Faculty Bibliography

BACKGROUND CONTEXT: The inter-relationship between the hip and spine has been increasingly studied in recent years, particularly as it pertains to the effect of spinal deformity and hip osteoarthritis (OA). Changing from standing (ST) to seated (SE) requires rotation of the femur from an almost vertical plane to the horizontal. OA of the hip significantly limits hip extension, resulting in less ability to recruit pelvic tilt (PT) in ST, and requiring increased PT in SE to compensate for loss of hip flexion. To date, the effect of total hip arthroplasty (THA) in altering spinopelvic SE and ST mechanics has not been reported. PURPOSE: To investigate the change in spinopelvic alignment parameters between seated and standing positions in pre and post THA patients. STUDY DESIGN/SETTING: Retrospective review at a single academic institution. PATIENT SAMPLE: Adult patients undergoing THA with full body sitting and standing radiographs pre- and post-THA. OUTCOME MEASURES: Spinopelvic alignment measures including pelvic incidence (PI), pelvic tilt (PT), T1 pelvic angle (TPA), sacral slope (SS), sagittal vertical axis (SVA), pelvic incidence and lumbar lordosis mismatch (PI-LL), and lumbar lordosis (LL).
METHOD(S): Patients >=18yo undergoing THA for hip OA with full spine SE and ST radiographs pre and post THA were included. Spinopelvic alignment was analyzed pre-THA and post-THA in both ST and SE positions in a relaxed posture with the fingers on the clavicles. Paired t-test analysis was performed to compare Pre-and Post-THA groups. The effect of TL deformity (SVA>50, TPA>20, PI-LL>10) on these changes was also analyzed. Statistical significance set at p<0.05.
RESULT(S): There were 192 patients assessed. 179 patients had thoracolumbar (TL) deformity; TPA>20 (N=46), PI-LL>10 (N=55), and SVA>50 (N=78). In standing position, patients have a significant reduction in SVA post THA vs pre THA (34.09+/-42.69 vs 45.03+/-46.87, p=0.001) as a result of an increase in PT (15.7+/-9.74 o vs 14.6+/-9.88o,p=0.028), without significant changes in spinal alignment parameters including lumbar lordosis (-51.26+/-14.59 vs -50.26+/-14.87, p=0.092), thoracic kyphosis (35.98+/-12.72 vs 35.40+/-13.16, p=0.180), sacral slope (38.15+/-10.77 vs 38.83+/-11.31, p=0.205), T1 pelvic angle (14.22+/-9.94 vs 14.51+/-10.13, p=0.053) and PI-LL mismatch (2.59+/-14.61 vs 3.35+/-14.92, p=0.183). This change in ST_SVA was larger in patients with TL deformity, specifically in those with SVA>50 (61.29+/-45.69 vs 89.48+/-35.91, p=0.001), in PI-LL > 10 (59.08+/-45.49 vs 73.36+/-48.50, p=0.001) and in TPA>20 subsets (62.14+/-49.94 vs 82.28+/-49.55, p=0.001). When moving from ST to SE, the DELTAPT was reduced post THA (16.70+/-15.27o vs 20.85+/-17.27o, p=0.001) in addition to a smaller SE_PT vs pre-THA (32.41+/-14.47 vs 35.46+/-14.20, p=0.006).
CONCLUSION(S): Post Total Hip Arthroplasty (THA), patients demonstrated an increased recruitment of pelvic retroversion to achieve a better global balance by reduction in standing SVA. This compensation was achieved solely by greater mobility of their hip and pelvis, and without a significant change in spinal alignment. ST_SVA reduction was more pronounced in patients with thoracolumbar (TL) spinal deformity (SVA>50, TPA>20, PI-LL>10). On the converse, PT was reduced in sitting (SE) post-THA compared to pre-THA, and the compensatory change in PT was also reduced between ST and SE as a result of restoration of hip flexion. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Robot-guided lumbar instrumented fusion (RGLF) has the potential to improve safety and accuracy of pedicle screw placement. However, there are pitfalls in adopting this new technology and, as in adopting any new OR technology, there may be early complications. Optimizing workflow by avoiding interbody placement prior to pedicle screws placement (interbody-first workflow, IFW) and using caution in patients with poor bone quality (L1 Hounsfield units [HU] under 148) may improve outcomes. PURPOSE: To determine risk factors for robot-related complications and suggest optimal OR workflow. STUDY DESIGN/SETTING: Single-center retrospective study. PATIENT SAMPLE: A total of 344 RGLF cases from 2018 to 2021. OUTCOME MEASURES: L1 and UIV HU, levels fused, L5-S1 inclusion, interbody placed first workflow (IFW), hyperlordotic interbody, robot registration method, robot registration failure, intraoperative robot mechanical failures and pedicle screw malpositioning.
METHOD(S): Retrospective analysis of RGLFs at a single institution. Univariate analysis with t-tests, Mann-Whitney U tests, or chi-squared analysis assessed demographics, L1 and UIV HU, levels fused, L5-S1 inclusion, IFW, hyperlordotic cage, and robot registration method as risk factors for robot registration failure, intraoperative robot mechanical failures, and pedicle screw malpositioning. Multivariate logistic regression of risk factors approaching or achieving significance was conducted. A receiver operating characteristic (ROC) curve was created to determine a threshold for independent risk factors.
RESULT(S): A total of 344 RGLFs were included. In registered vs registration failure cases, smoking (12.73% vs 28.57%; p=0.041), L1HU (139.81+/-46.86 vs 177.16+/-55.74; p=0.009), L5-S1 inclusion (50.00% vs 80.95%; p=0.006), and IFW (58.07% vs 85.71%; p=0.014) were significant risk factors on univariate analysis. On multivariate analysis, smoking (p=0.003), L1HU (p=0.006), and L5-S1 inclusion (p=0.022) were independent risk factors and IFW approached significance (p=0.099) for risk of registration failure. In successful vs all robot failures cases, age (55.72+/-13.38 vs 59.92+/-11.38 years; p=0.046), female gender (48.70% vs 69.44%; p=0.018), levels fused (1.37+/-0.63 vs 1.67+/-0.76; p=0.010), L5-S1 inclusion (50.00% vs 69.44%; p=0.027), and IFW (57.47% vs 77.78%; p=0.012) were significant risk factors on univariate analysis. On multivariate analysis, female gender (p=0.047) and L5-S1 inclusion (p=0.049) were independent risk factors and IFW approached significance (p=0.055) for risk of mechanical failure. In successful vs pedicle screw malpositioned cases, IFW was a significant independent risk factor for pedicle screw malpositioning on multivariate analysis (p=0.038). On subanalysis of 124 robot-guided anterior-posterior lumbar fusion (RG APLF), L1 HU was an independent risk factors for registration failure (p=0.007) and approached significance for mechanical failures (p=0.051). ROC analysis revealed a cutoff of L1 HU of 148.55 for mechanical failures (area under the curve = 0.778). Levels fused (1.41+/-0.69 vs 2.00+/-0.54; p=0.018) was a significant risk factor for pedicle screw malpositioning on univariate analysis.
CONCLUSION(S): In all RGLFs, IFW was a risk factor for robot-related complications. In RG APLF, low L1 HU was a risk factor. Robot-related complications may be avoided by placing pedicle screws prior to interbody and by using caution in patients with poor bone quality. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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STUDY DESIGN/METHODS:Retrospective cohort analysis. OBJECTIVE:The aim of this study was to compare postoperative outcomes of Coflex interspinous device versus laminectomy. SUMMARY OF BACKGROUND DATA/BACKGROUND:Coflex Interlaminar Stabilization device (CID) is indicated for one- or two-level lumbar stenosis with grade 1 stable spondylolisthesis in adult patients, as an alternative to laminectomy, or laminectomy and fusion. CID provides stability against progressive spondylolisthesis, retains motion, and prevents further disc space collapse. METHODS:Patients ≥18 years' old with lumbar stenosis and grade 1 stable spondylolisthesis who underwent either primary single-level decompression and implantation of CID, or single-level laminectomy alone were included with a minimum 90-day follow-up at a single academic institution. Clinical characteristics, perioperative outcomes, and postoperative complications were reviewed until the latest follow-up. χ2 and independent samples t tests were used for analysis. RESULTS:Eighty-three patients (2007-2019) were included: 37 cases of single-level laminectomy (48.6% female) were compared to 46 single-level CID (50% female). CID cohort was older (CID 69.0 ± 9.4 vs. laminectomy 64.2 ± 11.0, P = 0.042) and had higher American Society of Anesthesiologists (ASA) grade (CID 2.59 ± 0.73 vs. laminectomy 2.17 ± 0.48, P = 0.020). CID patients had higher estimated blood loss (EBL) (97.50 ± 77.76 vs. 52.84 ± 50.63 mL, P = 0.004), longer operative time (141.91 ± 47.88 vs. 106.81 ± 41.30 minutes, P = 0.001), and longer length of stay (2.0 ± 1.5 vs. 1.1 ± 1.0 days, P = 0.001). Total perioperative complications (21.7% vs. 5.4%, P = 0.035) and instrumentation-related complication was higher in CID (10.9% vs. 0% laminectomy group, P = 0.039). There were no other significant differences between the groups in demographics or outcomes. CONCLUSION/CONCLUSIONS:Single-level CID devices had higher perioperative 90-day complications, longer operative time, length of stay, higher EBL compared to laminectomies alone. Similar overall revision and neurologic complication rates were noted compared to laminectomy at last follow-up.Level of Evidence: 3.

Background/UNASSIGNED:Adolescent idiopathic scoliosis (AIS) is a common cause of spinal deformity in adolescents. AIS can be associated with certain intraspinal anomalies such as syringomyelia (SM). This study assessed the rate o f SM in AIS patients and compared trends in surgical approach and postoperative outcomes in AIS patients with and without SM. Methods/UNASSIGNED:-tests and Chi-squared tests for categorical and discrete variables, respectively. Results/UNASSIGNED:< 0.001). Conclusions/UNASSIGNED:These results indicate that patients concordant with AIS and SM may be treated more cautiously (lower invasiveness score and less fusions) than those without SM.

STUDY DESIGN/METHODS:Retrospective cohort study. OBJECTIVE:Assess trends in sports-related cervical spine trauma using a pediatric inpatient database. SUMMARY OF BACKGROUND DATA/BACKGROUND:Injuries sustained from sports participation may include cervical spine trauma such as fractures and spinal cord injury(SCI). Large database studies analyzing sports-related cervical trauma in the pediatric population are currently lacking. METHODS:KID was queried for patients with external causes of injury secondary to sports-related activities from 2003-2012. Patients were further grouped for cervical spine injury type, including C1-4 & C5-7 fracture with/without spinal cord injury (SCI), dislocation, and SCI without radiographic abnormality (SCIWORA). Patients were grouped by age into Children(4-9),Pre-Adolescents(Pre,10-13),and Adolescents(14-17). Kruskall-Wallis tests with post-hoc Mann-Whitney-U's identified differences in cervical spine injury type across age groups and sport type. Logistic regression found predictors of TBI and specific cervical injuries. RESULTS:38,539pts identified(12.76yrs,24.5%F). Adolescents had the highest rate of sports injuries per year(p < 0.001). Adolescents had the highest rate of any type of cervical spine injury, including C1-4 and C5-7 fracture with and without SCI, dislocation, and SCIWORA(all p < 0.001). Adolescence increased odds for C1-4 fracture w/o SCI 3.18x, C1-4 fx w/ SCI by 7.57x, C5-7 fx w/o SCI 4.11x, C5-7 w/SCI 3.63x, cervical dislocation 1.7x, and cervical SCIWORA 2.75x, all p < 0.05. Football injuries rose from 5.83% in 2009 to 9.14% in 2012 (p < 0.001), and were associated with more SCIWORA(1.6%vs1.0%,p = 0.012), and football injuries increased odds of SCI by 1.56x. Concurrent TBI was highest in Adolescents at 58.4%(Pre:26.6%,Child:4.9%,p < 0.001), and SCIWORA was a significant predictor for concurrent TBI across all sports(OR: 2.35[1.77-3.11], p < 0.001). CONCLUSIONS:Adolescent athletes had the highest rates of upper/lower cervical fracture, dislocation, and SCIWORA. Adolescence and SCIWORA were significant predictors of concurrent TBI across sports. The increased prevalence of cervical spine injury with age sheds light on the growing concern for youth sports played at a competitive level, and supports recently updated regulations aimed at decreasing youth athletic injuries. LEVEL OF EVIDENCE/METHODS:3.

BACKGROUND CONTEXT/BACKGROUND:Expandable cages (EXP) are being more frequently utilized in transforaminal lumbar interbody fusions (TLIF). EXP were designed to reduce complications related to neurological retraction, enable better lordosis restoration, and improve ease of insertion, particularly in the advent of minimally invasive surgical (MIS) techniques, however they are exponentially more expensive than the nonexpandable (NE) alternative. PURPOSE/OBJECTIVE:To investigate the clinical results of expandable cages in single level TLIF. STUDY DESIGN/SETTING/METHODS:Retrospective review at a single institution. PATIENT SAMPLE/METHODS:Two hundred and fifty-two single level TLIFs from 2012 to 2018 were included. OUTCOME MEASURES/METHODS:Clinical characteristics, perioperative and neurologic complication rates, and radiographic measures. METHODS:Patients ≥18 years of age who underwent single level TLIF with minimum 1 year follow-up were included. OUTCOME MEASURES/METHODS:clinical characteristics, perioperative and neurologic complications. Radiographic analysis included pelvic incidence-lumbar lordosis (PI-LL) mismatch, segmental lumbar lordosis (LL) mismatch, disc height restoration, and subsidence ≥2 mm. Statistical analysis included independent t tests and chi-square analysis. For nonparametric variables, Mann-Whitney U test and Spearman partial correlation were utilized. Multivariate regression was performed to assess relationships between surgical variables and recorded outcomes. For univariate analysis significance was set at p<.05. Due to the multiple comparisons being made, significance for regressions was set at p<.025 utilizing Bonferroni correction. RESULTS:Two hundred and fifty-two TLIFs between 2012 and 2018 were included, with 152 NE (54.6% female, mean age 59.28±14.19, mean body mass index (BMI) 28.65±5.38, mean Charlson Comorbidity Index (CCI) 2.20±1.89) and 100 EXP (48% female, mean age 58.81±11.70, mean BMI 28.68±6.06, mean CCI 1.99±1.66) with no significant differences in demographics. Patients instrumented with EXP cages had a shorter length of stay (3.11±2.06 days EXP vs. 4.01±2.64 days NE; Z=-4.189, p<.001) and a lower estimated blood loss (201.31±189.41 mL EXP vs. 377.82±364.06 mL NE; Z=-6.449, p<.001). There were significantly more MIS-TLIF cases and bone morphogenic protein (BMP) use in the EXP group (88% MIS, p<.001 and 60% BMP, p<.001) as illustrated in Table 1. There were no significant differences between the EXP and NE groups in rates of radiculitis and neuropraxia. In multivariate regression analysis, EXP were not associated with a difference in perioperative outcomes or complications. Radiographic analyses demonstrated that the EXP group had a lower PI-LL mismatch than the NE cage group at baseline (3.75±13.81° EXP vs. 12.75±15.81° NE; p=.001) and at 1 year follow-up (3.81±12.84° EXP vs. 8.23±12.73° NE; p=.046), but change in regional and segmental alignment was not significantly different between groups. Multivariate regression demonstrated that EXP use was a risk factor for intraoperative subsidence (2.729[1.185-6.281]; p=.018). CONCLUSIONS:Once technique was controlled for, TLIFs utilizing EXP do not have significantly improved neurologic or radiographic outcomes compared with NE. EXP increase risk of intraoperative subsidence. These results question the value of the EXP given the higher cost.

BACKGROUND CONTEXT: C5 palsy stands as a known but poorly understood complication of cervical spine surgery with rates reported as high as 30%. Although there are multiple studies presenting different risk factors, variability in findings have led to controversy in the etiology of postoperative C5 palsy. PURPOSE: To evaluate factors that predispose a patient to developing C5 palsy following cervical spine surgery. STUDY DESIGN/SETTING: Retrospective review of a large single center academic institution. PATIENT SAMPLE: This study included 239 cervical spinal procedures from 2013 to 2018. OUTCOME MEASURES: Patient demographics, surgical procedure and approach, perioperative clinical characteristics, postoperative rate of C5 palsy, C5 palsy resolution, and radiographic outcomes.
METHOD(S): Patients >=18 years of age who underwent cervical spinal surgery including the C4/C5 level, with minimum 1-year follow-up were included. C5 palsy was defined as deltoid +/- bicep weakness with Modified Rankin Scale grading at least 1 point below baseline (BL). Characteristics studied include: demographics, surgical procedure and approach (decompression and/or fusion). Radiographic analyses of MRI and CT measurements of foramen dimensions and spinal cord drift at BL and follow-up were performed. Statistical analyses included t-tests, chi-square analysis, and multivariate logistic regression to determine independent predictive factors. A receiver operating characteristic curve was run to determine the cutoff levels for predictive factors. Significance set at p<0.05.
RESULT(S): A total of 239 patients were included, with a C5 palsy rate of 6.3% for all cases. Subjects that developed C5 palsy were older (64.67+/-8.61 vs 57.56+/-11.61, p=0.021), had more levels decompressed posteriorly (3.20+/-1.82 vs 1.12+/-1.74, p<0.001), a higher rate of preoperative myelomalacia (60% vs 19.6%, p=0.008), and higher CCI (3.80+/-1.97 vs 2.35+/-1.95, p=0.005). Anterior cervical discectomy and fusion (ACDF) surgeries had a 2.4% rate of C5 palsy while the posterior approach rate was 11.9% (p<0.007). The highest rate was in laminectomy and posterior fusion at 15.2% (p<0.001). There were no significant differences in palsy resolution between those treated surgically compared to those not treated. Radiographically, C5 palsy patients had smaller postoperative foramen width measurements than those who did not develop C5 palsy (2.16+/-1.04 vs 3.31+/-1.25, p=0.023 on the right; 1.84+/-0.80 vs 3.02+/-1.25, p=0.014 on the left). When controlling for technique, CCI, age, BMI, and myelomalacia, multivariate regression analysis revealed increasing levels of laminectomy to be a significant independent predictor of C5 palsy (1.602 (2.258-1.136) for each additional level decompressed, p=0.007). The cut-off value for levels decompressed via laminectomy was determined to be 3.50 levels (>=0.7 AUC <=0.8). Postoperative foramen width was also an independent risk factor for C5 palsy (0.009 (0.000-0.726), p=0.035), it was determined that risk of C5 palsy increases at <2.625mm foramen width (>=0.8 AUC <=0.9).
CONCLUSION(S): C5 palsy following cervical spine surgery is correlated with residual postoperative foraminal stenosis and posterior surgery with increasing number levels decompressed. Patients undergoing more than 3.5 level laminectomy with less than 2.625mm foramen width postoperatively are at highest risk of developing C5 palsy. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Recombinant human bone morphogenetic protein 2 (BMP) is increasingly utilized in minimally invasive (MIS) transforaminal lumbar interbody fusions (TLIF) in order to increase rate of fusion by promoting bone growth through the induction of osteoblast differentiation, awhile reducing morbidity related to iliac crest autograft. Despite these benefits, BMP use is still controversial due to its pro-inflammatory mechanism of action and potential to cause radiculitis. PURPOSE: To assess whether BMP is a risk factor for postoperative radiculitis in TLIF. STUDY DESIGN/SETTING: Single-center retrospective cohort study. PATIENT SAMPLE: A total of 397 TLIFs from June 2012 to December 2018. OUTCOME MEASURES: Perioperative clinical characteristics, post-operative risk of radiculitis and complication, and future reoperation rates.
METHOD(S): Patients >= 18 years-old undergoing elective single-level TLIFs from 2012 to 2018 were included. Outcome measures included perioperative clinical characteristics, postoperative risk of radiculitis and complication, and future reoperation rates. Radiculitis was defined the delayed onset of radicular symptoms postoperatively in patients whom had initial resolution of radicular symptoms immediately postoperatively, in the absence of persistent neurological compression on postoperative imaging. Statistical analyses included independent t-tests and chi-square analysis. Propensity score matching was utilized to control for demographic differences between the groups. Independent predictors for post-operative radiculitis were assessed by multivariate logistic regression. Significance set at p<0.05.
RESULT(S): A total of 397 cases were included in the study (59.33 +/- 13.49 mean age, 28.98 +/- 6.29 mean BMI, 52.90% female, 2.29 +/- 1.92 average Charleston comorbidity Index). There were 223 open procedures and 174 MIS. For the entire cohort, 238 cases utilized BMP and 159 did not, with 102 MIS pairing with BMP use. The MIS TLIFs had a higher percentage of BMP use than open TLIFs (58.6% vs 25.7%, p<0.001), lower estimated blood loss (212.28 +/- 193.79 mL vs 410.91 +/- 337.98 mL, p<0.001) higher fluoroscopy dosage (52.43 +/- 48.61mGy vs 16.77 +/- 27.84mGy, p<0.001), and a lower length of stay (3.20 +/- 2.55 days vs 4.11 +/- 2.52 days, p<0.001). There were no other differences in perioperative clinical characteristics. There was a significantly higher rate of postoperative radiculitis in the MIS TLIFs compared to open (12.6% vs 6.8%, p=0.046) and use of BMP compared to no BMP (13.2% vs 6.7%, p=0.029). There was a 15.7% radiculitis rate when MIS was paired with BMP use. There were no other notable differences in complication rates or rates of reoperation. Individually, MIS had a 12.6% radiculitis rate (p=0.046) and BMP use had a 13.2% rate (p=0.029). Propensity score match controlled for the significant difference in CCI between the MIS and open groups (N=168 each). Multivariate regression indicated that MIS (p=0.314) and BMP (p=0.109) were not independent predictors individually when controlling for age, gender, and BMI. When technique was paired with biologic use the regression revealed MIS + BMP is a risk factor of post-operative radiculitis (2.265(4.753-1.079), p=0.031).
CONCLUSION(S): While BMP and MIS technique were not independent risk factors for postoperative radiculitis, there is an increased risk of radiculitis when using BMP in MIS TLIF. 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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BACKGROUND CONTEXT: The thoracolumbar junction poses increased risk for high stress on upper lumbar discs when not adequately fused. However, controversy persists. This study evaluates outcomes of upper instrumented vertebrae (UIV) selection in the thoracic versus the upper lumbar spine when fusing to the sacrum. PURPOSE: To compare revision rates for thoracolumbar fusions to the sacrum and pelvis at 1- and 2-year follow-up, stratified by UIV selection. STUDY DESIGN/SETTING: Retrospective cohort study at a single institution. PATIENT SAMPLE: A total of 968 patients who had thoracolumbar fusion surgery between 2012-2018 with at least one year of postoperative follow-up. OUTCOME MEASURES: Reoperation rates from 1 and 2 years after revision surgery, reoperation diagnoses, body mass index (BMI), gender, Charleston Comorbidity Index (CCI), perioperative complications, ASA grade (ASA), operative time (OT), and blood loss (EBL).
METHOD(S): A retrospective review of patients undergoing revision spinal fusion with lower instrumented vertebra of S1 or pelvis between 2012-2018 at a single institution was performed. Patients with less than 1 year of follow-up after their index procedure were excluded from the analysis. Patients were categorized based on UIV into 6 groups: T9-T11, L1, L2, L3, L4, and L5. Demographic and operative data were collected and compared between the different UIV groups in each cohort using chi-squared and ANOVA tests. Revision rates at 1- and 2-year follow-up and the reasons for revision were compared between groups.
RESULT(S): There were 168 revision spinal fusions that reached 1-year follow-up, with 54 having UIV at T9-T11, 2 fusions L1 to sacrum, 26 fusions L2 to sacrum, 25 fusions L3 to sacrum, 36 fusions L4 to sacrum, 23 fusions L5 to sacrum. There was significant difference in patient age, with oldest in the L1 group (65.5+/-3.5) and youngest in the L5 group (51+/-15.4 p<0.001). There was significant difference in gender as both cases in L2 was female and L5 fusions only had 39.1% females (p = 0.006). There were no differences in BMI, CCI, and ASA. EBL (1891.6mL+/-1226.9mL p <0.001) and length of stay (7.7+/-3.0 p <0.001) was highest in the T9-11 UIV group. Operative time was highest in the L1 (464.5+/-174.7 p<0.001) UIV group. Levels added on top of prior fusion were calculated by subtracting UIV of index fusion to past UIV. Adding on 2 levels had a 1-year revision rate of 14.3% (p = 0.032), while adding on 1 level had a 0% 1-year revision rate. Adding on 4 levels had a revision rate of 12.5%, and adding on 7 levels had a 50% 1-year revision rate. At 2 years, adding on 1 level had revision rate of 25% and adding on 2 levels had a revision rate of 20% (p = 0.769). There is no statistically significant difference in perioperative complication rates between UIV groups (p = 0.114). The reoperation rate at 1 year for all levels was 9% and highest in UIV at L1 (50%, p=0.06). At 2-year follow-up, the reoperation rate for the total cohort was 32.34% with the highest revision rate for fusion from L2 to sacrum (53.85%) followed by (T9-T11 sacrum fusion 42.31%, L4 to sacrum31.71%, L3 to sacrum 30%, L5 to sacrum 25.04%, L1 to sacrum 25%, p=0.195). Grouping the UIV into lower thoracic (T9-T11), upper lumbar (L2-L3), and lower lumbar (L4-L5) showed similar revision rates at one year (p=0.697). At two years, lower thoracic group had a revision rate of 40% versus, 23.3% in the upper lumbar group (p =0.399).
CONCLUSION(S): There is no statistically significant difference in reoperation rates for revision thoracolumbar fusions to the sacrum/pelvis associated with different UIV selection. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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