic tilt (PT=24.8±9.5°), pelvic incidence (PI=57.4±13.8°), sagittal vertical axis (SVA=35.8±40.8mm), lumbar lordosis (LL=45.7±13.6°), thoracic kyphosis (TK=36.8±13.0°), T9-spinopelvic inclination (T9SPI=9.62±4.0°), and T1-spinopelvic inclination (T1SPI=4.43±10.4°). There were 54% of patients who had an insufficient lumbar lordosis based on the relationship between PI and LL (LL CONCLUSIONS Patients with DLS have global sagittal misalignment compared to published normative controls, highlighted by less lumbar lordosis, a PI to LL mismatch, and increased PT. Spinopelvic alignment was not associated with patient outcomes, although positive sagittal balance may also be influenced by spinal stenosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Optimum pelvic incidence minus lumbar lordosis value after operation for patients with adult degenerative scoliosis

Background ContextSchwab classification for adult degenerative scoliosis (ADS) concluded that health-related quality of life was closely related to curve type and three sagittal modifiers. It was suggested that pelvic incidence minus lumbar lordosis value (PI-LL) should be corrected within −10°~+10°. However, recent studies also indicated that ideal clinical outcomes could also be achieved in patients without the ideal PI-LL mentioned above. PurposeThis study evaluated the relation between the clinical outcomes and the PI-LL of Chinese patients with ADS who received long posterior internal fixation and fusion. Study DesignThis was a single-center retrospective comparative study of patients treated by long posterior internal fixation and fusion in our hospital between 2010 and 2014. Patient SampleInclusion criteria were age >45 years at the time of surgery, Cobb angle of lumbar curves ≥10°, long posterior internal fixation and fusion ≥least 3 motion segments, follow-up ≥2 years, complete preoperative and postoperative radiographic data, and functional evaluation results. Exclusion criteria were history of previous lumbar spine surgery, other kinds of scoliosis, history of severe spinal trauma, spinal tumor, ankylosing spondylitis, and spinal tuberculosis. Seventy-four patients were enrolled in this study. Outcome MeasuresOperative parameters included intraoperative blood loss, duration of surgery, length of hospital stay, number of fusion levels, and decompression. The radiological measurements included Cobb angle of the curves and PI-LL. Clinical outcomes were evaluated by the Japanese Orthopaedic Association score, Oswestry Disability Index (ODI), visual analog scale, and Lumbar Stiffness Disability Index (LSDI). In addition, the complications of surgery were also collected. One-way analysis of variance, Student t test, Kruskal-Wallis test, Pearson chi-square test, and curve estimation were calculated for variables. MethodsAll the patients were divided into Group 1 (long instrumentation and fusion to L5) and Group 2 (long instrumentation and fusion to S1). Operative parameters, radiological measurements, clinical outcomes, and complications of surgery were compared between two groups to confirm whether distal fusion level could influence therapeutic effect. Then patients were divided into PI-LL<10° (Group A), 10°≤PI-LL≤20° (Group B), PI-LL>20° (Group C). Operative parameters, radiological measurements, clinical outcomes, and complications of surgery were compared between each of the two groups. Curve estimation was performed to evaluate the relationship between postoperative PI-LL and clinical outcomes. ResultsNo difference was found between Group 1 and Group 2 in all postoperative parameters (p>.05). There were significant differences in final ODI (p<.001) and final LSDI (p<.001) among Group A, Group B, and Group C. Cubic curve model fitted the relationship between PI-LL and final ODI better than other models (R2=0.379, p<.001). Cubic curve model fitted the relationship between PI-LL and final LSDI better than other models (R2=0.691, p<.001). There was a significant difference in proximal junctional kyphosis (PJK) among groups (p=.038). No significant difference was found in other parameters. ConclusionsOptimal PI-LL value may be achieved between 10° and 20° in Chinese patients with ADS after long posterior instrumentation and fusion surgery with excellent clinical outcomes and a lower PJK occurrence.

How Lumbar Disc Geometrics Affect the Risk for Rod Fracture in Patients Undergoing Adult Spinal Deformity Surgery: An Initial Report

IntroductionRod fracture (RF) may have significant consequences for patients, including pain, loss of deformity correction, and the need for revision surgery. Risk factors associated with RF includes age, previous spine surgery, insufficient sagittal plane correction, rod material and bending, and pedicle subtraction osteotomy (PSO). Lumbar disc geometrics, regardless of PSO, may be a risk factor affecting RF rates. Out Objective is to evaluate disc geometrics as a risk factor for RF in patients undergoing surgical correction for adult spinal deformity (ASD).Materials/Methods: A retrospective review of a single surgeon's practice from 2010 to 2014 was performed. All patients who underwent long fusion constructs for adult deformity with a minimum of 2-year follow-up with radiographs were included. Patients were divided into 2 Groups: Group 1 (RF) - patients who sustained a rod fracture, Group 2 - patients without RF. ResultsThirty-seven of 41 patients met inclusion criteria. Group 1 - included 11 patients (30%) with RF, all requiring revision surgery. Group 2 - included 26 patients (70%) who did not have evidence of RF at 2-year follow-up. There was no significant difference between the 2 Groups regarding age, weight, construct length (12 versus 11 levels), apical lordosis level (L3), pre or post-operative lumbar lordosis, or mean number of non-fused lumbar discs (3). Twenty-one of the 37 patients (54%) had a PSO performed. There was no difference in the prevalence of PSO between the 2 Groups: 5/11 patients (45%) in Group 1 (RF) versus 17/26 patients (65%) in Group 2. Nineteen of the 37 patients (51%) had previous lumbar spinal surgery. Measurements comparing intervertebral disc geometry 2 levels immediately cranial and caudal to the PSO or the apical lumbar vertebra were noted to have a significant difference in the mean cranial disc height (9.5mm versus 6.5mm, p < 0.01), mean cranial diameter (40mm versus 34mm, p < 0.01), mean cranial volume (13284mm3 versus 8145mm3, p < 0.01), and mean caudal volume (10635mm3 versus 7771mm3, p = 0.02). Caudal disc heights and diameters were larger in the RF group, but did not reach statistical significance. ConclusionsThe overall prevalence of RF was 27% with no difference in PSO rate between the 2 Groups. Patients with RF had significantly larger non-fused disc heights, diameters and volumes. The increased disc geometrics may allow for increased micro-motion in the anterior column resulting in increased failure rates. Lumbar interbody support in those discs at risk may improve stability and decrease RF rates. Further data analysis and clinical correlation is required.