5/11/2013 None related to this study E. Tabaraee, D. Shearer, C. - PowerPoint PPT Presentation

5/11/2013 None related to this study E. Tabaraee, D. Shearer, C. Ames, S. Burch, V. Deviren, S. Berven, S. Hu, D. Chou, P. Mummaneni, B. Tay University of California, San Francisco 5/11/2013 � Cervical Myelopathy � Inc incidence � Hirabayashi Pros � Address OPLL Motion preserving � Noninstrumented Protective Easier revision � Motion sparing Avoid fusion/instrument � Safe and Efficacious… complications Cost-effective? � Cervical spondylotic � OPLL 1

5/11/2013 � Cons � axial neck pain � C5 palsy � closure � Techniques � Open door � French door � w/ fusion � Spacers � Structural rib allografts � Hydroxyapatite spacers � Metallic Plates 2

5/11/2013 � Allograft � Plating � To compare outcomes, complications, and costs associated with two of the more common implants � Pros: � Pros: � Effective used in open-door laminoplasty. � Rigid fixation � affordable � Early rom � Cons: � Hinge healing � Shorter op time? � Intraop contour � Lower ebl? � Fragile � Cons: � Postop bracing � Expensive � Hardware complications? 3

5/11/2013 There is no difference in neck pain and nurick scores � We performed a retrospective analysis 1. at final follow-up for laminioplasty patients with � 106 patients. either allograft struts or metallic mini-plates � The primary outcomes were neck visual analog scale There is no intraoperative, immediate postoperative, 2. (VAS) pain scores and Nurick scores. or financial benefit to using metallic mini-plates � Secondary outcomes included length of procedure, estimated blood loss, length of stay, complications, and direct costs. � Preoperative Inclusion Exclusion Primary diagnosis of CSM or OPLL • Revision surgery � Demographics, Charlson Comorbidity index, Nurick, • History of either previous or concomitant • >18 years of age • Neck-VAS cervical fusion Involving 3 or 4 levels • • Diagnosis of spinal cord tumor, multiple � Intraoperative • Use of either structural rib myeloma, or infection allograft struts or metallic mini- • Use of any other laminar spacers other than � EBL, operative time, # of levels, # implants plates only rib allograft or metallic mini-plates Use of both rib allograft and mini-plates � Postoperative • Diagnosis of neuromuscular disease (i.e. • � Length of stay, direct costs, Nurick, Neck-VAS, f/u cerebral palsy) Diagnosis of neuro-autoimmune disease • months (i.e. multiple sclerosis) � Statistics: � Fisher, t-test 4

5/11/2013 Allograft (n=51) Plates (n=55) p-value Allograft (n=51) Plates (n=55) p-value Age, mean (SD) 62.2 (1.7) 61.3 (1.7) 0.70 Preop neck VAS, 4.3 (0.4) 3.7 (0.5) 0.33 Male Gender, no. (%) 31 (60.8) 32 (58.2) 0.84 mean (SD) Number of 2.9 (0.3) 3.1 (0.3) 0.66 Final Neck VAS, 2 (0.4) 2.2 (0.4) 0.92 Comorbidities, mean mean (SD) (SD) Charlson Comorbidities 2.7 (0.2) 3 (0.3) 0.42 Preop Nurick Score, 2 (0.2) 2.3 (0.2) 0.22 Index, mean (SD) mean (SD) OPLL, no. (%) 4 (7.8) 10 (18.2) 0.15 Final Nurick Score, 1.4 (0.2) 1.5 (0.2) 0.97 Total Months Follow 31 (3.1) 23 (1.8) 0.005 mean (SD) Up, mean (SD) * SD (standard deviation), No. (number), SD (standard deviation), VAS (visual analog OPLL (ossification of posterior longitudinal scale), * (statistically significant) ligament), * (statistically significant) Allograft (n=51) no. Plates (n=55) p-value (%) no. (%) Allograft Plates (n=55) p-value (n=51) Surgeon Specialty, C5 palsy 4 (7.8) 3 (5.5) 0.67 no. (%)* <0.001 Persistent wound drainage 1 (2) 0 (0) 0.48 Orthopaedic 38 (74.5) 3 (5.5) Surgery Neurosurgery 10 (19.6) 52 (94.6) 0 (0) 1 (1.8) 1.00 Dural tear Pulmonary Embolism 1 (2) 0 (0) 0.48 Combined (two surgeons from 3 (5.9) 0 (0) different specialties Deep Infection 3 (5.9) 1 (1.8) 0.35 Estimated blood loss, Wound Dehiscence 1 (2) 2 (3.6) 1.00 mean (SD) 287.7 (45.4) 229.9 (27.8) 0.28 Foraminotomies, 2.7 (0.3) 1.3 (0.2) 0.0001 Lamina Fracture 0 (0) 1 (1.8) 1.00 mean (SD)* Number of levels, 4.1 (0.1) 4 (0.1) 0.79 Foraminal Stenosis 0 (0) 2 (3.6) 0.50 mean (SD) Adjacent Segment Disease 0 (0) 1 (1.8) 1.00 Number of implants, 3 (0.09) 3.7 (0.1) mean (SD)* <0.0001 Progressive Kyphosis 2 (3.9) 0 (0) 0.23 Length of Procedure, 161 (5) 136.6 mean (SD)* (7.3) 0.007 Length of Stay, mean 3.8 (0.4) 3.9 (0.4) Readmission for pain 1 (2) 0 (0) 0.48 (SD) 0.94 control Cervical collar used, 51 (100) 17 (30.9) no. (%)* 13 ( 23.5) 11 (20) 0.81 <0.001 Total Complications SD (standard deviation), no. (number), * (statistically significant) 5

5/11/2013 Allograft (n=51) Plates (n=55) p-value no. (%) no. (%) allograft Plate Deep Infection 3 (5.9) 1 (1.8) 0.35 Wound Dehiscence 1 (2) 2 (3.6) 1.00 Collar 2 2.3 Lamina Fracture 0 (0) 1 (1.8) 1.00 Foraminal Stenosis 0 (0) 2 (3.6) 0.50 No collar N/a 1.8 Adjacent Segment Disease 0 (0) 1 (1.8) 1.00 Progressive Kyphosis 2 (3.9) 0 (0) 0.23 Total Reoperations 6 (11.8) 7 (12.7) 1.00 � Results: Average follow-up was 27 months. � Safe and effective � The postoperative neck VAS scores and Nurick scores � Kawai (Spine, 1988) improved significantly from baseline but there was no � Heller (Spine, 2001) difference in the final outcome scores or complications. � First to compare implants � The average length of operation and number of � Plates shorter op time, no bracing necessary foraminotomies were higher for the allograft group. � Allograft more affordable � Among the plate group, patients treated � Laminoplasty implants � without a hard collar did not experience an increase rate of � Cost saving vs. laminectomy/fusion complications. � Highsmith (JNS, 2004) � The mean direct cost for the mini-plate group was $2098 � $4200 per C3-6 construct more. � Marcaio- OR time (J of Anes, 2005) � $62/min � Not included- Operative time, anesthesia costs, indirect cost � Agabagi- cost of brace (jaaos, 2011) � $750 6