Faculty Bibliography

BACKGROUND CONTEXT: The International Spine Study Group (ISSG) and the European Spine Study Group (ESSG) developed an adult spinal deformity (ASD) specific risk calculator based on the largest and most granular, prospective ASD database. The calculators utilize preoperative radiographic, surgical, and patient-specific variables in order to predict patient-reported outcomes and complication rates at 2 years. PURPOSE: Assess the ISSG-ESSG risk calculator usability in a single institution ASD population. STUDY DESIGN/SETTING: Retrospective cohort study- single surgeon institution. PATIENT SAMPLE: ASD pts: A total of 631 patients undergoing surgery for adult spinal deformity. OUTCOME MEASURES: Improvement from BL SRS-22 [Pain, Function, total], major complications, Oswestry Disability Index (ODI).
METHOD(S): ASD pts were isolated in the single-center ASD Database 2013-2020. Frail pts were isolated (Frail[F] 0.3>0.5). Basic demographics were assessed for these F pts via chi-squared and t-tests. Each F patient was inputted into the ESSG risk calculator to identify individual predictive rates for postoperative 2-year HRQL outcomes as well as major complications. These calculated predicted outcomes were analyzed against those identified from the ASD database in order to validate the calculator predictability in a single center institution via Brier scores. Having a score closer to 1 means the EESG calculator is not predictive of that specific outcome. A score closer to 0 meant the EESG calculator was a predictive tool for that factor.
RESULT(S): A total of 631 ASD pts were isolated (55.8;16.8yrs, 26.68kg/m², 0.95+/-1.3CCI). Of these patients, 7.8% were frail. Fifty percent of frail pts received an interbody fusion, 58.3% received a decompression, and 79.2% had an osteotomy. Surgical details: mean operative time 342.9+/-94.3minutes, mean estimated blood loss 2131.82+/-1011mL, and an average length of stay 7.12+/-2.5days. The EESG calculator predicted the likelihood of improvement for the following HRQL's ODI(86%), SRS-22 Mental Health (71.1%), SRS-22 Total (87.6%), major complication (53.4%). The single institution had lower percentages of improvement in ODI (24.6%), SRS-22 Mental Health (21.3%), SRS-22 Total (25.1%), and lower presence of major complication (34.8%). The calculated Brier scores identified the calculator's predictability for each factor: ODI (0.24), SRS-22 Mental Health (0.21), SRS-22 Total (0.25), major complication (0.28).
CONCLUSION(S): The newly developed ESSG-ISSG risk-assessment tool has a wide application in single institutions as it accurately predicts 2-year outcomes for various SRS-22 questionnaires and development of major complications. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Based on biomechanical studies, the use and type of interbody device at the lumbosacral junction creates variable stress/strain on the lumbopelvic fixation. This variability may lead to differential failure mechanisms and rates within following correction of adult spinal deformity (ASD). PURPOSE: We aimed to evaluate the relationship of lumbosacral interbody presence and type with lumbopelvic fixation failure after ASD correction utilizing iliac (IS) or S2 alar iliac (S2AI) screws. STUDY DESIGN/SETTING: Retrospective review of prospective, multicenter ASD database. PATIENT SAMPLE: A total of 342 patients. OUTCOME MEASURES: Pelvic fixation loosening, IS/S2AI screw fracture, S1 screw fracture, rod fracture (below L4), revision surgery, pseudarthrosis, HRQLs.
METHOD(S): Inclusion criteria consisted of patients with ASD (coronal Cobb >=20degree, sagittal vertical axis (SVA) >=5cm, pelvic tilt >=25degree and/or thoracic kyphosis >60degree) >=18 years old and 2yr f/u who underwent >5 level fusion with pelvic fixation. Patients with prior L5-S1 fusion were excluded. Patients were divided into three groups based on the lumbosacral interbody fusion strategy (none, ALIF, TLIF/PLIF). Univariate testing via one-way ANOVA and chi-square tests, and multivariate logistic regression, accounting for significant confounders, were used to examine the difference between the three groups in regard to pseudarthosis, pelvic fixation loosening, rod fracture and revision surgery. Level of significance=p<0.05.
RESULT(S): A total of 342 patients met inclusion criteria (L5-S1 interbody groups: none=164, ALIF=87, TLIF=91). The three groups were similar in terms of baseline comorbidities, gender, BMI, pelvic fixation type (iliac screws vs S2AI), and use of BMP2 posteriorly. There were differences in rate of interbody BMP2 use (ALIF 22.9%, TLIF 48.35%, p=0.0001), use of unilateral pelvic fixation (none 7.36%, ALIF 19.8%, TLIF 3.29%, p=0.0001) and age (none 65.41, ALIF 60.47, TLIF 63.81, p=0.0005). Multivariate logistic regression revealed ALIF at L5-S1 was associated with lower odds of pseudarthrosis (OR 0.16, p-0.026) and rod fracture (OR 0.19, p=0.012) compared to no interbody fusion, while TLIF was no different than no interbody. There were no differences between groups in regard to pelvic fixation loosening or revision surgery.
CONCLUSION(S): The use of ALIF at L5-S1 during correction of ASD protects against fixation failure at the lumbopelvic junction compared to the use of TLIF or no interbody. This more protective effect of ALIF at the lumbosacral junction may allow for selective unilateral pelvic fixation for ASD surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: The choice of surgical approach in CD surgery is often dictated by surgeon preference and experience. This choice could significantly impact the costs and outcomes of an operation, therefore the approaches should be analyzed in order to determine the optimal approach from a cost-utility perspective. The cost utility of different surgical approaches in cervical deformity (CD) has not been investigated in the literature. PURPOSE: Investigate the cost utility of differing approaches in operative CD patients. STUDY DESIGN/SETTING: Retrospective review of a prospective multicenter cervical deformity database. PATIENT SAMPLE: A total of 105 CD patients. OUTCOME MEASURES: Costs, EuroQol-5D (EQ-5D), Quality adjusted life years (QALYs), Cost per quality adjusted life years.
METHOD(S): Included CD patients (C2-C7 Cobb>10degreeor CK>10degree, cSVA>4cm or CBVA>25degree) >18yr with follow-up (1-year) surgical and health related quality of life scores. Costs were calculated using the PearlDiver database, which reflects both private insurance and Medicare reimbursement claims. QALYs and cost per QALY were calculated using a 3% discount rate to account for residual decline to life expectancy (78.7 years). After accounting for complications, LOS, revisions, and death, cost per QALY at 1Y and life expectancy [LE] were calculated for surgical approach (anterior-only, posterior-only [excluding PSO and VCR to account for differences in instrumentation], combined). In a subanalysis, approach groups were propensity-score matched for TS-CL to account for baseline (BL) deformity.
RESULT(S): A total of 105 CD patients met inclusion criteria (61.9 yrs, 63% female, 28.6kg/m2, CCI: 0.97). By approach, 21.9% underwent anterior only, 37.1% posterior only and 41% combined approaches. Average number of levels fused was 6.9, with a mean EBL of 948 ml and total operative time of 544.2 minutes. Mean EQ5D at BL was 0.74+/-0.07 and at 1Y was 0.79+/-0.08 (a difference of 0.05+/-0.08). Average difference in EQ5D from BL to 1Y was significant (p=0.002) across approach: 0.093 anterior-only, 0.021 posterior-only, 0.044 combined. 13% (3) of anterior-only patients underwent a revision, 10.3% (4) of posterior and 13.9% (6) of combined approaches. The average costs per surgery for CD patients at 1-year undergoing surgery by anterior approach was $27,640.75, $38,499.44 posterior-only, and $36,553.41 combined approach (p>0.05).The cost per QALY was higher for posterior-only patients at 1-year ($948,946.81) compared to anterior-only ($152,616.65) and combined ($424,110.14), p<0.001. If the utility gained was sustained to life expectancy, the cost per QALY for the anterior-only group was $21,665.87, posterior-only was $134,715.06 and combined approach was $60,207.82., p<0.001. After PSM for TS-CL, 15 patients remained in each group. The cost per QALY remained higher for posterior-only patients at 1-year and LE (both p<0.050).
CONCLUSION(S): After accounting for comorbidities, complications, revisions, and death, all surgical approaches showed improvement in postoperative EQ5D scores, however posterior approach demonstrated overall lower cost effectiveness. CD patients who underwent anterior-only approach had the lowest average costs for CD corrective surgery, as well as the lowest cost per QALY (best cost-effectiveness) compared to posterior and combined approaches. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Adult spinal deformity (ASD) correction involves complex, invasive procedures. However, it is unknown how metabolic syndrome affects the cost efficiency of ASD surgery. PURPOSE: Investigate the differences in ASD surgery cost for metabolic syndrome patients. STUDY DESIGN/SETTING: Retrospective review of a single center ASD database. PATIENT SAMPLE: A total of 557 ASD patients. OUTCOME MEASURES: Complications, revisions and costs.
METHOD(S): ASD patients (scoliosis >=20degree, SVA>=5cm, PT >=25degree, or TK >=60degree) >=18, undergoing >=4 level fusions were included. Descriptive analysis assessed mean baseline demographic, radiographic and surgical data were assessed. Patients diagnosed with: BMI >30, diabetes mellitus, and HTN were classified metabolic syndrome patients (MetS). Independent samples T-tests assessed baseline differences in SVA, PT, PI-LL, and levels fused between MetS and non-MetS patients. Total surgery costs for MetS and non-MetS ASD patients were compared. Costs were calculated using the PearlDiver database, which reflects both private insurance and Medicare reimbursement claims. Complications and comorbidities (CC) and major complications and comorbidities (MCC) were assessed according to CMS.gov manual definitions.
RESULT(S): A total of 557 patients met inclusion criteria. Baseline demographics and surgical details: age 60.8 +/- 13.2, 67.5% female, BMI 28.3 +/- 6.67, 6.2% anterior approach, 81.0% posterior approach, 12.8% combined approach, 10.4 +/- 3.9 levels fused, op time 423.5 +/- 166.4 minutes, EBL 2061.4 +/- 1631.5 cc, LOS 7.6 +/- 5.4 days. 11 MetS patients were included. There was no significant difference in BL SVA (54.2degree vs 70.3degree), PT (26.7degree vs 23.7degree), PI-LL (16.4degree vs 21.2degree), or levels fused between groups (10.5 vs 10.6) (all p>0.05). Twenty-seven percent of MetS patients experienced a CC or MCC, with 18% undergoing revisions within 90 days (vs 13.2% and 3.2% for non-MetS, p<0.05). The average costs of surgery for MetS patients was $68,004.06 vs $48,726.40 for non-MetS patients (p<0.05).
CONCLUSION(S): Metabolic syndrome is a growing concern among health care providers. In metabolic syndrome patients undergoing corrective adult spinal deformity surgery, the total costs of surgery was 28.4% higher for metabolic syndrome patients ($68,004.06 vs $48,726.40). Optimizing modifiable factors like diabetes or BMI in preoperative patients may have an impact on cost effectiveness. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: The Miller et al. adult spinal deformity frailty index (ASD-FI) correlates with increased complication risk after surgery; however, its development is rooted in health related quality of life metrics (HRQLs) that may be subjective, and the 40 factors needed for its calculation limit the index's utility in a clinical setting. PURPOSE: Develop a simplified, modified frailty index for ASD patients STUDY DESIGN/SETTING: Retrospective cohort study PATIENT SAMPLE: A total of 531 ASD patients OUTCOME MEASURES: HRQLs, length of stay (LOS) METHODS: ASD patients (scoliosis>=20degree, SVA>=5cm, PT>=25degree, or TK >=60degree) with baseline (BL) and 2-year HRQL follow up. HRQL components were removed from the FI and top contributors to the ASD-FI score of the remaining were assessed via Pearson correlation, and included in forward multiple stepwise regressions. Factors with the largest R2 value were including in the modified, ASD-FI (clin-ASD-FI). Factors included in the clin-ASD-FI were regressed against mortality, extended length of hospital stay (>8 days), revisions, major complications and weights for the clin-ASD-FI were calculated via Beta/Sullivan. Total clin-ASD-FI score was created with a score from 0 to 1. Linear regression correlated the clin-ASD-FI with ASD-FI scores and published cut-offs for the ASD-FI were used to create the new frailty cutoffs: not frail (NF: < 0.11), frail (F: 0.11-0.21) and severely frail (SF: >0.21). Binary logistic regression assessed odds of complication or reop for frail patients. Logistic regressions were run to determine whether the clin-ASD-FI is superior to previously utilized measures predicting risk (age, ASA, previous FI, and CCI) for complications and reop.
RESULT(S): A total of 531 ASD patients (59.5yrs, 79.5%F). The final stepwise regression model R2 of 0.681: <18.5 or >20 BMI (weight: 0.0625 out of 1), cardiac disease (0.125), disability employment status (0.3125), diabetes mellitus (0.0625), hypertension (0.0625), osteoporosis (0.125), blood clot (0.1875), and bowel incontinence (0.0625). These factors calculated the score from 0 to 1, with a mean cohort score of 0.13+/-0.14. Breakdown by clin-ASD-FI score: 51.8% NF, 28.1% F, 20.2% SF. Increasing frailty severity was associated with longer LOS (NF: 7.0, F: 8.3, SF: 9.2 days; p<0.001). When assessing BL HRQL status between the new clin-ASD-FI groups, ODI, EQ5D, SRS, PCS, MCS, NRS-Back, and NRS-Neck were worse with increasing categorical frailty (all p<0.001). Frailty independently predicted occurrence of any complication (9.357[2.20-39.76], p=0.002) and reop (2.79[0.662-11.72], p=0.162). Specific complications predicted included infection, neurologic, operative, radiographic, and wound complications (OR: 1.69-5, all p<0.001). Chi-square and p-values for the historical risk predictors of complications are as follows: Age(complication: 1.01[1-1.03] p=0.052; reop: 0.999[0.984-1.01] p=0.866), ASA(complication: 1.102[1.20-2.18], p=0.002; reop: 1.31[0.927-1.84], p=0.177), previous frailty index(complication: 8.57[1.66-44.17], p=0.010; reop=2.629[0.498-16.06], p=0.241), CCI(complication: 1.24[1.10-1.40], p<0.001; reop: 1.06[0.943-1.20], p=0.320).
CONCLUSION(S): Utilizing an existing ASD frailty index, we proposed a modified version eliminating the patient-reported components. This index is a true assessment of physiologic status, and represents a superior risk factor to other risk assessment tools for baseline and revision spinal deformity surgery as a result of its immutability with surgery, lack of subjectivity, and ease of use. Future studies should explore external validation of the proposed frailty index. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Prior studies demonstrated that symptomatic adult spinal deformity (SASD) is a heterogeneous condition with varying degrees of negative health impact depending on the specific type and severity of deformity. Currently, there is some controversy regarding the subset of SASD with global coronal malalignment (GCM) and its associated health impact. Moreover, few reports have assessed the health impact of this global coronal parameter in comparison to other deformity types. A comparative study of deformity types with severe global malalignment (eg, severe GCM) may provide clinically relevant insights and identify potential differences in demographics and health impact. PURPOSE: To compare demographics and health impact of SASD patients with severe global malalignment (primary sagittal [SAG-only] vs primary coronal [COR-only] vs sagittal+coronal [MIX]). STUDY DESIGN/SETTING: Retrospective analysis of a prospective multicenter database. PATIENT SAMPLE: Enrollment required age >=18 yrs and one of the following: scoliosis >=20degree, sagittal vertical axis (SVA) >=5cm, pelvic tilt >=25degree, and/or thoracic kyphosis >=60degree. OUTCOME MEASURES: Short Form-36 (SF-36) PCS score.
METHOD(S): Consecutive SASD patients from a prospective multicenter database were evaluated for type and severity of global malalignment. Severe alignment thresholds included SVA >=10cm (SAG-only), GCM >=6cm (COR-only), or both SVA >=10cm and GCM >=6cm (MIX). SF-36 PCS scores were compared with U.S. normative values.
RESULT(S): Of 492 SASD patients that met threshold alignment criteria, 463 (94%) completed the SF-36 and were included (78% women, mean age 65 years, mean BMI 28.6 kg/m2, previous spine surgery in 65%). Deformity types were SAG-only (58%), COR-only (19%) and MIX (23%). COR-only had more women (94%, p<0.001), younger age (61 years, p=0.004), and lower BMI (26 kg/m2, p<0.001). Charlson Comorbity Index (CCI) scores and total number of comorbidities were comparable among the deformity types (p>0.05). All deformity types were 'frail' based on ASD-Frailty Index scores (SAG-only [3.9], COR-only [3.1], MIX [4.0]). Overall mean PCS was lower compared to similar age- and gender-matched U.S. normative values (29.0 vs 45.3, p<0.001). Mean PCS was significantly different between deformity types (p<0.001): SAG-only (28.5) vs COR-only (33.1) vs MIX (27.0). PCS offsets from normative population scores were significantly different between deformity types (p=0.001): SAG-only (-16.6) vs COR-only (-13.4) vs MIX (-18.2).
CONCLUSION(S): Demographic comparisons demonstrated significantly more women, younger age, and lower BMI in the COR-only deformity type. Severe global malalignment (SVA >=10cm and/or GCM >=6cm) had substantial debilitating impact on health, with MIX deformity type (i.e., severe global sagittal and coronal malalignment) experiencing the greatest health impact. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Scoliosis is frequently associated with Chiari malformation (CM). More specifically, reports have been made about this association with CM-1 in the absence of syrinx status. There is paucity in literature in the surgical risks associated with concurrent CM types and scoliosis diagnosis. PURPOSE: To identify the risks adolescent patients have when diagnosed with CM and scoliosis. STUDY DESIGN/SETTING: Adolescents in pts in Kids' Inpatient Database (KID) during the years of 2003-2012. PATIENT SAMPLE: A total of 35,073 Chiarim pts. OUTCOME MEASURES: Complications.
METHOD(S): CM and scoliosis pts were isolated in KID from 2003-2012. The patients were stratified into three groups: those with concomitant CM and scoliosis (CmS), those with only CM (OCm), and those with only scoliosis (Scol). Demographics, incidence, comorbidity profiles, surgical strategy, and postoperative complications were assessed. Comorbidity profiles were stratified by body systems (neurological, musculoskeletal, pulmonary, cardiovascular, renal). Groups were compared using t-tests and chi-squared tests for continuous and discrete variables, respectively. Multivariate logistic regressions were used to assess association between surgical characteristics/diagnosis with complication rate.
RESULT(S): Included 90,707 spine pts, 63.3% Scol, 38.7%Ocm, and 2.0%Cms. Scol were older (13.6yrs vs CM: 5.9 vs Both:10.9) and had a higher invasiveness score (2.4 vs OCm: 0.5 vs Both:1.5), while CmS pts were more comorbid (0.9 vs OCm: 0.55 vs Scol: 0.89; all p<0.001). CmS pts had higher rates of surgical decompression (25.4%) and Scol pts had higher rates of fusions (35.3%) and osteotomies (1.2%; all p<0.001). However, CmS pts had the highest surgical rate (37.1% vs Scol: 36.6% vs OCm:10.6%) among the cohort (p<0.001). Controlling for age and invasiveness, Scol pts receiving a fusion (1.8[1.08-3.2] operation were associated with development of postoperative complications as well as OCm osteotomies (2.9[1.4-6.0]) and fusions (1.8[1.2-2.9]), and CmS fusion surgeries (1.8[1.0-3.2]; all p<0.05). Having a complication of acute respiratory distress (2.1[3.4-1.3]) and anemia (0.6[0.85-0.36]) were independently associated with CmS operation (all p<0.05).
CONCLUSION(S): Having concurrent scoliosis and Chiari malformation increases operative risk for when decompressive surgeries are performed. Being independently inflicted with scoliosis or Chiari leads to increased complication rate when paired with fusion surgeries. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: While neurological complications are known to occur following cervical fusions, few studies with sufficient power have quantified the difference in neurological outcomes as posterior cervical fusion (PCF) surgical invasiveness increases. PURPOSE: Compare longer vs shorter PCF complication rates. STUDY DESIGN/SETTING: Retrospective review of the New York State Statewide Planning and Research Cooperative System (SPARCS) database. PATIENT SAMPLE: All patients undergoing >=2 level PCF. OUTCOME MEASURES: Ninety-day neurological or medical complications status post short-cervical (SC), long-cervical (LC), or long cervicothoracic (LCT).
METHOD(S): From the NYS Statewide Planning and Research Cooperative System (SPARCS) database, retrospective review of all patients who underwent >=2 level PCF from 2009-13 with <= 90-day follow-up were identified and stratified by levels fused: 2-3 (SC), 4-8 (LC), and >= 9 (LCT). Data on demographics, hospital-related parameters, and 90-day neurological and other complications, readmissions, and revisions were collected. Regression analysis identified independent predictors of neurologic and overall complications.
RESULT(S): A total of 6,981 patients were included (SC, n=2,964, LC, n=3,899, LCT, n=118). LC patients were older than SC and LCT (60.8 vs 58.2 and 56.1), while LCT patients were more often female (59.3% vs LC 42.1% and SC 44%) and had higher total charges ($187,996 vs LC $99,020 and SC $82,239) and LOS (12.4 vs 6.1 and 6.9 days), all p<0.001. LC had the highest C5-C7 nerve palsy and overall neurological complication rates compared to SC and LCT patients (3.3 vs 1.8 and 1.7%, p=0.001; 3.8 vs 2.3 and 2.5%, p<0.001). Adverse events of the phrenic and recurrent laryngeal nerve were comparable. Implant infection (0.2 vs 0.3 vs 3.4%), and total complication rates (20.3 vs 23.7 vs 42.4%) increased with the number levels fused SC, LC, and LCT respectively, p<=0.017. 90-day readmissions and revisions were comparable. Only LC was a predictor of sustaining 90-day neurological complication (OR=1.7), while both LCT and LC predicted 90-day medical (OR=3.5, 1.3) and total complications (OR=2.7, 1.2), respectively, p<=0.008.
CONCLUSION(S): Compared to 2-3 levels, longer PCF had higher C5-C7 nerve palsy rates (3.3%) and 70% increased odds of sustaining >=1 neurological complication. Longer PCF was also associated with increased rates of medical and total complications. This data can improve the ability to counsel patients regarding the risks and expectations of potential adverse outcomes preceding cervical fusion via posterior or combined anterior-posterior approach. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Proximal junctional failure (PJF) is a common and particularly adverse complication of adult spinal deformity (ASD) surgery. There is evidence that the rigidity of posterior spinal constructs may impact risk of PJF. PURPOSE: We hypothesized that lower mean screws per level and decreased rod stiffness would be associated with lower incidence of PJF. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Patients with ASD and 2-year minimum follow-up were included. Only patients undergoing fusion of >=5 levels, and with LIV at the sacro-pelvis were included. Patients undergoing revision surgery were excluded. In total, 420 patients were analyzed. OUTCOME MEASURES: The primary outcome variable was PJF, defined using previously published radiographic criteria (PJ angle >28degreeand PJ angle >22degree, and >=8mm/>=3mm listhesis at upper thoracic / thoracolumbar levels, respectively).
METHOD(S): The primary independent variables were the mean number of screws per level fused analyzed with a cutoff of 1.8 (determined by ROC analysis) and rod material/diameter. Multivariable logistic regression was utilized to investigate confounding factors, including age, history of osteoporosis, BMI, gender, CCI, preoperative Schwab modifiers, preoperative TPA, postoperative change in lumbar lordosis, upper instrumented vertebra, osteotomy, approach, UIV type (ie, pedicle screw vs other), and number of levels fused.
RESULT(S): Of the total patients, 78.8% were female. PJF occurred in 14.1% of patients. The mean screws per level was 1.7 (SD 0.2), and 57.6% of patients had <1.8 screws per level. PJF occurred in 19.4% vs 9.8% of patients with >=1.8 vs <1.8 screws per level, respectively (p<0.01). In multivariable analysis, patients with <1.8 screws per level exhibited lower odds of PJF (OR 0.39, p<0.01). Rod material and diameter (both p>0.2) were not significantly associated with PJF. Screw density specifically adjacent to the UIV was not related to PJF (p>0.2).
CONCLUSION(S): Among ASD patients undergoing long-segment primary fusion to the pelvis, the risk of PJF was lower among patients with <1.8 screws per level. Rod diameter and material, however, were not significantly associated with PJF. This finding may be related to construct rigidity. It is possible that residual confounding by other patient and surgeon-specific characteristics may exist. Further biomechanical and clinical studies exploring the relationship between screw density and PJK/PJF are warranted. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Recent studies have suggested that for patients with chronic neck pain, both psychological and physical symptoms need to be addressed. Studies have shown that psychological distress is associated with poor outcomes in these patients. The fear avoidance model has been used to explain how maladaptive thoughts and behaviors contribute to chronicity and disability. Cognitive behavioral therapy (CBT) addresses these risk factors through education about pain, modification of maladaptive beliefs, and increasing patient's self-efficacy. PURPOSE: Determine the effectiveness of brief psychological intervention on psychological outcomes in cervical spine surgery. STUDY DESIGN/SETTING: Prospective, blind, and placebo-controlled trial. PATIENT SAMPLE: A total of 42 symptomatic Cervical Degenerative Disorders patients. OUTCOME MEASURES: Distress and Risk Assessment Method (DRAM), Fear Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), Outcome Expectation Question (OEQ). Neck Disability Index (NDI), modified Japanese Orthopedic Association (mJOA).
METHOD(S): Forty-two patients age >18 with symptomatic cervical degenerative disease have been enrolled in the study. If patients met psychological distress criteria, they were in the treatment group: DRAM >17 and <33, FABQ >49/66, PCS >30/52 or OEQ <=2 (randomized to CBT or Placebo). CBT and Placebo treatment groups had 6 sessions prior to surgery. The control group had no intervention prior to surgery. Baseline and 1-year (1Y) changes were assessed for all outcome measures.
RESULT(S): Forty-two patients were enrolled (53.6 years, BMI 29.4 kg/m2); 23 patients met psychological distress criteria and were randomized into a treatment group (14 CBT vs 9 placebo). Ten patients were in the control group, with nine exceeding DRAM scores to be CBT candidates. At enrollment, the CBT group had greater EQ5D scores (CBT: 10.8, Placebo: 9.5, Control: 7.5, DRAM:8.7) while the Placebo group had greater PCS scores (Placebo: 33.1, CBT: 32.4, Control:18.6, DRAM: 30.8; all p<0.05). From BL to 1Y postop, the CBT patients improved in all psychological-related questionnaires (NDI: 29.2 to 2, PCS: 32.4 to 20.7, FABQ:41.3 to 32.3, mJOA: 2.3 to 3.4, DRAM:12.9 to 16.6). Placebo patients also improved post-operatively, but to a lesser degree in NDI (26.6 to 2), PCS (33.1 to 28.3), and worsened in FABQ (40.4 to 54.1), mJOA(12.5 to 11.8), and DRAM (36.6 to 31.6). In contrast, patients in the control group showed improvement to a much lesser degree than CBT and Placebo patients (NDI: 18.1 to 2, PCS:18.6 to 3.2, FABQ:26.2 to 17.6, mJOA: 15.3 to 16.4). DRAM patients showed minimal changes in psychological- and spine-related questionnaires. Comparing treatment groups at 1Y, CBT pts had significantly lower FABQ scores than Placebo pts (32.3 vs 54.1; p<0.05). CBT pts also had better DRAM scores than the control group at 1Y (30.3 vs 11.4; p=0.03).
CONCLUSION(S): Cognitive behavior treatment can be beneficial in patients undergoing cervical surgery as it was identified in our study to minimize fear avoidance beliefs more than the Placebo group. This type of professional treatment has also shown a steady improvement in all psychological questionnaires and spine related neck disability from baseline to 1-year postoperatively. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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