RESIDENT: Kyle A Smith
AUTHORS: Kyle A Smith
SUBMITTED: 1/28/19 9:23
SUBJECT CATEGORY: Spine
RESIDENT AWARD: RMNS Resident Award

TITLE: Cervical Total Disc Replacement Versus Anterior Cervical Discectomy and Fusion: Reoperation Rates, Complications, and Hospital Resource Utilization in 72,688 Patients in the United States

KEYWORDS: ACDF, Readmissions, Spine, Complications

STUDY DESIGN: Retrospective chart review

ABSTRACT: Background:  Healthcare readmissions are important causes of increased cost and have profound clinical impact. Thirty-day readmissions in spine surgery have been well documented. However, rates, causes, and outcomes are not well understood outside 30 days. The authors analyzed 30-day and 90-day readmissions for a retrospective cohort of anterior cervical discectomy and fusions (ACDF) and total disc replacement (TDR) for degenerative cervical conditions.

METHODS: Methods:  The Nationwide Readmissions Database approximates 50% of all U.S. hospitalizations with patient identifiers to track patients longitudinally. Patients greater than 18 years old were identified. Rates of readmission for 30-days and 90-days were calculated. Predictor variables, complications, outcomes, and costs were analyzed via univariate and multivariable analyses (SPSSv.23).

RESULTS: Results:  Between January and September 2013, 72,688 patients were identified. The 30-day and 90-day readmission rates were 2.67% and 5.97%, respectively. The most prevalent reason for 30-day readmission was complication of medical/surgical care (20.3%), whereas for 90-day readmission, degenerative spine etiology (19.2%). Common risk factors for 30- and 90-day readmission included older age, male gender, Medicare/Medicaid, prolonged initial length of stay, and various comorbidities. Unique risk factors for 30-day and 90-day readmissions included adverse discharge disposition and mechanical implant-related complications, respectively. When comparing ACDF and TDR, ACDFs were associated with increased 90-day readmissions (6.0%vs.4.3%). The TDR cohort had a shorter length of stay, lower complication rate, and fewer adverse discharge dispositions.

CONCLUSION: Conclusion:  Identification of readmission causes and predictors is important to potentially allow for changes in peri-operative management. Decreasing readmissions would improve patient outcomes and reduce healthcare costs. 

LEARNING OBJECTIVES: 

At the completion of the session or demonstration, participants should be able to: 1) Understand some common, nationwide complications and causes of readmission, 2) Identify predictors of readmission following anterior cervical spine surgery, and 3) Understand data present in the NRD and utilization for practice improvement.

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

yes

Presented at CNS Joint Section (DSPN) meeting

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting? no


RESIDENT: Vin Shen  Ban
AUTHORS: Vin Shen  Ban; Salah G. Aoun; Jeffrey  Beecher; Tarek Y. El Ahmadieh; Awais  Vance; Om J Neeley; Cameron M McDougall; Joan  Reisch; Babu  Welch; Hunt H. Batjer; Duke S Samson; Jonathan A. White
SUBMITTED: 5/14/19 19:06
SUBJECT CATEGORY: Cerebrovascular
RESIDENT AWARD: RMNS Resident Award

TITLE: The Southwestern Aneurysm Severity Index for Unruptured Aneurysms
KEYWORDS: aneurysm, microsurgery, clipping, outcomes
STUDY DESIGN: Retrospective chart review

ABSTRACT: The Southwestern Aneurysm Severity Index (SASI) has recently been studied as an outcome prediction tool for ruptured aneurysms treated microsurgically. We now assess its relevant components with the aim of building a tailored prediction model for unruptured intracranial aneurysms treated microsurgically. 

METHODS: Patients presenting to our institution with unruptured aneurysms from 1996-2015 treated with microsurgery were included. Outcome was defined as GOS at discharge (GOSd) dichotomized to 1-3 vs 4-5. The SASI was composed of multiple prospectively recorded patient demographic, clinical, radiographic and aneurysm specific variables. Univariate and multivariate analyses were used to construct the best predictive models for patient outcome. In constructing a modified SASI scoring system, the cohort was randomly split, with one half acting as the derivation sample and the other as the validation sample. 

RESULTS: We identified 1,708 eligible patients. The GOSd was 1-3 in 294 patients (17.2%) and 4-5 in 1414 patients (82.8%). Univariate chi-square analyses revealed age (p<0.001), sex (p<0.001), Non-Neurological ASA score (NNASA, p<0.001), aneurysm location (p<0.001), multiple aneurysms with the intent to treat (p<0.001), calcification/thrombosis (p<0.001), size>20mm (p<0.001), and intraoperative rupture (p=0.01) to be associated with unfavorable GOS.     In a multivariate stepwise logistic regression, the best predictive model for poor outcome included size>20mm (p<0.001), aneurysm location (p<0.001), age (p<0.001), NNASA (p=0.001), intraoperative rupture (p=0.01), and calcification/thrombosis (p=0.01).   

CONCLUSION: Patient clinical, radiographical, and aneurysmal characteristics were identified as being predictive of GOS at discharge. A modified version of the SASI scoring system for unruptured aneurysms treated microsurgically will be presented at the meeting.

LEARNING OBJECTIVES: 

1. Identify factors that influence outcomes after surgery for unruptured aneurysms.   2. Discuss the relative contributions of these factors towards outcomes.   3. Utilize the SASI scale to predict outcomes in unruptured aneurysms undergoing clipping. 

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

yes

Previously presented at the AANS meeting

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

no


RESIDENT: Kyle A Smith
AUTHORS: Kyle A Smith; Paul  Arnold
SUBMITTED: 1/28/19 9:32
SUBJECT CATEGORY: Spine
RESIDENT AWARD: RMNS Resident Award

TITLE: Timing of Decompression for Central Cord Syndrome: An Institutional Perspective
KEYWORDS: Spine, Central cord syndrome, SCI
STUDY DESIGN: Retrospective chart review

ABSTRACT: Decompressive surgical intervention has become a generally accepted and viable treatment methodology in the setting of CCS and radiographic evidence of spinal cord compression and/or instability.  However, the optimal timeframe of surgical intervention for CCS remains controversial.  An institutional retrospective review was done in attempt to make recommendations as to whether early (< 48 hours after the injury) versus late (> 48 hours after the injury) surgical decompressions surgeries is the optimal treatment for enhancing neurologic recovery in patients suffering from CCS.

METHODS: Patients, undergoing either early or late surgical treatment methods, characteristics including pre-operative ASIA scores, post-operative ASIA scores, cause of injury, age, length of stay (LOS) in the hospital, bladder incontinence, ambulation, and type of surgery were analyzed to evaluate the potential benefits of early versus late surgical options. 

RESULTS: A total of 39 patients were diagnosed and treated surgically for CCS.  Of the 39 patients, 18 patients (46.2%) had an early (within 48 hours) operation; whereas 21 patients (53.8%) received late operations.  Early surgical patients had a LOS that was 1.46 days longer than those in late surgery options.  There were no significant results in the areas of ambulation and incontinence with regards to the surgical timing.  Overall, early surgical patients progress in their motor recovery at an elevated rate and in their ASIA scores as compared to late surgical patients.  The ASIA letter score improvement was averaged to be 0.60 and 0.47 in early and late patients, respectively.  

CONCLUSION: Early surgery candidates had a longer LOS (a difference of 1.5 days) than those undergoing a late surgery.  However, early surgery patients were more likely to be able to walk without assistance and progress further in their motor recovery within the first year of their surgery than late surgery patients.  There were no significant differences in patients with incontinence between groups.  Overall, in our experience, decompression for cervical central cord syndrome seems to confer a functional benefit when done in the early period (< 48 hours after injury) compared to the late period (> 48 hours after injury).

LEARNING OBJECTIVES: 

At the completion of the session or demonstration, participants should be able to: 1) Identify institutional treatment trend for CCS, 2) Further evaluate treatment strategies for CCS based on one institution’s perspective, and 3) Offer further case data for future studies and treatment protocols for CCS.

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

no

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

yes

CNS DSPN Joint Section Meeting 2019


RESIDENT: Bradley  Lega
AUTHORS: Bradley  Lega
SUBMITTED: 2/19/19 10:33
SUBJECT CATEGORY: History
RESIDENT AWARD:

TITLE: Theodore Billroth and the origins of modern surgical practice
KEYWORDS: aseptic technique, Billroth, Lister, Virchow
STUDY DESIGN: Survey

ABSTRACT: Theodore Billorth was a leading 19th century surgeon at the famed Vienna school.  His practice illustrates the intersection of new ideas regarding sterile technique and the struggles that contemporary surgeons had with this revolutionary idea.  The goals of this lecture are to demonstrate how skilled, thoughtful surgeons dealt with an idea that was revolutionizing the practice of surgery.  His influence is especially pertinent to our profession (neurosurgery) as William Halsted toured through the Vienna school in 1878 just when these ideas were being implemented.  Further, Billroth’s notions of surgical education, data collection, and his experience in the Franco-Prussian War had lasting influence on Halsted and other surgeons.  The renowned educational system from which Harvey Cushing benefitted promulgated by Billroth and then Halsted directly fostered the establishment of neurosurgery as a respected discipline with its intellectual home in North America.  

METHODS: Discussion of primary and secondary texts. 

RESULTS: See above

CONCLUSION: A study of Theodore Billroth is instructive for practicing neurosurgeons to understand how previous generations dealt with technological revolutions that remade their profession, as well as the principles of surgical education that led to the establishment of the norms that govern training in our own profession. 

LEARNING OBJECTIVES: 

1. Describe the contributions of Billroth to adoption of aseptic technique  2. Describe the influence of Billroth on principles of surgical education  3. Describe the influence of Billroth on academic surgical practice including data collection for M&M conferences. 

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

no

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

no


RESIDENT: Jian  Guan
AUTHORS: Jian  Guan; Erica  Bisson; Mohamad  Bydon; Steve  Glassman; Kevin  Foley; Eric  Potts; Christopher  Shaffrey; Mark  Shaffrey; John J Knightly; Praveen  Mummaneni
SUBMITTED: 2/27/19 18:56
SUBJECT CATEGORY: Spine
RESIDENT AWARD: RMNS Resident Award

TITLE: Addition of Fusion to Decompression for Grade I Degenerative Lumbar Spondylolisthesis Is Associated with Greater Patient-Reported Outcome Improvements at 24-Month Follow-up: A Multicenter Study Using the Quality Outcomes Database

KEYWORDS: QOD, spondylolisthesis, outcomes

STUDY DESIGN: Retrospective chart review

ABSTRACT: Extensive investigation has not ascertained the ideal surgical management of grade 1 lumbar spondylolisthesis. Using the large, multicenter, prospectively collected Quality Outcomes Database (QOD), we compared 24-month outcomes for patients undergoing decompression alone versus decompression and fusion.

METHODS: Patients undergoing single-level surgery from 7/1/2014 through 6/30/2016 were identified. The primary outcome measure, 24-month Oswestry Disability Index (ODI) change, was analyzed with univariate and multivariable linear regression. EQ-5D scores, numerical rating scale (NRS) back and leg pain scores, and North American Spine Society patient satisfaction scores were also analyzed.

RESULTS: Of the 608 patients (82.4% with at least 24-month follow-up) who met the inclusion criteria, 140 (23.0%) underwent decompression alone and 468 (77.0%) underwent decompression and fusion. The 24-month change in ODI was significantly greater in the fusion group than the decompression-only group (-25.2±20.1 vs. -15.8±19.8, p<0.001). Fusion remained independently associated with 24-month ODI change in our multivariable model (B=-9.82, 95% CI -15.58 to -4.06, p=0.001). Patients in the fusion group were significantly more likely to present with back pain as the dominant symptom (41.5% vs. 25.7%, p<0.001), to reach minimal clinically important difference (12.8 points) in ODI at 24 months (72.5% vs. 56.6%, p=0.002), and to experience significantly greater NRS back pain improvement at 24-month follow-up (-4.0±3.0 vs. -2.0±3.9, p<0.001).

CONCLUSION: The results of our study suggest that decompression plus fusion may offer superior outcomes to decompression alone in patients with grade 1 lumbar spondylolisthesis at 24 months. Longer-term follow-up is warranted to assess whether this effect is sustained.

LEARNING OBJECTIVES: 

After completion of the session or demonstration, participants should be able to:    1) Identify patient reported outcome measures which change following surgical intervention for lumbar spondylolisthesis  2) Discuss the utility of large databases such as the QOD to evaluate outcomes for common neurosurgical procedures  3) Compare the outcomes of fusion and decompression in the treatment of patients with spondylolisthesis

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

yes

Presented at 2019 Lende Neurosurgical Meeting at Snowbird Utah

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

no


RESIDENT: Robert B Kim
AUTHORS: Robert B Kim; Christopher G Wilkerson; Michael  Karsy; Evan  Joyce; John  Rolston; William T Couldwell; Mark A. Mahan”
SUBMITTED: 3/5/19 11:07
SUBJECT CATEGORY: Spine
RESIDENT AWARD: RMNS Resident Award

TITLE: Any-cause Prolonged Length of Stay (pLOS) Is Associated With Increased Risk of Unplanned 30-day Readmission in Elective Spine Surgery Patients: Propensity Score-Matched Analysis of 33,840 patients. 

KEYWORDS: prolonged length of stay, unplanned readmission, elective spine surgery

STUDY DESIGN: Retrospective chart review

ABSTRACT: Unplanned hospital re-admissions are costly for patients and insurance payors alike. Increased length of hospital stay has been cited as a risk factor for readmission in a number of studies. However, a large-scale, multi-institutional, risk-adjusted study that evaluates association between prolonged length of stay (pLOS) and unplanned readmission in elective spine patients has not been performed. 

METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed to identify all patients who underwent elective spine procedures during 2007-2015. After exclusion, patients were subdivided into pLOS group (≥ 4 days) or control (0-3 days). Propensity-score matching algorithm was utilized to reduce baseline differences between the cohorts. Univariate and multivariate analyses were performed to assess the degree of association between pLOS and unplanned readmission.

RESULTS: The overall 30-day unplanned readmission rate of 33,840 elective spine patients was 5.5%. Propensity score matching yielded 16,920 well-matched pairs with mean standard difference of propensity score of 0.017. The mean LOS was 2 and 6 days for the control and pLOS group, respectively. In our univariate analysis, pLOS was associated with post-operative complications, especially medical complications (22.7% vs. 8.3%, p<0.001). Most wound-related complications occurred after discharge while most inpatient complications were medical in nature. Patients with medical complications were more likely to develop wound-related complications (5.1 % vs. 1.7%, p<0.001). In our multivariate analysis of propensity score-matched population which adjusted identified con-founders, pLOS was associated with an increased risk of 30-day unplanned readmission (OR 1.459, 95% CI 1.326-1.605), p<0.001). 

CONCLUSION: Causes of prolonged length of stay are likely multi-factorial in nature. In select patients who undergo elective spine procedures, patients with any-cause pLOS (defined as >4 days) are at increased risk of having unplanned 30-day readmission compared to patients with shorter hospital stays.

LEARNING OBJECTIVES: 

1. Understand how the population based studies can impact clinical practice.  2. Appreciate prolonged length of stay as a risk factor for unplanned readmission  3. Appreciate propensity score matching as an important tool to reduce baseline differences in retrospective studies.

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

no

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

no


RESIDENT: Steven R Ottersberg
AUTHORS: Steven R Ottersberg
SUBMITTED: 3/9/19 9:13
SUBJECT CATEGORY: History
RESIDENT AWARD: RMNS Resident Award

TITLE: Pharmacology and Pharmacogenomics of Cannabis Therapies

KEYWORDS: Cannabis, THC, CBD, dosing, genetics

STUDY DESIGN: Survey

ABSTRACT: The purpose of this talk is to provide an introduction to the receptors, enzymes and transporters of the endocannabinoid system (ECS).  A functional understanding of the ECS is essential to understand the variability in response in cannabis therapies. Polymorphisms in the genes that encode for the components of the ECS can be predictors of potential benefit or adverse events in the administration of cannabis therapies.  The fundamental pharmacology of cannabinoid and terpenoids is essential to understand the response in individual patients.  

METHODS: Literature review

RESULTS: The information presented in this talk is intended to provide the neurologist a functional understanding of what they may expect to observe in patients that self administer cannabis containing products.  It is assumed that the attendees do not recommend cannabis products but often see patients that are consuming cannabis containing products.  This talk is intended to give a physiological understanding of the endocannabinoid system, cannabis therapeutics and the genes that influence cannabis response.

CONCLUSION: With legalization in multiple states the number of patients self medicating with cannabis is growing.  Medical professionals do not learn about the endocannabinoid system in medical school and therefore do not have a working understanding of the roles of phytocannabinoid therapies.

LEARNING OBJECTIVES: 

Introduction to the endocannabinoid system, pharmacology of major cannabinoids and terpenoids, and genetic influences on cannabis response.

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

yes

This work has been presented at multiple medical conferences.  

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

yes

This presentation will be presented at Low Carb USA, Ancestral Health Symposium and American Association of Naturopathic Physicians.


RESIDENT: Jessa E Hoffman
AUTHORS: Jessa E Hoffman; Megan V Ryan; Greenan  Krista ; Charles  Wilkinson
SUBMITTED: 3/11/19 12:23
SUBJECT CATEGORY: Pediatrics
RESIDENT AWARD: RMNS Resident Award

TITLE: Successful Treatment of Brainstem Cavernous Malformation with Hematoma Evacuation Followed by Propranolol 

KEYWORDS: cavernous, malformation, brainstem, propranolol

STUDY DESIGN: Case report

ABSTRACT: Brainstem cavernous malformations are benign vascular lesions that can cause devastating neurologic decline when hemorrhagic. The definitive treatment for symptomatic brainstem cavernous malformations is generally considered to be microsurgical resection; however complete resection is difficult without risking damage to neurologic structures. Case studies suggest a role for propranolol in treating cavernous malformations, including after symptomatic hemorrhage and previous resection. Here we describe a hemorrhagic brainstem cavernous malformation successfully treated with the sequence of surgical evacuation of the hematoma followed by postoperative propranolol. The cavernoma itself was not resected.

METHODS: A nearly 3-year-old male presented with altered mental status, gait disturbance, and ptosis. CT and MRI demonstrated an acute pontine hematoma along with vasogenic edema and effacement of the fourth ventricle. A large vein suggested cavernous malformation. His condition slowly declined then acutely worsened. A repeat CT demonstrated expansion of hematoma and he was taken emergently to the OR.  Due to the sensitive location of the hematoma in the pons, we planned to evacuate the hematoma without resecting any of the cavernoma. Instead, we planned to treat the cavernoma with propranolol. Postoperatively, the patient’s condition improved, and was still improving at hospital discharge 2 weeks later.  He was treated with 2 mg/kg total daily of propranolol for 6 months beginning the day after surgery. 

RESULTS: Follow up MRI showed no cavernoma with only hemosiderin at the site of the evacuated hematoma. Thirteen months postoperatively he continues to improve with only mild deficits. 

CONCLUSION: This is the first reported case of a hemorrhagic brainstem cavernous malformation treated with a planned sequence of hematoma evacuation followed by propanolol without attempting to resect the cavernoma. The success of this strategy suggests it may be a viable way to minimize operative injury in patients with hemorrhagic cavernous malformations of the brainstem while still evacuating symptomatic hematomas and treating the cavernomas. 

LEARNING OBJECTIVES: 

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

no

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

no


RESIDENT: Joshua S Catapano
AUTHORS: Joshua S Catapano; Nicolas  Rubel; Lawton  Michael; Joseph  Zabrasmki
SUBMITTED: 3/12/19 14:03
SUBJECT CATEGORY: Cerebrovascular
RESIDENT AWARD: RMNS Resident Award

TITLE: Results of a standardized ventriculostomy protocol without an occlusive dressing in patients with aneurysmal subarachnoid hemorrhage

KEYWORDS: EVD, Subarachnoid hemorrhage, CSF infection

STUDY DESIGN: Retrospective chart review

ABSTRACT: Catheter-related infections are a potentially life-threatening complication of having an external ventricular drain (EVD). Patients with aneurysmal subarachnoid hemorrhage (aSAH) are at increased risk of infection associated with prolonged ventricular drainage, with a reported mean infection rate of 6%. We report the EVD-associated infection rate among patients with aSAH managed with a unique standardized treatment protocol without an occlusive EVD dressing.

METHODS: Patients with aSAH admitted from August 2015 through August 2017 were retrospectively analyzed for EVD placement. Cerebrospinal fluid (CSF) samples were obtained twice weekly for culture and routine studies. EVD-associated infection was defined as growth of CSF cultures.

RESULTS: During the 2-year study period, 122 patients presented with an aSAH, with 91 (74.6%) having EVD placement. In patients with EVDs, the mean age was 57.9 years (68% female); 88% of aSAHs were Fischer grade III-IV. Mean duration of EVD was 14 days, and 13% of patients required EVD replacement. Endovascular coiling and surgical clipping were performed in 34 (37%) and 53 (58%) patients with EVD, respectively. A total of 347 CSF studies were performed with no EVD-associated infections. There were 3 CSF Gram stains with false-positive gram stains, but  no growth on concurrent or multiple repeat cultures.

CONCLUSION: Using a standardized protocol for placement and management of EVDs in patients with aSAH is associated with low risk of CSF infection. Our study demonstrates that occlusive EVD dressings are not necessary and that routine CSF sampling in patients with EVD may lead to false-positive findings and unnecessary antibiotic administration.

LEARNING OBJECTIVES: 

1. Proper  EVD placement and management   2. Low risk of EVD infection with a standardized protocol  3. Lack t of occlusive dressing allows for decrease risk of infection and easier EVD site care. 

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

no

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

no


RESIDENT: Douglas G Orndorff
AUTHORS: Douglas G Orndorff; Jim A Youssef; Anneliese D Heiner
SUBMITTED: 3/15/19 12:22
SUBJECT CATEGORY: Spine
RESIDENT AWARD: 

TITLE: Efficacy Of Demineralized Bone Matrix For Instrumented Combined Posterolateral Interbody Lumbar Fusion

KEYWORDS: Demineralized bone matrix, patient-reported outcome measures, posterolateral lumbar fusion, transforaminal lumbar interbody fusion

STUDY DESIGN: Prospective controlled trial

ABSTRACT: Demineralized bone matrix (DBM) products, with their osteoconductive and osteoinductive properties, have become popular for use in spinal fusion procedures. The purpose of this study was to prospectively evaluate the performance of a demineralized bone matrix (DBM; Accell Evo3, IsoTis OrthoBiologics, Inc., Irvine, CA) as an adjunct to instrumented combined posterolateral interbody lumbar fusion.

METHODS: Twenty-nine patients underwent transforaminal lumbar interbody fusion (TLIF) along with pedicle screw instrumentation and posterolateral lumbar fusion (PLF) at L4-L5, L5-S1, or both. The TLIF procedure included interbody spacers of the surgeon’s choice plus DBM placed within the interbody cage (off-label and off-protocol use) and local autograft placed behind the cage within the disc space. The PLF procedure included DBM combined with local autograft. Fusion was assessed by plain film X-ray and by computerized tomography when available. Oswestry Disability Index (ODI) and visual analog scale for pain in the back (VAS-back) were collected preoperatively and at 6, 12, and 24 months postoperatively. Complications were recorded. Data were compared with a retrospective cohort of thirty patients treated with recombinant human bone morphogenetic protein-2 (BMP-2; Infuse, Medtronic, Fridley, MN; off-label use for both TLIF and PLF) and local autograft.

RESULTS: The interbody and posterolateral fusion rates per level and per patient were similar in both groups, as were the improvements in ODI and VAS-back. One BMP-2 subject experienced neuritis, possibly secondary to the use of rhBMP-2; no graft-related complications occurred in the DBM group. One patient in the DBM group was reoperated at the index level for pseudoarthrosis.

CONCLUSION: This first human prospective study on the performance of Accell Evo3 DBM in instrumented combined posterolateral interbody lumbar fusion suggests that this DBM may be a valid alternative to other bone graft adjuncts or biologics on the market.

LEARNING OBJECTIVES: 

1) Demineralized bone matrix products, with their osteoconductive and osteoinductive properties, have become popular for use in spinal fusion procedures.  2) The demineralized bone matrix and the bone morphogenetic protein evaluated in this study, combined with local autograft, had similar radiographic and clinical performance in instrumented combined posterolateral interbody lumbar fusion.  3) The demineralized bone matrix product evaluated in this study may be a valid alternative to other bone graft adjuncts or biologics on the market.  

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

yes

LSRS 2018

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

yes

NASS 2019


RESIDENT: Colin  Przybylowski
AUTHORS: Colin  Przybylowski; Xiaochun  Zhao; Jacob  Baranoski; Kristina  Chapple; Kaith  Almefty; Andrew  Little; Peter  Nakaji
SUBMITTED: 3/15/19 12:23
SUBJECT CATEGORY: Tumor
RESIDENT AWARD: RMNS Resident Award

TITLE: Preoperative embolization verus no embolization for WHO grade I intracranial meningioma: a retrospective matched cohort study

KEYWORDS: meningioma, embolization

STUDY DESIGN: Retrospective chart review

ABSTRACT: There is continued controversy over the clinical utility of preoperative embolization for reducing tumor vascularity of intracranial meningiomas prior to surgical resection. Previous studies comparing embolization and non-embolization patients did not control for detailed tumor parameters before assessing outcomes.

METHODS: We reviewed all patients who underwent surgical resection of a WHO grade I intracranial meningioma at our institution from 2008 to 2016. Propensity score matching was used to generate embolization and non-embolization cohorts of 52 patients each, and a retrospective review of clinical and radiographic outcomes was performed.

RESULTS: In total, 52 embolization patients (mean follow-up 34.8± 31.5 months) were compared to 52 non-embolization patients (mean follow-up 32.8 ± 28.9 months; P=0.63). Variables controlled for included patient age (P=0.82), tumor laterality (P>0.99), tumor location (P>0.99), tumor size (P=0.07), tumor invasion into a major dural sinus (P>0.99), and tumor encasement around the internal or middle cerebral artery (P>0.99). The embolization and non-embolization cohorts did not differ in terms of estimated blood loss during surgery (660.4±637.1 mL vs. 509.2±422.0 mL; P=0.17), postoperative Simpson grade IV resection (32.7% vs. 25.0%; P=0.39), peri-operative procedural complications (26.9% vs. 19.2%; P=0.35), development of permanent new neurologic deficit (5.8% vs. 7.7%; P=0.70), or favorable modified Rankin Scale score (0-2) at last follow-up (96.0% vs. 92.3%; P=0.43), respectively.

CONCLUSION: After controlling for patient age, tumor size, tumor laterality, tumor location, tumor invasion into a major dural sinus, and tumor encasement of the internal or middle cerebral artery, preoperative meningioma embolization intended to decrease tumor vascularity did not improve the surgical or clinical outcomes of patients with WHO grade I intracranial meningiomas treated with surgical resection.

LEARNING OBJECTIVES: 

1. Identify that meningiomas referred for preoperative embolization tend to be a unique set of tumors.  2. Identify the risks and theoretical benefits of preoperative embolization.  3. Understand that in our institutional retrospective study, preoperative embolization did not improve surgical or clinical outcomes of patients with intracranial meningiomas.

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

yes

The manuscript is under review for publication at the Journal of Neurosurgery.

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

yes

The abstract has been accepted as a poster presentation only at the AANS 2019 meeting.


RESIDENT: Douglas G Orndorff
AUTHORS: Anneliese D Heiner; Jim A Youssef; Douglas G Orndorff
SUBMITTED: 3/15/19 12:53
SUBJECT CATEGORY: Spine
RESIDENT AWARD: 

TITLE: Lateral Lumbar Interbody Fusion As A Treatment For Adult Degenerative Scoliosis: Survival Analysis

KEYWORDS: Adult degenerative scoliosis, lateral lumbar interbody fusion, reoperation, survival analysis

STUDY DESIGN: Retrospective chart review

ABSTRACT: Indications for lateral lumbar interbody fusion (LLIF), a minimally invasive spinal surgery technique, have expanded to include adult degenerative scoliosis. The purpose of this study was to estimate survival after LLIF with supplemental posterior decompression and instrumentation as a treatment for adult degenerative scoliosis.

METHODS: Chart data were retrospectively reviewed for patients who underwent LLIF with supplemental posterior decompression and instrumentation for adult degenerative scoliosis and were not lost to follow-up at less than two years’ postoperatively. Demographic and operative data were collected, as were dates of surgery, reoperation, and latest follow-up, and the reoperation reason. Kaplan-Meier survival estimations were calculated.

RESULTS: Sixty-one surgeries were performed—9 with one-level LLIF, 23 with two-level LLIF, 26 with three-level LLIF, and 3 with four-level LLIF. Average age at surgery was 67.7 years (standard deviation 8.2 years), and 36 (59.0%) of the surgeries were performed on female patients. Average follow-up time was 3.35 years (range 9 days–12.2 years). Twenty-two (36.1%) patients were reoperated. Twelve (19.7%) patients were reoperated for adjacent segment disease, two (3.3%) for herniated disc, two (3.3%) for stenosis plus synovial cyst, and one (1.6%) each for visceral injury, infection, hardware loosening, stenosis, pseudoarthrosis, and failed back syndrome with radiculopathy and pseudoarthrosis of a level that had been reoperated during the index LLIF surgery. The Kaplan-Meier survival estimates for avoiding any reoperation were 86.9% at one year, 77.0% at two years, 57.3% at five years, and 45.8% at eight to twelve years. The Kaplan-Meier survival estimates for avoiding reoperation for adjacent segment disease were 98.3% at one year, 88.3% at two years, 75.3% at five years, and 60.2% at eight to twelve years.

CONCLUSION: These results indicate that lateral lumbar interbody fusion plus supplemental posterior decompression and instrumentation is a valid treatment option for adult degenerative scoliosis.

LEARNING OBJECTIVES: 

1) Indications for lateral lumbar interbody fusion have expanded to include adult degenerative scoliosis.  2) Survival for avoiding reoperation for adjacent segment disease after lateral lumbar interbody fusion plus supplemental posterior decompression and instrumentation is estimated as 75.3% at five years.  3) Lateral lumbar interbody fusion plus supplemental posterior decompression and instrumentation is a valid treatment option for adult degenerative scoliosis.  

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

no

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

yes

NASS 2019


RESIDENT: Brandon A Sherrod
AUTHORS: Brandon A Sherrod; Michael  Karsy; Erica  Bisson
SUBMITTED: 3/30/19 12:01
SUBJECT CATEGORY: Spine
RESIDENT AWARD: RMNS Resident Award

TITLE: Dysphagia and Quality of Life Outcomes Following Anterior Cervical Fusion

KEYWORDS: Anterior Cervical Fusion, Dysphagia, Quality of Life, Outcomes

STUDY DESIGN: Retrospective chart review

ABSTRACT: Dysphagia is a known complication of anterior cervical surgery. Here were examined postoperative dysphagia and its association with quality of life outcomes. 

METHODS: Patients who underwent anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion, or combined anterior/posterior instrumentation and fusion at the authors’ institution from 2016 to 2018 were eligible for inclusion. Patients with three time points (pre-operative, first postoperative, second postoperative) of EAT-10 (validated dysphagia index) and EQ5D (validated quality of life index) measurements were then included for analysis. 

RESULTS: Sixty-four patients were included for analysis. Mean age at surgery was 57.9 years and 53.1% of patients were female. Fifteen (23.4%) patients underwent one-level ACDF, thirty (46.9%) underwent multi-level ACDF, and nineteen (29.7%) underwent combined anterior/posterior approach. There was no significant difference in postoperative EAT-10 score for anterior only vs. combined anterior/posterior approaches (p=0.126). Overall, there were significant differences in the pre- vs. first post-operative EAT-10 score (p=0.007) but not the first postoperative vs. second postoperative EAT-10 score (p=0.07) or preoperative vs. second postoperative EAT-10 score (p=0.275). When stratified by EAT-10 score ≥ 3 and <3, there was a significant difference in EQ5D score during the preoperative visit (p=0.019) but not the first postoperative visit (p=0.065) or second postoperative visit (p=0.455). There was a significant difference in the preoperative EQ5D scores vs. first postoperative (0.61 ± 0.03 vs. 0.73 ± 0.02, p=0.004) and second postoperative (0.61 ± 0.03 vs. 0.77 ± 0.03, p=0.0002).  In the multivariate linear regression analysis, history of prior cervical surgery (Î_ = -0.510, p=0.044) and BMI at surgery (Î_=0.572, p=0.013) were associated with EQ5D score. 

CONCLUSION: There was no difference in quality of life postoperative outcome for patients with dysphagia (EAT-10 ≥ 3) compared to patients without dysphagia. Quality of life was significantly improved overall at both postoperative visits vs. preoperative. 

LEARNING OBJECTIVES: 

1) Understand the relationship between quality of life and dysphagia related to anterior cervical fusion including how perioperative timing affects both  2) Understand the factors associated with quality of life outcome following anterior cervical fusion  3) Understand the validated scoring systems (EAT-10 and EQ5D) for measuring dysphagia and quality of life outcomes following surgery  

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

no

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

no


RESIDENT: Clinton D Morgan
AUTHORS: Clinton D Morgan; Michael D Bohl; Peter  Nakaji; Andrew  Little
SUBMITTED: 3/15/19 21:28
SUBJECT CATEGORY: Socioeconomic
RESIDENT AWARD: RMNS Resident Award

TITLE: The Barrow Innovation Center: A Novel Program in Neurosurgical Education

KEYWORDS: Medical education, intellectual property

STUDY DESIGN: Case report

ABSTRACT: Revolutions in neurosurgical care have not occurred without the challenge of existing standards of care. Innovation not only requires intellectual curiosity and topical expertise, it also is catalyzed by an education in the process of developing a new idea from sketch to prototype. 

METHODS: In the last 5 years, the Barrow Innovation Center has developed formal partnerships with the Arizona State University School of Law, School of Engineering, Texas A&M School of Engineering, and local engineering contracting firms. 

RESULTS: The Barrow Neurological Institute has created a novel program in neurosurgery resident education. Taking ideas from common clinical problems that neurosurgeons face every day, residents then present their novel solution to a fellow attending and resident neurosurgeons, a group of patent law clinic experts, and engineering collaborators. The Barrow Innovation Center then provides seed funds to minimize costs to access provisional patent filing and engineering costs. This formal arrangement has permitted the filing of over 25 patents, two active licensing negotiations for products developed by the Innovation Center, and numerous new projects in the pipeline. By reducing barriers to access to both intellectual property protection and engineering, the Innovation Center is giving residents the opportunity to tackle challenging problems in neurosurgery.Through administrative support, the Innovation Center is now moving into a new physical laboratory space for further development.

CONCLUSION: The Barrow Innovation Center represents a multi-disciplinary, novel program in resident education targeted to reducing barriers to access intellectual property protection, critique from neurosurgical colleagues, and engineering resources by curious trainees.

LEARNING OBJECTIVES: 

1. Understand the history of the development of the Barrow Innovation Center  2. Understand the value of intellectual property protection as an incentive for resident-driven innovation in a neurosurgical education program  3. Appreciate the pathway taken in an “privademic” medical center for a new resident idea taken from sketch to start-up company formation

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

no

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

no


RESIDENT:  AZ USA
AUTHORS: Tyler S Cole; Andrew S Ducruet
SUBMITTED: Tyler
SUBJECT CATEGORY:
RESIDENT AWARD: no

TITLE: Comparative nationwide trends in carotid endarterectomy and carotid artery stenting in the post-CREST era (2010–2015) “The CREST trial was published in 2010 and demonstrated equivalent composite outcomes when comparing carotid endarterectomy (CEA) and carotid artery stenting (CAS) in treating carotid artery stenosis. Since the time of publication, interventional treatment has evolved significantly. We aimed to investigate nationwide trends in these procedures and associated periprocedural stroke, myocardial infarction, death, and readmission rates.” Understand changing nationwide trends in CEA and CAS  Understand complication and readmission rates among the two procedures  Understand cost differences between the two procedures “We used the Nationwide Readmissions Database (NRD) from 2010–2015 to identify patients undergoing elective CEA and CAS. Patients undergoing other procedures were excluded. Nationwide trends were calculated based on weighted sample means. In order to compare the clinical outcomes above, CEA patients were matched to CAS patients on comorbidity, demographic, socioeconomic, and severity of illness measures.”

KEYWORDS: 

STUDY DESIGN: 

ABSTRACT: 

METHODS: 

RESULTS: Retrospective chart review

CONCLUSION: Socioeconomic

LEARNING OBJECTIVES: 

In the years following publication of the CREST trial, there has been a nationwide decrease in CEA for treatment of carotid stenosis with a concurrent increase in the proportion of symptomatic patients treated. CEA had a higher procedural stroke risk compared to CAS, but lower risk of inpatient mortality and readmission within 30 and 90 days. Hospital costs are significantly less for CEA compared to CAS.

AUTHOR DECLARATIONS: 

Has the work presented in this abstract, or substantially similar work, been presented or published by the author(s) previously?

yes

Is the work presented in this abstract, or substantially similar work, being submitted for presentation at another meeting?

yes