cervical spondylosis surgery level and age: a comparative analysis

118S Proceedings of the NASS 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S

claudication group had neuropathic pain. The LANSS pain score was not

significantly correlated with the VAS score for back pain, but did correlate

with the VAS score for leg pain (R50.73, p!0.001) and ODI back pain

score (R50.54, p!0.01).

CONCLUSIONS: One third of patients with LSS had a neuropathic pain

component. The presence of radicular pain correlated strongly with neuro-

genic claudication. The severity of leg pain and ODI scores were also

closely related to having a neuropathic pain component. This data will

be useful in understanding the pain characteristics of LSS and in better de-

signing clinical trials for neuropathic pain treatment in patients with LSS.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

http://dx.doi.org/10.1016/j.spinee.2013.07.308

P35. Harvest of Iliac Crest Autograft Not Associated with Localized

Pain

Geoffrey Stewart, MD1, Ronald W. Mercer, BA2; 1Orlando, FL, US;2Kissimmee, FL, US

BACKGROUND CONTEXT: There exist a wide variety of bone grafts,

substitutes and extenders which are utilized in spinal arthrodesis surgery.

There is considerable discrepancy in the literature and common wisdom

regarding the complications associated with the use of iliac crest autograft.

Chief among these is the perception that the procedure is painful and has

a high infection rate.

PURPOSE: The purpose of this study was to determine if patients expe-

rience more pain postoperatively on the donor side of their pelvis than on

the contralateral side.

STUDY DESIGN/SETTING: All patients of one surgeon who underwent

elective surgery to include lumbar fusion were asked to fill out a pain di-

agram at their preoperative and each postoperative visit. These diagrams

included a VAS pain scale for 5 regions, including each iliac crest.

PATIENT SAMPLE: Seventy six patients were identified who had fusion

surgery incorporating iliac crest autograft, and who had completed preoper-

ative diagrams and had follow up data to one year postop. All were included.

OUTCOME MEASURES: Outcome was measured by site-specific VAS

score as reported by the patients at various time points. Additionally, com-

plications were noted when they occurred.

METHODS: The surgical approach involved a midline skin incision in all

patients, with an epifascial dissection to the posterior superior iliac spine

and then subperiosteal exposure of the prominence. The prominence was

resected with an osteotomy and cancellous bone removed from between

the tables with Capener gauges. Care was taken to avoid penetration of

the cortex or sacroiliac joint. The defect was then irrigated and back filled

with tricalcium phosphate, and the fascia closed. Patient reported pain data

were compared from harvest and non-donor side and trends over time.

RESULTS: There were no significant differences in reported pain between

donor and non-donor side. There were no cases of donor site complications.

CONCLUSIONS: Iliac crest harvest and reconstruction via this method does

not result in increased pain on the side of the harvest. The complication rate

would be anticipated to bevery lowas no complicationswere seen in this series.




P36. Cervical Spondylosis Surgery Level and Age: A Comparative

Analysis

Mohsin Ali, BHSc, Edward Kachur, MD, Michael R. Bennardo, MSc,

Asma’a A. Yassin, MD, Kesava K. Reddy, MD, Aleksa Cenic, MD, MSc;

Division of Neurosurgery, Department of Surgery, Michael G. DeGroote

School of Medicine, McMaster University, Hamilton, Ontario, Canada

BACKGROUND CONTEXT: Many authors have reported C5–6 and

C6–7, followed by C4–5 as the most common levels of degeneration,

Refer to onsite Annual Meeting presentations and postmeeting proceedings for po

reporting disclosures and FDA device/drug

particularly in younger patients, whereas C3–4 is stated to be less fre-

quently involved. However, some radiographic studies have described

a higher incidence of C3–4 degeneration in the elderly.

PURPOSE: To determine the relationship between age and the spinal

level(s) operated upon in a series of cervical spondylosis patients.

STUDY DESIGN/SETTING: A prospective/retrospective surgical case

series conducted at Hamilton General Hospital, affiliated with McMaster

University, Hamilton, Canada.

PATIENT SAMPLE: We selected for patients whose cervical spondylo-

sis was of strictly degenerative etiology, and warranted surgical interven-

tion. Inclusion criteria were patients: operated on by the authors (EK, KR

or AC) over six years (January 2007 to December 2012) for cervical

spondylosis involving myelopathy and/or radiculopathy; and aged 18

years and above at time of surgery. Exclusion criteria were patients:

whose cervical spine surgery was done for reasons other than spondylo-

sis (i.e., tumor, infection, or trauma); or with previous surgery on the cer-

vical spine; or with the following conditions: ankylosing spondylitis,

spinal deformity, or a concurrent neurological condition (e.g., multiple

sclerosis).

METHODS: When reviewing each patient we noted: the patient’s age;

sex; which spinal level(s) were operated on; the surgical procedure em-

ployed; the presence of three cofactorsdhistory of smoking, hypertension,

and diabetes mellitus; and, for patients with multiple-level surgeries, the

most severe level(s), as determined by the radiologist’s report. We investi-

gated the relationship between age and spinal level, by comparing the

mean age of patients per spinal level operated on; the spinal levels exam-

ined were C3–C4, C4–C5, C5–C6 and C6–C7. Potential confounding fac-

tors were also examined. We investigated the relationship between three

cofactorsdsmoking, hypertension, and diabetes mellitusdand spinal

level. We applied all analyses before and after stratifying data into two

groupsdthose patients who had single-level surgeries (Group I) and those

with multiple-level surgeries (Group II).

RESULTS: 268 patients were reviewed. Overall, before and after stratifi-

cation, a clear trend emerged in our data when comparing age to spinal

level(s) operated upon: as ones ages, higher cervical spinal levels (that

is, C3–C4 and C4–C5) are more likely to degenerate warranting surgical

intervention. With respect to cofactors, the analyses bore consistent results

with and without stratification: smoking and diabetes mellitus were not re-

lated to spinal level, whereas patients with an involvement of a higher spi-

nal level were more likely to be hypertensive.

CONCLUSIONS: This surgical case series complements previous radio-

graphic analyses demonstrating higher incidence of C3–C4 involvement in

elderly cervical spondylosis patients. Our analyses show that as ones ages,

higher spinal levels are more likely to degenerate warranting surgical inter-

vention. This knowledge is important for practicing spine surgeons when

caring for elderly patients afflicted with cervical spondylosis.




P37. Mechanical Versus Chemical Prophylaxis for Deep Venous

Thrombosis in Patients Undergoing Lumbar Spinal Fusion:

Comparative Effectiveness and Cost-Benefit

Saniya S. Godil, MD1, Michael C. Dewan, MD1, Scott L. Parker, MD2,

Clinton J. Devin, MD3, Matthew J. McGirt, MD1; 1Vanderbilt University

Medical Center, Nashville, TN, US; 2Vanderbilt University, Nashville, TN,

US; 3Nashville, TN, US

BACKGROUND CONTEXT: Venous thromboembolism is a common

preventable cause of morbidity after surgery with an incidence ranging

from 0.3-31% in elective spinal surgery patients. Therefore, patients under-

going any surgical procedure receive routine prophylaxis for DVT. Re-

cently, the added utility of chemical DVT prophylaxis in addition to

mechanical DVT prophylaxis has been questioned.

ssible referenced figures and tables. Authors are responsible for accurately

status at time of abstract submission.




cervical spondylosis surgery level and age: a comparative analysis

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