66S Proceedings of the NASS 27th Annual Meeting / The Spine Journal 12 (2012) 65S–80S

129. Impact of Cervical Symptoms on Ability to Participate in

Recreational Activities

Donna D. Ohnmeiss, PhD1, Richard D. Guyer, MD2, Scott L. Blumenthal,

MD2, Jack E. Zigler, MD2; 1Texas Back Institute Research Foundation,

Plano, TX, US; 2Texas Back Institute, Plano, TX, US

BACKGROUND CONTEXT: Engaging in recreational activities is not

only important for quality of life and pleasure, but also can contribute to

overall health. Pain may interfere with a patient’s ability or interest to par-

ticipate in such activities. In reviewing our clinic’s data from patients un-

dergoing anterior cervical spine surgery for pain related to degenerative

conditions, it was noted that among the 10 scales of the Neck Disability

Index (NDI), the mean pre-operative score was greatest on the scale asking

about ability to participate in recreational activities. A literature search

found very little information available on recreational limitations associ-

ated with cervical degenerative conditions.

PURPOSE: The purpose of this study was to analyze the impact of cervi-

cal symptoms on recreational activities and changes following surgery.

STUDY DESIGN/SETTING: This study was based on a post hoc analy-

sis of prospectively collected data.

PATIENT SAMPLE: Data were collected prospectively from 100 patients

undergoing either anterior cervical fusion (ACF) or total disc replacement

(TDR) for the treatment of neck and/or arm pain related to cervical radi-

culopathy and/or painful disc degeneration.

OUTCOME MEASURES: Responses to NDI recreation scale were ana-

lyzed to determine extent of recreational activity limitations before surgery

and compare that to postoperative levels.

METHODS: The pre- and postoperative levels of recreational activity re-

ported by patients were compared using the six-item recreational activity

question on the NDI. Minimum follow-up was 12 months.

RESULTS: Preoperatively, none of the patients engaged in their recrea-

tional activities without pain and only 2.0% of patients could engage in

all their recreational activities with some pain. Postoperatively, these fig-

ures improved significantly (p!0.01) with 47% of patients indicating they

could engage in their activities without pain and an additional 31% report-

ing engaging in their activities with some pain. On the six-point scale, 22%

of patients improved one level and 71% improved at least 2 levels. Five

percent of patients remained at the same level of activity and 2% had re-

duced levels of recreational activity after surgery.

CONCLUSIONS: In this population of surgical patients, cervical symp-

toms greatly limited patients’ ability to participate in recreational activities

with 48% of patients reporting they could engage in no or ‘‘hardly any’’

recreational activities prior to surgery. This great of a limitation may be

underappreciated and there is little information available in the literature.

Postoperatively, significant improvement was demonstrated with 78% of

patients recreating with little or no pain and no limitations. Regaining

the ability to engage in recreational activity may improve the patient’s

overall quality of life.

FDA DEVICE/DRUG STATUS: ProDisc-C (Approved for this indica-

tion), Advent, KineflexjC, Neodisc, Discover, Mobi-C (Investigational/

Not approved)

http://dx.doi.org/10.1016/j.spinee.2012.08.191

130. Incidence of Adjacent Segment Disease in Anterior Cervical

Decompression and Fusion With Autograft Without Plating Versus

Allograft With Plating

Vijay Agarwal, MD1, Sandra Serafini, PhD2, Michael M. Haglund, MD3;1San Jose, CA, US; 2Durham, NC, US; 3Raleigh, NC, US

BACKGROUND CONTEXT: ACDF is used to treat several conditions,

with adjuncts such as grafts and locking plates to further enhance fu-

sion. Given the large number of cervical fusions, examining long-term

consequences is of importance. Adjacent segment disease, via

All referenced figures and tables will be available at the Annual Mee

degeneration at the inferior or superior segment(s), is the most well

documented consequence. The current rate of prevalence is approxi-

mately 25% over 10-years, with C5-C6 the segment at greatest risk. Dif-

ferences in incidence of ASD using various ACDF techniques are less

well investigated.

PURPOSE: To compare prevalence/incidence of adjacent segment dis-

ease requiring surgical intervention between Autograft Without Plating

(AWOP) and Allograft With Plating (one-level, ALP1; two-level,

ALP2).

STUDY DESIGN/SETTING: Retrospective study of anterior cervical

discectomy and fusions (ACDF) from 1996-2006 with follow-up through

2010.

PATIENT SAMPLE: Consecutive series of 611 patients (275 males, 336

females) and 627 ACDF procedures using AWOP (n5179, 73 males, 98

females, mean age 48.7 years) or ALP techniques (nALP15250, 122

males, 128 females, 49.6 years), nALP25198 (80 males, 118 females,

53.5 years) with maximum 13 year follow-up (AWOP range 8-13 years,

mean 5 10.83 years, ALP1 range 3-13 years, mean 5 6.05, ALP2 range

3-13 years, mean 5 6.17).

OUTCOME MEASURES: Differences in prevalence, segments at risk,

and mean annual incidence of adjacent segment disease requiring surgical

intervention in previous ACDF patients were measured, while Kaplan-

Meier survivorship analysis predicted time course to a second surgery (a

! 0.05).

METHODS: Retrospective analysis of one surgeon at our home institution

from 1996-2006 of ASD requiring surgical intervention, defined as mye-

lopathy or radiculopathy failing conservative therapy and leading to

a second ACDF adjacent to the original fusion. Chi-squared and indepen-

dent t-tests detected differences in prevalence, segments at risk, and mean

annual incidence. Kaplan-Meier survivorship analysis predicted time

course to a second surgery.

RESULTS: Prevalence was found in 14.5% (89 cases/611 patients) over

13 years. Further surgery occurred in 22.3% of cases after AWOP, signif-

icantly more than ALP1/ALP2 (10.4%/11.6%, p!.005). Mean annual in-

cidence was 1.6% for AWOP, significantly higher than ALP1/ALP2

(0.74%/0.68%, p!.05). Cumulative survival was 73.5% for AWOP, signif-

icantly lower than ALP1 only (88.4%, p!.03). Original fusions involving

C5-6 were at most risk (p!.05).

CONCLUSIONS: ALP1/ALP2 required about half the additional ACDFs

compared to AWOP over 13 years. Annual incidence was nearly double for

AWOP versus ALP procedures. The C5-6 level was at greatest risk, involv-

ing superior/inferior segments comparably.

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

any applicable devices or drugs.

http://dx.doi.org/10.1016/j.spinee.2012.08.192

131. Accurately Measuring the Quality and Effectiveness of Cervical

Spine Surgery in Registry Efforts: Determining the Most Valid and

Responsive Instruments

Saniya S. Godil, MD1, Scott L. Parker, MD2, Stephen K. Mendenhall2,

David N. Shau, BS2, Clinton J. Devin, MD2, Matthew J. McGirt, MD3;1Vanderbilt University, Nashville, TN, US; 2Nashville, TN, US; 3Vanderbilt

University Medical Center, Nashville, TN, US

BACKGROUND CONTEXT: There is a growing demand to measure the

real-world effectiveness and value of care across all specialties and disease

states. Prospective registries have emerged as a feasible way to capture

real-world care across large patient populations. However, the proven

validity of more robust and cumbersome patient reported outcomes instru-

ments (PROi) must be balanced with what is feasible to apply to large-

scale registry efforts. Hence commercial registry efforts that measure

quality and effectiveness of care in an attempt to guide quality improve-

ment, pay-for-performance, or value-based purchasing have incorporated

ting and will be included with the post-meeting online content.