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North American Spine Society, Nov. 12-15

Last Updated: November 17, 2014.

The North American Spine Society 29th Annual Meeting

The annual meeting of the North American Spine Society was held from Nov. 12 to 15 in San Francisco and attracted approximately 5,000 participants from around the world, including orthopedic surgery, neurosurgery, neurology, radiology, and anesthesiology specialists, as well as researchers, physical therapy specialists, and other spine care professionals. The conference featured presentations focusing on the latest advances in medical and surgical spine care.

In one study, Justin Smith, M.D., Ph.D., of the University of Virginia in Charlottesville, and colleagues found that operative treatment offers the potential for significant improvements in pain and disability among symptomatic adults with spinal deformity. In addition, nonoperative treatment appears to, at best, maintain presenting levels of pain and disability.

"Patients should be counseled that surgery for symptomatic spinal deformity can offer improvement in pain and disability. However, the decision of whether to pursue operative treatment is a very personal one for the patient and their family, since these procedures have relatively high rates of complications and can require extensive recovery time," said Smith. "Despite the data suggesting that nonoperative treatment at best maintains presenting levels of health-related quality of life at minimum two-year follow-up, it remains an option for patients who are either not surgical candidates or who do not wish to have surgery."

One author disclosed financial ties to Biomet and Globus Medical.

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In another study, Benjamin Kuhns, of Case Western Reserve University in Cleveland, and colleagues found that conventional magnetic resonance imaging (MRI) can miss cases of degenerative spondylolisthesis (DS). Therefore, standing lateral and flexion-extension (SLFE) radiographs should be ordered when DS is suspected.

"The key results are that we found the sensitivity of conventional MRI at diagnosing spondylolisthesis to be 78 percent, compared to a 98 percent sensitivity for standing lateral radiographs. We also found that increasing facet effusion size predicts for mobile, or dynamic, spondylolisthesis," said Kuhns. "Since the presence of DS can alter decision making when preparing for lumbar surgery, it is in the surgeon's best interest to confirm whether or not DS is present. If MRI was the only preoperative imaging and the surgeon suspects that DS might be present either clinically or from the presence of an effusion on the MRI, SLFE films should be ordered to clarify the diagnosis."

Abstract (subscription or payment may be required)

In patients with sagittal spinal deformity, Virginie Lafage, Ph.D., of the New York University Langone Medical Center in New York City, and colleagues found that clinicians should also consider intraoperative reconciliation tools in order to compare the actual correction of the deformity with the preoperative plan.

"For two-thirds of the patients, the severity of the preoperative deformity did not permit planning for ideal correction of the sagittal plane. The comparison of preoperative planning and postoperative alignment revealed that, on average, the lumbar lordosis within the fused segments was under corrected by 6 degrees, and that the changes in alignment in the unfused segments of the thoracic spine were not accurately anticipated," said Lafage. "Future study should focus on developing tools to provide a better estimate of the behaviors of the unfused segments of the spine and develop intraoperative monitoring tools."

Abstract (subscription or payment may be required)

Kristin Archer, Ph.D., D.P.T., of the Vanderbilt Orthopedic Institute in Nashville, Tenn., and colleagues found that a cognitive behavior-based program, delivered by physical therapists over the telephone, has the potential to be a low-cost, evidence-based program that clinicians can recommend for patients at risk for poor postoperative outcomes.

"We found that a targeted rehabilitation intervention for patients with high fear of movement resulted in larger reductions in back and leg pain and disability and a greater improvement in general physical and mental health compared to an education program," said Archer. "Intensive, clinic-based rehabilitation may not be needed to address psychosocial risk factors and decreased physical activity after spine surgery. Future research should consider screening patients for psychosocial risk factors and implementing targeted rehabilitation programs to improve long-term outcomes and patient satisfaction."

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Claudia Eder, M.D., of Orthopädisches Spital Speising in Vienna, and colleagues evaluated the dose-dependent effect of vancomycin on human osteoblasts in vitro. The investigators found that application of vancomycin was associated with dose-dependent inhibition of cell migration, cell proliferation and viability, as well as severe morphological changes.

"As bone remodeling after fusion surgery requires the migration, proliferation, and differentiation of osteoblasts at the fusion site, high dosages of intra-wound vancomycin might interfere with regenerative processes and increase the risk of non-union," the authors write.

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