Session 8: Spine
Torsdag den 27. oktober
9:30 – 10:30
Chairmen: Cody Bünger / Dennis Hallager
Rune Tendal Paulsen, Mikkel Østerheden Andersen, Leah Carreon, Jamal Bech Bouknaitir, Søren Fruensgaard
Center for spine surgery and research, Middelfart; Center for spine surgery and research, Middelfart; Center for spine surgery and research, Middelfart; Ortopædkirugisk afdeling, Køge; Ortopædkirurgisk afdeling , Silkeborg
Background: Lumbar spinal stenosis (LSS) is a
clinical syndrome of buttock or lower
extremity pain, which may occur with
or without back pain, associated with
diminished space available for the
neural and vascular elements in the
lumbar spine. LSS is typically seen in
elderly patients, with prevalence
estimated to be 47% in people over the
age 60. LSS is the most common
reason for spine surgery in Denmark
and the number of surgical procedures
is likely to increase due to
Purpose / Aim of Study: The purpose of this study was to
evaluate the patient reported outcomes
and perioperative complications of
spinal decompression surgery in
patients with LSS.
Materials and Methods: This study is a retrospective study of
prospectively collected data from 3420
consecutive patients with clinical and
MRI confirmed LSS. Patients were
treated with posterior decompression
surgery between 2009 and 2014 at
three regional centers in Denmark.
Patients treated with concomitant
fusion were excluded.
Data were obtained from the
DaneSpine register and collected pre-
and postoperative after at least one
year. Outcome measures were ODI,
EQ-5D, VAS, MCS, PCS and self-
reported walking distance.
Findings / Results: Of 3420 cases enrolled, 2591 (75%)
had complete data after at least one
Mean ODI scores were 39,8 and
improved to 24,0. Mean EQ-5D score
was 0,40 and improved to 0,66. Mean
VAS-leg improved from 54 to 36. Mean
VAS-back improved from 46 to 34.
Mean MCS improved from 28 to 36.
Mean PCS improved from 40 to 45.
All comparisons were statistically
significant with p-values of 0,0000
Conclusions: Decompression surgery improved all
patient-reported outcome measures
(ODI, EQ5D, MCS, PCS, VAS and
walking distance). Improvements were
all of statistical and clinical relevance.
Dennis Winge Hallager, Sven Karstensen, Naeem Bukhari, Martin Gehrchen, Benny Dahl
Spine Unit, Dept. of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Spine Unit, Dept. of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Spine Unit, Dept. of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Spine Unit, Dept. of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Spine Unit, Dept. of Orthopedic Surgery, Rigshospitalet, University of Copenhagen
Background: Mechanical failure rates following adult spinal
deformity surgery is reported up to 37%. The
importance of spinal alignment and balance is well
documented for surgical outcome, however the role
of these parameters as predictors for mechanical
failure remains uncertain.
Purpose / Aim of Study: We aimed at evaluating radiographic predictors for
mechanical failure following adult spinal deformity
Materials and Methods: All adult spinal deformity patients having at least five
thoracolumbar levels of instrumentation between
2008 and 2012 were included. Inability to measure
pre- and postoperative SVA and radiography
wearing a brace were exclusion criteria. Pre-,
postoperative and change in coronal Cobb, central
sacral vertical line, thoracic kyphosis (TK), lumbar
lordosis (LL), sacral slope (SS) and sagittal vertical
axis (SVA) were evaluated as predictors for
mechanical failure using cause-specific Cox
regression. Mechanical failure was defined as a
revision procedure because of rod breakage, screw
loosening or breakage, pseudarthrosis, fractures or
symptomatic degeneration immediate above or
below the instrumentation.
Findings / Results: 138 of 165 patients were included. Mean follow-up
was 3.9 years (range 2.1-6.8). Median age at
surgery was 61 years. Median 10 levels were
instrumented with 71% ending at S1 and 44% had
3-column osteotomy performed. 47% had
mechanical failure requiring revision during follow-
up. Multivariate regression adjusting for age showed
significant increased hazard from change in LL>30°
(HR: 1.9 (95%CI: 1.0-3.4), P=0.038), postoperative
TK>50° (HR: 1.9 (95%CI: 1.1-3.4), P=0.001) and
postoperative SS≤30° (HR: 2.1 (95%CI: 1.3-3.5),
Conclusions: Change in LL>30°, postoperative TK>50° and
postoperative SS≤30° independently increased the
hazard of mechanical failure following adult spinal
Dennis Karimi, Søren Morgen, Sidsel Fruergaard, Martin Gehrchen, Benny Dahl
Spine Section, Dept. of Orthopeadic Surgery, Rigshospitalet; Spine Section, Dept. of Orthopeadic Surgery, Rigshospitalet; , ; Spine Section, Dept. of Orthopeadic Surgery, Rigshospitalet; Spine Section, Dept. of Orthopeadic Surgery, Rigshospitalet
Background: Numerous pre-operative scoring systems based
on clinical and imaging variables have been
suggested to predict long-term survival in
patients undergoing surgical treatment for
symptomatic spinal metastasis, but the possible
role of gender as an independent predictor of
long-term survival has not been reported in
studies with long time follow-up. Since 2005,
Rigshospitalet, has been responsible for the
treatment of patients with acute symptoms of
spinal metastasis and serves as a referral unit for
the Eastern half of the country. This organization
makes it possible to follow a large group of
patients with MSCC and to follow long-term
Purpose / Aim of Study: To examine whether gender predicts long term
survival in patients with symptomatic spinal
metastasis after surgical treatment.
Materials and Methods: A prospective database including all patients referred
with acute symptoms of spinal metastasis was
established in 2005. Relevant variables were
registered at referral including age, gender, and
primary oncologic diagnosis. From January through
December 2015 the survival status of all patients
was obtained through the Central Office of Civil
Findings / Results: A total of 58 patients were operated for MSCC in
2005. The average age of the patients was 63 years
and 55% were males. At the ten years follow-up 55
patients had died and the average survival time after
surgery was 20 months. Survival time was
significantly longer for females compared to males;
32 vs. 10 months (P<0.05). The hazard-ratio of 10-
years survival for females was 2.12 (P< 0.01). This
difference remained significant after adjusting for
specific primary tumors and operation-age.
Conclusions: In spite of the small sample size, these results could
indicate that gender should be included in pre-
operative scoring systems used for patients with
Miao Wang, Cody Bünger, Abarajitha Thiyagarajah, MING SUN, EBBE STENDER HANSEN, HAISHENG LI, KESTUTIS VALANCIUS, PETER HELMIG, KRISTIAN HØY
Department of spine surgery, aarhus university hospital; Department of spine surgery, Aarhus University Hospital; Department of spine surgery, Aarhus University Hospital; Department of spine surgery, Aarhus University Hospital; Department of spine surgery, Aarhus University Hospital; Department of spine surgery, Aarhus University Hospital; Department of spine surgery, Aarhus University Hospital; Department of spine surgery, Aarhus University Hospital; Department of spine surgery, Aarhus University Hospital
Background: Adult scoliosis is a common disorder that is
associated with significant pain, and functional
impairment. Surgical treatment can significantly
restore the function and improve the quality of life.
However, the choice of lowest level of long fixation
remains controversial for spine surgeons.
Purpose / Aim of Study: The aim of this study is to investigate the surgical
outcome of iliac fixation and lumbosacral fixation in
adult scoliosis patients.
Materials and Methods: We retrieved 78 adult patients with scoliosis in
Aarhus University Hospital from March 2010 to May
2015. 63 female and 15 male patients. Average age
is 64-year old. Pre- and postoperative X-ray and the
revision operation were examined. McNemar test
was used to compare the revision rate between two
Findings / Results: In the lumbosacral fixation group, the lowest level of
initial surgical fixation was selected as lumbar level
(L4/L5) for 34 patients; sacrum level for 9 patients.
The iliac level was selected for 35 patients. In total
of 17 re-operations were performed. lumbar fixation
group had 15 reoperations (15/34 pts, 44%).
Sacrum fixation groups had 2 re-operations (2/9 pts,
22%). Iliac fixation groups had no reoperation. The
reoperation rate of lumbosacral group is significant
higher than iliac fixation group (p<.05). the 15 re-
operated patients from lumbar group underwent
different fixation surgeries. 3 another level fixation, 4
sacrum and 8 iliac fixation. two re- operated did not
undergo extended surgery to level.
Conclusions: Long fusion surgery ended at lumbar level has the
highest revision rate. The lowest level was selected
as iliac level for adult scoliosis has significantly
lower revision rate compared to lumbosacral level.
Signe Forbech Elmose, Else Bay Andersen, Mikkel Østerheden Andersen
Center for Spine Surgery and Research, Middelfart Hospital; Department of Anesthesiology, Vejle Hospital; Center for Spine Surgery and Research, Middelfart Hospital
Background: Studies have shown that the
antifibrinolytic drug TXA reduces blood
loss during major spine surgery. There
are no studies on the effect of TXA in
minor lumbar spine surgery and no
studies investigate the effect of TXA on
Purpose / Aim of Study: We investigate the effect of tranexamic
acid (TXA) compared to placebo in low-
risk adult patients undergoing elective
minor lumbar spine surgery. Primary
objective is operative time (OP-time)
and secondary objectives estimated
perioperative (peri-OP) blood loss,
incidence of dural tears, postoperative
symptomatic spinal epidural
hematomas (SEH) and venous
thromboembolic events (VTE).
Materials and Methods: A clinical double blind randomized,
placebo-controlled study. We included
220 patients (ASA 1-2), undergoing
lumbar decompressive surgery at
Middelfart Hospital. Exclusion criteria;
coagulopathy, hypersensitivity to TXA
or history of convulsion.
Randomization by blocks of 10, in two
groups, TXA or placebo.
Anticoagulation therapy was
discontinued 2-7 days preoperatively.
Patients received pre-incision either a
bolus of TXA (10mg/kg IV), or an
equivalent volume of placebo (saline).
Statistics: Students t-test, Wilcoxon
Mann-Whitney or chi2-test,
significance level p=0.05.
Findings / Results: 14 patients were excluded, 206
analyzed (TXA-group n=103, placebo-
group n=103). The groups had an
unequal sex ratio TXA 49/51 and
placebo 33/67 (female/male, %),
otherwise comparable by basic
demographics. There was no
significant difference in OP-time.
Statistical significant difference in
estimated post-OP blood loss, median
TXA 5ml (n=59) and placebo 21ml
(n=64), p<0.001. No difference in per-
OP blood loss or dural tears. No SEH
Conclusions: A single dose of TXA can significantly
reduce the post-OP blood loss in minor
lumbar spine surgery on low-risk adult
Peter Heide Pedersen, Søren Peter Eiskjær, Asger Greval Petersen
Orthopedic, Aalborg University hospital; Orthopedic, Aalborg University hospital; Røntgenfysik, Region North Jutland
Background: Ionizing radiation potentially leads to
tissue damage. It has been
documented in large cohort studies
that radiographic imaging during
childhood for spinal deformities eg.
scoliosis, increases the lifetime risk of
The EOS biplane x-ray imaging system
(EOS Imaging S.A, Paris France) has
been developed to produce high
quality images while at the same time
reducing radiation dose. At our
institution we use the EOS for pre- and
postoperative full spine examinations.
Purpose / Aim of Study: The purpose of the study is to make
first time organ dose and effective
dose evaluations with micro-dose
settings in full spine examinations. Our
hypothesis is that organ dose and
effective dose can be reduced 5-10
times compared to standard settings,
without too high image-quality trade
off, resulting in a theoretical reduction
of radiation induced cancer.
Materials and Methods: Patient dosimetry is performed on
anthropomorphic child phantoms.
Thermoluminiscent detectors are used
to measure organ dose. A first time
measurement with micro-dose settings
in both AP and PA will be performed in
addition to standard settings in AP and
PA positions. Effective dose is
calculated using mean organ doses
and tissue weighting factors. These
findings will be compared to previously
reported findings in standard settings
and to conventional digital x-ray(CR)
Findings / Results: In AP position we found a mean liver
organ dose of 0.03mSv as compared
to 0.25mSv with standard dose
settings, a significant dose reduction of
88%. As expected the liver dose was
higher in PA position than AP position,
0.05mSv vs. 0.03mSv.
Conclusions: Preliminary results with micro-dose
settings show a 88% reduction of
organ dose and a theoretical reduction
of radiation induced cancer. Previously
a 35% effective dose reduction was
reported for the EOS in standard
settings compared to CR.
Simon Toftgaard Skov, Jan Hendrik Duedal Rölfing, Haisheng Li, Ebbe Stender Hansen, Cody Bünger
Orthopaedic Research Lab., Århus Universitetshospital; Orthopaedic Research Lab., Århus Universitetshospital; Orthopaedic dep., Århus Universitetshospital; Orthopaedic dep., Århus Universitetshospital; Orthopaedic dep., Århus Universitetshospital
Background: Wear and corrosion of metal implants are of
great concern especially in MoM hip
implants. Evidence of MoM wear in spinal
implants in children is sparse.
Purpose / Aim of Study: To determine metal ion levels in children
with cobalt-chromium/titanium GR
undergoing interval lengthening.
Materials and Methods: Cross-sectional study in 34 patients
including 8 children prior to surgery, median
age 11.0 (range 3.3-15.8) were included
during 1.7 years. Standardized venous
blood samples were collected at median 2.6
(0-10) years post index surgery.
Contamination-free consensus guidelines
were followed. Blinded analysis was
performed for serum chromium(Cr),
cobalt(Co), molybdenum(Mo), titanium(Ti),
aluminium(Al), vanadium(V) using high-
resolution mass spectrometry at a certified
Findings / Results: The Cr levels at index were median 1.9 ppb
(0.5-10) vs. 1.1 ppb (0.5-80) during
elongation, p=0.46. Cr levels exceeded the
7 ppb warning threshold given by MHRA
(www.gov.uk) in 8 out of 34 children
between 2.4-3.4 years post index surgery.
All 8 Cr levels returned below threshold
within the following year, despite presence
of metal debris in most operated patients.
Co levels increased from median 0.2 (0-0.4)
ppb to 0.5 (0-2.6) ppb, p<0.0001.
The median Ti levels at index was below the
detection limit of 1 ppb (max 3.4) vs. 10.6
ppb (1.1-48.4) during elongation, p<0.001.
Al, Mo, V levels did not differ.
Conclusions: 8 patients had transient Cr levels above the
warning threshold. All returned below
threshold within the next year.
The children with elevated ion levels did not
differ clinically from the remaining group.
Minimizing and monitoring iatrogenic metal
ion exposure in these children is important
due to the increased risk of genotoxicity and
This study could not confirm an increased