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Use of transition rods as supplementary posterior fixation in combined antero-posterior corrections of the adult degenerative deformity

Authors:
BASS 2017 abstracts
Adult Spinal Deformity
1. Use of transition rods as supplementary posterior fixation in
combined antero-posterior corrections of the adult degenerative
deformity
Anastasios Panagiotou, Marcin Czyz, Nick Paidakakos, Amarjit Anand,
Bronek Boszczyk; Queen’s Medical Centre in Nottingham, Derby Rd,
Nottingham NG7 2UH
BACKGROUND CONTEXT: Proximal junctional kyphosis (PJK) is a
pathological kyphotic deformity adjacent to the instrumentation. Clinical
studies have highlighted risk factors that predispose patients to develop PJK.
Transition rods decrease the biomechanical indices that may be involved in
PJK, however, there is no current clinical evidence confirming this. We present
our own experience in using transition rods as a supplementary posterior
fixation after complex multilevel anterior column reconstruction in pa-
tients with adult degenerative deformity.
PURPOSE: To prove that the use of transition rods, together with other well-
documented technical principles, appears to be a safe and effective component
of the surgical armamentarium that may help in preventing PJK.
STUDY DESIGN/SETTING: Prospective clinical study.
PATIENT SAMPLE: In the analysed period, eleven patients (8 female and
3 male) with mean age 67±7.5 were treated surgically with a first stage of
multiple anterior ALIFs followed at a later stage by the use of supplemen-
tary posterior fixation with transition rods.
OUTCOME MEASURES: The mean pelvic incidence (PI), preoperative
lumbar lordosis (LL), global thoracic kyphosis (TK) and SVA. The amount
of correction to LL and to SVA. The median follow up, the global TK and
segmental TK above the top instrumented spinal segment. Recording of pre-
operative and postoperative pain scores and of any complications.
METHODS: Between 2014–2016, prospective data was collected for all
adult degenerative deformity cases with loss of sagittal balance where tran-
sition rods were used. In all cases transition rods were used as a supplementary
posterior fixation after multilevel anterior lumbar interbody fusion through
the visceral rotation described elsewhere. Information regarding surgical com-
plications was noted. Upright whole-spine lateral radiographs were analysed
with the use of SurgiMap software—spino-pelvic parameters, SVA as well
as segmental and global thoracic kyphosis were documented.
RESULTS: The mean pelvic incidence (PI) was 67°±7.54° (range: 34°–
58°), preoperative lumbar lordosis (LL): 23.5°±14.8°, global thoracic kyphosis
(TK): 31.81°±16.35° and SVA: 116.36±70.11 mm (range: 11.83–230.29 mm).
The amount of correction to LL was 27.81°±16° and to SVA:
97.99 mm±63.22 mm. In majority of patients transition rods were used for
instrumentation of two lower thoracic levels (range: 1–4 levels). Over the
median follow up of 12.5 months (95% CI 2.2–17.4) the global TK in-
creased by 6.72°±7.14° and segmental TK above the top instrumented spinal
segment increased by 1.27°±3.71°.
CONCLUSIONS: The use of transition rods, together with other well-
documented technical principles, appears to be a safe and effective component
of the surgical armamentarium that may help in preventing PJK. Long term
studies based on the wide cohort of patients is warranted.
CONFLICTS OF INTEREST: None.
FUNDING SOURCES: None.
http://dx.doi.org/10.1016/j.spinee.2016.12.009
2. Complications in spinal surgery—a comparison of patient and
surgeon reporting systems
Shrijit Panikkar, Naveed Yasin, Irfan Siddique, Rajat Verma,
Saeed Mohammad; Salford Royal Foundation Trust, Stott Lane, Salford,
Manchester, UK
BACKGROUND CONTEXT: With rise in Worldwide healthcare ex-
penses, healthcare providers have to better justify the cost. This in turn puts
further emphasis on accountability and has led to an increase in use and mea-
surement of outcome measures and complication rates as a way of comparing
services offered by different units and surgeons.
PURPOSE: To compare and correlate complications rate between patient
and surgeon reporting systems in spinal surgery in our unit.
STUDY DESIGN/SETTING: A retrospective analysis of prospectively com-
pleted Spine TANGO Core Outcome Measure Index (COMI) scores.
PATIENT SAMPLE: COMI scores completed prospectively over a period
of 6 months were analysed.
OUTCOME MEASURES: COMI Scores which included self reported scores
and functional measures were compared.
METHODS: A complication is defined as a deviation from a normal ex-
pected post operative course. Data was prospectively collected for 6 months
using the Spine TANGO Core Outcome Measure Index, examining the in-
dependently reported complications at discharge, both by patients and surgeons.
Complications were cross referenced with the patient records and further
graded to help with analysis.
RESULTS: The surgeon reported complication rate was 4.6% as com-
pared to the patient reported rate of 25%. The correlation coefficient was
0.17. The true complication rate was 15.2%.
CONCLUSIONS: Patients tend to over report complications particularly
the Grade I complications. It was felt that this could be improved by better
pre-operative counselling. Surgeons were found to under report complica-
tions but were found to be better at reporting Grade II and III complications.
A combination of both methods is likely to yield better results.
CONFLICTS OF INTEREST: None.
FUNDING SOURCES: None.
http://dx.doi.org/10.1016/j.spinee.2016.12.010
3. Impact of surgical site infection on surgical outcomes in adult
spinal deformity: a matched control study
Haddad Sleiman, Susana Nuñez-Pereira, Alba Vila-Casademunt,
Montse Domingo-Sabat, Emre Acaroglu,
Francisco Javier Sánchez Pérez-Grueso, Ibrahim Obeid,
Frank Kleinstück, Ahmet Alanay, Ferran Pellisé, ESSG, European Spine
Study Group; The Centre for Spinal Studies and Surgery, Queen’s Medical
Centre, Derby Rd, Nottingham NG7 2UH
BACKGROUND CONTEXT: Surgical Site Infection(SSI) is one of the
feared spinal surgery complications.
It is associated with increased short-term morbidity and overall costs.
It’s ultimate impact on deformity correction is still unclear.
PURPOSE: To study the morbidity of SSI inAdult Spinal Deformity(ASD)
population and its impact on deformity correction.
STUDY DESIGN/SETTING: Matched Cohort study using prospectively
collected data from an international multicentric ASD database.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately
reporting disclosure and FDA device/drug status at time of abstract submission.
The Spine Journal 17 (2017) S3–S22
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