Session 17: Spine
Fredag d. 26. oktober
13:00-14:30
Lokale: Reykjavik
Chairmen: Thomas Andersen og Malene Laursen
Rousing Rikke, Østerheden Andersen Mikkel, Ernst Carsten
ortopædkirurgisk afdeling, rygkirurgisk sektor, Odense Universitetshospital; rygkirurgisk afdeling, Middelfart sygehus; Rygkirurgisk afdeling, Silkeborg sygehus
Background: Percutaneous vertebroplasty (PVP) and ballon kyphoplasty (BK) has been used as treatment for painful low- energy fractures of the spine since the eighties. Several clinical studies have confirmed the pain-relieving effect of the procedures. But in 2009 two double-blinded RCT's comparing PVP with sham claimed that the effect of PVP was not better than injection of local anesthesia.
Purpose / Aim of Study: To review the literature for systematic reviews and randomised studies comparing PVP/BK with conservative treatment/sham concerning parameters as pain, quality of life, physical performance, and complications.
Materials and Methods: Systematic review of the literature from 1980 until February 2018 based on the following PICO question “Should patients over the age of 50 years with painful low energy fractures of the spine be offered vertebral injection of bone cement in case of insufficient non- operative treatment for 2-8 weeks?” resulted in 16 systematic reviews, including up to 10 RCT's, and two RCT's not included in the reviews. All reviews were Amstar assessed resulting in exclusion of 4 reviews because of the lack of metaanalysis. The answer to the PICO question was assessed based on the GRADE system.
Findings / Results: The metaanalysis show consistent and significant better outcome for PV/BK compared to conservative treatment concerning pain, quality of life and physical performance. Only two of the randomized studies were double- blinded and the minimal clinical relevant improvement has not been reached in these studies. There is not increased risk of new vertebral fractures in patients treated with PVP/BK compared to conservative treated patients.
Conclusions: Based on the above findings PVP/BK should be considered as treatment of patients with low energy fractures of the spine in case of insufficient conservative treatment for 2-8 weeks
ortopædkirurgisk afdeling, rygkirurgisk sektor, Odense Universitetshospital; rygkirurgisk afdeling, Middelfart sygehus; Rygkirurgisk afdeling, Silkeborg sygehus
Background: Percutaneous vertebroplasty (PVP) and ballon kyphoplasty (BK) has been used as treatment for painful low- energy fractures of the spine since the eighties. Several clinical studies have confirmed the pain-relieving effect of the procedures. But in 2009 two double-blinded RCT's comparing PVP with sham claimed that the effect of PVP was not better than injection of local anesthesia.
Purpose / Aim of Study: To review the literature for systematic reviews and randomised studies comparing PVP/BK with conservative treatment/sham concerning parameters as pain, quality of life, physical performance, and complications.
Materials and Methods: Systematic review of the literature from 1980 until February 2018 based on the following PICO question “Should patients over the age of 50 years with painful low energy fractures of the spine be offered vertebral injection of bone cement in case of insufficient non- operative treatment for 2-8 weeks?” resulted in 16 systematic reviews, including up to 10 RCT's, and two RCT's not included in the reviews. All reviews were Amstar assessed resulting in exclusion of 4 reviews because of the lack of metaanalysis. The answer to the PICO question was assessed based on the GRADE system.
Findings / Results: The metaanalysis show consistent and significant better outcome for PV/BK compared to conservative treatment concerning pain, quality of life and physical performance. Only two of the randomized studies were double- blinded and the minimal clinical relevant improvement has not been reached in these studies. There is not increased risk of new vertebral fractures in patients treated with PVP/BK compared to conservative treated patients.
Conclusions: Based on the above findings PVP/BK should be considered as treatment of patients with low energy fractures of the spine in case of insufficient conservative treatment for 2-8 weeks
Søren Ohrt-Nissen, Blaine Fritz, Lars Valentin, Kragh Kasper N, Claus Manniche, Benny Dahl, Thomas Bjarnsholt
Department of Orthopedic Surgery, Spine unit, Copenhagen University Hospital, Rigshospitalet; Department of Immunology and Microbiology., University of Copenhagen, Faculty of Health Sciences; Department of Orthopedic Surgery, Spine unit, Copenhagen University Hospital, Rigshospitalet; Department of Immunology and Microbiology., University of Copenhagen, Faculty of Health Sciences; Spine Centre of Southern Denmark, University of Southern Denmark; Department of Orthopaedic Surgery, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA; Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet
Background: Instrumented spinal fusion for adult spinal deformity is associated with a high revision rate with non- union as the most frequent complication. Weather spinal non-union has a microbiological causation has not yet been examined.
Purpose / Aim of Study: To access whether a chronic bacterial infection is present in a subset of patients with non-union after instrumented spinal fusion.
Materials and Methods: The study included adult patients with previous instrumented spinal fusion undergoing revision surgery for either non-union (case group) or other causes (control group). Five separate biopsies were collected, intraoperatively, from the non-union site and cultivated for 14 days under anaerobic conditions. If cultivation was positive in at least 2/5 tissue samples, the biopsy was sectioned and stained by fluorescence in situ hybridization Confocal laser scanning microscopy was used to examine the sections and visualize bacterial aggregates.
Findings / Results: The study included 32 non-union and 32 control patients. Cultivation yielded bacteria in at least 1/5 biopsies in 52% of patients with no difference between the groups (p=1.0). Bacteria of the same species was found in at least 2/5 samples in 7 non- union patients and 4 controls (p=0.509). P. acnes was found in 8 of these 11 samples. Microscopy demonstrated tissue-embedded bacterial aggregates in only one of these patients. The presence of bacteria was not associated with the number of previous spinal procedures or the pre-revision fusion length (p≥0.503).
Conclusions: Non-union after instrumented spinal surgery was not significantly associated with the presence of bacteria at the non-union site. Positive cultivation results are common after spinal instrumentation but should be supported by other diagnostic modalities in the absence of clinical signs of infection.
Department of Orthopedic Surgery, Spine unit, Copenhagen University Hospital, Rigshospitalet; Department of Immunology and Microbiology., University of Copenhagen, Faculty of Health Sciences; Department of Orthopedic Surgery, Spine unit, Copenhagen University Hospital, Rigshospitalet; Department of Immunology and Microbiology., University of Copenhagen, Faculty of Health Sciences; Spine Centre of Southern Denmark, University of Southern Denmark; Department of Orthopaedic Surgery, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA; Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet
Background: Instrumented spinal fusion for adult spinal deformity is associated with a high revision rate with non- union as the most frequent complication. Weather spinal non-union has a microbiological causation has not yet been examined.
Purpose / Aim of Study: To access whether a chronic bacterial infection is present in a subset of patients with non-union after instrumented spinal fusion.
Materials and Methods: The study included adult patients with previous instrumented spinal fusion undergoing revision surgery for either non-union (case group) or other causes (control group). Five separate biopsies were collected, intraoperatively, from the non-union site and cultivated for 14 days under anaerobic conditions. If cultivation was positive in at least 2/5 tissue samples, the biopsy was sectioned and stained by fluorescence in situ hybridization Confocal laser scanning microscopy was used to examine the sections and visualize bacterial aggregates.
Findings / Results: The study included 32 non-union and 32 control patients. Cultivation yielded bacteria in at least 1/5 biopsies in 52% of patients with no difference between the groups (p=1.0). Bacteria of the same species was found in at least 2/5 samples in 7 non- union patients and 4 controls (p=0.509). P. acnes was found in 8 of these 11 samples. Microscopy demonstrated tissue-embedded bacterial aggregates in only one of these patients. The presence of bacteria was not associated with the number of previous spinal procedures or the pre-revision fusion length (p≥0.503).
Conclusions: Non-union after instrumented spinal surgery was not significantly associated with the presence of bacteria at the non-union site. Positive cultivation results are common after spinal instrumentation but should be supported by other diagnostic modalities in the absence of clinical signs of infection.
Tanvir Johanning Bari, Dennis Winge Hallager, Niklas Tøndevold, Ture Karbo, Lars Valentin Hansen, Benny Dahl, Martin Gehrchen
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital
Background: Spinopelvic parameters and Sagittal Vertical Axis (SVA) are commonly used sagittal plane parameters for preoperative planning and postoperative evaluation of patients with Adult Spinal Deformity (ASD). Previous reproducibility studies have focused on describing the reliability using Intraclass Correlation Coefficients (ICC) thus quantifying the methods´ ability to distinguish between individuals. To our knowledge, no previous study in patients with ASD has reported the measurement error in terms of limits of agreement.
Purpose / Aim of Study: The current study aimed to report the agreement and reliability for measurements of Pelvic Incidence (PI), Pelvic Tilt (PT), Sacral Slope (SS) and SVA in ASD patients.
Materials and Methods: In a consecutive, one-center cohort of 64 patients referred for ASD evaluation, a blinded test-re-test study was performed. Reliability was assessed using ICC while 95% Limits of Agreement (LOA) were used to quantify agreement.
Findings / Results: We found “excellent” (ICC>0.9) results in all analyses of reliability except for inter-rater PI which was classified as “good” (ICC = 0.89). However, considerable inter-rater measurement error was observed for parameters depending on the angulation of the sacral endplate (95%LOA of ±11° and ±14° for SS and PI respectively) compared to ±5° for PT and ±7mm for SVA which depends on the location of the sacral endplate. Intra-rater agreement was only slightly better.
Conclusions: These are to our knowledge the first estimates of measurement error for sagittal spinopelvic parameters in ASD patients. Despite near excellent ICCs, we found considerable measurement error for parameters depending on the angulation rather than the location of the sacral endplate.
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital
Background: Spinopelvic parameters and Sagittal Vertical Axis (SVA) are commonly used sagittal plane parameters for preoperative planning and postoperative evaluation of patients with Adult Spinal Deformity (ASD). Previous reproducibility studies have focused on describing the reliability using Intraclass Correlation Coefficients (ICC) thus quantifying the methods´ ability to distinguish between individuals. To our knowledge, no previous study in patients with ASD has reported the measurement error in terms of limits of agreement.
Purpose / Aim of Study: The current study aimed to report the agreement and reliability for measurements of Pelvic Incidence (PI), Pelvic Tilt (PT), Sacral Slope (SS) and SVA in ASD patients.
Materials and Methods: In a consecutive, one-center cohort of 64 patients referred for ASD evaluation, a blinded test-re-test study was performed. Reliability was assessed using ICC while 95% Limits of Agreement (LOA) were used to quantify agreement.
Findings / Results: We found “excellent” (ICC>0.9) results in all analyses of reliability except for inter-rater PI which was classified as “good” (ICC = 0.89). However, considerable inter-rater measurement error was observed for parameters depending on the angulation of the sacral endplate (95%LOA of ±11° and ±14° for SS and PI respectively) compared to ±5° for PT and ±7mm for SVA which depends on the location of the sacral endplate. Intra-rater agreement was only slightly better.
Conclusions: These are to our knowledge the first estimates of measurement error for sagittal spinopelvic parameters in ASD patients. Despite near excellent ICCs, we found considerable measurement error for parameters depending on the angulation rather than the location of the sacral endplate.
Tanvir Johanning Bari, Dennis Winge Hallager, Niklas Tøndevold, Ture Karbo, Lars Valentin Hansen, Benny Dahl, Martin Gehrchen
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine, TX, USA; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital
Background: The Roussouly Classification System was developed to describe the variation in sagittal spine shape in normal individuals. A recent study suggests that patients´ spine types could influence the outcome following spinal surgery. The utility of a classification system depends largely on its reproducibility.
Purpose / Aim of Study: To provide the inter- and intra-rater reproducibility of the Roussouly Classification System in a single- center prospective cohort of patients referred for Adult Spinal Deformity (ASD).
Materials and Methods: Sixty-four consecutive patients were included in a blinded test-re-test setting using digital radiographs. All ratings were performed by 4 spine surgeons with different levels of experience. There was a 14-day interval between the two reading sessions. Inter- and intra-rater reproducibility was calculated using Fleiss’ Kappa and crude agreement percentages.
Findings / Results: We found moderate inter-rater and substantial intra- rater reproducibility. The most experienced rater had significantly higher intra-rater reliability compared to the least experienced rater. The two most experienced raters also had the highest crude agreement percentage; however, also had a significant difference in distribution of spine types.
Conclusions: The current study presents moderate inter-rater and substantial intra-rater reliability of the Roussouly Classification System. These findings are acceptable and comparable to previous results of reproducibility for a classification system in patients with ASD. Additional studies are requested to validate these findings as well as to further investigate the impact of the classification system on outcome following surgery.
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine, TX, USA; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital
Background: The Roussouly Classification System was developed to describe the variation in sagittal spine shape in normal individuals. A recent study suggests that patients´ spine types could influence the outcome following spinal surgery. The utility of a classification system depends largely on its reproducibility.
Purpose / Aim of Study: To provide the inter- and intra-rater reproducibility of the Roussouly Classification System in a single- center prospective cohort of patients referred for Adult Spinal Deformity (ASD).
Materials and Methods: Sixty-four consecutive patients were included in a blinded test-re-test setting using digital radiographs. All ratings were performed by 4 spine surgeons with different levels of experience. There was a 14-day interval between the two reading sessions. Inter- and intra-rater reproducibility was calculated using Fleiss’ Kappa and crude agreement percentages.
Findings / Results: We found moderate inter-rater and substantial intra- rater reproducibility. The most experienced rater had significantly higher intra-rater reliability compared to the least experienced rater. The two most experienced raters also had the highest crude agreement percentage; however, also had a significant difference in distribution of spine types.
Conclusions: The current study presents moderate inter-rater and substantial intra-rater reliability of the Roussouly Classification System. These findings are acceptable and comparable to previous results of reproducibility for a classification system in patients with ASD. Additional studies are requested to validate these findings as well as to further investigate the impact of the classification system on outcome following surgery.
Peter Muhareb Udby, Mikkel Østerheden Andersen, Tom Bendix, Stig Brorson, Søren Ohrt-Nissen, Leah Carreon , Michael Rud Lassen
Orthopedic department, Spine section, Zealand University Hospital Koege; Spine Surgery and Research, Spine Center of Southern Denmark – part of Lillebaelt Hospital.; Videncenter for Rygsygdomme, Glostrup hospital - Rigshospitalet; Orthopedic department, Spine section, Zealand University Hospital Koege; Orthopedic department, Spine section, Zealand University Hospital Koege; Norton Leatherman Spine Center, Norton Leatherman Spine Center, Louisville Kentucky; Orthopedic department, Spine section, Zealand University Hospital Koege
Background: Back pain is the leading global cause of disability. Some studies have shown that MC are strongly associated with low back pain (LBP) compared to disc degeneration alone. However, the long-term consequences in terms of Patient- Reported Outcomes (PROs) have not been reported. This study evaluated if MC is associated with long-term disability and pain.
Purpose / Aim of Study: To evaluate is patients with Modic changes (MC) have worse long-term outcomes compared to patients without.
Materials and Methods: In 2002, 207 patients with chronic low back pain were enrolled in an RCT comparing cognitive training with physical therapy. Inclusion criteria were age 18-60, almost daily LBP of ≥ 4 for more than 4 months in the past year. In 2017, these patients were then asked to complete the same PROs collected at baseline: back and leg pain (0-10), Roland-Morris Disability Questionnaire (RMDQ) and Inflammatory pain pattern (IPP). Patients were then stratified based on the presence or absence of MC on their initial low-Tesla MRI.
Findings / Results: Of the 204 cases with MRIs in 2002, 82 (40%) had MC in a least one lumbar segment. In 2017, 167 cases (82%) were available for follow-up including 65 (39%) with MC. There were no differences in demographics, smoking status, back-or leg-pain or IPP scores at baseline and at 13-year follow-up between patients with and without MC. RMDQ was similar in both groups at baseline but worse in patients without MC at follow-up.
Conclusions: The current study showed that patients without MC who had pain and were referred to a back clinic have the same clinical presentation as patients with MC. However, patients with MC were found to have better long-term outcomes compared to patients without.
Orthopedic department, Spine section, Zealand University Hospital Koege; Spine Surgery and Research, Spine Center of Southern Denmark – part of Lillebaelt Hospital.; Videncenter for Rygsygdomme, Glostrup hospital - Rigshospitalet; Orthopedic department, Spine section, Zealand University Hospital Koege; Orthopedic department, Spine section, Zealand University Hospital Koege; Norton Leatherman Spine Center, Norton Leatherman Spine Center, Louisville Kentucky; Orthopedic department, Spine section, Zealand University Hospital Koege
Background: Back pain is the leading global cause of disability. Some studies have shown that MC are strongly associated with low back pain (LBP) compared to disc degeneration alone. However, the long-term consequences in terms of Patient- Reported Outcomes (PROs) have not been reported. This study evaluated if MC is associated with long-term disability and pain.
Purpose / Aim of Study: To evaluate is patients with Modic changes (MC) have worse long-term outcomes compared to patients without.
Materials and Methods: In 2002, 207 patients with chronic low back pain were enrolled in an RCT comparing cognitive training with physical therapy. Inclusion criteria were age 18-60, almost daily LBP of ≥ 4 for more than 4 months in the past year. In 2017, these patients were then asked to complete the same PROs collected at baseline: back and leg pain (0-10), Roland-Morris Disability Questionnaire (RMDQ) and Inflammatory pain pattern (IPP). Patients were then stratified based on the presence or absence of MC on their initial low-Tesla MRI.
Findings / Results: Of the 204 cases with MRIs in 2002, 82 (40%) had MC in a least one lumbar segment. In 2017, 167 cases (82%) were available for follow-up including 65 (39%) with MC. There were no differences in demographics, smoking status, back-or leg-pain or IPP scores at baseline and at 13-year follow-up between patients with and without MC. RMDQ was similar in both groups at baseline but worse in patients without MC at follow-up.
Conclusions: The current study showed that patients without MC who had pain and were referred to a back clinic have the same clinical presentation as patients with MC. However, patients with MC were found to have better long-term outcomes compared to patients without.
Simon Thorbjørn Sørensen, Andreas Ole Kirkegaard, Leah Carreon , Rikke Rousing, Mikkel Østerheden Andersen
Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital
Background: Analgesics and bed rest is often not an effective treatment in cancer patients with painful vertebral fractures due to spinal metastasis. Percutaneous vertebroplasty (PVP) and kyphoplasty (KP) has been reported to provide rapid pain relief compared to other conventional treatment options.
Purpose / Aim of Study: To perform a systematic review evaluating the effectiveness and safety of vertebral augmentation for malignant vertebral compression fractures (VCFs).
Materials and Methods: Using PRISMA guidelines, studies on PVP or KP for VCFs in patients with malignant spinal lesions published between January 1, 2000 and January 3, 2018 were identified by combining the results of a report by Health Quality Ontario with an updated literature search. Data on patient demographics, outcome measures including Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), Karnofsky Performance Score (KPS), and complications were extracted from eligible studies.
Findings / Results: The review identified 2 RCTs, 16 prospective studies, 44 retrospective studies, and 25 case series for a patient sample size of 3426. At the earliest follow- up, pain improved from 7.48 to 3.00 with PVP, and from 7.05 to 2.96 with KP. ODI improved from 74.68 to 17.73 with PVP, and from 66.02 to 34.73 with KP. KPS improved from 66.99 to 80.28. Cement leakage was seen in 38.4% and 16.3% of patients treated with PVP and KP respectively. Symptomatic complications (N=43) were rare.
Conclusions: This review showed clinically relevant improvements in pain, ODI, and KPS in patients with VCFs due to malignancy treated with either PVP or KP. Cement leakage is common, but rarely symptomatic. PVP and KP are safe and effective palliative procedures for painful VCFs in patients with malignant spinal lesions.
Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital
Background: Analgesics and bed rest is often not an effective treatment in cancer patients with painful vertebral fractures due to spinal metastasis. Percutaneous vertebroplasty (PVP) and kyphoplasty (KP) has been reported to provide rapid pain relief compared to other conventional treatment options.
Purpose / Aim of Study: To perform a systematic review evaluating the effectiveness and safety of vertebral augmentation for malignant vertebral compression fractures (VCFs).
Materials and Methods: Using PRISMA guidelines, studies on PVP or KP for VCFs in patients with malignant spinal lesions published between January 1, 2000 and January 3, 2018 were identified by combining the results of a report by Health Quality Ontario with an updated literature search. Data on patient demographics, outcome measures including Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), Karnofsky Performance Score (KPS), and complications were extracted from eligible studies.
Findings / Results: The review identified 2 RCTs, 16 prospective studies, 44 retrospective studies, and 25 case series for a patient sample size of 3426. At the earliest follow- up, pain improved from 7.48 to 3.00 with PVP, and from 7.05 to 2.96 with KP. ODI improved from 74.68 to 17.73 with PVP, and from 66.02 to 34.73 with KP. KPS improved from 66.99 to 80.28. Cement leakage was seen in 38.4% and 16.3% of patients treated with PVP and KP respectively. Symptomatic complications (N=43) were rare.
Conclusions: This review showed clinically relevant improvements in pain, ODI, and KPS in patients with VCFs due to malignancy treated with either PVP or KP. Cement leakage is common, but rarely symptomatic. PVP and KP are safe and effective palliative procedures for painful VCFs in patients with malignant spinal lesions.
Frederik Taylor Pitter, Martin Lindberg-Larsen, Alma Pedersen, Benny Dahl
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University Hospital of Copenhagen; Department of Orthopedic Surgery and Traumatology, Odense University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Orthopedic Surgery, Texas Children’s Hospital & Baylor College of Medicine
Background: Revision rates following primary Adult Spinal Deformity (ASD) surgery have been reported to vary between 7 and 26 %. Most studies report loss to follow-up as a considerable limitation.
Purpose / Aim of Study: To investigate revision rates after ASD surgery and reasons for revision.
Materials and Methods: Nationwide cohort study with 2-year follow-up on all patients. Patients ≥18 years of age, undergoing primary instrumented surgery for ASD in Denmark between January 1st, 2006 and December 31st, 2014 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). All spinal revision procedures were identified. Medical records were reviewed to determine reason for revision and type of revision procedure. Overall comorbidities for each patient were summarized using the Charlson Comorbidity Index (CCI) based on data from DNPR.
Findings / Results: A total of 553 patients were identified. Of these, 19.9% were revised within the 2-year follow-up and 7.2% of patients were revised more than once. The most common reason for revision was implant failure (38.2%) followed by infection (11.8%). Increased age (hazard ratio (HR) = 1.14 (95% confidence interval (CI) 1.02-1.27) per 10 years) and increased comorbidity burden (CCI- score 1-2: HR= 1.54, 95%CI 1.01-2.34 and CCI- score ≥3: HR= 2.15, 95%CI 1.19-3.88) were associated with increased revision risk. Risk of revision increased from 2006 to 2014; year of primary surgery (2006 as reference) was associated with increased revision risk (HR= 1.10, 95%CI 1.02-1.19).
Conclusions: The revision risk within 2 years after primary ASD surgery was 20% nationwide in Denmark and implant failure was the most common reason for revision. Risk of revision surgery was positively correlated with increasing age and comorbidity burden.
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University Hospital of Copenhagen; Department of Orthopedic Surgery and Traumatology, Odense University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital; Department of Orthopedic Surgery, Texas Children’s Hospital & Baylor College of Medicine
Background: Revision rates following primary Adult Spinal Deformity (ASD) surgery have been reported to vary between 7 and 26 %. Most studies report loss to follow-up as a considerable limitation.
Purpose / Aim of Study: To investigate revision rates after ASD surgery and reasons for revision.
Materials and Methods: Nationwide cohort study with 2-year follow-up on all patients. Patients ≥18 years of age, undergoing primary instrumented surgery for ASD in Denmark between January 1st, 2006 and December 31st, 2014 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). All spinal revision procedures were identified. Medical records were reviewed to determine reason for revision and type of revision procedure. Overall comorbidities for each patient were summarized using the Charlson Comorbidity Index (CCI) based on data from DNPR.
Findings / Results: A total of 553 patients were identified. Of these, 19.9% were revised within the 2-year follow-up and 7.2% of patients were revised more than once. The most common reason for revision was implant failure (38.2%) followed by infection (11.8%). Increased age (hazard ratio (HR) = 1.14 (95% confidence interval (CI) 1.02-1.27) per 10 years) and increased comorbidity burden (CCI- score 1-2: HR= 1.54, 95%CI 1.01-2.34 and CCI- score ≥3: HR= 2.15, 95%CI 1.19-3.88) were associated with increased revision risk. Risk of revision increased from 2006 to 2014; year of primary surgery (2006 as reference) was associated with increased revision risk (HR= 1.10, 95%CI 1.02-1.19).
Conclusions: The revision risk within 2 years after primary ASD surgery was 20% nationwide in Denmark and implant failure was the most common reason for revision. Risk of revision surgery was positively correlated with increasing age and comorbidity burden.
Oliver Zielinski, Rune Bech, Martin Gehrchen, Benny Dahl
HovedOrtoCenteret, Rigshospitalet; HovedOrtoCenteret, Rigshospitalet; HovedOrtoCenteret, Rigshospitalet; Department of Orthopedics, Texas Children's Hospital
Background: The general epidemiology of any injury can be used to guide preventative treatment efforts, and identify areas of potential future concern. Trends of spinal injuries have previously been researched, however the epidemiology of traumatic spinal injuries in a general population has not yet been quantified in a large, prospective study, inclusion of the whole columna, all trauma mechanisms, and without focus on specific subpopulations.
Purpose / Aim of Study: Our aim was to describe current trends and relations of traumatic spinal injuries in a general Western population and identify potential areas where future preventative efforts can be aligned.
Materials and Methods: All patients referred due to suspicion of spinal injury to the Spine Unit at Rigshospitalet, during a one- year period, were prospectively assessed for inclusion. Epidemiological and etiological factors were registered for each patient and specific spinal injury.
Findings / Results: 714 spinal injuries were registered, with a mean of 1,53 injured levels per patient. The ratio of female to male patients was 1:1,17, and 53,1% of patients were >65 years of age with a mean age of 61,2 years. High-energy (HE) trauma accounted for 54,6% of injuries, while 62,7% of patients had no concomitant injuries. 55 injuries resulted in neurological damage. 80,3% of fractures were treated conservatively, while the remaining 19,7% were treated surgically.
Conclusions: Our results affirm what previous studies have shown with regards to traumatic spinal injuries in a general population, although we have shown a shift towards a more elderly patient group, and a more even gender distribution. This group of patients require further follow-up. Our data can be used as a tool in the future allocation of resources and as a way to guide preventative treatment efforts.
HovedOrtoCenteret, Rigshospitalet; HovedOrtoCenteret, Rigshospitalet; HovedOrtoCenteret, Rigshospitalet; Department of Orthopedics, Texas Children's Hospital
Background: The general epidemiology of any injury can be used to guide preventative treatment efforts, and identify areas of potential future concern. Trends of spinal injuries have previously been researched, however the epidemiology of traumatic spinal injuries in a general population has not yet been quantified in a large, prospective study, inclusion of the whole columna, all trauma mechanisms, and without focus on specific subpopulations.
Purpose / Aim of Study: Our aim was to describe current trends and relations of traumatic spinal injuries in a general Western population and identify potential areas where future preventative efforts can be aligned.
Materials and Methods: All patients referred due to suspicion of spinal injury to the Spine Unit at Rigshospitalet, during a one- year period, were prospectively assessed for inclusion. Epidemiological and etiological factors were registered for each patient and specific spinal injury.
Findings / Results: 714 spinal injuries were registered, with a mean of 1,53 injured levels per patient. The ratio of female to male patients was 1:1,17, and 53,1% of patients were >65 years of age with a mean age of 61,2 years. High-energy (HE) trauma accounted for 54,6% of injuries, while 62,7% of patients had no concomitant injuries. 55 injuries resulted in neurological damage. 80,3% of fractures were treated conservatively, while the remaining 19,7% were treated surgically.
Conclusions: Our results affirm what previous studies have shown with regards to traumatic spinal injuries in a general population, although we have shown a shift towards a more elderly patient group, and a more even gender distribution. This group of patients require further follow-up. Our data can be used as a tool in the future allocation of resources and as a way to guide preventative treatment efforts.
Andreas Ole Kirkeggard, Simon Thorbjørn Sørensen, Dorthe Schøler Ziegler, Leah Carreon, Mikkel Østerheden Andersen, Rikke Rousing
Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital
Background: In 2012 there were 14.1 million new cancer cases worldwide. The frequency of metastasis to the spine depends on the primary cancer, with the majority being breast, lung, and prostate. Traditional pain- relieving therapies include analgesics, bed rest, steroids, radiotherapy etc. are often not an effective treatment in cancer patients with painful vertebral fractures due to spinal metastasis. Traditional spinal surgery in general anesthesia is usually not an option in patients with advanced cancer and poor general condition. Percutaneous vertebroplasty (PVP) has been reported as a minimal invasive treatment option with apparent rapid pain relief compared to the other conventional treatment options.
Purpose / Aim of Study: The objective of this study was to assess the safety and efficacy of PVP on patients with malignant spinal lesions at a single site.
Materials and Methods: From the National Danish Surgical Spine database, DaneSpine, 30 consecutive cancer patients with vertebral fractures who underwent PVP from 2013 to 2017 were identified. From DaneSpine EuroQOL-5D (EQ-5D) and Oswestry Disability Index (ODI) scores were collected pre- and postoperatively. Incidence of complications and PMMA leaks was extracted from review of medical records and plain postoperative x-rays.
Findings / Results: The mean improvement in EQ-5D scores from baseline was 0.30 (p<0.01) after 3 months, and 0.25 (p=0.01) after 1 year. ODI improved from 44.1 to 23.3 (p<0.01). Despite a cement leakage rate of 14.8 %, no patients presented any clinically significant symptoms.
Conclusions: PVP is a safe procedure providing a statistically significant and clinically relevant improvement in quality of life and function. Our findings may provide useful information to health care professionals treating cancer patients with painful malignant spinal lesions.
Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital; Center for Spine Surgery & Research, Middelfart Hospital
Background: In 2012 there were 14.1 million new cancer cases worldwide. The frequency of metastasis to the spine depends on the primary cancer, with the majority being breast, lung, and prostate. Traditional pain- relieving therapies include analgesics, bed rest, steroids, radiotherapy etc. are often not an effective treatment in cancer patients with painful vertebral fractures due to spinal metastasis. Traditional spinal surgery in general anesthesia is usually not an option in patients with advanced cancer and poor general condition. Percutaneous vertebroplasty (PVP) has been reported as a minimal invasive treatment option with apparent rapid pain relief compared to the other conventional treatment options.
Purpose / Aim of Study: The objective of this study was to assess the safety and efficacy of PVP on patients with malignant spinal lesions at a single site.
Materials and Methods: From the National Danish Surgical Spine database, DaneSpine, 30 consecutive cancer patients with vertebral fractures who underwent PVP from 2013 to 2017 were identified. From DaneSpine EuroQOL-5D (EQ-5D) and Oswestry Disability Index (ODI) scores were collected pre- and postoperatively. Incidence of complications and PMMA leaks was extracted from review of medical records and plain postoperative x-rays.
Findings / Results: The mean improvement in EQ-5D scores from baseline was 0.30 (p<0.01) after 3 months, and 0.25 (p=0.01) after 1 year. ODI improved from 44.1 to 23.3 (p<0.01). Despite a cement leakage rate of 14.8 %, no patients presented any clinically significant symptoms.
Conclusions: PVP is a safe procedure providing a statistically significant and clinically relevant improvement in quality of life and function. Our findings may provide useful information to health care professionals treating cancer patients with painful malignant spinal lesions.
Mats Bue, Pelle Hanberg, Mikkel Tøttrup, Maja B Thomassen, Hanne Birke-Sørensen, Theis M Thillemann, Torben L Andersson, Kjeld Søballe
Department of Orthopaedic Surgery, Horsens Regional Hospital; Department of Orthopaedic Surgery, Horsens Regional Hospital; Department of Orthopaedic Surgery, Randers Regional Hospital; Orthopaedic Resarch Unit, Aarhus University Hospital; Orthopaedic Resarch Unit, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Clinical Biochemistry, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital
Background: Vancomycin may be an important drug for intravenous perioperative antimicrobial prophylaxis in spine surgery.
Purpose / Aim of Study: The present study aimed to assess single-dose vancomycin pharmacokinetics in the intervertebral disc, the vertebral cancellous bone, and subcutaneous adipose tissue using microdialysis in a porcine model.
Materials and Methods: Eight female pigs received 1,000 mg of vancomycin intravenously as a single dose over 100 minutes. Microdialysis probes were placed in the C3-C4 intervertebral disc, C3 vertebral cancellous bone, and subcutaneous adipose tissue, and vancomycin concentrations were obtained over 8 hours. Venous blood samples were obtained as reference.
Findings / Results: Ranging from 0.24 to 0.60, vancomycin tissue penetration was incomplete for all compartments. The lowest penetration was found in the intervertebral disc. The time to a mean clinically relevant minimal inhibitory concentration (MIC) of 4 μg/mL were 3, 17, 25, and 156 min for plasma, subcutaneous adipose tissue, vertebral cancellous bone and the intervertebral disc, respectively. In contrast to the other compartments, a mean MIC of 8 μg/mL was not reached in the intervertebral disc. An approximately three-times longer elimination rate was observed in the intervertebral disc in comparison to all the other compartments (p < 0.001), and the time to peak drug concentration was higher for all tissues compared with plasma.
Conclusions: Preoperative administration of 1,000 mg of vancomycin may provide adequate vancomycin tissue concentrations with a considerable delay, though tissue penetration was incomplete. However, in order also to achieve adequate intervertebral disc concentrations in all individuals and accommodating a potentially higher MIC target, supplemental application of vancomycin may be necessary.
Department of Orthopaedic Surgery, Horsens Regional Hospital; Department of Orthopaedic Surgery, Horsens Regional Hospital; Department of Orthopaedic Surgery, Randers Regional Hospital; Orthopaedic Resarch Unit, Aarhus University Hospital; Orthopaedic Resarch Unit, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Clinical Biochemistry, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital
Background: Vancomycin may be an important drug for intravenous perioperative antimicrobial prophylaxis in spine surgery.
Purpose / Aim of Study: The present study aimed to assess single-dose vancomycin pharmacokinetics in the intervertebral disc, the vertebral cancellous bone, and subcutaneous adipose tissue using microdialysis in a porcine model.
Materials and Methods: Eight female pigs received 1,000 mg of vancomycin intravenously as a single dose over 100 minutes. Microdialysis probes were placed in the C3-C4 intervertebral disc, C3 vertebral cancellous bone, and subcutaneous adipose tissue, and vancomycin concentrations were obtained over 8 hours. Venous blood samples were obtained as reference.
Findings / Results: Ranging from 0.24 to 0.60, vancomycin tissue penetration was incomplete for all compartments. The lowest penetration was found in the intervertebral disc. The time to a mean clinically relevant minimal inhibitory concentration (MIC) of 4 μg/mL were 3, 17, 25, and 156 min for plasma, subcutaneous adipose tissue, vertebral cancellous bone and the intervertebral disc, respectively. In contrast to the other compartments, a mean MIC of 8 μg/mL was not reached in the intervertebral disc. An approximately three-times longer elimination rate was observed in the intervertebral disc in comparison to all the other compartments (p < 0.001), and the time to peak drug concentration was higher for all tissues compared with plasma.
Conclusions: Preoperative administration of 1,000 mg of vancomycin may provide adequate vancomycin tissue concentrations with a considerable delay, though tissue penetration was incomplete. However, in order also to achieve adequate intervertebral disc concentrations in all individuals and accommodating a potentially higher MIC target, supplemental application of vancomycin may be necessary.